Does the COVID-19 Screening Test Affect the Postoperative Prognosis of Patients Who Undergo Emergency Surgery for Cerebral Hemorrhage? / 대한신경손상학회지

Objective@#The coronavirus disease 2019 (COVID-19) pandemic has affected all medical fields, including neurosurgery. Particularly, performing preoperative screening tests has become mandatory, potentially extending the time from admission to the emergency room and operating room, thus possibly affecting patients’ prognosis. This study aimed to determine the influence of COVID-19 screening time on patients’ postoperative prognosis. @*Methods@#From September 10, 2020, to May 31, 2021, we retrospectively evaluated 54 patients with cerebral hemorrhage who underwent emergency surgery in the emergency room after the screening test. The control group included 89 patients with cerebral hemorrhage who underwent emergency surgery between January 2019 and March 2020, i.e., the period before the COVID-19 pandemic. Prognosis was measured using the Glasgow Coma Scale scores, which were obtained preoperatively, postoperatively, and at discharge, and the modified Rankin Scale (mRS). Additionally, unfavorable outcomes (mRS score 3–6) and in-hospital mortality rates were investigated for postoperative prognostic assessments. @*Results@#No remarkable differences were observed in the time to surgical intervention and prognostic evaluation scores between patients with cerebral hemorrhage who underwent COVID-19 screening tests and subjects in the control group. @*Conclusion@#This study confirmed that patient treatment and prognosis were not significantly affected by additional preoperative screening testing times during the pandemic. We believe that our results are informative for the evaluation and performance of emergency neurosurgery during the pandemic.

Association between dairy product intake and hypertriglyceridemia in Korean adults

BACKGROUND/OBJECTIVES: Hypertriglyceridemia may be a more important predictor of cardiovascular disease in Asian population consuming carbohydrate-rich foods than in Western populations. Dairy products are known to play a beneficial role in obesity, dyslipidemia, and metabolic syndrome, but the results vary depending on gender and obesity. In this study, we investigated the associations between dairy product intake and hypertriglyceridemia in Korean adults.SUBJECTS/METHODS: The participants were selected from the Korea National Health and Nutrition Examination Survey 2007–2012 (KNHANES IV and V). A total of 22,836 participants aged 19–64 years were included in the analysis. A food frequency questionnaire used to determine the frequency of consumption of products (milk and yogurt). Multivariable logistic regression was used to assess the associations between dairy product intake and hypertriglyceridemia.RESULTS: A significantly decreased risk of hypertriglyceridemia was detected in the highest dairy product intake frequency group (≥ 1 time/day) (odd ratio [OR] = 0.79; 95% confidence interval [CI] 0.64–0.97, P for trend = 0.022) compared to that for the lowest dairy product intake frequency group. Among obese participants, the group with the highest intakes of milk (in men, OR = 0.64; 95% CI: 0.46–0.91, P for trend = 0.036) and yogurt (in women; OR = 0.53; 95% CI: 0.29–0.94, P for trend = 0.019) showed inverse associations with hypertriglyceridemia. No associations were detected in normal weight participants.CONCLUSION: The association between dairy product intake and hypertriglyceridemia differed by gender and obesity status. Further prospective studies are needed to confirm these associations.

The development of food image detection and recognition model of Korean food for mobile dietary management

BACKGROUND/OBJECTIVES: The aim of this study was to develop Korean food image detection and recognition model for use in mobile devices for accurate estimation of dietary intake. SUBJECTS/METHODS: We collected food images by taking pictures or by searching web images and built an image dataset for use in training a complex recognition model for Korean food. Augmentation techniques were performed in order to increase the dataset size. The dataset for training contained more than 92,000 images categorized into 23 groups of Korean food. All images were down-sampled to a fixed resolution of 150 × 150 and then randomly divided into training and testing groups at a ratio of 3:1, resulting in 69,000 training images and 23,000 test images. We used a Deep Convolutional Neural Network (DCNN) for the complex recognition model and compared the results with those of other networks: AlexNet, GoogLeNet, Very Deep Convolutional Neural Network, VGG and ResNet, for large-scale image recognition. RESULTS: Our complex food recognition model, K-foodNet, had higher test accuracy (91.3%) and faster recognition time (0.4 ms) than those of the other networks. CONCLUSION: The results showed that K-foodNet achieved better performance in detecting and recognizing Korean food compared to other state-of-the-art models.

