The Study of Operative Indications of Blunt Hepatic Trauma

PURPOSE: Nonoperative management is currently considered a treatment modality in 50 to 80% of patients with blunt liver injury. Nevertheless 10 to 50% of patients need operative management, and the criteria for operative management have not established. The purpose of this study is to find criteria for operative management of patients with blunt liver injury. METHODS: The records of 117 patients who experienced blunt hepatic injury from January 1992 to April 1999 were reviewed retrospectively with respect to hemodynamic stability, transfusion requirement, injury severity score, liver injury grade, amount of blood in the peritoneal cavity, and pooling of contrast material on computerized tomography (CT). RESULTS: Among the 117 patients, 29 patients (25%) were treated operatively (Group 1) and 88 patients (75%) were treated nonoperatively (Group 2). The initial systolic blood pressure in Group 1 was significantly lower than that of Group 2 (74.4+/-30.3 mmHg vs 107.1+/-27.2 mmHg, p<0.001). The amounts of transfusion for hemodynamic stability were 2.1 units in Group 1 and 0.4 units in Group 2 (p<0.001). The injury Severity score of Group 1 was significantly higher than that of Group 2 (20.8 +/- 11.0 vs 10.7+/-6.8, p=0.03). The mean injury grade was 3.7+/-0.1 for Group 1 and 2.4+/-1.0 for Group 2, which was a statistically significant difference was seen (p<0.001). The amount of hemoperitoneum in Group 1 was significantly higher than that of Group 2 (p<0.001). The pooling of contrast material on CT was detected in 3 cases in Group 1. CONCLUSION: We can establish the following criteria for operative management: operative management is necessary for hemodynamic instability during resusci tation, positive peritoneal irritation signs, and presence of pooling of contrast material on CT. In cases above grade IV, above 500 mL of hemoperitoneum on CT, or above 2 units of blood transfusion during resuscitation, close observation in an intensive care unit is necessary. If abnormality develops during observation, prompt operative management is mandatory.

Effects of Adjuvant Immunochemotherapy in Stage III Gastric Cancer

BACKGROUND: To evaluate the effectiveness of early postoperative adjuvant immunochemotherapy in a stage III (UICC, 1997) primary gastric carcinomas we analyzed cases histories of 140 patients retro spectively who had undergone curative gastrectomy at Wonkwang University Hospital from November 1988 to November 1995. METHODS: For immunotherapy, OK-432 intramuscularly or oral PSK was used for 2 months, and for chemotherapy, FAM (8 week cycle) or oral 5-FU derivatives and MMC were used for 6 months or longer. Immunotherapy was started at the 5th postoperative day and chemotherapy at the 7th to 10th postoperative day. Sixty-eight (68) patients received immunochemotherapy (therapy group; TG) and 72 patients did not (nontherapy group; NTG). Statistical analysis were carried out with Anova, Kaplan-Meier, and Log rank test. RESULTS: One hundred eight (108) patients were male, and 84 patients were younger than 60 years. Eighty-one (81) cases involves the lower stomach and 52 the middle stomach. Lymphatic invasion was seen in 60 cases. Twenty-five (25) cases were T2, 112 T3, 42 N1, 90 N2, 75 stage IIIa, and 65 stage IIIb. The overall 5-year survival rate was 48.6% (stage IIIa 58.7%, stage IIIb 36.9%, p<0.05). The 5-year survival rates for the TG and the NTG were 52.9% and 44.4%, respectively (p=0.10). The 5-year survival rates were 85.7% (n=18) and 85.7% (n=7) in T2, 54.0% (n=50) and 40.3% (n=62) in T3 (p<0.05), 69.6% (n=23) and 50.0% (n=24) in N1, 44.4% (n=45) and 42.2% (n=45) in N2 (p=0.14), 61.0% (n=41) and 55.9% (n=34) in stage IIIa, 40.7% (n=27) and 34.2% (n=38) in stage IIIb (p=0.16), 59.5% (n=37) and 48.8% (n=43) in the non-lymphatic invasion group, and 45.2% (n=31) and 37.9% (n=29) in the lymphatic invasion group (p=0.09). There was no significant difference in the 5-year survival rates of the other parameters, such as age, sex, tumor location, size, gross finding, tumor differentiation, between the TG and the NTG. CONCLUSION: The survival rate in the early postoperative immunochemotherapy group was not signi ficantly increased compared to that in the nontherapy group for stage III gastric cancer, but the immuno chemotherapy group showed a tendency for a higher 5-year survival than the nontherapy group did.

