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1.  YouTube as a source of patient information on gallstone disease 
AIM: To investigate the quality of YouTube videos on gallstone disease and to assess viewer response according to quality.
METHODS: A YouTube search was performed on September 18, 2013, using the keywords ‘‘gallbladder disease’’, ‘‘gallstone disease’’, and ‘‘gallstone treatment’’. Three researchers assessed the source, length, number of views, number of likes, and days since upload. The upload source was categorised as physician or hospital (PH), medical website or TV channel, commercial website (CW), or civilian. A usefulness score was devised to assess video quality and to categorise the videos into ‘‘very useful’’, ‘‘useful’’, ‘‘slightly useful’’, or ‘‘not useful’’. Videos with misleading content were categorised as ‘‘misleading’’.
RESULTS: One hundred and thirty-one videos were analysed. Seventy-four videos (56.5%) were misleading, 36 (27.5%) were slightly useful, 15 (11.5%) were useful, three (2.3%) were very useful, and three (2.3%) were not useful. The number of mean likes (1.3 ± 1.5 vs 17.2 ± 38.0, P = 0.007) and number of views (756.3 ± 701.0 vs 8910.7 ± 17094.7, P = 0.001) were both significantly lower in the very useful group compared with the misleading group. All three very useful videos were PH videos. Among the 74 misleading videos, 64 (86.5%) were uploaded by a CW. There was no correlation between usefulness and the number of views, the number of likes, or the length. The “gallstone flush” was the method advocated most frequently by misleading videos (25.7%).
CONCLUSION: More than half of the YouTube videos on gallstone disease are misleading. Credible videos uploaded by medical professionals and filtering by the staff of YouTube appear to be necessary.
PMCID: PMC3983464  PMID: 24744597
YouTube; Gallstone disease; Gallstone; Gallbladder; Cholecystitis
2.  At Which Stage of Gastric Cancer Progression Do Levels of Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Increase? Application in Advanced Gastric Cancer Treatment 
Journal of Gastric Cancer  2014;14(2):123-128.
Since there are no proven tumor markers that reflect the course of gastric cancer, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are commonly used alternatives. However, the degree of progression that corresponds to an increase in these markers, and the values of these markers at different cancer stages, remains unclear.
Materials and Methods
This study enrolled 1,733 gastric cancer patients who underwent surgery and whose pre-operative CEA and CA19-9 levels were known. Survival curves and mean values of the two markers were compared according to the degree of cancer progression: serosa-unexposed (SU), serosa-exposed (SE), direct invasion (DI), localized seeding (P1), and extensive seeding (P2).
The 5-year overall survival rates at each stage differed significantly, except between DI and P1 patients (17.1% vs. 10.5%, P=0.344). The mean CEA values in SU, SE, DI, P1, and P2 patients were 5.80, 5.48, 13.36, 8.06, and 22.82, respectively. The CA19-9 values for these patients were 49.40, 38.97, 101.67, 73.77, and 98.57, respectively. The increase in CEA in P2 patients was statistically significant (P=0.002), and the increases in CA19-9 in DI and P2 patients were significant (P=0.025, 0.007, respectively). There was a fair correlation between the two markers in P2 patients (r=0.494, P<0.001).
CA19-9 can be used to assess DI of gastric cancer into adjacent organs. Both markers are useful for predicting the presence of extensive peritoneal seeding.
PMCID: PMC4105377  PMID: 25061540
Carcinomatosis; Disease progression; Neoplasm invasiveness; Stomach neoplasms; Tumor markers, biological
3.  A comparison of the periumbilical incision and the intraumbilical incision in laparoscopic appendectomy 
The intraumbilical incision is being used more frequently, with increasing cases of single incision laparoscopic surgery. Since the umbilicus is deeper than the surrounding wall, it has abundant bacteria. No study has compared the adverse outcomes of periumbilical and intraumbilical incisions. We analyzed the wound complication rates of perforated appendicitis patients according to the types of umbilical incision.
