Suicide Risk in Patients With Diabetes Varies by the Duration of Diabetes: The Korea National Health and Nutrition Examination Survey (2019)

Objective@#The objectives of this study were to investigate the suicide risk in diabetes patients and evaluate the variations in suicide risk by the duration of diabetes using a large population sample in South Korea. @*Methods@#Data from 6,296 adults in the 2019 Korea National Health and Nutrition Examination Survey were included. The suicidal ideation, suicide plans, and suicidal behavior of diabetes patients were compared to the general population. After classifying the patients into ≤1 year, 2 to 9 years, and ≥10 years of diabetes duration, we evaluated the relationship between the duration of diabetes and the suicide risk. @*Results@#Diabetes patients had higher prevalences of suicidal ideation (9.1%, p<0.001) and suicide plans (3.6%, p<0.001) than the general population. After adjusting for potential confounding factors, suicide plans (adjusted odds ratio [aOR]=2.926, 95% confidence interval [CI]=1.325–6.463) were significantly associated with diabetes. In the 2 to 9 years group of diabetes patients, we found an increase in the risk of suicidal ideation (aOR=2.035, 95% CI=1.129–3.670), suicide plans (aOR=3.507, 95% CI=1.538–7.996), and suicidal behavior (aOR=7.130, 95% CI=2.035–24.978) after adjusting for the covariates. However, no increases in suicide risk were observed ≤1 year and ≥10 years after diabetes diagnosis. @*Conclusion@#In adults, diabetes is associated with an increase in suicide risk. Suicide risk in diabetes patients showed an inverted U-shaped depending upon the duration of diabetes.

Interactions between NCR + ILC3s and the Microbiome in the Airways Shape Asthma Severity

Asthma is a heterogeneous disease whose development is shaped by a variety of environmental and genetic factors. While several recent studies suggest that microbial dysbiosis in the gut may promote asthma, little is known about the relationship between the recently discovered lung microbiome and asthma. Innate lymphoid cells (ILCs) have also been shown recently to participate in asthma. To investigate the relationship between the lung microbiome, ILCs, and asthma, we recruited 23 healthy controls (HC), 42 patients with non-severe asthma, and 32 patients with severe asthma. Flow cytometry analysis showed severe asthma associated with fewer natural cytotoxicity receptor (NCR) + ILC3s in the lung.Similar changes in other ILC subsets, macrophages, and monocytes were not observed. The asthma patients did not differ from the HC in terms of the alpha and beta-diversity of the lung and gut microbiomes. However, lung function correlated positively with both NCR + ILC3 frequencies and microbial diversity in the lung. Sputum NCR + ILC3 frequencies correlated positively with lung microbiome diversity in the HC, but this relationship was inversed in severe asthma. Together, these data suggest that airway NCR + ILC3s may contribute to a healthy commensal diversity and normal lung function.

Resection of Ewing Sarcoma in the Paranasal Sinus Via the Endoscopic Modified Lothrop (Draf III) Approach

Ewing sarcoma is a rare type of bone tumor that typically occurs in the head and neck regions. Appropriate management strategies remain controversial. Herein, we report a case of Ewing sarcoma originating from the ethmoid sinus in a 38-year-old woman. The patient initially presented with unilateral nasal obstruction. Pathologic examination revealed a tumor composed of small round blue cells under hematoxylin and eosin staining with positive expressions for CD-99, CK, and FLI-1. The patient was successfully treated with neoadjuvant chemotherapy followed by complete surgical excision via the endoscopic modified Lothrop (Draf III) approach, adjuvant chemotherapy, and radiation therapy. There was no recurrence or complication up to the writing of this article. This study presents an appropriate management strategy for an extensive case of Ewing sarcoma invading the frontal sinus using an endoscopic approach.

A Case of Sphenoidal Meningoencephalocele Masquerading as an Isolated Sphenoid Mucocele / 대한이비인후과학회지

Isolated sphenoid sinus disease is often misdiagnosed because of its rarity and varing clinical presentation. A 51-year-old male visited the hospital with abnormal brain CT findings which showed homogenous opacification associated with sinus wall expansion on the right sphenoid sinus. Under the impression of isolated sphenoid mucocele, the fenestration of sphenoid sinus was conducted without surgical complication. But, cerebrospinal fluid rhinorrhea spontaneously developed 3 days after fenestration operation and then stopped by sealing the suspicious leakage site with free graft of inferior turbinate mucosa. Based on the pathological findings, paranasal sinus CT and MRI findings, this case is reported to be meningoencephalocele developed in sphenoid sinus.

