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Purpose@#Certain patient subgroups who do not respond to induction chemotherapy (IC) show inherent chemoresistance in locally advanced head and neck squamous cell carcinoma (LA-HNSCC). This study aimed to assess the prognostic value of IC, and role of IC in guiding the selection of a definitive locoregional therapy. @*Materials and Methods@#Out of the 445 patients in multi-institutional LA-HNSCC cohort, 158 (36%) receiving IC were enrolled. The study outcome was to assess overall survival (OS) through IC responsiveness and its role to select subsequent treatments. @*Results@#Among 135 patients who completed subsequent treatment following IC, 74% responded to IC (complete response in 17% and partial response in 58%). IC-non-responders showed 4.5 times higher risk of mortality than IC-responders (hazard ratio, 4.52; 95% confidence interval, 2.32 to 8.81; p < 0.001). Among IC-responders, 84% subsequently received definitive concurrent chemoradiotherapy (CCRT) and OS was not differed by surgery or CCRT (p=0.960). Regarding IC-non-responders, 54% received CCRT and 46% underwent surgery, and OS was poor in CCRT (24-month survival rate of 38%) or surgery (24-month survival rate of 63%). @*Conclusion@#Response to IC is a favorable prognostic factor. For IC-responders, either surgery or CCRT achieved similar survival probabilities. For IC-non-responder, multidisciplinary approach was warranted reflecting patients’ preference, morbidity, and prognosis.
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Background/Aims@#Treatment decisions for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are complicated, and multi-modal treatments are usually indicated. However, it is challenging for older patients to complete treatments. Thus, we investigated disease characteristics, real-world treatment, and outcomes in older LA-HNSCC patients. @*Methods@#Older patients (aged ≥ 70 years) were selected from a large nationwide cohort that included 445 patients with stage III–IVB LA-HNSCC from January 2005 to December 2015. Their data were retrospectively analyzed and compared with those of younger patients. @*Results@#Older patients accounted for 18.7% (83/445) of all patients with median age was 73 years (range, 70 to 89). Proportions of primary tumors in the hypopharynx and larynx were higher in older patients and older patients had a more advanced T stage and worse performance status. Regarding treatment strategies of older patients, 44.5% of patients received concurrent chemoradiotherapy (CCRT), 41.0% underwent surgery, and 14.5% did not complete the planned treatment. Induction chemotherapy (IC) was administered to 27.7% (23/83) of older patients; the preferred regimen for IC was fluorouracil and cisplatin (47.9%). For CCRT, weekly cisplatin was prescribed 3.3 times more often than 3-weekly cisplatin (62.2% vs. 18.9%). Older patients had a 60% higher risk of death than younger patients (hazard ratio, 1.6; p = 0.035). Oral cavity cancer patients had the worst survival probability. @*Conclusions@#Older LA-HNSCC patients had aggressive tumor characteristics and received less intensive treatment, resulting in poor survival. Further research focusing on the older population is necessary.
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Background/Aims@#The study investigated the incidence of thromboembolic events (TEE) in head and neck (H&N) cancer patients who received concurrent chemoradiotherapy (CCRT) with cisplatin, and analyzed the factors affecting TEE occurrence @*Methods@#Two hundred and fifty-seven patients who started CCRT with cisplatin for H&N cancer from January 2005 to December 2019 were analyzed. @*Results@#TEE occurred in five patients, an incidence rate of 1.9%. The 2-, 4-, and 6-month cumulative incidences of TEE were 0.8%, 1.6%, and 1.9%, respectively. Khorana score was the only factor associated with TEE occurrence (p = 0.010). @*Conclusions@#The incidence of TEE in H&N cancer patients who underwent CCRT with cisplatin was relatively low when compared to other types of cancer. However, patients with a high Khorana score require more careful surveillance for possible TEE occurrence.
