PURPOSE: In the last three decades liver transplantation (LT) has been established as a standard procedure for end-stage liver disease. However, the shortage of donor livers is the most significant factor inhibiting further application of clinical liver transplantation. In Korea, where B-hepatitis is endemic, most patients waiting for LT are adult with B-hepatitis associated end stage liver disease. Safe, in situ splitting of a cadaver donor liver for two separate adult recipients would be an attractive way to decrease the deaths of adult patients while waiting for organs. Split grafts weighing more than 1% of the recipient's body weight (Graft to Recipient Weight Ratio, GRWR>1%) should be transplanted in order to adequately meet postoperative metabolic needs. We investigated whether one cadaver liver can be split into two so that each graft has a GRWR>1%. METHODS: Between January 1999 and December 1999 at Guro medical center, we selected 47 patients diagnosed as early gastric cancer (EGC) or early stage colon cancer and reviewed their pre-operative abdominal CT films for use in our study. Pictures of CT films were taken with a digital camera and converted to TIF files in order to calculate the standard liver volumes which were then divided by the plane that represented two operative methods proposed in this study. First, we performed a Rt. lobectomy along the right side of the middle hepatic vein to increase the function of segment IV by preventing venous congestion. Second, we performed a Lt. lobectomy with hepatic IVC to save the volume of the caudate lobe (segment I). RESULTS: The body index of the 47 cases was distributed from -10% to 20%. The standard whole liver volume was 1266+/-299 ml (Mean+/-SD). Rt. lobe volume was 751+/-188 ml, and Lt. lobe volume was 515+/-154 ml. Each result was no less than 1% of 75 kg and 50 kg adult's body weight. CONCLUSION: On average, the GRWR of the Rt. lobe is more than 1% in a 75 kg adult by itself and that of the Lt. lobe can also be above 1% in a 50 kg adult by maximizing the function of segments I and IV using the surgical techniques mentioned above. Therefore, we would be able to successfully spilt a cadaver donor liver to a 75 kg and a 50 kg adult recipient, respectively.
Adult* ; Body Weight ; Cadaver ; Colonic Neoplasms ; End Stage Liver Disease ; Hepatic Veins ; Humans ; Hyperemia ; Korea ; Liver Diseases ; Liver Transplantation* ; Liver* ; Stomach Neoplasms ; Tissue Donors ; Tomography, X-Ray Computed ; Transplants

No abstract available.
Humans

No abstract available.
Humans ; Quality of Life*

PURPOSE: p27Kip1 protein is an inhibitor of cyclin-dependent kinases and is thought to be a potential prognostic indicator for numerous human cancers. We investigated the expression of p27Kip1 in gastric cancer in order to estimate its clinical utility. METHODS: Immunohistochemical assay for p27Kip1 protein was performed in 64 patients with primary gastric cancer. The correlation between p27Kip1 and clinical-biological parameters including patient survival was analyzed. RESULTS: p27Kip1 expression was suppressed in 40 (62.5%) of 64 gastric cancer patients. Expression of p27Kip1 was significantly reduced in poorly differentiated cancers (82.1%, 23/28; P=0.015) and was also reduced in tumors with a high S-phase fraction as compared with tumors showing a low S-phase fraction (86.7%, 26/30, 41.2%, 14/34; P=0.0002). In univariate analysis, the extent of the disease (P<0.001), and reduced expression of p27Kip1 (P=0.0006) were statistically significant to predict the patient's outcome, however depth of invasion (P=0.008) and pathologic stage (P=0.009) emerged as significant prognostic indicators in the multivariate analysis. CONCLUSION: The expression of p27Kip1 is closely linked with cell proliferation and differentiation of human gastric cancer. p27Kip1 appears to have potential as a prognostic marker in the management of gastric cancer patients.
Cell Proliferation ; Cyclin-Dependent Kinase Inhibitor p27* ; Cyclin-Dependent Kinases ; Humans* ; Immunohistochemistry ; Multivariate Analysis ; Prognosis ; Stomach Neoplasms*