The Effectiveness of Surgery-Based Treatment in Advanced Oropharyngeal Cancers / 대한이비인후과학회지

Background and Objectives@#Oropharyngeal cancers (OPCs) can be staged down to a lower stage with p16 positivity and de-escalated therapy has been the common practice. The aim of this study is to evaluate the survival outcomes based on various clinical factors in advanced OPC patients. Subjects and Method A total of 58 OPC patients in the stage IVA based on the American Joint Committee on Cancer 7th edition were treated with primary surgery or primary chemoradiation therapy from 2010 to 2016. A survival analysis was carried out using the Kaplan- Meier method, log-rank test, and Cox proportional hazards model. @*Results@#The median follow-up was 39.5 months. Thirty-eight and 20 patients received surgery- based and radiation therapy (RT)-based treatments, respectively. Clinical T-stage and treatment method were significant risk factors for 5-year disease-free survival (DFS) rate, and the treatment method was the only significant risk factor for overall-survival (OS) rate. 5-year DFS rate in the surgery-based treatment and RT-based treatment was 76.1% and 36.0% (p=0.001). On multivariate analysis, the surgery-based treatment group was associated with a significantly reduced hazard of death [the hazard ratio (HR) for the radiation-based treatment was 6.565 compared to the surgery-based treatment, p=0.002]. 5-year OS rate in the surgery-based treatment and RT-based treatment was 91.1% and 53.4% (p=0.003), respectively. On the multivariate analysis, the surgery-based treatment group was associated with a significantly reduced hazard of death (the HR for the radiation-based treatment was 7.544 compared to the surgerybased treatment, p=0.012). @*Conclusion@#The primary surgery-based treatment for advanced OPC showed a better survival outcome than the primary radiation-based treatment, irrespective of p16 positivity.

Nationwide Analysis of Mortality Rates and Related Surgical Procedures in Hearing Disability Patients in South Korea

Background and Objectives@#Hearing loss (HL) and its repercussions are major problems in today’s society. There are limited data on the relationship between degree of HL and otologic disorders. The aim of this study is to estimate mortality rates, rates of sudden idiopathic HL and related otologic surgical procedures in hearing disability patients in South Korea. @*Subjects and Methods@#Retrospective medical data for 160,205 patients with hearing disability was extracted. Mortality rates, rates of sudden idiopathic HL and related otologic surgical procedures were compared with a normal control group consisting of 865,475 people; approximately 5 times the number of hearing disability patients. @*Results@#According to the Korean National Disability Registry (NDR), 0.458% of the population in South Korea suffered from hearing disability in 2015. Higher rates of mortality and sudden idiopathic HL were reported in hearing disability patients, increasing up to a maximum of 1.594 times and 1,039.695 times, respectively, compared to the normal control group. Mastoidectomy surgery was 2.5 times more frequently performed and pressure equalizing (PE) tube insertion was about 15 times more frequently performed in hearing disability patients. @*Conclusions@#Hearing disability is related to higher risks of mortality, sudden idiopathic HL and otologic surgical procedures, including mastoidectomy and PE tubing.

