Analysis of the 119 emergency situation control center usage including dispatcher-assisted cardiopulmonary resuscitation instructions

OBJECTIVE: Analyses of the status of 119 emergency situation control center (119 ESCC) usage are lacking. Therefore, this study investigated the status of the 119 ESCC usage, including dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) instructions. METHODS: The emergency activity daily reports and emergency instruction sheets of 119 ESCC from January to December 2016 were reviewed. For more accurate status analysis, the computerized data of the 1339 Emergency Medical Information Center from January to December 2011 were also reviewed. RESULTS: In 2016, the total usage of the 119 ESCC was 1,393,876 calls, which was 27.8% lower than the 1,930,977 calls in 2011. Of the 1,393,876 eligible calls, the most common call was hospital guidance (n=743,799, 53.4%), followed by first aid (n=397,620, 28.5%), disease consultation (n=150,128, 10.8%), medical oversight (n=81,174, 5.8%), and interhospital transfer (n=5,123, 0.4%). Regarding the user number per 10,000 persons, Daejeon was the greatest at 57.2, whereas Changwon was the lowest at 11.5. A total number of DA-CPR was 19,439. The time from the call to chest compression were 173±88.6 seconds in the subjects having previous cardiopulmonary resuscitation training and 184.0±88.2 in the subjects having no such training (P < 0.001). CONCLUSION: The ratio of first aid instructions, including DA-CPR, among total usage of the 119 ESCC increased but the overall usage of the 119 ESCC decreased. Therefore, further efforts will be needed to improve the quality and professionality of the information provided through the operation of 119 ESCC.

Transplantation Techniques Unique in Pediatric Liver Transplantation / 대한이식학회지

In previous decades, pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality. Graft and patient survival have continued to improve as a result of proper selection criteria for both donors and recipients, improvement in medical, surgical and anesthetic management, organ availability, balanced immunosuppression, and early identification and treatment of postoperative complications. Most of all, refinements of the technique has directly related to good outcome. Therefore rapid establishment of surgical knowhow is mandatory. In pediatric liver transplantation, the utilization of split-liver grafts and grafts for living donors has provided more organs for pediatric patients and has had a significant impact on graft and patient survival. This has been one of the brilliant outcomes of surgical evolution. In addition, new surgical technique of minimal invasive live donor surgery has been recently widening the living donor liver transplantation for children. Although the recent outcome has been rapidly improved and the volume of living donor liver transplantation has been larger and larger in Korea, pediatric liver transplantation has been performed in a very limited large volume centers. Therefore, this review focuses on surgical technique in order to share the experiences and to improve the outcome of pediatric liver transplantation.

Characteristics of Adult-Onset Choledochal Cyst

PURPOSE: Choledochal cyst is a rare disease associated with an anomalous junction of the pancreaticobiliary ductal system (AJPBDS). We intended to demonstrate the characteristics of adult-onset choledochal cyst retrospectively. METHODS: ERCP findings of nineteen adult cases of choledochal cyst were compared with those of nine normal persons, in respect to the length and diameter of the common channel, and the angle of the pancreaticobiliary ductal junction. RESULTS: Patients of adult-onset choledochal cyst displayed a long, ectatic common channel and a larger angle of the pancreaticobiliary junction (p<0.05). All patients except one had AJPBDS. Thirteen patients were classified as Todani type Ia, one as type Ic and five as type IVa. Fourteen patients were classified as choledochopancreatic (C-P) type, two as pancreaticocholedochal (P-C) type, and three were unclassified by Kimura's classification. Sixteen patients were compatible with cystic type and three with cylindrical type by Okada's classification. Among the three cylindrical type patients two of them were classified as P-C type and one as C-P type. Histologically cystic type patients showed mild glandular or fibrotic patterns, however cylindrical type patients tended to show the severe glandular pattern. CONCLUSION: Adult-onset choledochal cyst was closely related with AJPBDS, although the reflux of pancreatic juice due to AJPBDS would not be the only cause to determine the morphology of adult-onset choledochal cyst. The meaning of this tendency toward a severe glandular pattern in cylindrical type patients requires elucidation.

