Characteristics of South Korean Patients with Hereditary Transthyretin Amyloidosis

BACKGROUND AND PURPOSE: This retrospective cross-sectional study included 18 patients from unrelated families harboring mutations of the transthyretin gene (TTR), and analyzed their characteristics and geographical distribution in South Korea. METHODS: The included patients had a diagnosis of systemic amyloidosis, clinical symptoms, such as amyloid neuropathy or cardiomyopathy, and confirmation of a TTR gene mutation using genetic analysis recorded between April 1995 and November 2014. RESULTS: The mean age at disease onset was 49.6 years, and the mean disease duration from symptom onset to diagnosis was 3.67 years. Fifteen of the 18 patients were classified as mixed phenotype, 2 as the neurological phenotype, and only 1 patient as the cardiac phenotype. The most-common mutation pattern in South Korea was Asp38Ala, which was detected in eight patients. Thirteen patients reported their family hometowns, and five of the eight harboring the Asp38Ala mutation were from the Gyeongsang province in southeast Korea. The other eight patients exhibited a widespread geographical distribution. A particularly noteworthy finding was that the valine at position 30 (Val30Met) mutation, which was previously reported as the most-common TTR mutation worldwide and also the most common in the Japanese population, was not detected in the present South Korean patients. CONCLUSIONS: South Korean patients with hereditary TTR amyloidosis exhibited heterogeneous TTR genotypes and clinical phenotypes. The findings of this study suggest that the distribution of TTR amyloidosis in South Korea is due to de novo mutations and/or related to the other countries in East Asia.

The Changing pattern of the Plain Abdominal Radiogram by Progression of the Intussusception in Children

The purpose of this study was to determine the success rate of air reduction as the primary treatment of intussusception and whether the success of air reduction could be predicted by plain x-ray. The authors reviewed the medical records of 54 consecutive patients diagnosed with intussusception from Jan 2005 to Dec 2007 at the Department of Surgery, Masan Samsung Hospital. The natures of symptoms and findings of plain abdominal radiography performed in the emergency department (ED) were reviewed. Air reduction failed more frequently (26.3%) in patients who visited ED more than 24 hours after symptom onset (p=0.009). The mean duration of symptom for operated patients was longer than air reduction group (p=0.01). Also, 3/4 of patients having localized distension of small bowel in the left upper quadrant abdomen had unsuccessful air reduction (p=0.002). In conclusion, the time interval from symptom onset to arrival at ED and localized distension of small bowel in the left upper quadrant abdomen significantly increased the failure rate of air reduction.

Neuroendocrine Carcinoma of the Colon and Rectum

PURPOSE: The aim of this study was to review our experience with neuroendocrine carcinoma (NEC) of the colon and rectum to highlight the clinical and pathological characteristics in this relatively uncommon malignancy. METHODS: From December 1995 to December 2006, 11 patients with NEC were identified from our database of 6,143 colorectal cancer patients (0.18%), which does not include carcinoid tumors. The pathology was retrospectively reviewed and the tumors were categorized as pure NEC, including well-differentiated NEC (n=3), poorly-differentiated (n=3) and mixed endocrine/exocrine tumor (n=5) on the basis of the histology and immunohistochemical findings. RESULTS: The mean age of the patients was 57 yr (range, 37 to 69 yr). The tumors were located as follows: 8 in the colon and 3 in the rectum. The diagnosis of NEC was suggested preoperatively from the tissue biopsy in 2 of 9 patients (22.2%). The tumors were advanced at the time of diagnosis, with American Joint Committee on Cancer Stage III (n=7) and Stage IV disease (n=4). Most tumors stained positive by immunohistochemistry for neuroendocrine markers, including synaptophysin (7/9, 77.8%); however, chromogranin was expressed in 4 of 9 NEC tumors (44.4%). Metastatic disease was detected at the time of diagnosis in 36.4% (4/11) of the patients. The median survival for NEC was 16 mo (3.6-67.4 mo), and for pure NEC and mixed endocrine/exocrine tumor was 4.1 mo and 23.6 mo, respectively. CONCLUSION: NEC had distinctive cytoarchitectural features and was often immunoreactive for neuroendocrine markers. Our findings showed that pure NEC had aggressive behavior and a poor prognosis.