Update on Clinical Manifestation in Acute Low-Tone Hearing Loss / 대한이비인후과학회지

Background and Objectives@#Acute low-tone hearing loss (ALHL) is gaining attention as an independent disease identity with close association with endolymphatic hydrops and early stage Meniere’s disease (MD). This study aims to compare patients of ALHL with patients exhibiting low-tone hearing loss and ear fullness without vertigo in various audio-vestibular assessments and in progression to overt MD.Subjects and Method A total of 249 patients with low-tone hearing loss with ear fullness without vertigo was enrolled in this study. Of these patients, 58 patients met criteria for ALHL, which was defined as having an average hearing loss of ≥30 dB at 125, 250, and 500 Hz and ≤20 dB at 2, 4, and 8 kHz. Demographics, electrocochleography (ECoG) abnormality, rate of hearing improvement, vestibular functions, and progression to MD were analyzed. @*Results@#An average low-tone hearing loss of ALHL patients was 42.8 dB, which recovered to 18.9 dB following a combined treatment of diuretics and oral steroid therapy. The hearing recovery rate of this group was 87.9% and the ECoG abnormality ratio was 42.5%. Also, 15.5% of ALHL patients eventually progressed to MD. @*Conclusion@#This study described demographics and characteristics of ALHL, demonstrating a successful response to the combined treatment of diuretics and oral steroid. Also, this report demonstrated a close relationship between the degree of low-tone hearing loss and ECoG abnormality and observed the progression to MD in ALHL patients. These data can be usefully applied in clinical setting to explain clinical outcomes of ALHL.

The Effects of Preoperative Aspirin on Coronary Artery Bypass Surgery: a Systematic Meta-Analysis

BACKGROUND AND OBJECTIVES@#Aspirin plays an important role in the maintenance of graft patency and the prevention of thrombotic event after coronary artery bypass graft surgery (CABG). However, the use of preoperative aspirin is still under debate due to the risk of bleeding.@*METHODS@#From PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, data were extracted by 2 independent reviewers. Meta-analysis using random effect model was performed.@*RESULTS@#We performed a systemic meta-analysis of 17 studies (12 randomized controlled studies and 5 non-randomized registries) which compared clinical outcomes of 9,101 patients who underwent CABG with or without preoperative aspirin administration. Preoperative aspirin increased chest tube drainage (weighted mean difference 177.4 mL, 95% confidence interval [CI], 41.3–313.4; p=0.011). However, the risk of re-operation for bleeding was not different between the preoperative aspirin group and the control group (3.2% vs. 2.4%; odds ratio [OR], 1.23; 95% CI, 0.94–1.60; p=0.102). There was no difference in the rates of all-cause mortality (1.6% vs. 1.5%; OR, 0.98; 95% CI, 0.64–1.49; p=0.920) and myocardial infarction (MI) (8.7% vs. 10.4%; OR, 0.83; 95% CI, 0.66–1.04; p=0.102) between patients with and without preoperative aspirin administration.@*CONCLUSIONS@#Although aspirin increased the amount of chest tube drainage, it was not associated with increased risk of re-operation for bleeding. In addition, the risks of early postoperative all-cause mortality and MI were not reduced by using preoperative aspirin.

A case of neck lipoblastoma in a pediatric patient / 대한두경부종양학회지

Lipoblastoma is a rare benign tumor with 80–90% occurring in children less than 3 years of age and 40% occurring in children less than 1 year of age. The most common site of incidence is limb, and then trunk. Neck is the rare site of incidence. The main symptom that the patient complains about is a rapidly growing neck mass without pain. When the size of mass increases, it can cause dyspnea, Horner's syndrome. Lipoblastoma is usually diagnosed as a lipoma in the fine needle aspiration. Since it is not differentiated from lipoma, liposarcoma, and hibernating adenoma in CT and MRI, the definitive diagnosis is histologic diagnosis through surgical resection. The treatment is complete surgical resection. And recurrence rate is 9–25% due to incomplete resection. Authors report this case with a review of literatures since we experienced a case of lipoblastoma diagnosed histopathologically after surgical treatment of neck mass.

The Effects of Preoperative Aspirin on Coronary Artery Bypass Surgery: a Systematic Meta-Analysis

BACKGROUND AND OBJECTIVES: Aspirin plays an important role in the maintenance of graft patency and the prevention of thrombotic event after coronary artery bypass graft surgery (CABG). However, the use of preoperative aspirin is still under debate due to the risk of bleeding. METHODS: From PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, data were extracted by 2 independent reviewers. Meta-analysis using random effect model was performed. RESULTS: We performed a systemic meta-analysis of 17 studies (12 randomized controlled studies and 5 non-randomized registries) which compared clinical outcomes of 9,101 patients who underwent CABG with or without preoperative aspirin administration. Preoperative aspirin increased chest tube drainage (weighted mean difference 177.4 mL, 95% confidence interval [CI], 41.3–313.4; p=0.011). However, the risk of re-operation for bleeding was not different between the preoperative aspirin group and the control group (3.2% vs. 2.4%; odds ratio [OR], 1.23; 95% CI, 0.94–1.60; p=0.102). There was no difference in the rates of all-cause mortality (1.6% vs. 1.5%; OR, 0.98; 95% CI, 0.64–1.49; p=0.920) and myocardial infarction (MI) (8.7% vs. 10.4%; OR, 0.83; 95% CI, 0.66–1.04; p=0.102) between patients with and without preoperative aspirin administration. CONCLUSIONS: Although aspirin increased the amount of chest tube drainage, it was not associated with increased risk of re-operation for bleeding. In addition, the risks of early postoperative all-cause mortality and MI were not reduced by using preoperative aspirin.

