RESUMEN
Purpose@#Endoscopic procedures can cause anxiety, which can lead to more uncomfortable, difficult, and incomplete procedures, in addition to greater use of sedative medication. Here, we investigate whether exposing patients to virtual reality (VR) prior to endoscopic procedures can reduce their anxiety levels. @*Materials and Methods@#Forty patients at Gangnam Severance Hospital were enrolled and divided into the VR group and the control group. Patients in the VR group were exposed to VR prior to their procedure to alleviate anxiety. The primary data outcomes were State-Trait Anxiety Inventory (STAI), pain score, satisfaction with sedation, and satisfaction with the procedure. @*Results@#The mean STAI-state and STAI-trait did not differ significantly between the control group and the VR group. While defining a high anxiety STAI score as ≥45 in an STAI-state, the proportion of patients with high anxiety at baseline was 35% and increased to 50% prior to the procedure in the control group. However, in the VR group, the proportion of patients with high anxiety at baseline was 60% and decreased to 50% prior to the procedure. The proportion changes of patients with high anxiety in the STAI-state exhibited a significant difference between the control and VR groups (p=0.007). Furthermore, patients’ satisfaction with sedation was significantly greater in the VR group compared to the control group (p=0.017). @*Conclusion@#VR exposure may relieve patients’ anxiety levels prior to endoscopic procedures, but further well-designed placebocontrolled studies are needed. VR, an inexpensive, easily available, and non-invasive method, also improved the satisfaction with sedation of endoscopic procedures.
RESUMEN
Background/Aims@#There are no data regarding the association between sarcopenic obesity status and nonalcoholic fatty liver disease (NAFLD) and NAFLD-associated liver fibrosis. Therefore, we aimed to investigate the relationship between sarcopenic obesity status (sarcopenia only, obesity only, and sarcopenic obesity) and NAFLD and liver fibrosis in Korean adults. @*Methods@#In total, 2,191 subjects completed a health checkup program, including abdominal ultrasonography and FibroScan. Subjects were classified into the following four categories: optimal body composition (nonobese and nonsarcopenic), sarcopenia only (nonobese), obesity only (nonsarcopenic), and sarcopenic obesity. Sarcopenic obesity was stratified by the skeletal muscle mass index and body fat using bioelectrical impedance analysis. NAFLD was diagnosed by ultrasonography, and liver fibrosis was assessed using transient elastography in subjects with NAFLD. @*Results@#The prevalence of NAFLD and liver fibrosis significantly increased according to the sarcopenic obesity status. In the logistic regression analysis, after adjusting for multiple risk factors, the odds ratio (OR) for the risk of NAFLD was largest in the sarcopenic obesity group (OR, 3.68; 95% confidence interval [CI], 2.94 to 4.60), followed by the obesity only (OR, 2.25; 95% CI, 1.67 to 3.03) and sarcopenia only (OR, 1.92; 95% CI, 1.30 to 2.84) groups, when compared with the optimal group. Additionally, liver fibrosis was independently associated with sarcopenic obesity status (OR 4.69, 95% CI 1.95 to 11.29; OR 4.17, 95% CI 1.56 to 11.17; OR 3.80, 95% CI 0.86 to 16.75, respectively). @*Conclusions@#These results demonstrated that sarcopenic obesity was independently associated with NAFLD and liver fibrosis and increased the risk of NAFLD and liver fibrosis more than obesity or sarcopenia alone.
RESUMEN
Background/Aims@#Food retention, which is a characteristic observed in patients with achalasia, can interfere with peroral endoscopic myotomy (POEM).However, there is no established guideline for esophageal preparation for POEM. A previous study has shown that drinking warmwater may reduce the lower esophageal sphincter pressure in patients with achalasia. This study aims to evaluate the possibility ofproper preparation of POEM by instructing the patient to drink warm water. @*Methods@#The warm water preparation was performed in 29 patients with achalasia who underwent POEM. The patients drank 1 L of warm water (60 o C) the night before POEM. We evaluated the esophageal clearness and determined the preparation quality. Twenty-nine patients were prospectively recruited and compared to control group. The control cohort comprised achalasia patients whoseendoscopic image was available from the achalasia database of our institution. A 1:2 propensity score-matched control cohort was established from the database of achalasia subjects (n = 155) to compare the outcome of the preparation. @*Results@#In the warm water preparation group, only 1 patient (3.4%) had some solid retention, but it did not interfere with the POEM procedure. The grade of clearness (P = 0.016) and quality of preparation (P < 0.001) were significantly better in the warm water preparation group than in the matched control group. There was no any adverse event at all related to warm water preparation protocol. @*Conclusions@#Drinking warm water dramatically reduces esophageal food retention and significantly improves the quality of esophageal preparation.This simple protocol is quite useful, safe, and cost-effective in the preparation of achalasia patients for POEM.