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) have a common route like sexually transmitted infections (STIs), vertical transmission and blood transfusion, etc. Therefore, it was necessary to be an attempt to confirm the relationship of HBV and HIV in Korea. We investigated the prevalence of Hepatitis B surface antigen (HBsAg) and Hepatitis B core antibody (anti-HBc) in HIV positive groups (n=430) and HIV negative groups (n=434) from January 2014 to October 2015. When comparing the prevalence of anti-HBc between the two groups, HIV positive group (36.0%) showed a higher prevalence than HIV negative group (24.7%), the result was statistically significant (p < 0.05). However, there was a little difference on HBsAg and not significant. Therefore, by showing a clear difference in anti-HBc between the two groups of HIV in Korea, it was confirmed to be associated with co-infections between Hepatitis B and HIV.
Blood Transfusion ; Coinfection* ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; HIV* ; Korea* ; Prevalence* ; Sexually Transmitted Diseases

PURPOSE: Differentiating gynecological emergency surgery indications among reproductive-age female patients presenting with acute abdominal pain is challenging for emergency department (ED) physicians. We evaluated the clinical demographics of female patients diagnosed with gynecological surgery indications in the ED and found clinical predictors associated with surgical indications overall and with each surgical indication. METHODS: We conducted a prospective review study of the hospital registries of reproductive-aged women who presented with abdominal pain but without underlying disease from April 2008 to October 2010. These registries included information concerning the patient's basic characteristics, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. Using a multivariate logistic regression analysis, we found a number of statistically significant factors indicating a gynecological emergency necessitating surgery. RESULTS: A total of 1047 cases involving female patients of reproductive age were initially included. We found 89 patients(8.50%) who were diagnosed as having gynecological surgery indications: 50(4.78%) were diagnosed with hemorrhagic ovarian cyst rupture, 16(1.53%) with ectopic pregnancy, and 23(2.20%) with ovarian torsion. Pain of more than 14 days from the last menstrual period (OR, 2.332; 95% CI, 1.406-3.968; p=0.001), bilateral lower abdominal tenderness (OR, 0.467; 95% CI, 0.288-0.758; p=0.002), rebound tenderness (OR, 0.54; 95% CI, 0.329-0.887; p=0.015), normal C-reactive protein value (CRP) (OR, 3.286; 95% CI, 1.717-6.290; p<0.001), and positive human chorionic gonadotropin test (OR, 0.058; 95% CI, 0.024-0.142; p<0.001) were related to gynecologic emergency surgery indication in a patient with abdominal pain. CONCLUSION: Clinical findings of the last menstrual period, bilateral abdominal tenderness, rebound tenderness, CRP value, and urine hCG result can be helpful in exclusion of gynecologic emergency surgical indications.
Abdominal Pain* ; C-Reactive Protein ; Chorionic Gonadotropin ; Demography ; Emergencies* ; Emergency Service, Hospital* ; Female ; Gynecologic Surgical Procedures ; Humans ; Logistic Models ; Ovarian Cysts ; Pregnancy ; Pregnancy, Ectopic ; Prospective Studies ; Registries ; Rupture

PURPOSE: Differentiating gynecological emergency surgery indications among reproductive-age female patients presenting with acute abdominal pain is challenging for emergency department (ED) physicians. We evaluated the clinical demographics of female patients diagnosed with gynecological surgery indications in the ED and found clinical predictors associated with surgical indications overall and with each surgical indication. METHODS: We conducted a prospective review study of the hospital registries of reproductive-aged women who presented with abdominal pain but without underlying disease from April 2008 to October 2010. These registries included information concerning the patient's basic characteristics, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. Using a multivariate logistic regression analysis, we found a number of statistically significant factors indicating a gynecological emergency necessitating surgery. RESULTS: A total of 1047 cases involving female patients of reproductive age were initially included. We found 89 patients(8.50%) who were diagnosed as having gynecological surgery indications: 50(4.78%) were diagnosed with hemorrhagic ovarian cyst rupture, 16(1.53%) with ectopic pregnancy, and 23(2.20%) with ovarian torsion. Pain of more than 14 days from the last menstrual period (OR, 2.332; 95% CI, 1.406-3.968; p=0.001), bilateral lower abdominal tenderness (OR, 0.467; 95% CI, 0.288-0.758; p=0.002), rebound tenderness (OR, 0.54; 95% CI, 0.329-0.887; p=0.015), normal C-reactive protein value (CRP) (OR, 3.286; 95% CI, 1.717-6.290; p<0.001), and positive human chorionic gonadotropin test (OR, 0.058; 95% CI, 0.024-0.142; p<0.001) were related to gynecologic emergency surgery indication in a patient with abdominal pain. CONCLUSION: Clinical findings of the last menstrual period, bilateral abdominal tenderness, rebound tenderness, CRP value, and urine hCG result can be helpful in exclusion of gynecologic emergency surgical indications.
Abdominal Pain* ; C-Reactive Protein ; Chorionic Gonadotropin ; Demography ; Emergencies* ; Emergency Service, Hospital* ; Female ; Gynecologic Surgical Procedures ; Humans ; Logistic Models ; Ovarian Cysts ; Pregnancy ; Pregnancy, Ectopic ; Prospective Studies ; Registries ; Rupture

