Appendicitis during Pregnancy: The Clinical Experience of a Secondary Hospital

PURPOSE: Appendicitis is the most common condition leading to an intra-abdominal operation for a non-obstetric problem in pregnancy. The aim of this study was to examine our experience and to analyze the clinical characteristics and the pregnancy outcomes for appendicitis during pregnancy that was reported in Korea. METHODS: We reported 25 cases of appendicitis during pregnancy that were treated at Good Moonhwa Hospital from January 2004 to March 2010. We also analyzed appendicitis during pregnancy reported in Korea between 1970 and 2008 by a review of journals. RESULTS: The incidence of acute appendicitis during pregnancy was one per 568 deliveries. The mean age was 27.92 years old, the gestational stage at the onset of symptoms was the first trimester in 10 patients (40%), the second trimester in 14 patients (56%), and the third trimester in 1 patient (4%). Among the 25 cases, 21 were treated with an open appendectomy and 4 with laparoscopic appendectomies. The postoperative complications were 2 wound infections and 1 spontaneous abortion. CONCLUSION: Our experience demonstrated that appendectomies on pregnant patients can be successfully performed at secondary hospitals.

Signet Ring Cell Carcinoma in Patient with Gastric Cancer, is it belong to the Undifferentiated Type?

PURPOSE: Although many studies on the clinicopathological characteristics of signet ring cell (SRC) carcinoma of the stomach have been made, there is no consistent report of the characteristics and prognosis of this condition. In this study, the clinicopathological features and prognosis of patients with SRC and non-SRC gastric cancer were compared. METHODS: Between 1990 and 2002, 1,884 patients, who underwent a curative resection for gastric cancer in our hospital, were analyzed retrospectively. Among them, 185 (9.8%) patients with SRC were compared with 1,699 (90.2%) patients with non-SRC. RESULTS: SRC in gastric cancer was found more commonly in younger patients and women. The depth of the invasion in the SRC patients was less invasive and a lymph node metastasis is less frequent. A higher frequency of the depressed gross type and middle third tumor location in SRC are similar characteristics of the undifferentiated type of gastric cancer. However, SRC in EGC have similar characteristics to the differentiated type of gastric cancer such as a higher rate of mucosa-confined tumors and less frequent lymph node metastasis. The five-year survival rate of SRC in AGC was similar to that of other pathologic types, and the pathologic type does not influence the survival rate. CONCLUSION: SRC patient in EGC should be considered as a differentiated type. Therefore, the mucosa confined tumor and less frequent lymph node metastases are expected.

The Analysis of Risk Factors of Donor Affecting the Graft Survival in Cadaveric Kidney Transplantation

PURPOSE: The supply of donor organs does not meet the demand of transplantation. To find a possible way of expanding the donor pool, we have evaluated the risk factors of cadaveric donors that influence the graft survival. METHODS: Between Feb. 1995 and Dec. 1999, we performed 200 cases of cadaveric kidney transplantation. The graft survival rates in 1 yr, 2 yr, & 3 yr are 93.0%, 91.1%, & 89.9%, respectively. We defined the marginal donor as a donor who possesses one of the risk factors of donor age > or = 50, or or =10 days (n=46), history of hypertension (n=30), CPR > or =20 min (n=7), prolonged hypotension (SBP or =20microgram/kg/min, or dobutamine > or =15microgram/kg/min) (n=78), serum creatinine level > or =2.5 mg/dl (n=16), or cold ischemic time > or =12 hr (n=34). We compared graft survival rates between the marginal donor group and the non-marginal donor group, and analyzed risk factors affecting graft survival by univariate and multivariate methods. RESULTS: CPR > or =20 min (71.5%, 71.5%, - vs 93.8%, 91.8%, 90.6%, p=0.027), prolonged hypotension (85.0%, 85.0%, 80.3% vs 95.0%, 92.6%, 92.6%, p=0.028) and serum creatinine > or =2.5 mg/dl (75.0%, 75.0%, 75.0% vs 94.6%, 92.4%, 91.0%, p=0.001) affect graft survival in univariate analysis. There is, However, no risk factor that affects graft survival in multivariate analysis. CONCLUSION: We can increase the supply of donor organs for kidney transplantation by the selective use of high-risk cadaver donor. However, a prospective randomized study including recipient factors is needed to define the acceptable conditions better.