RESUMEN
There are various methods for treating advanced hepatocellular carcinoma with portal vein invasion, such as systemic chemotherapy, transarterial chemoembolization, transarterial radioembolization, and concurrent chemoradiotherapy. These methods have similar clinical efficacy but are designed with a palliative aim. Herein, we report a case that experienced complete remission through “associating liver partition and portal vein ligation for staged hepatectomy (ALPPS)” after concurrent chemoradiotherapy and hepatic artery infusion chemotherapy. In this patient, concurrent chemoradiotherapy and hepatic artery infusion chemotherapy induced substantial tumor shrinkage, and hypertrophy of the nontumor liver was sufficiently induced by portal vein ligation (stage 1 surgery) followed by curative resection (stage 2 surgery). Using this approach, long-term survival with no evidence of recurrence was achieved at 16 months. Therefore, the optimal use of ALPPS requires sufficient consideration in cases of significant hepatocellular carcinoma shrinkage for curative purposes.
RESUMEN
Tensor fasciae latae muscle is a thick muscle with heavy fascial investment and is extensively used for the reconstruction of musculocutaneous tissue loss following major injuries including burn, trauma, and bed sore. Most of known reference values for the measurement of this muscle are from foreign subjects and no measurement in Korean subject were reported. This study demonstrates the characteristics of the arterial supply of the tensor fasciae latae muscle for flap. Total 67 Korean cadavers (41 males and 26 females), clinically normal and without deformity, were dissected. The pattern of distribution of the arteries supplying the muscle was studied, and entering points of each arteries to the muscle were measured as relative coordination from anterior superior iliac spine (A) and center of patella (B). The point of the line AB which meets perpendicular line from entering point of each vessel (P) was definde as C. The length of AP (X) and PC (Y) was measured. 1. Average length of the line AB was 424.7 mm and was longer in male (438.3 mm) than in female (403.1 mm) subjects ( p< 0.01). 2. The XY coordination of origin of the muscle from line AB was-48.8 mm and-21.7 mm and that of insertion of the muscle was 157.9 mm and-20.9 mm. 3. Average length, width, and thickness of the tensor fasciae latae muscle were 167.2 mm, 35.9 mm, 10.5 mm, respectively, and the muscles were longer in male than in female subjects ( p< 0.01). 4. The existence of ascending branch of lateral femoral circumplex artery was 77.5%. The ascending and transverse branches were 16.9%. The ascending and descending branches were 2.8%. The ascending branch of lateral femoral circumflex artery and branch of femoral artery were 1.4%. The ascending branch of lateral femoral circumflex artery and branch of deep femoral artery were 1.4%. 5. Lateral circumflex femoral artery reached the tensor fasciae latae muscle at X: 97.9 mm, Y: 31.3 mm. 6. Point where the muscular branch of lateral circumflex artery to the tensor fasciae latae muscle began, was X: 88.8 m, Y: 17.1 mm. 7. The length and external diameter of pedicle were 30.9 mm, and 2.6 mm respectively. 8. The average number of branches of pedicle to tensor fasciae latae muscle was 7.1. 9. When line AB length was based on 100%, the origin and insertion of the tensor fasciae latae muscle were-11.5% and 37.2% respectively. The branching point from lateral circumflex femoral artery was 23.5%. The last branching point before entering the muscle was 20.9%. The entering point of the branches of pedicles was 16.7%. These data provides the anatomical characteristics of the arterial supply of the tensor fascia latae muscle in Korean in clinical relevance with musculocutaneous flap.