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Background/Aims@#The optimal treatment (Tx) for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients with brain metastasis (BM) remains to be determined. @*Methods@#A retrospective review was conducted on 77 NSCLC patients with synchronous BM who underwent first-line EGFR-tyrosine kinase inhibitor (TKI) Tx. The outcomes of patients were analyzed according to the clinicopathological characteristics including local Tx modalities. @*Results@#Fifty-nine patients underwent local Tx for BM (gamma knife surgery [GKS], 37; whole brain radiotherapy [WBRT], 18; others, four) concurrently or sequentially with EGFR-TKI. Patients treated with TKI alone showed significantly lower incidence of central nervous system (CNS) symptoms. The median progression-free survival (PFS) and overall survival (OS) after the initiation of EGFR-TKI for all patients were 9 and 19 months, respectively. In 60 patients with follow-up brain imaging, the median time to CNS progression was 15 months. Patients with EGFR exon 19 deletion had a significantly longer median OS than those with other mutations including L858R (23 months vs. 17 months). Other clinical characteristics, including CNS symptoms, number of BM, and the use of local Tx were not associated with OS, as well as PFS. In terms of the local optimal Tx modality, no difference was found between GKS and WBRT in the OS and PFS. @*Conclusions@#This study suggests that EGFR-TKI may result in a favorable outcome in NSCLC patients with synchronous BM, especially in deletion 19 mutant, regardless of the extent of BM lesions or local Tx modalities. Patients with asymptomatic BM can be treated with EGFR-TKI and careful surveillance.
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Background@#Depression and anxiety are prevalent and can cause suffering in patients with Parkinson’s disease (PD). The Korean version of the Hospital Anxiety and Depression Scale (K-HADS) has been widely used to assess depression and anxiety symptoms in Korean patient with PD. The present study aimed to assess the reliability and validity of the K-HADS using Rasch measurement analysis. @*Methods@#A total of 106 PD patients (54 males, 52 females) who met the diagnostic criteria of the United Kingdom Brain Bank were recruited. Unidimensionality, the Rasch model fit, response category functioning, patient-item distribution, and the separation reliability of the K-HADS depression (K-HADS-D) and anxiety (K-HADS-A) subscales were statistically evaluated. @*Results@#The mean K-HADS-D and K-HADS-A scores were 8.08±4.69 (mean±standard deviation) and 5.44±4.18, respectively. Cronbach’s α coefficients of the K-HADS-D and K-HADS-A were 0.82 and 0.83. The Rasch analysis revealed that the K-HADS-D and K-HADS-A showed unidimensionality and no disordered functioning was observed in the 4-point polytomous scale. However, both K-HADS-D and K-HADS-A exhibited suboptimal separation reliability, while the K-HADS-A showed inadequate scale targeting with floor effect. @*Conclusions@#The present study comprises the first validation of the K-HADS using the Rasch measurement model, suggesting that the K-HADS-D and K-HADS-A are clinimetrically acceptable and reliable scales for use in Korean patients with PD. However, the moderate person separation indices implicate the relatively low discriminatory ability of the K-HADS in our study patients.
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BACKGROUND@#Polarization sensitive-optical coherence tomography (PS-OCT) provides the unique advantage of being able to measure the optical characteristics of tissues by using polarized light. Although the well-organized fibers of healthy muscle can change the polarization states of passing light, damaged tissue has different behaviors. There are studies on optical imaging methods applied to the respiratory organs; however, they are restricted to structural imaging. In particular, the intercostal muscle situated under the pleura is very challenging to visualize due to the difficulty of access.METHOD: In this study, PS-OCT was used to identify subpleural cancer in male New Zealand white rabbits (3.2–3.4 kg) and to assess the phase retardation changes in normal and cancerous chest walls. VX2 cell suspension was injected between the intercostal muscle and parietal pleura and a tented area was observed by thoracic scope. A group of rabbits (n = 3) were sacrificed at day 7 after injection and another group (n = 3) at day 14. @*RESULTS@#In the PS-OCT images, pleura thickness changes and muscle damage were criteria to understand the stages of the disease. The results of image and phase retardation analysis matched well with the pathologic examinations. @*CONCLUSION@#We were able to visualize and analyze subpleural cancer by PS-OCT, which provided structural and functional information. The measured phase retardation could help to identify the margin of the tumor. For further studies, various approaches into other diseases using polarization light are expected to have positive results.