Two cases of Mirizzi syndrome / 한국간담췌외과학회지

Impaction of a gallstone in the cystic duct or neck of the gallbladder can cause partial hepatic duct obstruction. Mirizzi originally described the syndrome of obstructive jaundice presented in the patient with gallstone in 1948. Cholecystobiliary fistula is a complicated form of Mirizzi syndrome in longstanding cholecystitis. A 70 year-old female was admitted due to jaundice. On laparotomy, the right heaptic duct was compressed by distended gallbladder. The other 60 year-old male patient was referred with jaundice. The patient underwent laparoscopic cholecystectomy two years ago. A large stone was migrated from remnant cystic duct through a cholecystocholedochal fistula. We report two cases of Mirizzi syndrome with a review of literature.

Expression of HLA-DR, ICAM-1, IL-2 and IL-4 in Renal Biopsy of Trasplanted Patient / 대한이식학회지

PURPOSE: We performed this study to evaluate the value as early markers predicting the acute rejection and differential diagnosis with other causes of renal dysfunction. METHODS: Immunohistochemical stains for HLA-DR, ICAM-1, IL-2 and IL-4 were performed on 44 cases of implantation biopsies which were divided into cases with acute rejection (R group, 14 cases) and cases without rejection episode (N group, 30 cases), and 45 gun biopsies for renal dysfunction which divided into cases diagnosed as rejection (A group, 28 cases) and cases diagnosed as other causes rather than rejection (B group, 17 cases). We analysed immunohistochemical results, various clinical datas such as age and sex of donor, living or cadaveric status of donor, the mean number of HLA-DR mismatch, age and sex of patient, serum creatinine level at post op 2 day for implantation biopsy and at the day on biopsy for renal dysfunction between above groups. RESULTS: 1) In 44 cases of implantation biopsies, positive immunohistochemical stains for HLA-DR were more frequent in R goup (71.43%) than in N group (26.66%). There was no significant difference of clinical datas and immunohistochemical stains for ICAM-1, IL-2 and IL-4. 2) In 45 cases of gun biopsies for renal dysfunction, immunohistochemical stains for HLA-DR were all positive in A group (100%) with higher rate of 3 stains (39.28%) than B group (positive; 70.58%, 3 ; 5.88%). Immunohistochmical stains for ICAM-1 were more frequently expressed in A group (100%) than B group (76.47%). Both stains revealed no significant difference according to the grades of rejection, disease other than rejection. There was no significant diffrence of immunohistochemical stains for IL-2 and IL-4, and clinical datas between two groups. CONCLUSION: We can conclude that the immunohistochemical stains for HLA-DR on implantation biopsies may predict the devepoment of the acute rejection and the immunohistochemical stains for HLA-DR and ICAM-1 on gun biopsies at the time of renal dysfunction may differentiate the reje.

A Case of Choledochal Web / 한국간담췌외과학회지

A web arising in the bile duct is a rare disease. Most cases are found at operation or autopsy becasue of the rare incidence and absence of specific clinical manifestations. However, early diagnosis has been feasible with the development of radiologic studies. We report a case of choledochal web with a review of the literature.

Experience with 129 Pediatric (<21 yr) Kidney Transplantations

BACKGROUND: Renal transplantation has become widely accepted as the treatment of choice for children with end-stage renal disease (ESRD). Two important criteria for successful pediatric renal transplantation are achievement of optimal growth, developement, and possession of a long functioning renal transplant. METHODS: In order to establish better strategies for successful pediatric renal transplantation outcome, we reviewed the results of 129 primary renal transplantations performed at our institution. One hundred twenty-nine renal allografts were transplanted to 129 pediatric ESRD patients under the age of 21 between July 1979 and November 1997. Mean age at transplantation was 13.4 yrs ( or =10 yrs: 100) and male to female ratio was 87:42. Original renal diseases were known in 90 recipients (69.8%) including 7 congenital or hereditary diseases (5.4%). Donor kidneys were obtained from 93 living-related donors (LRD), 20 living-unrelated donors (LUD), and 16 cadavers (CAD). Mean follow-up period was 57.8 months. Immunosuppression was done with AZA Pds (n=5) before 1985 and with CyA Pds (n=79) and AZA CyA Pds (n=45) thereafter. RESULTS: Twenty five grafts were lost (20.7%) due to 20 chronic rejections, 3 recurrences of the original renal disease and 2 patient deaths with functioning graft. Overall 1-, 3-, 5-, 10-yr graft and patient survival rates were 95.1%, 88.2%, 80.2%, 61.0% and 98.5%, 96.7%, 95.2%, 95.2%, respectively. In the multivariate analysis, the presence of acute rejection (p=0.014) and LUD (p=0.015) were significant prognostic factors for poor graft survival. Significantly superior growth in height after transplantation was observed in children transplanted at prepubertal age ( or =13 yrs). CONCLUSIONS: Long-term graft survival in pediatric renal transplantation can be obtained by aggressivemanagement of acute rejection, judicious surveillance for immunosuppression, and preferred selection of LRD. In addition, we recommend early renal transplantation in prepubertal children with ESRD on the basis of the significant posttransplant increment in height in prepubertal children.