Usefulness of combined chest and abdominal computed tomography for identification of infection sources in febrile patients without clinical clue

OBJECTIVE: This study examined the utility of combined chest and abdominal computed tomography (CT) for the identification of infection sources in acute febrile patients without clinical clues. The groups for whom combined CT was helpful and not were compared. In addition, the factors that affected the positive infection sources and predictors of the presence of infection sources when performing combined CT was investigated. METHODS: Acute febrile patients without clinical clues from a basic examination and the confirmation procedure were investigated prospectively for 6 months. A range of factors, such as demographic factors, duration of fever, vital signs, presence of prior medical treatment, inflammatory markers, and several sepsis prediction tools, were analyzed. RESULTS: Of the 87 patients, 32 (36.8%) tested positive for infection sources on combined CT, whereas 55 (63.2%) tested negative. The mean age, heart rate, procalcitonin (PCT) level, and proportion of the patients aged ≥65 years showed significant differences between the infection source-positive group and infection source-negative group (P=0.027, P=0.008, P=0.035, and P=0.026, respectively). The factors that affected the positive results for infection sources on combined CT included age (odds ratio [OR], 1.047; P=0.011), absence of chronic disease (OR, 0.157; P=0.045), and heart rate (OR, 1.056; P=0.030). Analysis of the receiver-operating characteristic curve showed that age (area under the curve [AUC], 0.630; P=0.041) and heart rate (AUC, 0.659; P=0.008) were significant predictive factors of positive results for infection sources. On the other hand, their predictive powers were poor, and PCT did not show a significant result (AUC, 0.565; P=0.351). CONCLUSION: In patients with underlying chronic disease, older age, increased heart rate due to fever, or a high PCT level, combined CT can be used to identify infection sources when its possible clinical benefits are considered to be high.

A Single Center Study of the Necessity for Routine Lumbar Puncture in Young Infants with Urinary Tract Infection

PURPOSE: Urinary tract infection (UTI) is the most common serious bacterial infection in infants younger than 3 months of age. Lumbar puncture is routinely performed to evaluate febrile young infants for sepsis. However, there is no clear consensus on the use of routine lumbar puncture to diagnose concomitant meningitis in infants with UTI. We evaluated the prevalence of coexisting bacterial meningitis and sterile cerebrospinal fluid (CSF) pleocytosis in young infants with UTI. METHODS: We retrospectively reviewed the medical records of 85 infants with UTI, aged from 29 to 99 days, who were admitted to Daegu Catholic University Medical Center from January 2013 to May 2016. We included 80 patients who had undergone lumbar puncture. Demographic features, clinical features, and laboratory findings were analyzed. Patients were divided into two groups based on the presence of sterile CSF pleocytosis and we compared these groups and assessed the differences between them. RESULTS: Of the 80 UTI patients enrolled, 34 (43%) had sterile CSF pleocytosis. None had bacterial meningitis, and CSF polymerase chain reaction for enterovirus was positive in two patients without CSF pleocytosis. There were no significant differences between the two groups with regards to age, body temperature, peripheral white blood cell count, urinalysis, and duration of hospital stay. CONCLUSIONS: Though sterile CSF pleocytosis is common in young UTI patients, coexisting bacterial or viral meningitis is very rare. Indications for lumbar puncture in these patients depend on clinical condition.

A Pneumonia Patient with Worsening Respiratory Distress by Chilaiditi Syndrome: A Case Report

Chilaiditi sign refers to the presence of bowel gas under the right diaphragm which is similar in appearance to a pneumoperitoneum on radiography, and is caused by abnormal anatomic positioning of the colon or small bowel between the liver and the diaphragm. When symptoms are present, this condition is known as Chilaiditi syndrome. The most common symptoms are gastrointestinal. It has been less commonly associated with chronic, recurrent respiratory distress. We report acute respiratory distress without gastrointestinal symptoms exacerbated by Chilaiditi syndrome in a pneumonia patient with no history of chronic respiratory disease.

