Initial Blood Glucose Can Predict the Outcome of OP Poisoning

PURPOSE: Many studies have examined the mechanisms of impaired glucose homeostasis after organophosphate (OP) exposure, however no study has evaluated the clinical utility of blood glucose measurements in patients with OP poisoning. The current study was conducted to evaluate the initial glucose level at presentation and the glycemic variables during the first 3 days after admission as a predictor of mortality. METHODS: This retrospective observational case series included 228 patients with a history of OP poisoning. Among other clinical data, information on the initial glucose level at presentation and mean glucose level, delta glucose level, and the presence of a hypoglycemic event during the first 3 days of admission, was collected. RESULTS: Survivors had lower initial glucose levels at presentation and glucose variability during the first 3 days of admission compared to non-survivors. The frequency of hypoglycemic events was higher in non-survivors. In multivariate analysis, the initial glucose level (> 233 mg/dl) was an independent predictor of mortality, along with age. CONCLUSION: The initial glucose level at presentation can be helpful in prediction of mortality in cases of OP intoxication at bedside. The physician should pay attention to patients with a glucose level >233 mg/dl at presentation after ingestion of OP.

The Diagnostic Efficacy of a Triple Prediction Test including Ischemia-Modified Albumin in Ruling Out Acute Coronary Syndrome

PURPOSE: In emergency departments (ED), the treatment of acute coronary syndrome (ACS) should be rapid and result from comprehensive diagnostic evaluation. There are increasing needs for supplies in the ED both for monitoring patients and for follow-up diagnostic measures to rule out ACS. The purpose of this study was to determine the effectiveness of a triple prediction test including Ischemia-modified albumin (IMA) as a tool for promptly ruling out ACS in lower-risk patients in ED. METHODS: Between September 2005 and July 2006, we analyzed patients with acute chest pain who were older than 28 years, who visited the ED within 3 hours from the last onset of chest pain, and who had normal or non-diagnostic electrocardiograms (ECG). The triple prediction test was defined as a nondiagnostic ECG, negative cardiac markers (creatine kinase-MB, troponin I), and a lower cutoff value for IMA. RESULTS: We analyzed 149 patients (male: female=105 : 44) whose mean age was 57.9+/-12.1 years. Thirty-two patients fell into IMA-negative group and 117 patients were in the IMA-positive group was 117 patients. There was no difference in sex, age, serum albumin level and medical history between groups. The area under the ROC curve was 0.640. At an IMA cutoff value of 85 U/ml, patients without ACS were negative (below the cutoff value) 4.0 times more than patients with ACS by ROC curve analysis. CONCLUSION: In ruling out ACS, triple predictive test including cardiac markers, ECG, and IMA had insufficient efficacy in the ED. Further studies warranted to reveal IMA is a clinical useful diagnostic test to rule out ACS.

Pylorus-Preserving Gastrectomy for Early Gastric Cancer

BACKGROUND: The physical results after a pylorus-preserving gastrectomy (PPG) for early gastric cancer were evluated. METHODS: From August 1996 to March 1998, sixteen (16) patients underwent a PPG, and 17 patients underwent a conventional distal gastrectomy with Billroth I anastomosis (DG). The patients undergoing the PPG and theDG procedures were assessed for 1 year following their surgical procedure. Changes in body weight, food intake volume, and abdominal symptoms, which were determined from questionaires, gastric-emptying tests using the acetaminophen method, and gastroscopic findings, were compared between the two groups. RESULTS: There were no significant differences in the body weight ratio and the amount of food taken in a meal between the two groups. Patients who had a PPG had fewer postoperative abdominal symptoms than those who underwent a DG. After a DG, emptying was much more rapid. Gastroscopy revealed that the mucosa of the stomach remnant after a PPG was less abnormal than it was after a DG, but food stasis was more frequent after a PPG. CONCLUSION: A PPG is a more physiological operation than a conventional DG and should be used in carefully selected patient with early gastric cancer to improve their quality of life.