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BACKGROUND@#The vocal cord tissue consists of three anatomical layers from the surface to deep inside: the epithelium that contains almost no collagen, the lamina propria that is composed of abundant collagen, and the vocalis muscle layer. It is clinically important to visualize the tissue microstructure using a non-invasive method, especially in the case of vocal cord nodules or cancer, since histological changes in each layer of the vocal cord cause changes in the voice. Polarizationsensitive optical coherence tomography (PS-OCT) enables phase retardation measurement to evaluate birefringence of tissue with varied organization of collagen fibers in different tissue layers. Therefore, PS-OCT can visualize structural changes between normal and abnormal vocal cord tissue.METHOD: A rabbit laryngeal tumor model with different stages of tumor progression was investigated ex-vivo by PSOCT. A phase retardation slope-based analysis, which quantifies the birefringence in different layers, was conducted to distinguish the epithelium, lamina propria, and muscle layers. @*RESULTS@#The PS-OCT images showed a gradual decrease in birefringence from normal tissue to advanced tumor tissue.The quantitative analysis provided a more detailed comparison among different stages of the rabbit laryngeal tumor model, which was validated by the corresponding histological findings. @*CONCLUSION@#Differences in tissue birefringence was evaluated by PS-OCT phase retardation measurement. It is also possible to indirectly infer the dysplastic changes based on the mucosal and submucosal alterations.
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Objectives@#：Sexual dysfunction is common in both untreated and treated patients with schizophrenia and known as affecting the quality of life and drug compliance. The primary objective of this study is to estimate the prevalence of sexual dysfunction in Korean patients with schizophrenia treated with antipsychotic medications compared with healthy controls. @*Methods@#：Subjects were 75 patients who were recruited from outpatients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR criteria, who had been stabilized on antipsychotic medications for more than three consecutive months. Control group consisted of 76 volunteers without history of any psychiatric disorder were excluded. We assessed for sexual dysfunction by the ASEX. @*Results@#：The prevalence of sexual dysfunction in the patient group was 57.33%, while that of the control group was 23.37%. Female gender and the use of antidepressants were best predictors of sexual dysfunction in patient group. Sexual difference at sexual drive observed in the control group diminished in the patient group. @*Conclusion@#：The present study demonstrated a higher prevalence of sexual dysfunction in patient group than control. Clinicians should consider the differential sexual dysfunction effects of antipsychotics when prescribing medications.
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BACKGROUND@#Polarization sensitive-optical coherence tomography (PS-OCT) provides the unique advantage of being able to measure the optical characteristics of tissues by using polarized light. Although the well-organized fibers of healthy muscle can change the polarization states of passing light, damaged tissue has different behaviors. There are studies on optical imaging methods applied to the respiratory organs; however, they are restricted to structural imaging. In particular, the intercostal muscle situated under the pleura is very challenging to visualize due to the difficulty of access.METHOD: In this study, PS-OCT was used to identify subpleural cancer in male New Zealand white rabbits (3.2–3.4 kg) and to assess the phase retardation changes in normal and cancerous chest walls. VX2 cell suspension was injected between the intercostal muscle and parietal pleura and a tented area was observed by thoracic scope. A group of rabbits (n = 3) were sacrificed at day 7 after injection and another group (n = 3) at day 14. @*RESULTS@#In the PS-OCT images, pleura thickness changes and muscle damage were criteria to understand the stages of the disease. The results of image and phase retardation analysis matched well with the pathologic examinations. @*CONCLUSION@#We were able to visualize and analyze subpleural cancer by PS-OCT, which provided structural and functional information. The measured phase retardation could help to identify the margin of the tumor. For further studies, various approaches into other diseases using polarization light are expected to have positive results.
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BACKGROUND@#The vocal cord tissue consists of three anatomical layers from the surface to deep inside: the epithelium that contains almost no collagen, the lamina propria that is composed of abundant collagen, and the vocalis muscle layer. It is clinically important to visualize the tissue microstructure using a non-invasive method, especially in the case of vocal cord nodules or cancer, since histological changes in each layer of the vocal cord cause changes in the voice. Polarizationsensitive optical coherence tomography (PS-OCT) enables phase retardation measurement to evaluate birefringence of tissue with varied organization of collagen fibers in different tissue layers. Therefore, PS-OCT can visualize structural changes between normal and abnormal vocal cord tissue.METHOD: A rabbit laryngeal tumor model with different stages of tumor progression was investigated ex-vivo by PSOCT. A phase retardation slope-based analysis, which quantifies the birefringence in different layers, was conducted to distinguish the epithelium, lamina propria, and muscle layers. @*RESULTS@#The PS-OCT images showed a gradual decrease in birefringence from normal tissue to advanced tumor tissue.The quantitative analysis provided a more detailed comparison among different stages of the rabbit laryngeal tumor model, which was validated by the corresponding histological findings. @*CONCLUSION@#Differences in tissue birefringence was evaluated by PS-OCT phase retardation measurement. It is also possible to indirectly infer the dysplastic changes based on the mucosal and submucosal alterations.