Usefulness of the Sequential Organ Failure Assessment (SOFA) Score in Patients with Sepsis due to Intra-abdominal Infection

PURPOSE: To determine the usefulness of the Sequential Organ Failure Assessment (SOFA) score for prediction of mortality in operated patients with sepsis due to intra-abdominal infection. METHODS: Eighty-eight septic patients operated on from January 2004 to June 2008 were evaluated retrospectively. The SOFA scores were measured four times in each patient: initial score, post-op (post-operation) score, POD1 (first post-operative day) score, and POD2 (second post-operative day) score. The maximum score and mean score were obtained from these measurements. These scores were compared between groups of patients classified by mortality. D scores (D0, D1, D2) reflecting the differences between subsequent scores were compared between the surviving group and deceased group according to re-operation. RESULTS: The initial, post-op, POD1, POD2, maximum, and mean scores showed statistically significant differences between the surviving group and deceased group. D1 and D2 showed statistically significant differences between surviving group and deceased group. CONCLUSION: The sequential measurement of SOFA score is a useful prediction system for patients with sepsis due to intra-abdominal infection.

Development and Application of E-Learning Human Anatomy Content for Undergraduate Students in Health Allied Science / 체질인류학회지

This study aimed to develop and implement a progressive e-learning teaching method in the teaching of human anatomy. For analysis of the effect of new teaching methods, we made a survey of user satisfaction, content difficulty, and course management. The e-learning content was developed by the authors and implemented to class, practice, and tests, for 16 weeks. The survey was conducted on sophomores of nursing science (NS, n=42) and sports science (SS, n=26), at Kangwon National University. These two groups of students filled out a questionnaire related to effectiveness of e-learning content and tool in learning human anatomy. The results were compared between two groups. The majority of the students were satisfied with the content, difficulty level, and management of the e-learning course. Through the board of virtual classroom, all of the students played positive manners in communication and activity. Students pointed out 'reinforcement of multimedia data', 'improvement of technical service' and 'addition of broad information' as the most notable improvements of content. Therefore, we conclude that an e-learning course for undergraduate nursing science and sports science students can provide an effective learning model.

The Relationship between Blood Transfusion and Mortality in Trauma Patients

PURPOSE: Using a propensity analysis, a recent study reported that blood transfusion might not be an independent predictor of mortality in critically ill patients, which contradicted the RESULTS of earlier studies. This study aims to reveal whether or not blood transfusion is an independent predictor of mortality in trauma patients. METHODS: A total of three hundred fifty consecutive trauma patients who were admitted to our emergency center from January 2004 to October 2005 and who underwent an arterial blood gas analysis and a venous blood analysis were included in this study. Their medical records were collected prospectively and retrospectively. Using a multivariate logistic analysis, data on the total population and on the propensity-score -matched population were retrospectively analyzed for association with mortality. RESULTS: Of the three hundred fifty patients, one hundred twenty-nine (36.9%) received a blood transfusion. These patients were older (mean age: 48 vs. 44 years; p=0.019) and had a higher mortality rate (27.9% vs.7.7%; p<0.001). In the total population, the multivariate analysis revealed that the Glasgow coma scale score, the systolic blood pressure, bicarbonate, the need for respiratory support, past medical history of heart disease, the amount of blood transfusion for 24 hours, and hemoglobin were associated with mortality. In thirty-seven pairs of patients matched with a propensity score, potassium, new injury severity score, amount of blood transfusion for 24 hours, and pulse rate were associated with mortality in the multivariate analysis. Therefore, blood transfusion was a significant independent predictor of mortality in trauma patients. CONCLUSION: Blood transfusion was revealed to be a significant independent predictor of mortality in the total population of trauma patients and in the propensity-score-matched population.