Clinical Study of Primary Gastric Lymphoma and Analysis of Prognostic Factors

BACKGROUND: The stomach is the most common extra nodal site for non-Hodgkin's lymphoma: primary gastric lymphomas are uncommon, constituting only 1% to 5% of malignant gastric lesions. METHODS: To elucidate the clinicopathologic features of this lymphoma, we retrospectively analyzed 33 patients with primary gastric lymphoma who had been treated at our hospital from Jan. 1986 to Dec. 1995. RESULTS: Primary gastric lymphomas were 1.2% of all gastric cancers. The mean age 46 years (range 25 to 68 years). There were 23 men and 10 women. The most frequent chief complaint was epigastric pain. The most common location was the gastric antrum and body. According to the working formulation, the malignancy grades were 4 low, 26 intermediate, and 3 high. The overall 5-year survival rate was 60%. Survival of five years according to the TNM stage of the disease was as follows: stage 1, 88%; stage II, 71%; stage III, 33%; and stage IV, 29%. Patient with stage I, II disease had a 5-survival rate of 80% versus 35% for stage III, IV disease (p<0.05). Tumor serosal involvement and 5-year survival was follows: no perigastric serosal involvement, 93%; serosal infiltration, 33% (p=0.0016). In cases undergoing a subtotal gastrectomy, 5-year survival rate was 70%, whereas patients undergoing a total gastrectomy had a 5-year survival rate of 30% (p<0.05). Those with tumors smaller than 7 centimeters had a 5-year survival rate of 66% versus 38% for larger neoplasms (p=0.09). CONCLUSIONS: By univariate analysis, the stage, operation methods, and serosa involvement were significant prognostic factors. However, in multivariate analysis, only the serosa involvement was significant prognostic factor.

Cholesterol Granuloma Presenting as Retroperitoneal Mass: A case report

Cholesterol granulomas are common in the mastoid region, but have rarely been reported in other areas. The authors report the case of a 53-year-old female who had a cholesterol granuloma of the retroperitoneum. The disease was confirmed by surgical pathologic examination of the tissue submitted. We report on that case and give a brief review of the literature.

Survival rate of hepatectomy according to liver cirrhosis in hepatoculluar carcinoma / 한국간담췌외과학회지

The authors analyzes the outcomes of patients with hepatocellular carcinoma and liver cirrhosis who underwent liver resection. Hepatic resection were carried out in 145 patients with hepatocellular carcinoma during 8-year period from 1990 to 1997. Of 145 hepatocellular carcinoma, one group of hepatocellular carcinoma with cirrhosis is 112(77.2%) cases, the other group of hepatocellular carcinoma without cirrhosis is 33(22.8%)cases. The serum HbsAg positivity is 80%(88/110) in hepatocellular carcinoma with cirrhosis, 63.6%(21/33) in hepatocellular carcinoma without cirrhosis. The serum Anti HCV positivity is 21.3%(20/94)in hepatocellular carcinoma with cirrhosis, 34.4%(10/29) in hepatocellular carcinoma without cirrhosis. According to liver resection, major resection is the right lobectomy, left lobectomy, extended right lobectomy, and extended left lobectomy, and minor resection is left lateral segmentectomy, segmentectomy, subsegmentectomy The survival rate and postoperative complications were compared hepatocellular carcinoma with cirrhosis with hepatocellular carcinoma without cirrhosis. The survival rate of 1 year, 2 year , 3 year and 5 year was 63%, 47%, 36% and 25% in hepatocellular carcinoma with cirrhosis and 63%, 56%, 48% and 39% in hepatocellular carcinoma without cirrhosis. The group without liver cirrhosis is somewhat higher in survival rate, but the outcome was not statistically significant.(p>0.05). Overall operative mortality was 4.1%(6/145), With liver cirrhosis 5,4%(6/112) in group. Of this 6 cases , four cases were hepatic failure, two cases postoperative bleeding. Group without liver cirrhosis had not mortality cases. Of the group combined with liver cirrhosis, the operative mortality for operation method was 13%(3/23) in major resection group, 3.4%(3/89) in minor resection group.

Primary Gastric Small Cell Carcinoma / 대한암학회지

Small cell carcinoma is derived from APUDcells of any parts of the body. Usually the cases are discovered in the lungs and have poor prognosis. Small cell carcinoma has been increasingly reported in various organ outside the lungs, such as the larynx, thymus, esophagus, stomach, pancreas, uterine cervix, and prostate. Primary small cell carcinoma of the stomach is extremly rare. The histology of the tumor was similar to that of ordinary small cell carcinoma of the lung, and the secretory granules were identified by electron microscopy. We report a patient with gastric pure small cell carcinoma who treated by a radical total gastrectomy and chemotherapy.