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Objectives@#：Sexual dysfunction is common in both untreated and treated patients with schizophrenia and known as affecting the quality of life and drug compliance. The primary objective of this study is to estimate the prevalence of sexual dysfunction in Korean patients with schizophrenia treated with antipsychotic medications compared with healthy controls. @*Methods@#：Subjects were 75 patients who were recruited from outpatients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR criteria, who had been stabilized on antipsychotic medications for more than three consecutive months. Control group consisted of 76 volunteers without history of any psychiatric disorder were excluded. We assessed for sexual dysfunction by the ASEX. @*Results@#：The prevalence of sexual dysfunction in the patient group was 57.33%, while that of the control group was 23.37%. Female gender and the use of antidepressants were best predictors of sexual dysfunction in patient group. Sexual difference at sexual drive observed in the control group diminished in the patient group. @*Conclusion@#：The present study demonstrated a higher prevalence of sexual dysfunction in patient group than control. Clinicians should consider the differential sexual dysfunction effects of antipsychotics when prescribing medications.
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Background@#Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. @*Methods@#All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. @*Results@#In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. @*Conclusions@#Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.
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After a partial mastectomy, large or ptotic breasts can be reconstructed using breast reduction techniques. Wise-pattern reduction is typically used to remove masses in any quadrant of the breast, but this technique leaves a large inverted T-shaped scar. Instead, the short scar periareolar inferior pedicle reduction (SPAIR) technique involves a periareolar line and does not result in a scar along the inframammary fold (IMF). A 49-year-old patient with macromastia and severely ptotic breasts was diagnosed with invasive cancer of the left breast. Her large breasts caused pain in her back, shoulders, and neck. She also expressed concern about postsurgical scarring along the IMF. In light of this concern, we chose the SPAIR technique, and we designed and performed the procedure as described by Hammond. During surgery, we removed 36 g of breast tumor and 380 g of breast parenchyma from the left breast. To establish symmetry, we also removed 410 g of tissue from the right breast. Postoperatively, the patient reported satisfaction regarding the reduction mammaplasty and, in particular, noted decreased back, shoulder, and neck pain. In summary, we used the SPAIR technique to achieve oncologic and aesthetic success in a patient with macromastia and a tumor located lateral to the nipple-areolar complex.
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Background@#This study aimed to investigate the relationship between exercise and depression based on responses to 2016 Korean National Health and Nutrition Examination Survey (KNHANES) and the Patient Health Questionairre-9 (PHQ-9). Specifically, this study examined which physical activities have the greatest effects in combating depression. @*Methods@#This study was based on data from 2016 KNHANES and responses to the PHQ-9 questionnaire on physical activity. We selected 2,245 people of age >19 years, who completed the surveys. Physical activity variables included number of days of walking, duration of walking, days of strength training, and aerobic physical activity. These variables subdivided into aerobic and muscle strengthening activities and their effects on depression were examined. @*Results@#All the variables, except duration of walking, were negatively correlated with the PHQ-9 scale scores. However, of the physical activity variables included in the hierarchical regression analysis, only the number of days of walking over 1 week had a statistically significant negative effect on the PHQ-9 scores. @*Conclusion@#For adults, aerobic activity (walking) had a greater effect on reducing depression than muscle strengthening activity. The frequency and consistency of walking had a greater impact than the duration of walks. These results suggest that regular walking is a better form of physical activity than strength training for its effect on mood and it assists in overcoming depression.
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PURPOSE: This randomized phase III study was designed to compare the efficacy and safety of irinotecan plus cisplatin (IP) over etoposide plus cisplatin (EP) in Korean patients with extensive-disease small-cell lung cancer (SCLC). MATERIALS AND METHODS: Patients were randomly assigned to receive IP, composed of irinotecan 65 mg/m2 intravenously on days 1 and 8+cisplatin 70 mg/m2 intravenously on day 1 every 3 weeks, or EP, composed of etoposide 100 mg/m2 intravenously on days 1, 2, 3+cisplatin 70 mg/m2 intravenously on day 1, every 3 weeks for a maximum of six cycles, until disease progression, or until unacceptable toxicity occurred. The primary endpoint was overall survival. RESULTS: A total of 362 patients were randomized to IP (n=173) and EP (n=189) arms. There were no significant differences between IP and EP arms for the median overall survival (10.9 months vs. 10.3 months, p=0.120) and the median progression-free survival (6.5 months vs. 5.8 months, p=0.115). However, there was a significant difference in response rate (62.4% vs. 48.2%, p=0.006). The pre-planned subgroup analyses showed that IP was associated with longer overall survival in male (11.3 months vs. 10.1 months, p=0.036), < 65 years old (12.7 months vs. 11.3 months, p=0.024), and Eastern Cooperative Oncology Group performance status 0/1 (12.4 months vs. 10.9 months, p=0.040) patient groups. The severity of treatment-related adverse events such as grade 3/4 anemia, nausea and diarrhea was more frequent in patients treated with IP. CONCLUSION: The IP chemotherapy did not significantly improve the survival compared with EP chemotherapy in Korean patients with extensive-disease SCLC.