Pulmonary Infection after Kidney Transplantation / 대한이식학회지

The infectious complications after renal transplantation remain as an important causes of both mortality and graft loss. The lung is the most common target for post-transplant infection. We analyzed the causative agents, treatments and outcomes of post-transplant pulmonary infections. From 1990 to 1998, 192 renal allografts were performed at Hallym University Hospital. Seven cases (3.6%) of 5 males and 2 females developed serious pulmonary infections and required hospitalization. The mean age was 42.6 years. The onsets of pulmonary infections were from a month to 6 months in 3 cases, from 6 months to a year in one case and after a year in 3 cases. Triple therapy regimen was used in 4 cases as an immunosuppression therapy. Acute rejections developed in 6 cases. Causative organisms were Cytomegalovirus in 2 cases, Mycobacteria in 2 cases, Aspergillus in a case, Nocardia in a case and unknown in a case. Despite appropriate antibiotics, four patients did not respond to the treatment and died. The early recognition of infection and appropriate therapy is important to reduce fatal consequence.

Clinical Experience of Kidney Transplantation in the Hallym University Hospital / 대한이식학회지

Renal transplantation has been adopted as the treatment of choices for most patients with a end stage renal disease. This is the presentation of our experience of renal transplantation at Hallym University Hospital. From March 1984 to July 1998, 207 cases of renal transplantations were performed, 15 cases out of which were lost during follow-up period and excluded from the study. The mean age of recipients was 37.1 years. The male to female ratio was 1.5:1. Eighty nine renal allografts (46.4%) were from living unrelated donors, 59 (30.7%) from living donors and 44 (22.9%) from cadaveric donors. As an immunosuppression theray, a triple regimen was used in 104 cases (54.2), a double regimen in 86 (44.8%) and a single regimen in one (0.5%). The overall rejection developed in 87 cases (45.3%). The rejection rate was 59.3% in renal allografts from living related donors, 37.1% from living unrelated donors and 43.2% from cadavaric donors. The OKT3 and the antilymphocyte globulin (ALG) were used for steroid resistent rejection in 8 and 2 cases, respectively. Post-transplant diabetes mellitus were noticed in 22 cases (11.5). The most common complication was infection (28.1%), and 11 recipeints (5.7%) died during follw-up period. Infection was the leading cause of mortality. The overall graft survival was 92.2% at 1 year span and 83.1% at 3 year span. The overall patient survival was 95.6% at 1 year span and 92.5% at 3 year span.

Relationship of Renal Implantation Biopsies and Acute Rejection during Immediate Posttransplantation Period / 대한이식학회지

