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1.  Localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis 
A 61-year-old male was admitted to our hospital due to right lower abdominal pain and watery diarrhea for 3 d. Beginning 3 wk before he arrived in our hospital, he took 3rd-generation cephalosporin (cefixime) for
2 wk due to chronic left ear otitis media. Colonoscopic examination revealed yellowish patches of ulcerations and swelling covered with thick serosanguineous exudate in the cecum and ascending colon. After 7 d of oral metronidazole treatment, his symptoms completely disappeared. We report a case of localized pseudomembranous colitis in the cecum and ascending colon mimicking acute appendicitis associated with cefixime.
PMCID: PMC3662872  PMID: 23710293
Enterocolitis; Pseudomembranous; Appendicitis; Abdomen; Acute; Diarrhea; Cefixime
2.  Tumescent local anesthetic technique for inguinal hernia repairs 
We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs.
The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed.
The mean operation time (±standard deviation) and hospital stay were 64.5 ± 17.6 minutes and 2.7 ± 1.5 days. The postoperative complication rate was 17.8%. There were four cases of recurrences (2.5%) at a mean follow-up of 24 ± 14 months.
Our results suggest that local anesthesia with the tumescent technique is an effective and safe modality for inguinal hernia repairs.
PMCID: PMC4255543  PMID: 25485241
Inguinal hernia; Tumescent local anesthesia; Safety
3.  Circulating cell-free DNA as a promising biomarker in patients with gastric cancer: diagnostic validity and significant reduction of cfDNA after surgical resection 
The aim of this study is to determine whether levels of circulating free DNA (cfDNA) increase according to cancer progression, whether they are restored after surgical resection, and to evaluate cfDNA in gastric cancer patients as a useful biomarker.
A case-control study design was used. Thirty gastric cancer patients and 34 healthy subjects were enrolled from two hospitals in South Korea. The plasma cfDNA of patients with gastric cancer were obtained before surgery and 24 hours after surgery, and then analyzed by a quantitative, real-time polymerase chain reaction. Plasma samples were also obtained from the control group.
The mean levels of cfDNA in the healthy control group, patients with early gastric cancer, and with advanced gastric cancer were 79.78 ± 8.12 ng/mL, 106.88 ± 12.40 ng/mL, and 120.23 ± 10.08 ng/mL, respectively (P < 0.01). Sensitivity was 96.67% and specificity was 94.11% when the cutoff value was 90 ng/mL. Variables representing the tumor burden such as tumor size, T stage, TNM stage, and curative resection are also associated with the levels of cfDNA. The levels of cfDNA in the 24-hour-after-surgery group decreased significantly (112.17 ± 13.42 ng/mL vs. 77.93 ± 5.94 ng/mL, P < 0.001) compared to the levels of cfDNA in the preoperation group.
The changes in the levels of cfDNA can act as reliable biomarkers to detect cancer early, to predict tumor burden, estimate curative resection and even prognosis.
PMCID: PMC3994618  PMID: 24761422
Circulating free DNA; Biological biomarker; Gastric neoplasms
4.  A Peterson's hernia and subsequent small bowel volvulus: surgical reconstruction utilizing transverse colon as a new Roux-en-Y limb - 1 case 
Peterson's hernia is an internal hernia that can occur after Roux-en-Y anastomosis. It often accompanies small bowel volvulus and is prone to strangulation. Reconstruction of intestinal continuity after massive small bowel resection in a patient who undergoes near total gastrectomy and Roux-en-Y anastomosis can be difficult. A 74-year-old man who had undergone a near total gastrectomy and Roux-en-Y gastrojejunostomy for stomach cancer presented with abdominal pain. The preoperative computed tomography showed strangulated small bowel volvulus. During the emergent laparotomy, we found a strangulated Peterson's hernia with small bowel volvulus. After resection of the necrotized intestine, we made a new Roux-en-Y anastomosis connecting the remnant stomach and the jejunum with a transverse colon segment. We were safely able to connect the remnant stomach and the jejunum by making a new Roux-en-Y anastomosis utilizing a transverse colon segment as a new Roux-limb by two stage operation.
PMCID: PMC3868685  PMID: 24368991
Roux-en-Y; Gastrectomy; Hernia; Volvulus
5.  Differences in the Survival of Gastric Cancer Patients after Gastrectomy according to the Medical Insurance Status 
Journal of Gastric Cancer  2013;13(4):247-254.