Results and Risk Factors in Hepatic Resection 506 cases

BACKGROUND: With advances in the techniques of liver resection as well as with better improvement of preoperative and postoperative care, hepatic resections for liver disease have become more common. This study presents a review of our experience for hepatic resection and an analysis of potential risk factors affecting the morbidity and the mortality in a hepatectomy. METHOD: From 1970 to 1996, 506 patients underwent hepatic resections; 139 patients with benign hepatic diseases, 329 patients with primary hepatic malignancy, and 38 patients with secondary hepatic malignancy. RESULTS: We divided the patients into two groups. Group 1 had 272 patients (from 1970 to 1990), and group 2 had 234 patients (from 1991 to 1996). As compared with group 1, group 2 had more malignant diseases than non-malignant diseases as operative indications. In the patients resected for primary hepatic malignancy, the 1-, 2-, 3-, and 5-year survival rates were 56.6%, 36.7%, 30.1%, and 15.2%, respectively, and 1-, 2-, 3-, 4-, and 5-year survival rates for a hepatocellular carcinoma were 58.5%, 41%%, 30.1%, 25.3%, and 17.2% and for a cholangiocarcinoma 39.5%, 22.5%, 19%, 8.3%, and 5.2%, respectively. The overall operative mortality rate was 5.9% (30/506), 7.4% in group 1 and 4.3% in group 2. The significant risk factors for perioperative mortality were liver cirrhosis, jaundice, increase of postoperative alkaline phosphatase, extended time needed for operation (above 4 hours), massive transfusion during operation (above 5,000 cc), malnutrition and/or weight loss (above 10%), low hemoglobin (below 10 gm%) and low serum albumin level (below 3.0 gm). Also, the major complicationsinfluencing perioperative mortality were liver failure, perioperative hemorrhage, cholangitis, intraabdominal abscess, sepsis, pulmonary lesions, and renal failure. CONCLUSION: After 1990, minor resections having enough margin from the hepatic malignant lesion have increased. However there has been no difference in the survival rate compared with that for a major resection for hepatic malignant diseases. Rather, operative morbidity, perioperative mortality, and postoperative complications have decreased in favor of a minor resection for hepatic malignant diseases.

Clinical Rewiew of Stomach Cancer in Young Patients

Several studies have demonstrated the poor prognosis for young patients with gastric cancer. However few reports exist about the dependence of the survival rate on curative resection and cancer stage. Hospital records of 107 young gastric cancer patients who underwent operations from 1980 to 1996 were reviewed, and the results were compared with those from 3176 cases involving whole age gastric cancer patients. There were no significant differences in operation method, tumor invasion, and tumor stage between both age groups. In whole age patients, males were predominant; however in young patients, females were predominant (p=0.005). In young patients, the tumors more frequently occurred in the upper 1/3 than in whole age patients(p<0.0001). A comparison of histologic types showed that poorly differentiated histologic types, such as signet ring cells and diffuse types, according to Lauren's classification, were more frequently observed in young patients (p<0.0001). The 5- year overall survival rate revealed a difference, but with borderline significance, between the young and the whole age patients (39.4% vs 48.6%, p=0.0505). However, patients who had undergone a curative resection showed no statistically significant difference(56.9% vs 63.9%; p=0.264). And patients with noncurative resection showed a statistically significant difference(0% vs 11.7%, p=0.034). The survival rate according to TNM stage revealed a statistically significant difference at stages I b and III b (Stage I b - 100% vs 84.5%, p=0.047; Stage III b - 8.8%, vs 28.0%, p=0.049). In conclusion, young patients with stomach cancer who underwent a curative resection showed a similar survival rate to that of whole age patients, and the largest survival rate was for cancer in a relatively early stage. Hence curative resection and early diagnosis are mandatory in young patients with stomach cancer.

Effectiveness of Routine Nasogastric Decompression in Elective Gastric Surgery

BACKGROUND : Prophylactic nasogastric decompression is used routinely after elective gastric surgery in spite of many disadvantages and complications - discomfort, pain, especially postoperative atelectasis. The aim of this study was to determine whether routine nasogastric decompression benefitted patients undergoing elective stomach operations. METHODS : Two hundreds forty patients were studied prospectively. All patients underwent elective gastric surgery from January 1994 to March 1996 by one surgeon at Gospel Hospital. In the intubated group, 120 consecutive patients were treated with a nasogastric tube (silastic, 16 French) just before or during the operation, it being removed on the 1st or the 2nd postoperative day. In the tubeless group, a nasogastric tube was not inserted at all in 120 consecutive patients. We compared the differences between two groups with respect to the mean duration of flatus passing, the incidence of postoperative pulmonary complication, leakage, reoperation, wound dehiscence, and operation mortality. RESULTS : The two groups showed no significant differences in age, sex and operation methods. Flatus passed earlier in the tubeless group, but the difference was statistically insignificant. The patients suffering from atelectasis were much larger in number in the intubated group (p<0.03). There were no significant differences in the incidence of anastomotic leakage, wound dehiscence, reoperation and operation mortality. CONCLUSIONS : The routine omission of nasogastric intubation was not associated with increased risks, such as leakage, wound dehiscence, reoperation, postoperative pulmonary complication, delayed flatus passing or diet intake, operative morbidity and motality. Conversely, the incidence of postoperative atelectasis was twice as high in the intubated group. We conclud that routine nasogastric intubation should be used only in specific cases and routine use of nasogastric intubation is not justified.