Research on Psychiatric Treatment by Psychiatrists of Chosun-Governor Hospital and Keijo Imperial University Hospital in Korea during Japanese Colonial Rule / 신경정신의학

This review describes the types of psychiatric treatment studied during the Japanese colonial period of 1910–1945 in Korea, known at the time as Chosun. Twenty-nine research papers and abstracts on psychiatric treatment were reviewed, which were published in the Shinkeigaku-zassi (Neurologia), the Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica) and the Journal of Chosun Medical Association, by faculty members of the department of neuropsychiatry, Chosun-Governor Hospital and Keijo (Seoul) Imperial University School of Medicine. The major research area was biological psychiatry and biological treatment, as Japanese pioneers in psychiatry at that time had introduced German psychiatry into Japan. Professor Kubo published the most papers, followed by Dr. Hattori, Dr. Hikari, and Professor Suits. In Chosun-Governor Hospital, research on prolonged sleep therapy was an active field. In the Imperial University Hospital, malarial fever therapy, sulphur-induced fever therapy, and insulin shock treatment were the most frequent research topics. Some were tried for the first time in the Japanese Empire, which reflected the pioneering position of the university. These achievements are attributed to Professor Kubo. Six papers on psychotherapy were published. Among them, two papers were on persuasion therapy, three papers were case reports of psychoanalytic therapy, and one paper on Freud. However, this psychoanalytic therapy research seemed to be limited trials conducted following literal guidance, and no further development was noted. Generally, research was characterized by simple design, small numbers of subjects, lack of objective evaluation method, lack of statistical treatment, and especially lack of ethical consideration comparing with today's standard.

Research by Psychiatrists of Chosun Chongdokbu Hospital and Keijo Imperial University in Korea during Japanese Colonial Rule / 신경정신의학

Eighty-three of 114 original articles and abstracts of research published by neuropsychiatrists of Chosun Chongdokbu Hospital (the Japanese colonial government hospital in Korea) and Keijo (Seoul) Imperial University Hospital during the Japanese colonial period (1910-1945) in journals including Shinkeigaku-zassi (Neurologia), Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica), and The Journal of Chosun (Korea) Medical Association were reviewed. Most articles were on clinical research based on descriptive and biological psychiatry while only 4 articles were on dynamic psychiatry, probably because Japanese pioneers in psychiatry had introduced German psychiatry into Japan during the 1880s. The first paper was written by Dr. Shim Ho-sub. Professor Kubo of Keijo (Seoul) Imperial University published most articles, followed by Dr. Hikari, Dr. Hattori, and Dr. Sugihara. There were more articles on symptomatic psychosis and morphine addiction, followed by general paralysis, schizophrenia, neurological diseases, narcolepsy, epilepsy, and neurasthenia. The meaningful articles even for today were comparative studies between Japanese and Koreans and articles on opioid use disorder in Korea. Authors reported a markedly lower rate of psychotic inpatients in the population of Koreans compared with Japanese. Japanese researchers argued that, because of simpleness in social life in Korea and less violence or excitement in symptoms, Korean mental patients could be cared for by family or members of the community, or be treated by shamanism rather than bringing them to a public mental hospital, and poverty also prohibited hospital care. Finding of higher ratio of schizophrenia to manic-depressive psychosis among Koreans than Japanese was discussed in relation to delayed cultural development of Korea compared to Japan. In addition, traditional customs prohibiting marriage between relatives in Korea was related to low prevalence of manic-depressive psychosis, local endemic malaria was related to low prevalence of general paresis, and poor general hygiene was related to high prevalence of epilepsy. Unclear (undifferentiated) form of psychotic symptoms including hallucination and delusion was reported in more Koreans than Japanese. Also Korean patients showed a more atypical form in diagnosis. Authors added that they had found no culture-specific mental illness in Korea. However, no Korean psychiatrists were included as author in such comparative studies. Comparative studies on constitution between Koreans and Japanese mental patients and prisoners were also unique. However, no Korean psychiatrists participated in such comparative studies. In studies on morphine addiction in Koreans, Japanese researchers argued that such studies were necessary to prevent introduction of morphine-related criminal phenomena to Japan. Meanwhile, Dr. Kubo had left a notion on adaptation problems of Japanese living in the foreign country, Korea. Nevertheless he reported nothing about psychosocial aspects of mental illness in relation to political, cultural, and economic difficulties Koreans were experiencing under the colonial rule of Japan. These general trends of studies based on German biological and descriptive psychiatry and policies of colonial government to isolate "dangerous" mental patients in hospital appeared to reflect colonial or ethnopsychiatry of those days. These policy and research trends seem to have worsened stigma attached to mental disorders. Japanese tradition of psychiatric research was discontinued by return home of Japanese scholars with the end of WWII and colonial rule.