In Korea, the entire population must enroll in the national health insurance system, and those who are classified as having a lower socioeconomic status are supported by the medical aid system. The aim of this study was to evaluate the association of the medical insurance status of gastric cancer patients with their survival after gastrectomy.
Materials and Methods
A total of 247 patients who underwent surgical treatment for gastric cancer between January 1999 and December 2010 at the Seoul Medical Center were evaluated. Based on their medical insurance status, the patients were classified into two groups: the national health insurance registered group (n=183), and the medical aid covered group (n=64). The survival rates were calculated using the Kaplan-Meier method.
The median postoperative duration of hospitalization was longer in the medical aid covered group and postoperative morbidity and mortality were higher in the medical aid group than in the national health insurance registered group (P<0.05). The overall 5-year survival rate was 43.9% in the medical aid covered group and 64.3% in the national health insurance registered group (P=0.001).
The medical insurance status reflects the socioeconomic status of a patient and can influence the overall survival of gastric cancer patients. A more sophisticated analysis of the difference in the survival time between gastric cancer patients based on their socioeconomic status is necessary.
PMCID: PMC3915187  PMID: 24511421
Stomach neoplasms; Health insurance; Survival
6.  Clinical Correlation between Gastric Cancer Type and Serum Selenium and Zinc Levels 
Journal of Gastric Cancer  2012;12(4):217-222.
We conducted this study to study the clinical correlation between the characteristics of gastric cancer and serum selenium and zinc levels.
Materials and Methods
The following data were measured in the baseline serum selenium and zinc levels of 74 patients with curative gastrectomy subsequent to confirmed gastric cancer, from March 2005 to August 2012.
Among the 74 gastric cancer patients, 53 patients were male. Mean serum selenium and zinc levels were 118.7±33.1 ug/L and 72.2±24.3 ug/dl, respectively. Seven patients (9.5%) showed lower selenium level, and 33 patients (44.6%) showed lower zinc level. Serum Selenium level was 99.1±31.8 ug/L in cardia cancer group (10 cases) and 121.8±32.4 ug/L in non-cardia cancer group (64 cases)(P=0.044). According to tumor gross type, zinc level was 78.7±29.6 ug/dl in early gastric cancer (33) and 66.9±17.8 ug/dl in advanced gastric cancer (41) (P=0.064).
The serum selenium level was highly correlated with the location of gastric cancer. The serum zinc level was lower in advanced gastric cancer.
PMCID: PMC3543971  PMID: 23346493
Stomach neoplasms; Selenium; Zinc
7.  Urachal cyst presenting with huge abscess formation in adults 
Urachal disease, a disorder where embryonic remnant of the cloaca and the allantois present after birth as a midline fibrous cord, is usually detected in infancy and childhood. But urachal disease in adults is rare. We report a case of a huge abscess derived from a urachal cyst in an adult. A 52-year-old man presented with peri-umbilical distension and abdominal pain for 2 weeks. Ultrasonography and abdominal computed tomography scan demonstrated a huge abscess derived from the abdominal wall. After prompt incision and drainage, the remaining abscess cavity was removed completely under general anesthesia. Pathologic report was consistent with urachal duct cyst, and the patient was discharged in a week without complication.
PMCID: PMC3467394  PMID: 23091800
Urachal cyst; Adult
8.  Severe acute pancreatitis due to tamoxifen-induced hypertriglyceridemia with diabetes mellitus 
The side effects of tamoxifen are generally mild, including the effect on lipoprotein metabolism. However, there are few cases of severe tamoxifen induced hypertriglyceridemia. Hypertriglyceridemia is a marked risk factor for acute pancreatitis and approximately 2% to 5% of cases of acute pancreatitis are related to drugs. We report on tamoxifen-induced hypertriglyceridemia and acute pancreatitis in a 40 years old woman with type 2 diabetes mellitus occurred by dexamethasone. She was treated with insulin infusion and fenofibrate, and goserelin acetate was started instead of tamoxifen after discharge from the hospital. Also, probable pathogenic hypotheses about the correlation between tamoxifen and dexamethasone induced type 2 diabetes mellitus on severe acute pancreatitis are provided. Clinicians should take care of risks of severe acute pancreatitis on using tamoxifen, especially for patients with dexamethasone induced diabetes mellitus. These individuals should undergo pre-post tamoxifen lipid screening and careful history taking of drugs, including dexamethasone.
PMCID: PMC4076723  PMID: 25035662
Tamoxifen; acute pancreatitis; hypertriglyceridemia; type 2 diabetes mellitus; dexamethasone

Results 1-8 (8)