Predictive Factors for Lymph Node Metastasis in Early Gastric Cancer

This report is a clinical review of 298 cases of early gastric cancer that were treated at Kosin Medical Hospital during 8 years from 1984 to 1992. In 1962, the Japanese Gastroenterological Endoscopy Society defined early gastric cancer as a lesion confined to the mucosa or submucosa and not related to the presence of lymph-node metastasis. The prognosis for early gastric cancer (EGC) is generally excellent, but the proportion of EGC cases progressing to advanced gastric cancer is steadily increasing nowadays. The presence or absence of lymph-node metastasis in EGC is an important prognostic factor; in other words, the survival rate or recurrence rate of node-negative EGC is known to be much better than that of node-positive EGC. The incidence of EGC among resected gastric cancers was 14.7%, and has been increasing annually. The mean age of the EGC patient was 52.4 years, and the most common type was IIc. The size of the lesion was variable, but the most common range was 1~3 cm. Lymph-node metastasis accurred more frequently with the larger sized lesions. In this study, several factors such as age, sex, tumer location, tumer size, depth of invasion, macroscopic and histologic type were evaluated to determine frequency of lymph node metastasis. In the analysis of these eight facters, sex, tumer size, depth of invasion and Lauren type were statistically correlated with lymp node metastasis.

Gardner's Syndrome Report of one case

Gardner's syndrome is a familial disease consisting of gastrointestinal adenomatous polyposis, osteomas of the mandible, skull, and long bones, and a variety of sol tissue lesions, including sebaceous cysts, fibromas, lipomas, and desmoid tumors. The colon is the most common site for polyposis, but the stomach, duodenum, small bowel, and periampullary area may also be involved. The diagnostic evaluation, malignant potential, and management is identical to that for familial adenomatous polyposis. The extracolonic manifestations of Gardner's syndrome are frequent and varied. Gardner's syndrome is inherited as autosomal dominant traits. Authors experienced one case that is a 32 year old female patient who had colonic and duodenal multiple polyposis, desmoid tumor in abdominal wall and right mesocolon and odontoma on mandible.

Perimpullary Carcinoma: A Study on Prognostic Factors Influencing long Term Survival After Pancreaticoduodenectomy

From November 1987 to December 1995, 76 patients with periampullary cancer underwent resectional surgery in the department of surgery, Kosin medical college. The object of this study was to assess the prognostic factors of the periampullary cancer after pancreaticoduodenectomy. The postoperative mortality rate was 11.8%. Significant morbidity occurred in 39.5% of the patients, early reoperation was required in 9.2% of these patients, and the mean hospital stay was 21.7 days. Univariate analysis on all patients revealed that the survival rate was significantly related to the size of the tumor (> or =3.0 cm 13%, 50 20.5%, 0.05). These results indicated that patients with a tumor size lesser than 3cm, without lymph node involvement, and under the age of 50 had a long term survival rate.

A Case of Rectal Cancer in 12 year Old Boy

Children's rectal cancer is a very rare condition and its reported incidence is below 0.5%. The prognosis is very poor due to the advanced stage at diagnosis and a higher malignant potential. Recently some authors treated rectal cancer of children with surgery and they have had a better prognosis. We experienced a case of rectal cancer in a 12 year old boy treated with surgery and chemotherapy and reviewed related literature.

