Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease

PURPOSE: Single-incision laparoscopic surgery (SILS) for colorectal surgery is widely performed for many disease entities. However, there are few reports about the role of repeat single-incision laparoscopic surgery (R-SILS). The aim of this study is to analyze R-SILS data to evaluate the feasibility and safety of the occurrence and review its outcomes. METHODS: This is a retrospective review of the prospectively collected SILS database in Samsung Medical Center, Seoul, Korea, between April 2009 and December 2015. A retrospective review of 38 patients who underwent R-SILS from 2,207 patients who underwent primary SILS for colorectal surgery was performed. RESULTS: The indications of R-SILS were 23 primary SILS-related complications, 10 cancer-related, and 5 other surgical indications. Of the 38 repeat surgeries, 24 were emergent operations, and 14 were elective operations. Fecal diversion for anastomotic leakage after rectal surgery was the most common reason for reoperation. There were 2 cases of conversions: one case was converted to conventional multi-port, and the other case was converted to open surgery. Mean operative time was 137.9±64.1 min, estimated blood loss (EBL) was 105±98 ml, and length of hospital stay was 10.1±8.1 days. Post-operative complication was noted in 5 (13.2%) of 38 R-SILS cases, and there was no 30-day postoperative mortality. CONCLUSION: Repeat single-incision laparoscopy surgery is feasible and safe in select patients when performed by an experienced surgeon.

Development and evaluation of a food frequency questionnaire for Vietnamese female immigrants in Korea: the Korean Genome and Epidemiology Study (KoGES)

The objectives of this study were to develop a food-frequency questionnaire (FFQ) for Vietnamese female immigrants in Korea and to evaluate the validity of the FFQ. A total of 80 food items were selected in developing the FFQ according to consumption frequency, the contribution of energy and other nutrients, and the cooking methods based on one-day 24 hour recall (24HR) from 918 Vietnamese female immigrants between November 2006 and November 2007. The FFQ was validated by comparison with 24HR of 425 Vietnamese female immigrants between November 2008 and August 2009. The absolute nutrient intake calculated from the FFQ was higher than that estimated by 24HR for most nutrients. The correlation coefficients between 24HR and FFQ ranged from 0.10 (vitamin C) - 0.36 (energy) for crude intake, 0.05 (vitamin E) - 0.32 (calcium) for per 1000 kcal, and 0.08 (zinc) - 0.34 (calcium) for energy-adjusted, respectively. More than 70% of subjects were classified into the same or adjacent agreement groups for nutrients other than fiber, sodium, vitamin A, vitamin C, and vitamin E, while less than 10% of subjects were classified into complete disagreement groups. We conclude that the FFQ appears to be an acceptable tool for estimating nutrient intake and dietary patterns of Vietnamese female immigrants in Korea. Future studies to validate the FFQ using various biomarkers or other dietary assessment methods are needed.

Dietary factors related to body weight in adult Vietnamese in the rural area of Haiphong, Vietnam: the Korean Genome and Epidemiology Study (KoGES)

The objectives of this study were to examine the association between dietary factors and underweight and overweight adult Vietnamese living in the rural areas of Vietnam. A cross-sectional study of 497 Vietnamese aged 19 to 60 years (204 males, 293 females) was conducted in rural areas of Haiphong, Vietnam. The subjects were classified as underweight, normal weight, and overweight based on BMI. General characteristics, anthropometric parameters, blood profiles, and eating habits were obtained and dietary intake was assessed using 24-hour recalls for 2 consecutive days. A high prevalence of both underweight (BMI or = 23 kg/m2) individuals was observed (14.2% and 21.6% for males and 18.9% and 20.6% for females, respectively). For both genders, the overweight group were older than the under- and normal weight groups (P = 0.0118 for males and P = 0.0002 for females). In female subjects, the overweight group consumed significantly less cereals (P = 0.0033), energy (P = 0.0046), protein (P = 0.0222), and carbohydrate (P = 0.0017) and more fruits (P = 0.0026) than the underweight group; however, no such differences existed in males. The overweight subjects overate more frequently (P = 0.0295) and consumed fish (P = 0.0096) and fruits (P = 0.0083) more often. The prevalence of both underweight and overweight individuals pose serious public health problems in the rural areas of Vietnamese and the overweight group was related to overeating and high fish and fruit consumption. These findings may provide basic data for policymakers and dieticians in order to develop future nutrition and health programs for rural populations in Vietnam.