Relative Adrenal Insufficiency in Postresuscitation Patients

PURPOSE: Relative adrenal insufficiency is common in intensive care unit patients. Basal cortisol and the cortisol response following the injection of synthetic corticotropin were prospectively evaluated in postresuscitation patients after cardiac arrest. METHODS: This is a prospective cohort study of relative adrenal insufficiency of patients with return of spontaneous circulation (>24 hours) after cardiac arrest who were admitted to the intensive care unit over three-year period from January 2005 to December 2007. Relative adrenal insufficiency was measured the next day after return of spontaneous circulation following cardiac arrest. RESULTS: Seventy-five patients were included over three years. Relative adrenal insufficiency developed in 41 patients. In patients with relative adrenal insufficiency, SOFA (sequential organ failure assessment) and lactate were elevated (p=0.03, 0.048), mortality was higher (p=0.014) and basal cortisol concentrations were significantly increased (p=0.001). In patients with therapeutic hypothermia, there were no significant differences with or without relative adrenal insufficiency (p=0.847). The factors associated with mortality, as assessed by multiple logistic regression were relative adrenal insufficiency, therapeutic hypothermia and the time from arrest to the start of cardiopulmonary resuscitation. CONCLUSION: Both basal cortisol and the cortisol response after the injection of synthetic corticotropine must be considered in predicting patients outcome. For patients with relative adrenal insufficiency, some specific treatments such as cortisol can be considered. More prospective multicenter study is needed.

The Relationship between Brachial Ankle Pulse Wave Velocity andAtherosclerotic Risk Factors

PURPOSE: Aging and atherosclerotic changes enhance the stiffness of the arterial wall, and the pulse wave travels faster in stiffer vessel. Measurement of the brachial ankle pulse wave velocity (baPWV) is a non-invasive method for evaluating the stiffness of the vessel wall. We investigated the relation between the baPWV and risk factors for atherosclerosis. METHOD: We studied 180 subjects (38 male and 142 female; mean age 46 years, range 24 to 76 years). The instrument used for evaluating the baPWV was a Vasoguard (VIASYS Healthcare, Dublin, Ohio, USA), and measurements were performed in the right arm and in both ankles. Data were analyzed using Pearson correlation, t-test, and multiple regression analysis. Multiple regression analysis was performed for age, sex, smoking, hypertension, height, weight, body mass index (BMI), total cholesterol, LDL, HDL, TG, and HbA1c. RESULT: Right and left baPWVs were significantly increased (P<0.05) in subjects with the following risks: older age, high body weight, high BMI, high total cholesterol, high LDL, high TG, high HbA1c, and low HDL. Right and left baPWVs were also significantly increased (P<0.05) in male subjects with a history of smoking and hypertension. Multiple regression analysis showed that age, sex, and LDL were independent determinants of the right and left baPWVs. CONCLUSION: This study provides evidence that increased age, male gender, and high serum LDL levels are risk factors that contribute to arterial stiffness. Measurement of the baPWV may be a useful method for evaluating vascular status.

The Value of Initial Ionized Calcium as a Predictor of Mortality and Triage Tool in Adult Trauma Patients

Ionized hypocalcemia is a common finding in critically ill patients, but the relationship between ionized hypocalcemia and mortality risk in trauma patients has not been well established. The aim of this study was to assess the usefulness of initial ionized calcium (iCa) in predicting mortality in the trauma population, and evaluate its superiority over the three other triage tools: base deficit, systemic inflammatory response syndrome (SIRS) score, and triage-revised trauma score (t-RTS). A proand retrospective study was performed on 255 consecutive trauma patients admitted to our Emergency Medical Center from January to December, 2005, who underwent arterial blood gas analysis. Multivariate logistic regression analysis confirmed iCa (< or =0.88 mM/L), low Glasgow coma scale score, and a large transfusion amount to be significant risk factors associated with mortality (p<0.05). The sensitivities of iCa, base deficit, SIRS score, and t-RTS were 82.9%, 76.4%, 67.1%, and 74.5%, and their specificities were 41.0%, 64.1%, 64.1%, and 87.2%, respectively. Receiver operating characteristic curve analysis determined the areas under the curves of these parameters to be 0.607+/-0.062, 0.736+/-0.056, 0.694+/-0.059, and 0.875 +/-0.043, respectively (95% confidence interval). Although initial iCa (< or =0.88 mM/L) was confirmed as a significant risk factor associated with mortality, it exhibited a poorer discriminative power for mortality prediction than other predictors, especially t-RTS.