Holmium Laser Enucleation of the Prostate is Effective in the Treatment of Symptomatic Benign Prostatic Hyperplasia of Any Size Including a Small Prostate

PURPOSE: Although transurethral resection of the prostate (TURP) is considered the standard surgical treatment for benign prostatic hyperplasia (BPH), Holmium laser enucleation of the prostate (HoLEP) is replacing TURP. We compared TURP with HoLEP with matching for prostate size. MATERIALS AND METHODS: We retrospectively reviewed the medical charts of patients who underwent TURP and HoLEP performed by one surgeon at our institute. All patients were categorized into 3 groups on the basis of prostate size (group 1, 80 g), and 45 patients were selected for each method. RESULTS: No major intraoperative complications were encountered. The mean resected tissue weight was 6.3, 18.3, and 28.0 g for groups 1, 2, and 3, respectively, for TURP and 8.7, 25.0, and 39.8 g, respectively, for HoLEP. The mean operation time was 51.8, 89.3, and 101.9 minutes for TURP and 83.6, 122.8, and 131.2 minutes for HoLEP in groups 1, 2, and 3, respectively. HoLEP had better resection efficacy than TURP for any size prostate, but there was no statistical difference between the methods. Both methods resulted in an immediate and significant improvement of International Prostate Symptom Score, peak urinary flow rates, and postvoid residual urine volume. CONCLUSIONS: HoLEP is effective for BPH treatment, regardless of prostate size, even in a small prostate. The perioperative morbidity of HoLEP is also comparable to that of TURP.

Knockdown of Bcl-xL Enhances Growth-Inhibiting and Apoptosis-Inducing Effects of Resveratrol and Clofarabine in Malignant Mesothelioma H-2452 Cells

Mcl-1 and Bcl-xL, key anti-apoptotic proteins of the Bcl-2 family, have attracted attention as important molecules in the cell survival and drug resistance. In this study, we investigated whether inhibition of Bcl-xL influences cell growth and apoptosis against simultaneous treatment of resveratrol and clofarabine in the human malignant mesothelioma H-2452 cells. Resveratrol and clofarabine decreased Mcl-1 protein levels but had little effect on Bcl-xL levels. In the presence of two compounds, any detectable change in the Mcl-1 mRNA levels was not observed in RT-PCR analysis, whereas pretreatment with the proteasome inhibitor MG132 led to its accumulation to levels far above basal levels. The knockdown of Bcl-xL inhibited cell proliferation with cell accumulation at G2/M phase and the appearance of sub-G0/G1 peak in DNA flow cytometric assay. The suppression of cell growth was accompanied by an increase in the caspase-3/7 activity with the resultant cleavages of procaspase-3 and its substrate poly (ADP-ribose) polymerase, and increased percentage of apoptotic propensities in annexin V binding assay. Collectively, our data represent that the efficacy of resveratrol and clofarabine for apoptosis induction was substantially enhanced by Bcl-xL-lowering strategy in which the simultaneous targeting of Mcl-1 and Bcl-xL could be a more effective strategy for treating malignant mesothelioma.

Multicenter Study on the Clinician's Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea / 대한평형의학회지

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

National Evidence-based Collaborating Agency (NECA) Round-table Conference Consensus Statement: multidisciplinary responses to suicide, the first ranked cause of death in adolescents

The National Evidence-based Collaborating Agency (NECA) holds the NECA Round-table Conference that not only disseminates objective and systematic information on topics of social concern in public health care but also organizes discussions on core issues under dispute in the literature through panels composed of multidisciplinary experts. Accordingly, the Round-table Conference was composed of multidisciplinary experts including medical specialists in the areas of psychiatry and preventive medicine, psychiatric and mental health nursing, psychologists, social welfare experts, consultation experts, religious leaders, and government officials from the Ministry of Education, Science and Technology, and Ministry of Health and Welfare. The Round-table Conference, tasked with analysis of the actual status and causes of, and search for solutions for suicide in adolescents, has reached consensus on the current status, trend, risk factors and prevention factors, problems and issues in prevention and coping strategies, effective prevention and coping strategies and areas of research needed for the future. The Round-table Conference commented on the actual status and gravity of suicides in adolescents, and came to the agreement that mental health issues including stress from interpersonal relationships and depression are the key risk factors of suicide. It was further agreed that problems in the measures being implemented for each of the areas include lack of manpower and funding, and inadequate organic association and cooperation among relevant institutions. They also agreed that development of a government-initiated suicide prevention program for adolescents, association among relevant experts, and development, and management of practical guidelines that are of broad and practical use are important. Furthermore, the panels were in agreement that the mass media must comply with the recommended level of coverage in reporting of suicide as adolescents are greatly influenced by provocative mass media reports due to their strong impulsive dispositions.