Many factors can be recognized for the acute rejection such as: degree of HLA mismatching, cytokine gene expression, ischemic time, etc. Some authors have suggested the importance of early routine biopsy of renal allograft to predict acute rejection. This prospective study on renal implantation biopsies was performed to evaluate the relationship between the implantation biopsies and the acute rejection during the immediate post-transplantation period. From December 1996 to February 1998 implantation biopsies were performed on 46 renal allografts within 40~60 minutes after vascular anastomosis using tru-cut needle (18G). Two samples were obtained from transplanted kidney in each patient. Serial sections were stained for the light microscopic examination. The slides were evaluated for histologic features such as interstitial cellular infiltration, nephrosclerosis, tubular damage, glomerular neutrophil count (GL-PMN), and peritubular neutrophil count (PTC-PMN). Forty six biopsies were grouped into acute rejection group (R group, n=10) and non-rejection group (N group, n=36) during immediate posttransplantation period (1 month). Acute rejections were confirmed by ultrasonography guided biopsy. Histologic findings were classified according to Banff schema. The statistical analysis was performed by using Chi-Square Test and Spearman Rank Sum Test. During the immediate post-transplantation period, acute rejection developed in 10 cases (21.7%) of which 9 cases were the biopsy-proven rejection. The male to female ratio was 21:25. Recipients were ranged from 22 to 54 years old with a mean age of 38.2+/- 9.1. Original disease of recipient were chronic glomerulonephritis in 15 cases (32.6%), hypertension in 8 cases, diabetes mellitus in 3 cases, RPGN in 2 cases. Fifteen cases (32.6%) were of unknown etiology. The mean number of HLA mismatches was 4.6+/- 0.9 in R group, 4.7+/- 1.2 in N group, and the mean number of HLA-B & DR mismatches was 2.2+/- 0.4 in R group, 2.3+/- 0.7 in N group. The ratio of the living vs. cadaveric donors was 34:12. No statistical difference was observed between two groups in interstitial cellular infiltration, nephrosclerosis and tubular damage. The GL-PMN was 0.6 0.9 in R group, while 0.1 +/- 0.4 in N group. The PTC-PMN was 5.3+/- 3.3 in R group and 0.3+/- 1.1 in N group (p<0.05). The presence of more than five PTC-PMN count was related with the occurrence of acute rejection (p<0.01). In conclusion, the PTC-PMN of renal implantation biopsies is a possible predicting factor for acute rejection in this preliminary report.

A Case of Liver Transplantation using a Jump Graft in a Patient with Portal Vein Thrombosis and Postoperative Chylous Ascites

Venous anomalies, including portal vein thrombosis (PVT) and prior portosystemic shunts, are not uncommon in orthotopic liver transplantation (OLT) and require vascular reconstruction. PVT has been considered as a contraindication to OLT because of surgical complexity and increased postoperative morbidity and mortailty rates. Postoperative chylous ascites occur following disruption of abdominal lymphatics after retroperitoneal dissection. Chyloperitoeum after OLT is very rare. We report a case of piggyback OLT in a cirrhotic patient with portal vein thrombosis. A thromboendarterectomy was attempted first, and a venous jump graft was required between the donor portal vein and the infrapancreatic superior mesenteric vein. An aortic conduit was used for the hepatic arterial reconstruction. Retroperitoneal dissection was inevitable. Chylous ascites developed after the operation and were managed successfully with a low-at diet. In conclusion, we suggest that the presence of PVT is not a contraindication for OLT. Chylous ascites are rare after OLT, and the treatment of choice is a conservative one based on diet control.

Liver Resection under Total Vascular Occlusion for Hepatoma in Contact with Hepatic Vein or Inferior Vena Cava / 한국간담췌외과학회지

Total vascular occlusion (TVO) of the liver was used during parenchyma resection in two patients with large hepatoma located near hepatic vein or inferior vena cava. This technique was achieved by clamping the porta hepatis as well as suprahepatic and infrahepatic IVC. Durations of TVO were 15 and 25 minutes respectively. Three and four units of packed RBC were transfused for each patient. Postoperative hepatic or renal failure did not occur. The technique of TVO is easy and safe for resection of large and critically located tumors that would otherwise present operative risk.

Treatment of Budd-Chiari Syndrome by Portacaval & Cavo-Atrial Bypass

The Budd-Chiari syndrome is no longer a rare disease in the world, but there has been small cases reported until now in Korea. There are three forms of Budd-Chiari syndrome, among them membranous web in the inferior vena cava is the most common form in the oriental area. Authors have expereinced the Budd-Chiari syndrome, 49 year old female patient, caused by membranous web associated with the long thrombus in the inferior vena cava. She underwent side-to-side portacaval shunt and cavoatrial shunt using 19 mm diameter, 25 cm length polytetrafluoroetylene graft. Postoperative major morbidities were ARF and pneumonia. She has improved clinically and pathologically after operation. It is concluded that combined portacaval shunt and cavoatrial shunt has been effective to relieve the symptoms of Budd-Chiari syndrome caused by membranous web and inferior vena cava thrombotic occlusion.