Correlation between the Expression of Nuclear Factor-kappaB p65 Protein with the Expression of Nuclear Factor-kappaB p50 Protein and the Clinicopathologic Factors in Colorectal Cancer

PURPOSE: Nuclear Factor-kappaB p65 (NF-kappaB p65) and nuclear Factor-kappaB1 p50 (NF-kappaB p65) have been shown to play roles in cell proliferation, apoptosis, cytokine production and oncogenesis. This study was designed to investigate the expressions of NF-kappaB p65 and NF-kappaB p50 proteins in premalignant lesions and colorectal adenocarcinoma. METHODS: Paraffin sections of 20 normal mucosa specimens, 20 low grade tubular adenoma specimens, 20 high grade tubular adenoma specimens and 64 adenocarcinoma specimens were analyzed immunohistochemically for the expressions of NF-kappaB p65 and NF-kappaB p50 proteins. RESULTS: The expressions of NF-kappaB p65 and NF-kappaB p50 proteins were significantly higher in the adenocarcinoma tissue compared with that in the normal mucosa, the low grade tubular adenoma and the high grade tubular adenoma tissues. The frequency of a NF-kappaB p50 expression was higher in the poorly differentiated histologic grade specimens, in the presence of nodal metastasis and in the high stage specimens. There were significant correlations between the NF-kappaB p65 and NF-kappaB p50 proteins. CONCLUSION: The expressions of NF-kappaB p65 and NF-kappaB p50 proteins may play a role in the pathogenesis of colorectal carcinoma.

Prognostic Determinants in Patients with Traumatic Pancreatic Injuries

The aim of this study was to identify factors that predict morbidity and mortality in patients with traumatic pancreatic injuries. A retrospective review was performed on 75 consecutive patients with traumatic pancreatic injuries admitted to the Emergency Medical Center at Masan Samsung Hospital and subsequently underwent laparotomy during the period January 2000 to December 2005. Overall mortality and morbidity rates were 13.3% and 49.3%, respectively. A multivariate regression analysis revealed that greater than 12 blood transfusions and an initial base deficit of less than -11 mM/L were the most important predictors of mortality (p<0.05). On the other hand, the most important predictors of morbidity were surgical complexity and an initial base deficit of less than -5.8 mM/L (p<0.01). These data suggests that early efforts to prevent shock and rapidly control of bleeding are most likely to improve the outcome in patients with traumatic pancreatic injuries. The severity of pancreatic injury per se influenced only morbidity.

Indications for an Immediate Laparotomy in Patients with Abdominal Stab Wounds

PURPOSE: There is little controversy that a classic indication such as hemodynamic instability or any sign of peritoneal irritation requires an immediate laparotomy in the management of abdominal stab wounds. However, omental herniation or bowel evisceration as an indication for an immediate laparotomy is controversial. The purpose of this study was to evaluate the significance of these factors as indications for an immediate laparotomy. METHODS: The medical records of 98 consecutive abdominal stab wounds patients admitted to the Emergency Center of Masan Samsung Hospital from January 2000 to December 2006 were carefully examined retrospectively. Using multivariate logistic regression analysis, thirty-nine factors, including the classic indication and intraabdominal organ evisceration, were evaluated and were found to be associated with a need for a laparotomy. Also, the classic indication was compared with a new indication consisting of components of the classic indication and intra-abdominal organ evisceration by constructing a contingency table according to the need for a laparotomy. RESULTS: Multivariate logistic regression analysis revealed any sign of peritoneal irritation, base deficit, and age to be significant factors associated with the need for a laparotomy (p<0.05). The sensitivity, specificity, and accuracy rates of the classic indication were 98.6%, 72.0%, and 91.8%, respectively, and those of the new indication were 93.2%, 84.0%, and 90.8%, respectively. The differences in those rates between the above two indications were not significant. CONCLUSION: Intra-abdominal organ evisceration was not a significant factor for an immediate laparotomy. Moreover, the new indication including intra-abdominal organ evisceration was not superior to the classic indication. Therefore, in the management of abdominal stab wounds, the authors suggest that an immediate laparotomy should be performed on patients with hemodynamic instability or with any sign of peritoneal irritation.