Comparison of entecavir and clevudine for treatment of chronic hepatitis B / 대한내과학회지

BACKGROUND/AIMS: Entecavir (ETV) and clevudine (CLV) are potent inhibitors of hepatitis B virus (HBV) DNA polymerase and have demonstrated clinical efficacy. No comparative study has reported on these two medications among patients with naive chronic hepatitis B (CHB). We assessed the clinical outcome of CHB patients treated with either ETV or CLV. METHODS: A nonrandomized comparative study was conducted retrospectively. The clinical results from treatments of either 0.5 mg ETV (n=56) or 30 mg CLV (n=45) were analyzed during a 1 year period. The median reduction in serum HBV DNA, undetectable HBV DNA, HBeAg seroconversion, and normalization of alanine transaminase (ALT) were compared between the two groups. RESULTS: After 1 year on antiviral therapy, the median reduction in serum HBV DNA from baseline to the endpoint was greater in patients in the ETV group than in those in the CLV (5.73 vs. 4.5 log copies/mL, p=0.009) group. ALT normalization occurred in 85.5% (47/55) of the ETV cases and 77.3% (34/40) of the CLV cases (p=0.215). HBV DNA was undetectable in 80.0% (44/55) of the ETV group and 78.0% (32/41) of the CLV group (p=0.505). HBeAg seroconversion occurred in 15.4% (6/39) of those administered ETV and in 14.3% (4/28) administered CLV (p=0.593). Within 12 months, a virological breakthrough was documented in three patients undergoing CLV treatment, and CLV-related myopathy developed in three other patients. CONCLUSIONS: ETV and CLV showed excellent antiviral effects in patients with CHB. ETV was superior for viral suppression and showed fewer side effects than CLV.

A Case of Cold Agglutinin Disease Accompanied by Bacterial Pneumonia That Was Treated with Rituximab / 대한수혈학회지

Cold agglutinin disease (CAD) is a small group of disorders that is characterized by cold-reactive autoantibodies that bind to erythrocyte carbohydrate antigens, and this causes hemagglutination and complement-mediated hemolysis. Autoimmune hemolytic anemia (AIHA) is an immune disorder that is mediated via auto-antibodies produced by lymphoid B cells against red blood cells. The disorder may be a primary (idiopathic) or secondary disease with an underlying autoimmune disease, a lymphoproliferative disorder or infection. The mainstay of initial treatment is immunosuppression with glucocorticosteroids. For those who do not have satisfactory response to initial glucocorticosteroids or they have a relapse after initially successful treatment, splenectomy or other immunosuppressive agents such as azathioprine, cyclosporine and intravenous immunoglobulin (IVIG) could be the next available options. More recently, rituximab, which is a human-murine chimeric monoclonal antibody specific for the CD20 antigen found on the surface of B lymphocytes, is also available. We report here on the successful use of rituximab for the treatment of a Korean elderly patient with CAD and the patient presented with recurrent AIHA.

