Achieving the Preperitoneal Space in Totally Extraperitoneal Inguinal Hernia Repair: Dissection with or without a Balloon Dissector

PURPOSE: A balloon dissector is widely used to achieve the preperitoneal space in totally extraperitoneal (TEP) inguinal hernia repair. The aim of this study was to compare the operative results of TEP cases performed with (the balloon dissection group) or without (the plain dissection group) a balloon dissector. METHODS: A retrospective analysis was conducted with a consecutive series of inguinal hernia repairs performed by a single surgeon in OOO Hospital between April 2008 and April 2012. All 128 patients with full-length video recordings were included. The distribution of the operation method was altered during the study period, from dissection with a balloon dissector to without it. RESULTS: Of 128 cases, 57 belonged to the balloon dissection group and the other 71 belonged to the plain dissection group. The demographic features and clinical characteristics were similar in both groups. Mean operation time (57.7 vs. 45.6 min, p<0.001) and laparoscopic recording time (31.6 vs. 25.0 min, p=0.004) were significantly shorter in the plain dissection group without differences in the degree of bloodstaining and the frequency of peritoneal tearing. Postoperative complications did not differ between the two groups. CONCLUSION: Plain dissection may be a safe and feasible alternative method of achieving the preperitoneal space in TEP by an experienced surgeon.

Therapeutic Target Achievement in Type 2 Diabetic Patients after Hyperglycemia, Hypertension, Dyslipidemia Management

BACKGROUND: Our study group established "3H care" in 2002. The meaning of "3H care" attain and maintain adequate controls over hypertension, hyperlipidemia, and hyperglycemia in type 2 diabetic patients. This study evaluated the achievement of target goals after one year or more of "3H care" by specialists in our diabetic clinic. METHODS: This was a retrospective study of 200 type 2 diabetic patients who received "3H care" for one year or more in our diabetic clinic. We evaluated achievement of target goals for metabolic controls as suggested by the American Diabetes Association. RESULTS: Overall, 200 type 2 diabetes patients were enrolled, of whom 106 were males (53%) and 94 were females (47%). After one year of "3H care," the mean HbA1c was 7.2+/-1.5% and the percentage of patients achieving glycemic control (HbA1c <7%) was 51.8%. However only 32.2% of hypertensive patients achieved the recommended target. After one year of "3H care," the percentages of those who achieved the target value for dyslipidemia were 80.0% for total cholesterol, 66.3% for low density lipoprotein cholesterol, 57.9% for triglyceride, and 51.8% for high density lipoprotein cholesterol. The percentage that achieved all three targets level was only 4.4% after one year and 14.8% after two years. CONCLUSION: The results of this study demonstrate that only a minor proportion of patients with type 2 diabetes achieved the recommended goals despite the implementation of "3H care." It is our suggestion that better treatment strategies and methods should be used to control hypertension, hyperlipidemia and hyperglycemia.

Diffuse Alveolar Hemorrhage Associated with Antineutrophil Cytoplasmic Antibody levels in a Pregnant Woman Taking Propylthiouracil

Propylthiouracil (PTU) is known to be a potential cause of antineutrophil cytoplasmic antibody (ANCA) positive small vessel vasculitis, resulting in glomerulonephritis and diffuse alveolar hemorrhage (DAH). Herein, we describe a 25-year-old pregnant woman who developed a perinulcear ANCA (p-ANCA) and myeloperoxidase ANCA (MPO-ANCA) positive DAH during PTU therapy. The patient improved after corticosteroid therapy and discontinuation of the PTU. Methimazole was prescribed in spite of the risk of recurrence of DAH because of the pregnancy. The patient is currently free from pulmonary problems. Our case shows that the alternative agent, methimazole, can be used to treat hyperthyroidism in a pregnant patient with PTU associated DAH.

Group G Streptococcal Endocarditis Associated with Bilateral Endogenous Endophthalmitis / 감염과화학요법

The group G streptococcal endocarditis is a rare form of infective endocarditis when present, and it is associated with serious neurological complications. Also, endogenous endophthalmitis due to group G streptococcal endocarditis has rarely been reported, and usually leads to total loss of vision. We report a case of group G streptococcal endocarditis which presented clinically as endophthalmitis unrelated to trauma or surgery in a 85-year-old diabetic man.

A Case of Granulocytic Sarcoma Relapsed in Both Breasts After Complete Remission of Acute Myelogeous Leukemia / 대한진단검사의학회지

Granulocytic sarcoma (GS) is a localized tumor composed of immature granulocytic cells. GS can involve any site in the body. The common sites are periosteum, bone, soft tissue, lymph node, and skin; the breast is an unusual site for GS. They can be present at the time of diagnosis, at relapse, and sometimes preceding the diagnosis. We describe a 49-year-old woman with acute myelogenous leukemia, FAB AML M2, who was diagnosed with granulocytic sarcoma in both of her breasts at months after complete remission.

Prognostic Factors and Survival according to the Okuda Stage in Patients with Hepatocellular Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: There are several staging systems to decide the stage of hepatocellular carcinoma (HCC), but yet incomplete. Okuda stage which includes both tumor characteristics and liver function is widely used. The aims of this study were to assess the usefulness of known prognostic factors and Okuda staging system in 237 cases of HCC. METHODS: A retrospective analysis of 237 cases of HCC diagnosed from 2000 to 2002 was performed. We analyzed prognostic factors such as age, sex, liver cirrhosis, Child-Pugh classification, tumor size, albumin, bilirubin, alpha-FP, ascites, encephalopathy and Okuda stage. Prognostic analysis was performed for single variables and estimating survival distributions were analyzed by the Kaplan-Meier method, statistically compared by the log-rank test. RESULTS: Patients had a mean age of 57.5 years and were predominantly men (79.7%). Liver cirrhosis were noticed in 214 cases (90.3%). The overall median survival period was 25.7 months. The median survival period was correlated to bilirubin, ascites, alpha-FP, tumor size, and Child-Pugh classification, but not to age, sex, and pattern of viral infection. The median survival period of the Okuda stage I, II and III cases was 35.8, 11.9 and 8.5 months (p<0.001). CONCLUSIONS: The median survival period of patients with HCC is significantly correlated to Okuda staging system, and survival period has improved than the initial data when the Okuda staging system was published in 1985. However, in order to discriminate early staged HCC more accurately, other prognostic factors such as alpha-FP and tumor morphology should be included in future staging system for HCC.

Group G Streptococcal Endocarditis Associated with Bilateral Endogenous Endophthalmitis / 감염과화학요법

The group G streptococcal endocarditis is a rare form of infective endocarditis when present, and it is associated with serious neurological complications. Also, endogenous endophthalmitis due to group G streptococcal endocarditis has rarely been reported, and usually leads to total loss of vision. We report a case of group G streptococcal endocarditis which presented clinically as endophthalmitis unrelated to trauma or surgery in a 85-year-old diabetic man.