The Usefulness of Laparoscopic Cholecystectomy for Polypoid Lesions of the Gallbladder

PURPOSE: A laparoscopic cholecystectomy is now the gold standard for the treatment of gallstone disease. While the widespread use of ultrasonography has increased the frequency of the diagnosis of polypoid lesions of the gallbladder (PLG), no optimal strategies for evaluating and treating these lesions have been established. The aims of this study were to identify the risk factors for malignancy, and evaluate the usefulness of laparoscopic cholecystectomy for PLG. METHODS: The clinical and histopathological data from ninety PLG patients, who received a laparoscopic cholecystectomy, between January 1998 and December 2005, were retrospectively analyzed. Data were evaluated using a multiple logistical regression analysis. RESULTS: There were 82 benign PLG, including 38 cholesterol polyps, 22 adenomas, 18 hyperplastic polyps and 4 adenomyomas, and 8 malignant PLG. The average age of the patients with malignant PLG was significantly older than that of those with benign PLG (P=0.001). The average malignant PLG diameter was significantly larger than that of the benign PLG (P=0.000). The malignant PLG were mostly a single lesion; whereas, half of the benign PLG were multiple lesions. In the multiple logistical regression analysis, polyp sizes greater than 1.5 cm and an age over 50 years were the two most important factors for predicting malignancy of PLG. Seven of eight patients with malignant PLG are still alive at a mean of 43.8 months after surgery, and without any recurrence. CONCLUSION: The risk factors for malignancy were found to be the polyp size and patient age. A laparoscopic cholecystectomy can be considered an adequate treatment for patients with a stage I gallbladder carcinoma.

The Usefulness of Initial Arterial Base Deficit in Trauma Patients

PURPOSE: The arterial base deficit (BD) has proven to be useful in the evaluation and management of trauma patients. Indicators such as the Triage-Revised Trauma Score (t-RTS) and the systemic inflammatory response syndrome (SIRS) score have been used as triage tools for emergency trauma patients in Korea. The purpose of this study was to assess the usefulness of the initial BD in predicting injury severity and outcome in the trauma population. METHODS: The medical records of 308 consecutive trauma patients admitted to the Emergency Center of Masan Samsung Hospital from January 2004 to December 2004 were carefully examined prospectively and retrospectively, and 291 patients were selected as subjects for this research. The SIRS score and the t-RTS were calculated based on the records from the emergency department, and the BD was calculated based on the arterial blood gas analysis obtained within 30 minutes of admission. The efficiency of the three indicators as triage tools was evaluated by using cross tabulations in two - by - two matrices and by using a receiver operating characteristic (ROC) curve analysis. RESULTS: When the mortality was used as the outcome parameter, the sensitivity and the accuracy of the initial BD were higher than those of the SIRS score (p<0.05) and were same as those of the t-RTS. The areas under the ROC curves of the initial BD, the SIRS score, and the t-RTS were 0.740+/-0.087, 0.696+/-0.082, and 0.871+/-0.072, respectively (95% confidence interval). When emergency operation and blood transfusion requirements were used as outcome parameters, the comparisons of the sensitivities and the accuracies of the initial BD and the other two indicators showed the same pattern as mentioned above. The areas under the ROC curves of the initial BD were 0.7~0.8 and were larger than those of the SIRS score (p<0.05). CONCLUSION: The ability of the initial BD to predict injury severity and outcome was similar to those of the t- RTS and the SIRS score. Therefore, the authors suggest that the initial BD may be used as an alternative to previous triage tools for trauma patients

Two Cases of Histopathologically Advanced (Stage IV)Early Gastric Cancer / 대한소화기학회지

Various minimally invasive surgical techniques in some cases of early gastric cancer are becoming common practice. However, there are rare cases of advanced cancer with distant metastasis although the invasion of the gastric wall is limited to the mucosa and/or submucosa (defined as early gastric cancer according to UICC-TNM classification). We report two cases of early gastric cancer with distant metastasis (stage IV). Both tumors were defined as early cancer because they were confined to the submucosa. One was a type IIa early cancer, histologically classifiable as a signet ring cell carcinoma (according to the Japanese Classification of Gastric Carcinoma and UICC-TNM classification); the other was a surface spreading type IIb IIc, classifiable as a signet ring cell carcinoma, too. Stage IV factors were ovarian metastasis (Krukenberg tumor) in the former and N3 in the latter case.

