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Background/Aims@#Papillary adenocarcinoma is classified to differentiated-type gastric cancer and is indicated for endoscopic submucosal dissection. However, due to its rare nature, there are limited studies on it. The purpose of this study was to determine the outcome of endoscopic submucosal dissection in patients with papillary-type early gastric cancer and to find the risk factors of lymph node metastasis. @*Methods@#Patients diagnosed with papillary-type early gastric cancer at eight medical centers, who underwent endoscopic submucosal dissection or surgical treatment, were retrospectively reviewed. The clinical results and long-term outcomes of post-endoscopic submucosal dissection were evaluated, and the risk factors of lymph node metastasis in the surgery group were analyzed. @*Results@#One-hundred and seventy-six patients with papillary-type early gastric cancer were enrolled: 44.9% (n=79) in the surgery group and 55.1% (n=97) in the endoscopic submucosal dissection group. As a result of endoscopic submucosal dissection, the en bloc resection and curative resection rates were 91.8% and 86.6%, respectively. The procedure-related complication rate was 4.1%, and local recurrence occurred in 3.1% of patients. Submucosal invasion (odds ratio, 3.735; 95% confidence interval, 1.026 to 12.177; p=0.047) and lymphovascular invasion (odds ratio, 7.636; 95% confidence interval, 1.730 to 22.857; p=0.004) were the risk factors of lymph node metastasis in papillary-type early gastric cancer patients. @*Conclusions@#The clinical results of endoscopic submucosal dissection in papillary-type early gastric cancer were relatively favorable, and endoscopic submucosal dissection is considered safe if appropriate indications are confirmed by considering the risk of lymph node metastasis.
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Although the use of mesh reinforcement during large hiatal hernia repair may reduce the rate of recurrence, various mesh-related complications have been reported. A 65-year-old woman presented with dysphagia. The patient was diagnosed with a large hiatal hernia and treated with laparoscopic fundoplication and Collis gastroplasty with mesh repair. Six months after surgery, the patient presented with dysphagia and vomiting. Esophagogastroduodenoscopy showed migration of mesh material into the esophagogastric junction. We performed a proximal gastrectomy with mesh removal. The patient was discharged without any postoperative complications. Herein, we encountered a rare case requiring surgical treatment to resolve mesh-induced esophagogastric perforation after hiatal hernia repair. Meshassociated complications, such as erosion or migration, should be considered as they may be more common than previously reported. Additionally, these complications are currently underscored in clinical practice. Regarding mesh applications, symptoms of mesh-related complications, such as dysphagia, should be carefully monitored for early detection.
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Background@#Ultrafiltration (UF) would enhance coagulation profiles by concentrating coagulation elements during cardiopulmonary bypass (CPB) for cardiac surgery. @*Methods@#We retrospectively reviewed electronic medical records of 75 patients who had undergone cardiac surgery with rotational thromboelastometry-based coagulation management in a university hospital and analyzed the UF-induced changes in the maximum clot firmness (MCF) of extrinsically activated test with tissue factor (EXTEM) during CPB in 30 patients. @*Results@#The median volume of filtered-free water was 1,350 ml, and median hematocrit was significantly increased from 22.5% to 25.5%. As the primary measure, UF significantly increased the median MCF-EXTEM from 48.0 mm to 50.5 mm (P = 0.015, effect size r = 0.44). The area under the receiver operating characteristic curve pre-UF MCF-EXTEM for discrimination of any increase of MCF-EXTEM after applying UF was 0.89 (95% CI [0.77, 1.00], P 50.5 mm. There was a significant interaction between pre-UF MCF-EXTEM values and applying UF (P < 0.001 for the subgroup, P = 0.046 for UF, P = 0.003 for interaction). @*Conclusions@#Applying UF improved clot firmness, and the improvement was more pronounced when pre-UF MCF-EXTEM had been reduced during CPB.
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The statistical significance of a clinical trial analysis result is determined by a mathematical calculation and probability based on null hypothesis significance testing. However, statistical significance does not always align with meaningful clinical effects; thus, assigning clinical relevance to statistical significance is unreasonable. A statistical result incorporating a clinically meaningful difference is a better approach to present statistical significance. Thus, the minimal clinically important difference (MCID), which requires integrating minimum clinically relevant changes from the early stages of research design, has been introduced. As a follow-up to the previous statistical round article on P values, confidence intervals, and effect sizes, in this article, we present hands-on examples of MCID and various effect sizes and discuss the terms statistical significance and clinical relevance, including cautions regarding their use.