PROGNOSTIC FACTORS OF HEPATOCELLULAR CARCINOMA AFTER CURATIVE HEPATIC RESECTION / 한국간담췌외과학회지

To further define the prognostic factors associated with long term survival of hepatocellular carcinoma, we retrospectively studied 371 patients with pathologically diagnosed hepatocellular carcinoma who underwent curative hepatic resection between 1991 and 1995. We included the 16 patients who underwent noncurative hepatic resection in calculating overall survival. The male to female ratio was 5.1 to 1 and their average age was 52.5 years. About 20 variables were subject to univariate and multivariate analysis and their survivals were calculated using the Kaplan-Meier method. 55.6% of (220 of 396) patients had liver cirrhosis and 73.2% of (290 of 396) patients were positive in HBsAg. Operative mortality and inhospital death rate were 1.5% and 0.8%, each and postoperative morbidity rate was 22.5%. The cumulative 1, 3 and 5 year survival rates including noncurative resected cases were 85.9%, 67.2% and 54.8%, respectively. The cumulative 1, 3 and 5 year survival rates of 371 curative resected cases were 87.3%, 68.7% and 56.4%, respectively. Disease free 1, 3, 5 year survival rates of 371 curative resected cases were 74.8%, 48.2% and 40.8%, respectively. The factors such as alpha- fetoprotein, Child's classification, prothrombin time, extent of liver resection, and number of tumor were statistically significant factors associated with cumulative survival.(p<0.05) And alpha-fetoprotein, total necrosis after TACE, viral hepatitis, and invasion of portal vein were significant factors associated with cumulative disease free survival. Only alpha-fetoprotein was associated significantly with cumulative survival and cumulative disease free survival. Length to the resection margin was not significantly associated with survival.

Initial Perfusion Solution for Donor hepatectomy in Canine Liver Transplantation: Ringers' Lactated Solution: UW Solution

The purposes of initial preservation solution are rapid cooling of the organ and washing out the intravascular components. After the introduction of University of Wisconsin (UW) solution, it has become the standard organ preservation solution in liver transplantation. However, due to several problems such as high viscosity and potassium concentration, let alone its cost, there has been several attempts to use UW solution in combination with other preservation solutions for initial perfusion of the graft during the organ harvest procedure. In order to evaluate the efficacy of Ringers' Lactated (RL) solution as an initial perfusion solution, we performed orthotopic hepatic allografts on dogs. In 4 dogs, UW solution was used as the initial perfusion solution and in the other 4, RL solution was used. After initial perfusion, UW solution was used successively for the preservation of the graft. All harvested grafts were stored in UW solution. Average cold ischemic time was 163.5 minutes for RL group and 159 minutes for UW group. The two groups were compared in terms of hematologic and biochemical markers before and after the transplantation. The extent of graft injury during cold ischemia and after reperfusion was also compared directly under light and electron microscope. There was no difference in cold and warm ischemic time, anhepatic time, and total operation time between the two groups. The groups did not differ in liver function test, complete blood count and coagulation profile. Histologic exams also showed similar changes between the two groups. In conclusion, RL solution can be used as the initial perfusion solution in hepatic transplantation.