Adrenal Cortex Hormones ; Bacteria ; Cellulitis ; Dermis ; Extremities ; Fever ; Hypersensitivity ; Leukocytosis ; Neutrophils ; Rare Diseases ; Sweet Syndrome

Objective: Agriculture is a hazardous industry. However, previous studies have focused on injuries to agricultural workers without comparison with injuries to nonagricultural workers. Therefore, we compared the clinical characteristics and outcomes of injuries reported at an emergency department (ED) between agricultural workers and nonagricultural workers. Methods: We established a prospective ED-based agricultural injury surveillance system at a tertiary university hospital. Adult patients visiting the ED for an injury were divided into farmer and non-farmer groups depending on their engagement with agriculture. Using an adjusted multivariate analysis and propensity score matching (age, sex, inhabitant, and insurance type), we compared the clinical characteristics and outcomes of injuries between the farmer and non-farmer groups. Results: In total, 38,556 injured adult patients (37,746 in the non-farmer group and 810 in the farmer group) were available for the unmatched sample analysis. The 1,620 matched subjects were equally classified after one-to-one nearest-neighbor propensity score matching. A multivariate logistic regression analysis of the unmatched sample revealed higher adjusted odds ratios (ORs) for intensive care unit admission (adjusted OR, 1.752; P=0.003) and overall surgery (adjusted OR, 1.870; P<0.001) in the farmer group. In contrast, univariate logistic regression analyses of the propensity score–matched sample found a higher OR in the farmer group only for overall surgery (OR, 1.786; P<0.001). Conclusion Injuries of agricultural workers had higher odds only of requiring surgery; differences in injury-related mortality between groups were not statistically significant in either the matched or unmatched sample analyses.

Objective: Agriculture is a hazardous industry. However, previous studies have focused on injuries to agricultural workers without comparison with injuries to nonagricultural workers. Therefore, we compared the clinical characteristics and outcomes of injuries reported at an emergency department (ED) between agricultural workers and nonagricultural workers. Methods: We established a prospective ED-based agricultural injury surveillance system at a tertiary university hospital. Adult patients visiting the ED for an injury were divided into farmer and non-farmer groups depending on their engagement with agriculture. Using an adjusted multivariate analysis and propensity score matching (age, sex, inhabitant, and insurance type), we compared the clinical characteristics and outcomes of injuries between the farmer and non-farmer groups. Results: In total, 38,556 injured adult patients (37,746 in the non-farmer group and 810 in the farmer group) were available for the unmatched sample analysis. The 1,620 matched subjects were equally classified after one-to-one nearest-neighbor propensity score matching. A multivariate logistic regression analysis of the unmatched sample revealed higher adjusted odds ratios (ORs) for intensive care unit admission (adjusted OR, 1.752; P=0.003) and overall surgery (adjusted OR, 1.870; P<0.001) in the farmer group. In contrast, univariate logistic regression analyses of the propensity score–matched sample found a higher OR in the farmer group only for overall surgery (OR, 1.786; P<0.001). Conclusion Injuries of agricultural workers had higher odds only of requiring surgery; differences in injury-related mortality between groups were not statistically significant in either the matched or unmatched sample analyses.