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Tables and figures are commonly adopted methods for presenting specific data or statistical analysis results. Figures can be used to display characteristics and distributions of data, allowing for intuitive understanding through visualization and thus making it easier to interpret the statistical results. To maximize the positive aspects of figure presentation and increase the accuracy of the content, in this article, the authors will describe how to choose an appropriate figure type and the necessary components to include. Additionally, this article includes examples of figures that are commonly used in research and their essential components using virtual data.
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General medical journals such as the Korean Journal of Anesthesiology (KJA) receive numerous manuscripts every year. However, reviewers have noticed that the tables presented in various manuscripts have great diversity in their appearance, resulting in difficulties in the review and publication process. It might be due to the lack of clear written instructions regarding reporting of statistical results for authors. Therefore, the present article aims to briefly outline reporting methods for several table types, which are commonly used to present statistical results. We hope this article will serve as a guideline for reviewers as well as for authors, who wish to submit a manuscript to the KJA.
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Clip migration into the common bile duct (CBD) is a rare complication of laparoscopic biliary surgery. We report a case of Hem-o-lok clip migration-induced CBD stone in a 66-year-old man who underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) 4 years ago. The patient visited the emergency room for upper abdominal pain. CT scan revealed increased CBD diameter and multiple CBD stones. We performed endoscopic retrograde cholangiopancreatography for CBD stone extraction. Cholangiography revealed multiple suspected filling defects in the CBD; stones and unknown foreign body were removed using Basket. The foreign body found in the duodenum was a Hem-o-lok clip. When epigastric pain develops in a patient who has undergone LC and LCBDE, it is possible that biliary stone occurs due to clip migration.
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Background/Aims@#For the management of hilar malignant biliary obstruction (HMBO), endoscopic biliary drainage (EBD) is preferred over percutaneous transhepatic biliary drainage (PTBD) because of its convenience. However, there is no established guideline for malignant hilar obstruction that requires multiple stenting. In this study, we compared the efficacy of bilateral metal stents (BMS) versus multiple plastic stents (MPS). @*Methods@#In this retrospective study, we analyzed 102 patients who underwent EBD with either BMS or MPS due to HMBO caused by hilar cholangiocarcinoma between 1996 and 2018 at Samsung Medical Center. We compared the successful drainage rates, cholangitis events, overall complications, mortality, and conversion rates to PTBD between the two groups. @*Results@#The successful drainage rates in the BMS group and the MPS group were 71.4% (25/35) and 65.6% (44/67), respectively, with no significant difference. The MPS group had a higher cholangitis risk (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.21 to 3.58) and higher 6-month mortality (HR, 2.91; 95% CI, 1.26 to 6.71) than the BMS group. There were no significant differences in overall complications or the conversion rate to PTBD between the groups. @*Conclusions@#In patients with malignant HMBO, the BMS group showed better outcomes in terms of the cholangitis rate and 6-month mortality than the MPS group. Therefore, if possible, bilateral metal stenting is recommended for HMBO caused by hilar cholangiocarcinoma.
ABSTRACT
General medical journals such as the Korean Journal of Anesthesiology (KJA) receive numerous manuscripts every year. However, reviewers have noticed that the tables presented in various manuscripts have great diversity in their appearance, resulting in difficulties in the review and publication process. It might be due to the lack of clear written instructions regarding reporting of statistical results for authors. Therefore, the present article aims to briefly outline reporting methods for several table types, which are commonly used to present statistical results. We hope this article will serve as a guideline for reviewers as well as for authors, who wish to submit a manuscript to the KJA.
ABSTRACT
Clip migration into the common bile duct (CBD) is a rare complication of laparoscopic biliary surgery. We report a case of Hem-o-lok clip migration-induced CBD stone in a 66-year-old man who underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) 4 years ago. The patient visited the emergency room for upper abdominal pain. CT scan revealed increased CBD diameter and multiple CBD stones. We performed endoscopic retrograde cholangiopancreatography for CBD stone extraction. Cholangiography revealed multiple suspected filling defects in the CBD; stones and unknown foreign body were removed using Basket. The foreign body found in the duodenum was a Hem-o-lok clip. When epigastric pain develops in a patient who has undergone LC and LCBDE, it is possible that biliary stone occurs due to clip migration.