A retrospective review was done of 280 patients with perforated appendicitis. One hundred fifty nine patients were treated with the intraumbilical incision, and 121 patients were treated with the periumbilical incision. We compared the perioperative outcomes according to each laparoscopic incision.
There was no difference in operation time, postoperative hospital stay and analgesic requirement between the two groups. One case in the intraumbilical group (0.6%) and three cases in the periumbilical group (2.5%) developed wound infections. The umbilical complication rate showed no difference.
The wound complication rate of intraumbilical and periumbilical incisions are not different. Although this retrospective study has inherent limitations, the intraumbilical incision seems to be a safe and feasible alternative for the periumbilical incision that can be easier to perform, with better cosmetic results.
PMCID: PMC3514478  PMID: 23230554
Intraumbilical; Laparoscopic technique; Appendectomy
4.  Transumbilical single port laparoscopic appendectomy using basic equipment: a comparison with the three ports method 
Single port laparoscopic surgery is a rapidly evolving laparoscopic surgical approach. We report a comparison of transumbilical single port laparoscopic appendectomy (TUSPLA) and conventional laparoscopic appendectomy (CLA) in a Korean military hospital.
This single-center retrospective study of 63 patients who received laparoscopic appendectomy was conducted between May 2011 and October 2011. Nineteen patients received TUSPLA and 44 patients received CLA. Clinical outcomes such as operation time, hospital stay, postoperative pain, diet, and postoperative complication were reviewed.
There were no statistically significant differences between TUSPLA and CLA patients, respectively, in operation time (58.9 minutes vs. 52.3 minutes, P = 0.262), duration of hospitalization (10.2 days vs. 10.6 days, P = 0.782), mean visual analogue scale score (2.6 vs. 2.5, P = 0.894), and return to diet (1.6 days vs. 1.7 days, P = 0.776). There were two cases (10.5%) of short-term complications in the TUSPLA group and four cases (9.1%) of short-term complications in the CLA group. All patients were fully recovered at discharge.
TUSPLA is a feasible alternative for CLA. When a glove port is used, no special instruments are needed. Thus, it can be performed in a hospital equipped with basic laparoscopic surgical instruments.
PMCID: PMC3467387  PMID: 23091793
Laparoscopy; Appendectomy; Single-port; Transumbilical; Scarless
5.  The Feasibility of Short Term Prophylactic Antibiotics in Gastric Cancer Surgery 
Journal of Gastric Cancer  2010;10(4):206-211.
Most surgeons administer prophylactic antibiotics for 3 to 5 days postoperatively. However, the Center for Disease Control (CDC) guideline recommends antibiotic therapy for 24 hours or less in clean/uncontaminated surgery. Thus, we prospectively studied the use of short term prophylactic antibiotic therapy after gastric cancer surgery.
Materials and Methods
A total of 103 patients who underwent gastric cancer surgery between October 2007 and June 2008 were prospectively enrolled in a short term prophylactic antibiotics program. One gram of cefoxitin was administered 30 minutes before the incision, and one additional gram was administered intraoperatively for cases with an operation time over 3 hours. Postoperatively, one gram was administered 3 times, every 8 hours. Patients were checked routinely for fever. All cases received open surgery, and the surgical wounds were dressed and checked for Surgical Site Infection (SSI) daily.
Of the 103 patients, 15 were dropped based on exclusion criteria (severe organ dysfunction, combined resection of the colon, etc). The remaining 88 patients were included in the short-term program of prophylactic antibiotic use. Of these patients, SSIs were detected in 8 (9.1%) and fever after 2 postoperative days was detected in 11 (12.5%). The incidence of SSIs increased with patient age, and postoperative fever correlated with operation time.
Short term prophylactic antibiotic usage is feasible in patients who undergo gastric cancer surgery, and where there are no grave comorbidities or combined resection.
PMCID: PMC3204497  PMID: 22076187
Stomach neoplasm; Antibiotic prophylaxis; Anti-bacterial agents

Results 1-5 (5)