Comparison of Systemic Inflammatory Response Syndrome Score, Triage Score, and Triage-Revised Trauma Score as Triage Tools for Trauma Patients in the Emergency Department

PURPOSE: Since the definition of the systemic inflammatory response syndrome (SIRS) was introduced in 1992, it has been a useful indicator in predicting the extent of severity in and the prognosis for medical, surgical, and trauma patients. Indicators such as the Triage Score (TS) and the Triage-Revised Trauma Score (t-RTS) have been used as triage tools for emergency trauma patients in Korea. This study was performed to evaluate the ability of these three indicators as triage tools for trauma patients admitted into an emergency center. METHODS: The medical records of five hundred seven consecutive trauma patients admitted to the Emergency Center of Masan Samsung Hospital from October 2004 to December 2004 were carefully examined prospectively and retrospectively, and three hundred ninety-one patients were selected as subjects for this research. The SIRS score, the TS, and the t-RTS were calculated based on the records from the Emergency Department, and the injury severity score was calculated based on all the data obtained during hospitalization. The efficiency of the three indicators as triage tools was evaluated by using cross tabulations in two by two matrices and by using a receiver operating characteristic (ROC) curve analysis. RESULT: When mortality was used as the outcome parameter, the sensitivity of the SIRS score was lower than that of the TS (p<0.05), and the specificity and the accuracy of the SIRS score were lower than those of the t-RTS (p<0.01). The areas under the ROC curves of the SIRS score, the TS, and the t-RTS were 0.759+/-0.095, 0.949+/-0.033, and 0.900+/-0.085, respectively (95% confidence interval, p<0.002, vs. TS). When an injury severity score of 15 was used as the outcome parameter, the comparisons of the sensitivities, the specificities and the accuracies of the SIRS score and the other two indicators showed the same pattern as mentioned above, and the areas under the ROC curves of the SIRS score, the TS, and the t-RTS were 0.688+/-0.058, 0.762+/-0.059, and 0.686+/-0.067, respectively (95% confidence interval). CONCLUSION: The ability of SIRS score was the same as, or lower than, that of the TS and the t-RTS. Therefore, the SIRS score cannot be recommended over the other two indicators as triage tools for emergency trauma patients.

The Effect of Pneumoperitoneum on Thoracoabdominal Aortic Blood Flow in Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND:We performed this study to determine the influence of the administration of pneumoperitoneum on the blood flow of the thoracoabdominal aorta during laparoscopic cholecystectomy (LC). METHODS: Ten patients for LC were enrolled in this study. Anesthesia was performed with propofol, fentanyl and rocuronium. Pneumoperitoneum was made by CO2 gas intraperitoneal instillation at an intraperitoneal pressure of 10-12 mmHg. Peak velocity of blood flow in the systolic phase (PV), mean acceleration of blood flow from the start of systole (MA) and systolic flow time corrected for heart rate (FTc), measured by esophageal doppler monitoring (EDM), and heart rate (HR) and mean brachial BP (MBP) were measured 1, 5 and 10 min after the institution of pneumoperitoneum, (T1, T5 and T10) and compared with those before the institution of pnuemoperotoneum (T0). LC was started after recording all measurements and a position change to the reverse-Trendelenberg position. RESULTS: PV, MA, FTc and HR showed no significant change throughout this study, but MBP at T5 and T10 (110.1 +/- 18.5 mmHg and 107.8 +/- 10.4 mmHg) were significantly higher than at T0 (84.9 +/- 12.9 mmHg) (P = 0.002 and 0.005 respectively). CONCLUSIONS: The administration of pneumoperitoneum neither changed nor interferenced with abdominal aortic blood flow.