Surgical Technique of Minimal Incision Approach with CO2 Laser for Congenital Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transcanal antrotomy approach (TCA) enables not only good exposure but also minimal incision approach required for pediatric congenital cholesteatoma (CC). The addition of "CO2 laser enabled ablation and resection (CLEAR)" would facilitate safe and complete removal of CC from stapes. This study evaluates the clinical results of surgically removing CC through TCA with CLEAR (minimal incision approach with CO2 laser, MICL). SUBJECTS AND METHOD: The medical records of patients who underwent endaural extended tympanostomy, MICL, or postauricular approach for CC removal from January 2009 to September 2011 were reviewed in this study. RESULTS: MICL was performed in 37 patients of Potsic I, II CC. It was effective in surgical exposure and reducing the chance of residual CC. MICL could satisfactorily avoid postauricular tympanomastoidectomy, which allowed preservation of healthy mastoid air cells for almost all Potsic III CC, including posterior CC (14 patients). MICL was also useful for 6 cases of Potsic IV CC that extended beyond the incus posterosuperiorly to the auditus ad antrum. Children were not committed to second look operation because the attic was exteriorized with-out the cavity problem and the complete removal of CC from the stapes was facilitated with CLEAR. CONCLUSION: MICL enabled sufficient exposure with less invasive approach as well as complete CC removal, which reduced the postoperative complications and needs for second look operation. This surgical technique could be widely used for Potsic stage I, II, III, and some IV CC.

Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer

PURPOSE: The aim of this study was to compare survival in patients that underwent palliative resection treatment versus non-resection for incurable colorectal cancer (ICRC). METHODS: The case records of 201 patients with ICRC between January 2000 and December 2009 were reviewed. Demographics, American Society of Anesthesiologists (ASA) score, carcinoembryonic antigen (CEA) level, the location of the colon cancer, histology, metastasis, treatment options and median survival were analyzed retrospectively. We divided the patients into four groups according to the treatment modalities: resection alone, resection with post-operative chemotherapy, non-resection treatment by chemotherapy alone, and stent or bypass. Median survival times were compared according to each treatment option, and the survival rates were analyzed. RESULTS: 105 patients underwent palliative resection whereas 96 were treated with non-resection modalities. A palliative resection was performed in 44 cases for resection alone and in 61 cases for resection with post-operative chemotherapy. In patients treated with non-resection of the primary tumor, chemotherapy alone was done in 65 cases and stent or bypass in 31 cases. Multivariate analysis showed a median survival of 14 months in patients with palliative resections with post-operative chemotherapy, which was significantly higher than those for chemotherapy alone (8 months), primary tumor resection alone (5 months), and stent or bypass (5 months). Gender, age, ASA score, CEA level, the location of colon cancer, histology and the presence of multiple metastases were not independent factors in association with the median survival rate. CONCLUSION: In the treatment of ICRC, palliative resection followed by post-operative chemotherapy shows the most favorable median survival compared to other treatment options.

Paragonimiasis in the Abdominal Cavity and Subcutaneous Tissue: Report of 3 Cases

Paragonimiasis is a parasitic disease caused by the lung fluke, Paragonimus spp. Lung flukes may be found in various organs, such as the brain, peritoneum, subcutaneous tissues, and retroperitoneum, other than the lungs. Abdominal paragonimiasis raises a considerable diagnostic challenge to clinicians, because it is uncommon and may be confused with other abdominopelvic inflammatory diseases, particularly peritoneal tuberculosis, and peritoneal carcinomatosis. Also, subcutaneous paragonimiasis does not easily bring up clinical suspicion, due to its rarity. We herein report 2 cases of abdominal paragonimiasis and 1 case of subcutaneous paragonimiasis in Korea.