Clinical Usefulness of Prophylactic Metronidazole after Head and Neck Cancer Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Head and neck cancer surgery has a high risk of infection, because surgical fields are exposed to the oral cavity and the pharynx during surgery. The purpose of this study is to evaluate the usefulness of prophylactic metronidazole by identifying factors contributing to postoperative fistulas in clean-contaminated head and neck cancer surgery.SUBJECTS AND METHOD: A total of 234 patients underwent mucosa-opening surgery between January 2002 and October 2015. Of those, 167 patients received conventional prophylactic antibiotics and 67 patients received metronidazole in addition to the conventional prophylactic antibiotics. Various clinical factors were evaluated to find association with postoperative fistula.@*RESULTS@#The multivariate analysis showed that the tumor site, advanced T stage, and the preoperative treatment were significantly associated with fistula formation, and the prophylactic use of metronidazole significantly reduced the number of postoperative fistulas.@*CONCLUSION@#In cases where the incidence of postoperative fistulas are more likely to increase, such as in the advanced T stage, in oral/pharyngeal cancer, and preoperative non-surgical treatment, prophylactic metronidazole may be useful for preventing postoperative fistulas.

Successful Remission of Recurrent Anaphylaxis after Omalizumab Administration in a Patient with Systemic Mastocytosis / 대한내과학회지

Mastocytosis is a disorder characterized by abnormal mast cell proliferation and accumulation in one or more tissues. It presents in two major variants: cutaneous mastocytosis and systemic mastocytosis. Because the symptoms are related to mast cells, histamine receptor antagonists and leukotriene receptor antagonists are recommended as therapeutic options. Here, we report a 54-year-old male patient with a history of urticaria pigmentosa who presented with recurrent anaphylaxis. His serum tryptase level was 31.7 ng/mL and mast cell infiltration was observed in his bone marrow. He had frequent attacks of anaphylaxis despite treatment with ketotifen, levocetirizine, and montelukast. Symptoms related to systemic mastocytosis were controlled and the patient exhibited no recurrence of anaphylaxis following the introduction of monthly omalizumab injection. Omalizumab can be considered as a treatment option in patients with systemic mastocytosis unresponsive to conventional oral medications.

Distal Femoral Varus Osteotomy for Valgus Arthritis of the Knees: Systematic Review of Open versus Closed Wedge Osteotomy

PURPOSE: The purpose of this review is to compare the clinical and radiological outcomes between open and closed wedge distal femoral varus osteotomy (DFO). METHODS: A literature search of online databases (MEDLINE, EMBASE, and Cochrane Library database) was made in addition to manual search of major orthopedic journals. Data were searched from the time period of January 1990 to October 2016. A modified Coleman Methodology Score system was used to assess the methodologic quality of the included studies. A total of 20 studies were included in the review. All studies were level IV evidence. RESULTS: Comparative analysis of open and closed wedge DFO did not demonstrate clinical and radiological differences. The survival rates were also similar. Five studies (56%) on open wedge DFO mentioned the need for either bone grafting or substitute for osteotomy gap filling and reported higher incidences of reoperation for plate removal than the closed wedge DFO studies. CONCLUSIONS: The present systematic review showed similar performance between open and closed wedge DFO. Outcomes including survival rates were not statistically significantly different. However, additional bone grafting or substitutes were often needed to prevent delayed union or nonunion for open wedge techniques. Additional operations for plate removal were commonly required due to plate irritation in both techniques.