Hemodynamic Changes Measured by a Thoracic Electrical Bioimpedance Technique during a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: We performed this study to determine the changes of hemodynamic parameters following major surgical events such like incision for trochar insertion, institution and deflation of pneumoperitoneum during a laparoscopic cholecystectomy. METHODS: Ten-female patients ASA physical status 1 during a laparoscopic cholecystectomy were enrolled into this study. Anesthesia was performed with propofol, alfentanil and vecuronium. Pneumoperitoneum was instituted by CO2 gas with intraperitonial pressure under 12 mmHg. Hemodynamic parameters before skin incision (BI), after skin incision (AI), 2, 5, 10, 15 and 20 min after the institution of pneumoperitoneum (P + 2, P + 5, P + 10, P + 15 and P + 20), 2 and 5 min after deflation (D + 2 and D + 5) were measured by the use of a thoracic electrical bioimpedance technique (TEB). RESULTS: Trochar insertion did not significantly change the hemodynamic parameters. Heart rate, total fluid content and left cardiac work index were not significantly changed through this study. Mean BP (MBP), pre-ejection period (PEP) and systemic vascular resistance index (SVRI) were significantly increased, and acceleration time index (ACI), cardiac index (CI), stroke index (SI) and velocity index (VI) were significantly more decreased after institution of pneumoperitonium than those of BI and AI. However, all parameters in P + 20, D + 2 and D + 5 were not significantly different from those of BI and AI. CONCLUSIONS: MBP, PEP, SVRI, ACI, CI, SI and VI measured by TEB were significantly changed by the institution of pneumoperitonium during a laparscopic cholecystectomy, but they all recovered to the values before the institution of pneumoperitonium within 20 min.

Stomal Complications in Children

This is a 20 year analysis of the problems associated with enterostomy formation, and closure. Forty-three stomas were established in 43 patients: 23 for anorectal malformations, 11 for Hirschsprung's diseases, 4 for necrotizing enterocolitis, 3 for multiple ileal atresias, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. Thirty boys and 13 girls were included (mean age 4.8 months). Stoma complications were encountered in 13 patients (30.2 %): stomal prolapse, stenosis, obstruction, paracolic hernia, retraction, dysfunction, and skin excoriation. Four patients (9.3 %) required stomal revision. Occurrence of complications was not related to age and primary disease, but sigmoid colostomy showed lower complication rate than transverse colostomy (20.0 % vs 42.9 %, p<0.05). There were five deaths but, only one (2.3 %) was directly related to the enterostomy complication. Twenty-one stomas were closed in our hospital and complications occurred in seven patients (33.3 %). The most common complication was wound sepsis in 5 children. In conclusion, because the significant morbidity of stomal formation still exists, refinements of the surgical technique seem to be required. Sigmoid loop colostomy is preferred whenever possible.

The Usefulness of Automated Biopsy Device for the Diagnosis of Head and Neck Masses: Comparison with Fine-Needle Aspiration Biopsy

PURPOSE: To evaluate the diagnostic usefulness of ultrasound-guided cutting-needle biopsy(CNB) with an automated biopsy device in head and neck masses. MATERIALS AND METHODS: A series of 153 consecutive head and neck masses in 133 patients, biopsied with an 18G cutting-needle and automated biopsy device under ultrasound guidance, was analysed for diagnostic yield and complications. Fine-needle aspiration biopsy(FNAB) was also performed on 88 masses and compared with the findings of CNB. RESULTS: Diagnostic specimens were obtained in 135 (88.2 %) of 153 masses. Eighty-four (90.3 %) of 93 lymph node CNBs provided a diagnostic histological specimen. Tuberculous lymphadenitis or chronic reactive hyper-palsia was diagnosed by CNB in 22 cases, but only six case were diagnosed by FNAB. Ten metastatic lymph nodes and two malignant lymphomas diagnosed by CNB were concordant with the findings of FNAB ; the exception was one case in which metastasis involved lymph nodes. Twenty-seven (77%) of 35 CNBs of thyroid nodule provided a diagnostic specimen. Seven of 28 FNAB cases in which CNB failed to provide a diagnostic specimen, revealed two papillary cancers and three benign nodular lesions. Twenty-five CNBs of soft tissue and salivary gland tumors provided diagnostic specimens; the exception was one probable hemangioma (96 %). In six of 11 FNABs of soft tissue and salivary gland masses, a diagnostic specimen was not obtained. There were four cases of hematoma (2.6%) without clinical significance. CONCLUSION: CNB of head and neck masses using an automated biopsy device is a useful and safe method. In the case of thyroid masses, however, FNAB is more useful and safe than CNB.