Dietary Intakes and Eating Behaviors of Vietnamese Female Immigrants to Korea through Marriage and Korean Spouses and Correlations of Their Diets / 대한지역사회영양학회지

This study aimed to examine nutritional status and similarities of diets between Vietnamese female immigrants and Korean spouses and dietary changes of Vietnamese females after immigration. Subjects were 608 couples visiting 13 medical centers for the Cohort of Intermarried Women in Korea from November 2006 to November 2007. Anthropometric and biochemical measurements were obtained and dietary intakes were assessed using one-day 24-hour recall. Sixty-eight percent of wives answered there have been changes in their diets and consumptions of meats, fish, dairy products, vegetables, and fruits increased after immigration. Energy intakes of wives and spouses were 1491.7 kcal and 1788.8 kcal, respectively, showing most couples (80.1%) consumed less than the Korean estimated energy requirements. More than half of the couples were below the Korean estimated average requirements of zinc, vitamin B2, and folate. The correlation coefficients between couples ranged 0.15-0.38 for unadjusted, 0.22-0.35 for per 1000 kcal, and 0.21-0.40 for energyadjusted, respectively. The proportions of couples in the same quartiles of each nutrient intake and in the same answers of each question of Mini Dietary Assessment were about 30% across nutrients and around 50% across questions. The length of residence is related to similarities of nutrient intakes between couples: similarities decreased after 3 years of residence in Korea. In conclusion, nutritional intakes of inter-married couples were inadequate although wives reported that their dietary intakes increased after immigration. Inadequate nutrient intakes of wives were partly explained by similar diets between couples because these wives without enough adjustment to Korean culture were more likely to follow what their spouses ate. Findings from this study may be helpful to improve the nutritional status of inter-married couples and make policies and programs for them. A follow-up study should identify factors affecting inadequate nutritional status of intermarried couples and similarities of their diets.

Two Cases of Pulmonary Infection due to A. xylosoxidans Infection in an Immunocompentent Patient / 결핵및호흡기질환

lcaligenes xylosoxidans is a catalase and oxidase positive, motile, nonfermentative and gram-negative rod bacterium. A. xylosoxidans infection is a rare cause of pulmonary infection and little information concerning treatment is available. The majority of patients that develop A. xylosoxidans infection belong to a high-risk group due to an immunocompromised condition or due to pulmonary cystic fibrosis. We report two rare cases of immunocompentent patients that developed a pulmonary infection due to A. xylosoxidans. A 77-year-old man was admitted with a lung abscess. The patient denied having any prior medical illness. A culture of bronchial washing fluid showed the presence of A. xylosoxidans. Despite appropriate antibiotic treatment, the patient died from acute respiratory distress syndrome (ARDS). Another patient, a 61-year-old man without an underlying disease, was admitted with empyema. Under the condition of a closed thoracostomy, a high fever persisted and the empyema was also aggravated. A. xylosoxidans was detected from a culture of pleural fluid. Susceptible antibiotic treatment was provided and surgical intervention was performed. We report these cases with a review of the literature.

Bilateral Anterior Ischemic Optic Neuropathy with Sudden Sensorineural Hearing Loss in a Long term Hemodialysis Patient / 대한신장학회지

Anterior ischemic optic neuropathy (AION) is rarely reported in end stage renal disease. In particular, AION combined with sudden sensorineural hearing loss (SNHL) has not been reported in domestic and international journals. Here we report the first case of this combined condition. A 58-year-old male patient in end-stage renal disease presented on painless bilateral visual and hearing deterioration. Clinical findings and imaging studies were compatible with a diagnosis of AION and SNHL. Despite of high-dose steroid therapy, vision and hearing were not significantly recovered. Uremic patients often have coexisting pathology such as hypotension during dialysis, atherosclerosis and anemia, predisposing to AION and SNHL. We describe a patient of dialysis for 10 years who presented with bilateral visual and hearing loss due to complications of long-term dialysis. Our case suggests that nephrologists have to know and treat more carefully this rare but emergent complications of dialysis.

A Case of Endobronchial Metastasis from Renal Cell Carcinoma 7 Years after Nephrectomy / 결핵및호흡기질환

A distant metastasis from a renal cell carcinoma is quite common after a radical nephrectomy. For this reason, a5 year scheduled follow up is recommended. However, a distant metastasis 5 years after the resection is quite rare. We encountered an endobronchial metastasis from a renal cell carcinoma that was discovered 7 years after the radical nephrectomy, and did not present during the 5 year scheduled follow up regimen. We report this case with a review of the literatures.