Successful Remission of Recurrent Anaphylaxis after Omalizumab Administration in a Patient with Systemic Mastocytosis / 대한내과학회지

Mastocytosis is a disorder characterized by abnormal mast cell proliferation and accumulation in one or more tissues. It presents in two major variants: cutaneous mastocytosis and systemic mastocytosis. Because the symptoms are related to mast cells, histamine receptor antagonists and leukotriene receptor antagonists are recommended as therapeutic options. Here, we report a 54-year-old male patient with a history of urticaria pigmentosa who presented with recurrent anaphylaxis. His serum tryptase level was 31.7 ng/mL and mast cell infiltration was observed in his bone marrow. He had frequent attacks of anaphylaxis despite treatment with ketotifen, levocetirizine, and montelukast. Symptoms related to systemic mastocytosis were controlled and the patient exhibited no recurrence of anaphylaxis following the introduction of monthly omalizumab injection. Omalizumab can be considered as a treatment option in patients with systemic mastocytosis unresponsive to conventional oral medications.

A case of oral desensitization for hypersensitivity to exogenous progesterone

Hypersensitivity reaction to progesterone is a rare pathologic condition which consists of autoimmune response to endogenous progesterone, known as autoimmune progesterone dermatitis, and hypersensitivity reaction to exogenous progestogen. We report the case of a 31-year-old woman with a history of whole body urticaria during exogenous progesterone supplementation for in vitro fertilization (IVF). She was admitted to the hospital for the diagnosis and management of progestogen hypersensitivity. An intradermal test with progesterone revealed positivity to 5 mg/mL of progesterone. For her next IVF, progesterone desensitization was performed in a method combining oral and intramuscular progesterone administration. After successfully achieving a target dose of 100 mg per day, the route of progesterone administration was converted to intravaginal tablet (90 mg twice a day) without any hypersensitivity reactions.

The Effect of Different Sagittal Angles of the Tibial Guide on Aperture Widening of the Tibial Tunnel during Modified Transtibial Anterior Cruciate Ligament Reconstruction: A Randomized In Vivo Study

PURPOSE: The effect of sagittal plane angle of the tibial tunnel on the severity of tibial intra-articular aperture expansion caused by iatrogenic re-reaming in anterior cruciate ligament (ACL) reconstruction using a modified transtibial technique is unknown. The purpose of this study was to compare the severity of intra-articular aperture widening at different angles (40°, 45°, and 50°) of the tibial guide (TG). MATERIALS AND METHODS: Ninety-seven patients who underwent modified transtibial ACL reconstruction were randomly allocated to TG 40°, 45°, and 50° groups. Intra-articular tibial aperture width (TW) and tibial tunnel length (TTL) were measured intraoperatively using an arthroscopic ruler and a depth gauge. RESULTS: The TG 50° group had significantly greater tibial aperture widening than the TG 40° group. There was a significant difference among TG 40°, 45°, and 50° groups and the percentage of knees with TTL <35 mm was 8%, 9% and 3%, respectively. There were 2 females with TTL <35 mm in TG 40° and 45° groups each. The average mediolateral length of the tibial plateau was 75 mm. CONCLUSIONS: This study shows that the TG angle of 40° would reduce the severity of intra-articular aperture widening of the tibial tunnel compared to 45° or 50° in modified transtibial ACL reconstruction.

A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum

PURPOSE: Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral release for recurrent patellar instability with genu valgum. MATERIALS AND METHODS: Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performed with reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view. RESULTS: At a mean follow-up of 20±11.7 months (range, 12–42 months), KSS scores improved significantly, from 46.7±5.2 preoperatively to 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly, from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001). CONCLUSION: Use of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, corrects deformity, and improves clinical outcomes.