Study on 10 Year Follow-up after Radical Gastrectomy for Stomach Cancer

A retrospective study was made from 468 cases of stomach cancer from January 1980 to December 1985 in Gospel Hospital, Kosin Medical College. The purpose of this report is to clarrify the 10 year survival rate and prognostic factors. The results were as follows: 1) There was a male preponderance with a male to female ratio of 1.7:1. The peak incidence of age was 6th decade. 2) In 468 radical gastrectomized patients, the most common primary site was lower one-third of stomach(61.2%). 3) About stage distributions, 8.8% of patients were in stage Ia, 19.7% in Ib, 26.5% in II, 24.1% in IIIa, 17.5% in IIIb and 3.4% in IV. 4) The 10 year survival rates according to T and N factors were 86.4% in T1, 54.4% in T2, 37.4% in T3, and 15.6% in T4 ; 64.5% in N0, 32.5% in N1, and 18.4% in N2(P=0.0001) 5) The 10 year survival rates according to methods of operation were 46.5% in subtotal gastrectomy and 15.3% in total gastrectomy. 6) The 10 year survival rates according to WHO pathologic classification were 20% in papillary, 47.2% in well differentiated tubular, 48.2% in moderately differentiated tubular, 32.4% in poorly differentiated, 32.1% in mucinous, and 25.0% in signet ring cell type. 7) The 10 year survival rates according to Lauren classification were 46.3% in intestinal, 28.9% in diffuse, and 38.7% in mixed type.

Alteration of Phospholipase C Activity in Human Gastric Cancer Tissues

Phospholipase C (PLC) plays a pivotal role in transmembrane signal transduction pathway for cellular proliferation differentiation and growth. Thus far, there have been few reports in which PLC activity was investigated in human malignant neoplastic tissues. In the present study, we evaluated PLC activity in 23 human gastric cancer tissues and normal mucosal tissues to investigate whether alteration of PLC activity is associated with gastric cancer. The amount of [14C] diacylglycerol, one of the earliest products of inositol phospholipid hydrolysis by PLC, was measured by thin layer chromatography. Also, expression of PLC-gamma1, which is one of the most important PLC isozymes,was examined by immunohistochemistry using specific monoclonal antibody directed against PLC-gamma1. The results are summarized as follows. PLC activity in all 23 gastric cancer tissues (1.35+/-1.04 units/mg of protein) was significantly higher than normal mucosal tissues (0.28+/-0.21 units/mg of protein) (P0.05). PLC-gamma1 immunoreactivity was detected in all of 23 cases studied. The intensity and extent of PLC-gamma1 immunoreactivity was not correlated with PLC enzyme activity, although stronger intensity was demonstrated in malignant cells in comparison to normal gland epithelial cells. The present study provides the first evidence of significant elevation of PLC activity in human stomach cancer tissues. Our results strongly suggest that PLC might be involved in tumorigenesis and/or progression(uncontrolled continuous cycling of cells) of human gastric cancer. Further studies are needed to elucidate the role of elevated PLC activity in cancer tissues.

Clinical Analysis of 300 Renal Transplantations / 대한비뇨기과학회지

Three hundred renal transplantations were performed by the transplantation team in the Kosin Medical College from December, 1984 to August, 1993. Prognosis and complications with affecting factors and demographic data were analysed and the results were as follows; 1. In 300 recipients, 206 cases were male and 94 cases were female. 146 cases were male and 154 cases were female in 300 donors 2. All 300 cases were living transplantations ; among them, 207 cases were related and 93 cases were unrelated donors. 3. The most common underlying disease of recipients was chronic glomerulonephritis (89%). 4. In 263 donors, the left kidney was selected for graft. 5. For donor nephrectomy, flank incision( anterior incision) was used in all cases and among them 12th transcostal incision was made in 134 cases. 6. For ureteroneocystostomy, modified MacKinnon`s method was performed in 297 cases and Politano-Leadbetter procedure was used in only 3 cases. 7. Postoperative urologic complications occurred in 26 cases( 8.3%) ; perirenal hematoma, 16 cases for which revision was done; urine leakage, 8 cases for which 6 cases needed revision. 8. Complications of donor nephrectomy occurred in 8 cases( 2.6%) ; retroperitoneal hematoma, 2 cases; pneumothorax, 2 cases; pleural effusion, atelectasis, ulcer perforation and stress ulcer, one case respectively. 9. The survival rate for the graft was 91.6% for one year, 88.1 % for 2 years, 81.5% for 3 years, 77.7% for 4 years and 74.3% for 5 years. The survival rates of the recipients were 94.4%, 93.6%, 91.4%, 89.7% and 89.7% according to each year respectively.

The influence of linoleic acid and ursolic acid on mouse peritoneal macrophage activity / 대한면역학회지

No abstract available.

DNA ploidy as a prognostic factor in stomach cancer

No abstract available.

A clinical study of total gastrectomy for gastric cancer

No abstract available.