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Purpose@#This study examined the comparison of effects of non-surgical continuous and intermittent traction on pain, balance and physical function in the treatment of knee osteoarthritis. @*Methods@#A total of 30 knee osteoarthritis patients were recruited and randomized to a continuous traction group (n=10), an intermittent traction group (n=10), and a control group (n=10). The continuous traction group and intermittent traction group received a non-surgical continuous and intermittent knee joint traction workout five times a week, for 4 weeks. All subjects were assessed with the numeric rating scale (NRS), timed up and go test (TUGT), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and after the 4-week treatment. @*Results@#As a result of comparison within groups, the continuous traction group, intermittent traction group, and control group showed a significant difference for NRS, TUGT, and WOMAC after the experiment (p<0.05). According to the comparison of the three groups, the continuous traction group showed a more effectively significant difference than the intermittent traction group and the control group in the balance and physical functions before and after the experiment (p<0.05). @*Conclusion@#This study showed that non-surgical continuous traction treatment was effective in improving pain, balance ability, and physical function in knee osteoarthritis patients.
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Purpose@#This study aimed to verify the effects of bridge exercise with resistance to one hip joint adductor muscle on the thickness of external and internal oblique abdominal muscles, transversus abdominis muscle, and erector spinae muscle. @*Methods@#The subjects were divided into two exercise groups: 15 for Bridge Exercise Group (BEG) and 15 for One Hip joint Adduction Bridge Exercise Group (OHABEG). The study used an ultrasonic instrument to measure trunk muscle thickness. OHABEG performed a bridge exercise with one hip Joint adduction. BEG performed a bridge exercise without resistance. @*Results@#The external oblique abdominal, internal oblique abdominal, and the transversus abdominis muscles showed a significant increase by period and time in intra-group interactions (p0.05). The erector spinae muscle had a significant increase in each period (p0.05). @*Conclusion@#These results demonstrated that bridge exercise with one hip joint adduction had positive effects on trunk muscle thickness. These results confirm that a bridge exercise with one hip joint adduction has a positive effect on the muscle thickness of trunk, suggesting the possibility of using it as a rehabilitation treatment for a lumbar stabilization exercise and as a basic data.
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Purpose@#To identify the effect of breathing training on the physical function and psychological problems in patients with chronic stroke. @*Methods@#In total, 26 patients with chronic stroke were randomly assigned to one of two groups: the experimental group, who underwent breathing training and neurodevelopmental treatment, and the control group, who underwent neurodevelopmental treatment (13 patients per group). Physical function was evaluated using the balance and Activities of Daily Living (ADL). Psychological problems were assessed using the Depression. Balance was measured using the Berg Balance Scale (BBS). ADLs were measured using the Modified Barthel Index (MBI). Depression was measured using the Beck Depression Inventory (BDI). The BBS, MBI, and BDI were recorded before and after the 4-week treatment. @*Results@#As a result of comparison within groups, the experimental and control group showed significant difference for BBS, MBI and BDI after the experiment (p<0.05). In comparison between two groups, the experimental group showed more significant difference in BBS, MBI and BDI than the control group (p<0.05). @*Conclusion@#This study showed that breathing training was effective improvement physical function, and psychological problems in patients with chronic stroke.
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Several assumptions such as normality, linear relationship, and homoscedasticity are frequently required in parametric statistical analysis methods. Data collected from the clinical situation or experiments often violate these assumptions. Variable transformation provides an opportunity to make data available for parametric statistical analysis without statistical errors. The purpose of variable transformation to enable parametric statistical analysis and its final goal is a perfect interpretation of the result with transformed variables. Variable transformation usually changes the original characteristics and nature of units of variables. Back-transformation is crucial for the interpretation of the estimated results. This article introduces general concepts about variable transformation, mainly focused on logarithmic transformation. Back-transformation and other important considerations are also described herein.
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Background@#The present study was to compare the potential impact of remifentanil-based propofol-supplemented anesthesia regimen vs. conventional sevoflurane-sufentanil balanced anesthesia on postoperative recovery of consciousness indicated by c) values in patients undergoing cardiac surgery. @*Methods@#Patients undergoing cardiac surgery were randomly allocated to get the remifentanil-based propofol-supplemented anesthesia employing target-controlled infusion (TCI) of remifentanil and propofol (Group-PR, n = 15) or a balanced-anesthesia employing sevoflurane-inhalation and TCI-sufentanil (Group-C, n = 19). In Group-PR, plasma concentration (Cp) of TCI-remifentanil was fixed at 20 ng/ml, and the effect-site concentration of TCI-propofol was adjusted within 0.8–2.0 μg/ml to maintain BIS value of 40–60. In Group-C, sevoflurane dosage was adjusted within 1–1.5 minimum alveolar concentration to maintain BIS of 40–60, and Cp of TCI-sufentanil was fixed at 0.4 ng/ml. The inter-group difference in the time for achieving postoperative BIS > 80 (T-BIS80) in the intensive care unit was determined as the primary outcome. The inter-group difference in the extubation time was determined as the secondary outcome. @*Results@#T-BIS80, was shorter in Group-PR than Group-C (121.4 ± 64.9 min vs. 182.9 ± 85.1 min, respectively; the difference of means –61.5 min; 95% CI –115.7 to –7.4 min; effect size 0.812; P = 0.027). The extubation time was shorter in Group-PR than in Group-C (434.7 ± 131.3 min vs. 946.6 ± 393.3 min, respectively, P < 0.001). @*Conclusions@#Compared with the conventional sevoflurane-sufentanil balanced anesthesia, the remifentanil-based propofol-supplemented anesthesia showed significantly faster postoperative conscious recovery in patients undergoing cardiac surgery.