Acute Respiratory Failure Caused by Hepatopulmonary Fistula in a Patient with Hepatocellular Carcinoma / 결핵및호흡기질환

A 59-year-old man presented with acute dyspnea following sudden productive cough and expectoration of a full cup of "blood-tinged" sputum. He had been diagnosed with hepatitis B virus-related hepatocellular carcinoma and had received transarterial chemoembolization 5 years ago for a 20-cm hepatic mass; he denied any history of hematemesis and the last esophagogastroduodenoscopy from a year ago showed absence of varix. Chest computed tomography (CT) with angiography showed new appearance of right basal lung consolidation but no bleeding focus. Despite the use of systemic antibiotics, the patient developed respiratory failure on day 7 of hospitalization. After intubation, a massive amount of brown sputum with anchovy-paste-like consistency was suctioned via the endotracheal tube. Bronchoscopic toileting was performed and the patient was extubated. In the ward, he continued to expectorate the brown sputum. On day 25 of hospitalization, a repeat CT scan showed simultaneous disappearance of the pneumonic consolidation and the necrotic fluid within the hepatic mass, suggesting the presence of a fistula. He has continued to receive systemic antibiotics, sorafenib, and entecavir, and follow up by respiratory and hepato-oncology specialists.

Development of a Rabbit Model for a Preclinical Comparison of Coronary Stent Types In-Vivo

Along with the development of innovative stent designs, preclinical trials in animal models are essential. Many animal models have been used and appear to yield comparable results to clinical trials despite substantial criticisms about their validity. Among the animal models, porcine coronary artery models have been the standard models for the preclinical evaluation of endovascular devices. However, rapid growth rate, high body weight potential, and the propensity to develop granulomatous inflammatory reactions are major limitations of the porcine coronary artery model. Compared with porcine coronary artery models, the comparative rabbit iliac artery model has the advantages of being small and easy to handle and relatively inexpensive. Furthermore, the rabbit model has been known to reliably reflect human restenosis histopathologically and have major advantages such as pairwise comparison, which makes each animal serve as its own control subject, therefore, maximizing its statistical power for comparative testing. However, despite the widespread use of this model, a systematic description of the procedure and harvest protocols has never been published. This article describes the surgical procedure, stent implantation procedure, method for tissue harvesting, and how measurements are performed. Although the results of animal models may not perfectly extrapolate to humans, the comparative rabbit iliac artery model may be a useful tool for assessing and comparing the efficacy of new coronary stents with conventional stent systems. This thorough description of the techniques required for vascular access, stent implantation, tissue preparation, and measurement, should aid investigators wishing to begin using the comparative rabbit iliac artery model.

Comparison of Clinical Outcomes between the Hem-o-lok Clip and Endoloop Ligature in Securing the Base of the Appendix

PURPOSE: There are various techniques for securing the base of the appendix during performance of laparoscopic appendectomy. Many studies have reported that Endo-GIA is useful for securing the base of the appendix; however, it is costly. Many hospitals now use Endoloop ligature (ELL) for securing the base of the appendix. Many studies have demonstrated the many advantages of the Hem-o-lok clip (HLC) for securing the base of the appendix. The aim of this study is to compare the surgical outcomes of securing the base of the appendix between HLC and ELL during performance of laparoscopic appendectomy. METHODS: A retrospective cohort study was conducted for comparison between HLC and ELL for securing the base during performance of laparoscopic appendectomy. From May 2008 to October 2011, 102 patients underwent laparoscopic appendectomy performed by a single surgeon. Thirty one patients were excluded for various reasons. In 38 patients, the base of the appendix was secured by HLC, and in 33 patients, ELL was applied. Data included age, sex, body mass index (BMI), cost of materials, preoperative white blood count (preoperative WBC), preoperative c-reactive protein (preoperative CRP), preoperative fever, operation time, hospital days, diameter of the appendiceal base, number of perforated appendicitis, and intraoperative or postoperative complication. RESULTS: HLC was used in 38 patients, with a meanage of 36.4 years old. ELL was applied in 33 patients, with a meanage of 19.3 years old. Significant difference in age of patients was observed between the groups (p<0.001). The groups were comparable with regard to sex, BMI, preoperative WBC, preoperative CRP, preoperative fever, operation time, hospital stay, diameter of the appendiceal base, perforated appendicitis, and intraoperative or postoperative complication. The cost of six HLCs was 32,940 won, and that for one ELL was 29,610 won, therefore, there was no significant difference in the cost of material between the tw o groups of patients. CONCLUSION: Except for age, no difference was observed between the two groups. If a single HLC set is available for securing the base of the appendix, there will be a significant difference of the material cost between the two groups. ELL is more useful for securing the appendiceal base, with a larger diameter, which is inappropriate for use of HLC.