Subject(s)
Humans , Male , Anemia , Arm , Cisplatin , Diarrhea , Disease Progression , Disease-Free Survival , Drug Therapy , Etoposide , Lung Neoplasms , Nausea , Small Cell Lung CarcinomaABSTRACT
BACKGROUND: Lesch types 2 (L2, anxiety model) and 3 (L3, depressive model) of alcoholism exhibit different responses to anti-craving agents, and most treatment guidelines provide differential treatment strategies for bipolar depression (DEP) and unipolar DEP. We compare the psychological characteristics of L2 and L3 alcoholism and between the unipolar and bipolar subgroups.METHODS: We reviewed medical records of patients who were diagnosed with alcohol use disorder using the DSM-5 diagnostic criteria and classified as L2 and L3 using Lesch Alcohol typology software. All patients completed self-report scales (Alcohol Use Disorders Identification Test [AUDIT], Beck Anxiety Inventory [BAI], Beck Depression Inventory-II [BDI-II], and Korean Symptom Checklist-95 [KSCL95]). The data were analyzed using descriptive statistics, the Wilcoxon Rank-Sum test, and ANOVA.RESULTS: Of the 43 patients, 23 were assigned L2, and 20 were assigned L3. The scores for the KSCL95 subscales fell generally in the increasing order of the L2-unipolar (L2U, n=10), L2-bipolar (L2B, n=13), L3-unipolar (L3U, n=11), and L3-bipolar (L3B, n=9) types. The L3B scores were greater than the L3U scores for most KSCL95 subscales, by contrast with the DEP and BAI scores.CONCLUSION: We found psychological differences between L2 and L3 and identified the unique psychological characteristics for each subgroup by polarity. The psychological characteristics of these subgroups of alcohol use disorder may help improve the treatment success rates through individualized treatment strategies.
Subject(s)
Humans , Alcoholism , Anxiety , Bipolar Disorder , Depression , Depressive Disorder , Medical Records , Weights and MeasuresABSTRACT
PURPOSE: We aimed to evaluate health-related quality of life (HRQOL) at 1-year post-diagnosis in breast cancer (BC) patients and its association with overall survival using data from the National Cancer Center Hospital. MATERIALS AND METHODS: Data of a BC cohort were first obtained between 2004 and 2006 and followed up. HRQOL was assessed using EORTC QLQ-C30 and BC specific module QLQ-BR23 few days after diagnosis and 1 year after that. We examined and compared the difference in the two HRQOL scores measured for each patient by the patient's current survival status. The Cox proportional hazards model was fitted to evaluate the impact of HRQOL on survival, with adjustment for baseline HRQOL and other factors. RESULTS: Of 299 enrolled patients, 206 responded at 1-year post-diagnosis (80.6%) and were followed up for 11.6 years on average. At 1-year post-diagnosis, survivors had better HRQOL scores than those who died, although their health status was similar at baseline. Survivors reported significant increase 1 year after diagnosis in global health status and emotional scales. Between the groups, functional scales such as physical, role, and emotional were significantly different. Functional scales, including physical (adjusted hazard ratio [aHR], 0.70), role (aHR, 0.68), emotional (aHR, 0.72), and symptom scales, including fatigue (aHR, 1.34), dyspnea (aHR, 1.29), appetite loss (aHR, 1.24) were significantly associated with overall survival. Patients who were less worried about future health had favorable survival(aHR, 0.83). CONCLUSION: Besides treatment-related symptoms, non-medical aspects at 1-year post-diagnosis, including functional well-being and future perspective, are predictive of long-term survival. Intervention to enhance physical, role, and emotional support for women soon after their BC diagnosis might help to improve disease survival outcomes afterwards.