The Effect of Radical Subtotal Gastrectomy on the Esophageal Motility and Acid Reflux at Short Term Interval / 대한소화관운동학회지

BACKGROUND/AIMS: A lymph-node dissection around the abdominal esophagus, vagotomy, and dissection to the phrenoesophageal membrane performed during a radical subtotal gastrectomy result anatomical changes and may result functional changes in the lower esophageal sphincter. We performed this study to define the changes of the esophageal reflux and motility in the development of these complications. METHODS: We performed this study before and after the radical subtotal gastrectomy with the esophageal manometry and 24hour ambulatory esophageal pH monitoring in 16 gastric cancer patients. RESULTS: There were no significant changes of the length, resting pressure of the lower esophageal sphincter, and the velocity of peristalsis in the lower esophageal area after the radical subtotal gastrectomy (3.94+/-0.66 vs. 3,85+/-0.61, 24.93+/-8.68 vs. 24.21+/-9.43, 3.99+/-0.95 vs. 3.79+/-1.01, respectively). There were no significant changes of the number of reflux episodes >or= 5 min (0.56+/-0.96 vs. 0.44+/-1.03), the duration of longest reflux episodes (5.19+/-6.84 vs. 4.25+/-7.22), and the total reflux time of pH below 4 (11.13+/-14.32 vs. 12.19+/-19.11) after the radical subtotal gastrectomy. CONCLUSION: This study suggests that acid reflux and esophageal motility after the radical subtotal gastrectomy might not be affected by anatomical derangement due to the surgical procedure itself.

Impact of the Pattern of Acute Rejection Episodes on Graft Survival / 대한이식학회지

The major reason for the chronic graft loss is chronic rejection. The only predictive factor for chronic rejection is a prior acute rejection episode resulting in a poorer long-term outcome. Also the number of acute rejection episodes is a strong predictor of long-term allograft failure. This study evaluated the impact of a first acute rejection episode and the severity of the rejection and the number of acute rejection episodes on allograft survival. Total of 136 renal transplant were performed between August 1987 to January 1996 at Wonkwang university hospital, and we studied 108 renal transplants that were followed for a minimum of 1.5 years. Acute allograft rejection was mainly diagnosed by clinical evaluation and laboratory data. Transplant patients were divided into three groups according to the time to the first acute rejection; no rejection (group I, n=44); acute rejection during the first 6 months (group II, n=42), acute rejection after 6 months (group III, n=22) and divided into four groups according to the number of acute rejection episodes; no rejection (Group A, n=44), one time (Group B, n=24), two times (Group C, n=23), and more than three times (Group D, n=17). Five-year allograft survival rate for group I-III was 96.4%, 82.7%, 58.5%, respectively (p<0.05 for each comparison to group I). Later acute rejection episodes were associated with worse response to rejection therapy and Group III had higher serum creatinine concentration after rejection therapy than Group II (2.46 1.13 mg/dl vs 1.19 0.7 mg/dl, p<0.05). Five-year allograft survival rate for group A-D was 93.4%, 73.2%, 57.4%, 74.5%, respectively, Group A shows higher graft survival rate, but there was not significant difference in long-term allograft survival among Group B-D. We conclude that late occurrence of a first acute rejection portends a worse prognosis for long-term allograft survival and decreases response to rejection therapy and results in poor graft function. Prevention of later rejection may require a broader focus, with additional efforts directed at improving patient compliance and renal allograft monitoring.