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Properly set sample size is one of the important factors for scientific and persuasive research. The sample size that can guarantee both clinically significant differences and adequate power in the phenomena of interest to the investigator, without causing excessive financial or medical considerations, will always be the object of concern. In this paper, we reviewed the essential factors for sample size calculation. We described the primary endpoints that are the main concern of the study and the basis for calculating sample size, the statistics used to analyze the primary endpoints, type I error and power, the effect size and the rationale. It also included a method of calculating the adjusted sample size considering the dropout rate inevitably occurring during the research. Finally, examples regarding sample size calculation that are appropriately and incorrectly described in the published papers are presented with explanations.
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Esophageal anastomotic leak is the most common and serious complication followingesophagectomy. However, the standard treatment for anastomotic leaks remains unclear.Recently, endoscopic vacuum therapy has become an important non-surgical alternativetreatment method for patients with esophageal anastomotic leak. This treatment involvesthe endoscopic placement of a sponge connected to a nasogastric tube into the defectcavity or lumen. Subsequently, continuous negative pressure is delivered to the cavitythrough the tube. Several studies have reported a treatment success rate of 80% to 100%.In this study, we review the mechanism of action, the method of performing the procedure,its safety and efficacy, and prognostic factors for failure of endoscopic vacuum therapyin the management of patients with anastomotic leak, and on this basis attempted toconfirm the possibility of establishing a standardized treatment protocol using endoscopicvacuum therapy.
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Acupuncture is regarded as a relatively safe procedure, but it may have various complications. Cardiac tamponade after acupuncture is an extremely rare complication but can have fatal outcomes. We present a 73-year-old female patient with decreased consciousness and dyspnea after acupuncture at an oriental medical clinic. Initial vital signs were a blood pressure of 60/40 mmHg and a heart rate of 110 beats/min. Echocardiography and chest computed tomography were performed in the emergency department to determine the cause of the shock, and the result came out as hemopericardium. The patient underwent through an emergency cardiac surgery under the diagnosis of cardiac tamponade following acupuncture and was fully recovered after surgery.
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Several assumptions such as normality, linear relationship, and homoscedasticity are frequently required in parametric statistical analysis methods. Data collected from the clinical situation or experiments often violate these assumptions. Variable transformation provides an opportunity to make data available for parametric statistical analysis without statistical errors. The purpose of variable transformation to enable parametric statistical analysis and its final goal is a perfect interpretation of the result with transformed variables. Variable transformation usually changes the original characteristics and nature of units of variables. Back-transformation is crucial for the interpretation of the estimated results. This article introduces general concepts about variable transformation, mainly focused on logarithmic transformation. Back-transformation and other important considerations are also described herein.
ABSTRACT
Purpose@#This study examined the comparison of effects of non-surgical continuous and intermittent traction on pain, balance and physical function in the treatment of knee osteoarthritis. @*Methods@#A total of 30 knee osteoarthritis patients were recruited and randomized to a continuous traction group (n=10), an intermittent traction group (n=10), and a control group (n=10). The continuous traction group and intermittent traction group received a non-surgical continuous and intermittent knee joint traction workout five times a week, for 4 weeks. All subjects were assessed with the numeric rating scale (NRS), timed up and go test (TUGT), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and after the 4-week treatment. @*Results@#As a result of comparison within groups, the continuous traction group, intermittent traction group, and control group showed a significant difference for NRS, TUGT, and WOMAC after the experiment (p<0.05). According to the comparison of the three groups, the continuous traction group showed a more effectively significant difference than the intermittent traction group and the control group in the balance and physical functions before and after the experiment (p<0.05). @*Conclusion@#This study showed that non-surgical continuous traction treatment was effective in improving pain, balance ability, and physical function in knee osteoarthritis patients.