A Clinical Analysis of 195 Cases of Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the newest treatment modality to be introduced for the management of the gallstone disease and is gaining rapid acceptance elsewhere. Despite its rapid and widespread acceptance, early data suggest that some complications and limitations are common when compared to standard cholecystectomy. The aim of this study was to identify problems in laparoscopic cholecystectomy and the reasons for secondary or operative conversion. From August 1991 to December 1994, 195 consecutive patients were treated with laparoscopic cholecystectomy at the Department of General Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University. The results were as follows; 1) The most prevalent age group was the 5th decade (24.6%) and the sex ratio (M : F) was 1 : 1.4. 2) The most common symptom was right upper quadrant pain (66.2%). 3) The majority (66.7%) of the admitted patient came to our hospital within 6 months of the onset of symptoms. 4) The number of patients with previous abdominal operations was 44 patients (22.6%), and the most common operation was an appendectomy (8.2%). 5) The patients with associated diseases were 124 patients (63.6%), gastritis being noted in 35 patients (17.9%). 6) The preoperative diagnostic rate was 96% by abdominal ultrasonography and 23.6% by ERCP 7) The average operative time was 103 minutes. 8) The most frequent operative finding was adhesion (72.3%). 9) The mean period of hospitalization after operation was 3.5 days. 10) The most dominant type in pathologic classification was chronic cholecystitis (86.7%). 11) The number of conversions to an open cholecystectomy was 14 (7.2%). 12) Among 195 patients, complications were noted in 10 patients (5.1%) : bile leakage from the bile duct or the liver bed(3 patients), bile duct injury (2 patients), subphrenic abscess (2 patients), atelectasis (1 patient), wound hematoma (1 patient), and drain site bleeding (1 patient).

An Analysis of the Process to Organ Donation in Brain-dead Patients / 대한이식학회지

Organ procurements were performed in 9 brain-dead patients at our hospital since 1995. They were 7 males and 2 females. The causes of brain death were trauma in 7 patients and CVA in 2 patients. When brain death was confirmed, hypernatremia over 145 mEq/L was showed in 6 and hypothermia in all. Blood transfusion was done in 6 patients for correction of anemia preoperatively. The time intervals from brain death confirmation to organ procurement were from 1 hour to 2 days. Multi-organ harvests were done in 4 patient, 60 year-old female and 2 patients who received the cardioversion before harvest were given up to procure liver and heart preoperatively. And 2 patients were not procured heart and liver because of pathologic findings of intraoperative frozen biopsy. Among 22 recipients, 1 kidney recipient died postoperatively. We conclude that the intensive care should be performed in the brain dead donor for multi-organ harvest and better results of organ transplantations. Beside the organ procurement and transplantation team, another intensive care team for brain dead donor should be composed if possible.

Orthotopic Liver Transplantation in the Oldest Patient in Korea / 한국간담췌외과학회지

We present a case of orthotopic liver transplantation in 63 year-old female patient with liver cirrhosis, who is the record of the oldest recipient in Korea. The donor was 20 year-old male patient with subarachnoidal hemorrhage. The operation time was 12 hours. The duration of cold ischemic time and anhepatic phase were 8 hours and 85 minutes respectively. After operation the patient resumed clear consciousness. The ventilator was weaned and removed. On the third postoperative day, reoperation was required due to hemoperitoneum. Splenectomy was performed for a tearing in the hilum. After reoperation, acute renal failure and sepsis developed. Continous arteriovenous hemofiltration was continued for 3 weeks. The patient was discharged on postoperative 59th day. The patient is doing well with normal liver function. No episode of acute rejection occurred until now. More aggressive approach has been feasible in organ transplantation for older patients by advanced knowledge of perioperative management. We conclude that age over 60 years should not be a barrier to liver transplantation.

Central Pontine Myelinolysis after Liver Transplantation: A case report / 대한마취과학회지

Central pontine myelinolysis (CPM) is a demyelinating disorder that almost exclusively affects the central portion of basis pontis and occurs in patients with malnutrition, chronic debilitating disorders and electrolyte abnormalities. CPM after liver transplantation is considered that had the relationship to rapid correction of hyponatremia and shift in osmolality. Our first case of 4 liver transplantations altered consciousness at the 5th day after transplantation and did not recover fully until 14 months. At first, atrial fibrillation and atelectasis due to left main broncheal obstruction were thought the causes of impaired consciousness as postoperative hypoxic event. At that time, CT scan showed diffuse brain atropy that suggested previous hepatic encephalopathy and/or hypoxic ischemic encephalopathy. After that, MRI revealed CPM and diffuse cortical atropy. We concluded that CPM associated with rapid correction of hyponatremia perioperatively alter patient's consciousness with hypoxic brain injury.

Natural history hepatocellular carcinoma and survival rate in relation to various treatment modalities: analysis for past 20 years experiences / 대한내과학회지

No abstract available.