Postoperative pneumoperitoneum: guilty or not guilty? / 대한외과학회지

PURPOSE: The aim of this study was to determine the incidence and duration of postoperative pneumoperitoneum on plain radiographs and to identify the radiologic findings associated with anastomotic leakage. METHODS: A retrospective analysis was conducted on plain radiographs of 384 patients who underwent intra-abdominal anastomoses between March 2005 and December 2008. RESULTS: Of the 384 patients, 93 patients (24.2%) had postoperative pneumoperitoneums. Of the 93 patients, 86 patients (92.5%) had physiologic pneumoperitoneums and 7 patients (7.5%) had pneumoperitoneums associated with anastomotic leakage. The initial air height was significantly greater in the leakage group than the physiologic air group (12.16 +/- 7.65 mm vs. 7.71 +/- 5.08 mm, P = 0.04). The area under the receiver operating characteristic curve of the initial height of free air for anastomotic leakage was 0.69 (95% confidence interval, 0.59 to 0.78). The best cut-off point was 11.7 mm. The height of the pneumoperitoneum increased with time in the leakage group. Ileus was significantly more prevalent in the leakage group than the physiologic air group (P 11.7 mm, increasing air height over time, and the presence of ileus on plain radiographs suggest a high likelihood of anastomotic leakage.

Anterior Urethral Valve and Diverticulum in a Neonate with Febrile Urinary Tract Infection

Anterior urethral valve is a rare congenital anomaly that can cause obstructive uropathy. Herein, we report a case of an anterior urethral valve that led to the development of febrile urinary tract infection in a neonate.

Torsion of a mucocele of the vermiform appendix: a case report and review of the literature / 대한외과학회지

Torsion of a mucocele of the vermiform appendix is an extremely rare condition and also a rare cause of an acute abdomen with a clinical presentation that is indistinguishable from acute appendicitis, and thus, the condition is diagnosed during operation. Here, the authors describe the case of a 78-year-old female, who presented with intermittent abdominal pain. The appendix had a pelvic position and the torsion was counterclockwise. In addition, the torsion was associated with mucocele of the appendix, which was considered a secondary factor of torsion. Appendectomy and drainage were performed.

Value and Safety of Midazolam Anesthesia during Transrectal Ultrasound-Guided Prostate Biopsy

PURPOSE: Although transrectal ultrasound-guided prostate biopsy is useful for diagnosing prostate cancer, it is a painful procedure. There are many methods for providing pain relief and for treating discomfort during the procedure, but occasionally these are reported to be of limited use. We aimed to evaluate the value and safety of midazolam-induced anesthetic transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: From August 2008 to December 2009, 104 male patients, who were examined with transrectal ultrasound-guided prostate 12-core biopsy, were randomly assigned to two groups. Group 1 (n=51) received ketorolac (Tarasyn(R)) 30 mg. Group 2 (n=53) was treated with midazolam (Dormicum(R)) 3 mg, which was increased to 5 mg if necessary. Immediately after the procedure, the patients were asked to rate their comfort level by using a 10-point visual analog self-assessment pain scale. RESULTS: The pain scale in group 2 was significantly lower than that in group 1 (p<0.05). The patients assigned to group 2 experienced no side-effects from midazolam and were more satisfied than the patients in group 1 (p<0.05). CONCLUSIONS: Midazolam anesthesia relieves pain effectively, and the patient's satisfaction is better than with conventional transrectal ultrasound-guided prostate biopsy. Midazolam-induced anesthetic transrectal ultrasound-guided prostate biopsy is useful and safe.

The Efficacy, Safety and Effectiveness of the Laparoscopic Varicocelectomy: Comparative Study of 2 Trocars and 3 Trocars

OBJECTIVE: Varicocelectomy can be accomplished using a variety of approaches, including retroperitoneal, transinguinal, subinguinal or scrotal approach and there are advantage and disadvatage, respectively. The goal of this study is to evaluate the efficacy, safety and effect of the laparoscopic varicocelectomy and compare 2 trocars laparoscopic technique with 3 trocars. METHODS: Between March 2003 and December 2007, 46 patients with varicocele were treated using 3 trocars (group A) or 2 trocars (group B) laparoscopic varicocelectomy. Data regarding operative time, time of vein ligation, hospital stay, recurrence rate and complications of each procedure were retrospectively evaluated. RESULTS: Of the 46 patients 39 with left side varicocele constituted the population of the present study; the others, with bilateral varicocele, were excluded. No significant differences were found in terms of mean operative time, mean time of vein ligation, mean hospital stay and morbidity between group A and B. CONCLUSION: Laparoscopic varicocelectomy is feasible, safety and effective surgical technique. Compared with 3 trocars, 2 trocars laparoscopic varicocelctomy results in similar operative and postoperative outcomes. In addition, it is cost-effective and cosmetic.