Subject(s)
Female , Humans , Appetite , Breast Neoplasms , Breast , Cohort Studies , Diagnosis , Dyspnea , Fatigue , Global Health , Korea , Proportional Hazards Models , Prospective Studies , Quality of Life , Survivors , Weights and MeasuresABSTRACT
PURPOSE: Headache is a common symptom during childhood. It is usually persistent and requires special care. This study aimed to identify the characteristics of headache in children < 7 years of age. METHODS: We reviewed 3 years of clinical files on children < 7 years of age with a chief complaint of headache. RESULTS: This study included 146 children (66 males, 80 females; mean age, 5.5±1.0 years). Mean symptom duration was 5.8±7.9 months. Attack durations were longer than 2 hours in 31 patients, shorter than 2 hours in 70 patients, and unchecked in 45 patients. Attack frequency was 15.1±10.6 times per month. Pain locations and characteristics were also variable. Mean pain severity score was 5.1±2.2 on the visual analog scale. Of 38 patients who underwent electroencephalography, 9 showed positive findings. Of 41 who underwent brain magnetic resonance imaging, 20 showed positive findings. The diagnoses were migraine (including probable migraine) in 34, tension-type headache in 5, and congenital malformations in 3. Medications were used in 29 patients: acetaminophen in 17, ibuprofen in 8, naproxen sodium in 1, and topiramate or amitriptyline in 3. CONCLUSION: In children aged < 7 years, headache has a relatively benign course, but detailed history taking is needed for more accurate diagnosis.
Subject(s)
Child , Female , Humans , Male , Acetaminophen , Amitriptyline , Brain , Diagnosis , Electroencephalography , Headache , Ibuprofen , Magnetic Resonance Imaging , Migraine Disorders , Naproxen , Tension-Type Headache , Visual Analog ScaleABSTRACT
PURPOSE: Laparoscopic appendectomy (LA) is a popular procedure for acute appendicitis. Its minimally invasive nature has made LA a commonly performed surgical technique for surgical residents. However, single incision laparoscopic surgery (SILS) poses a challenge to inexperienced surgical residents. We described our initial experience in teaching SILS for appendectomy in our medical center. METHODS: Twenty nine cases of SILA were performed by single surgical resident and 110 cases of LA were performed by four surgical residents and five board-certified surgeons. Data were reviewed retrospectively. RESULTS: The mean SILA and multi-port laparoscopic appendectomy (MLA) operative time was 44.5±14 min (range 25~85 min) and 74.8±26 min (range 20~125 min), respectively. The shorter time for SILA was significant (p<0.05). Postoperative hospital stay was 3.3±1.6 days (range 2~6 days) following SILA and 4.0±2.9 days (range 2~12 days) following MLA (p<0.05). Three cases of wound infection developed following SILA. Complications in the MLA patients included one cases each of operative bladder injury and postoperative ileus. CONCLUSION: SILA is a considerable training method for laparoscopic surgery for a surgical resident learning SILS.
Subject(s)
Humans , Appendectomy , Appendicitis , Ileus , Laparoscopy , Learning , Length of Stay , Methods , Operative Time , Retrospective Studies , Surgeons , Urinary Bladder , Wound InfectionABSTRACT
PURPOSE: Sacral dimples are a common cutaneous anomaly in infants. Spine ultrasonography (USG) is an effective and safe screening tool for patients with a sacral dimple. The aim of this study was to determine the clinical manifestations in patients with an isolated sacral dimple and to review the management of spinal cord abnormalities identified with USG. METHODS: We reviewed clinical records and collected data on admissions for a sacral dimple from March 2014 through February 2017 that were evaluated with spine USG by a pediatric radiologist. During the same period, patients who were admitted for other complaints, but were found to have a sacral dimple were also included. RESULTS: This study included 230 infants under 6-months-old (130 males and 100 females; mean age 52.8±42.6 days). Thirty-one infants with a sacral dimple had an echogenic filum terminale, and 57 children had a filar cyst. Twenty-seven patients had a low-lying spinal cord, and only one patient was suspected of having a tethered cord. Follow-up spine USG was performed in 28 patients, which showed normalization or insignificant change. CONCLUSION: In this study, all but one infant with a sacral dimple had benign imaging findings. USG can be recommended in infants with a sacral dimple for its convenience and safety.