BACKGROUND: Many renal allograft patients were received blood transfusions in the pre- or posttransplant period. Before cyclosporine era, many studies showed that immunomodulation which induced by blood transfusion before renal allograft improved graft survival. However, the graft-protective effects of blood transfusion have been questioned in the recent studies. We compared the effects of perioperative blood transfusion on renal allograft rejection and graft survival in transfusion and nontransfusion groups. METHODS: 462 patients (127 cadaveric v.s 335 living) who were received renal allograft from January, 1994 to December, 1997 in our center were grouped into the transfusion and nontransfusion group. All the patients received same triple immunosuppressive regimens (cyclosporine, azathioprine, prednisone). Rejection and graft survival were analyzed retrospectively. Mean follow up period was 838 days (range: 5-1,640). RESULTS: Out of 462 patients, 389 (84.2%) were transfused and mean transfused volume was 4.56 0.38 pints. 73 (15.8%) showed rejection on biopsy. The transfusion group showed 61 (15.7%) rejections and nontransfusion group showed 12 (16.4%) rejections. There was no statistically significant difference of rejection between transfusion and nontransfusion group (p=0.86). Regardless of cadaveric and living renal allograft group, there was no difference of blood transfusion effect on rejection (p=0.53 v.s p=0.98). Rejection was one of the negative factor affecting graft survival significantly (p=0.00). In terms of graft survival, there was no difference between the transfusion and nontransfusion group (p=0.11) CONCLUSION: We conclude that pre- and posttransplant blood transfusions have no detectable beneficial or harmful effects on rejection and graft survival in renal allograft under the current cyclosporine based immunosuppressive medication.
Allografts* ; Azathioprine ; Biopsy ; Blood Transfusion* ; Cadaver ; Cyclosporine ; Follow-Up Studies ; Graft Survival* ; Humans ; Immunomodulation ; Retrospective Studies ; Transplants*

BACKGREOUND: The pneumonectomy may depress the right ventricular (RV) function transiently. The thermodilution ejection/volumetric catheter is known to be most useful method assessing the changes in RV performance during pulmonary resection. The purpose of this study was to examine the RV function during and immediately after pneumonectomy using thermodilution methods. METHODS: 16 patients undergoing pneumonectomy were studied. After induction of anesthesia, a multilumen thermodilution catheter mounted with a rapid response thermister was inserted. Using computer system, RV ejection fraction (RVEF), cardiac output, and RV end-diastolic volume (RVEDV) were measured when the patient was in lateral position (control), after one lung ventilation (OLV) and the main pulmonary artery ligated, and at the completion of resection. Arterial blood gases were analyzed and pulmonary vascular resistance (PVR) was calculated. RESULTS: Systolic pulmonary blood pressure (SPAP)(28.3 +/- 6.2 mmHg) increased compared to the control (24.6 +/- 5.9) without a significant change of PVR. No statistically significant difference was found in either RVEF or RVEDV at each times. CONCLUSIONS: Our study demonstrate the pneumonectomy do not depress the RV function immediately and RVEF do not show any correlation with PVR or RVEDV.
Anesthesia ; Blood Pressure ; Cardiac Output ; Catheters ; Computer Systems ; Gases ; Humans ; One-Lung Ventilation ; Pneumonectomy* ; Pulmonary Artery ; Thermodilution ; Vascular Resistance ; Ventricular Function, Right*

Carcinoma of the prostate is a common malignancy affecting elderly men. Lung metastasis from prostate cancer occurs frequently, but tumor metastasis to the central bronchi that clinically mimics primary bronchogenic carcinoma are very rare. We report a 73-year old man with endobronchial metastasis from prostatic carcinoma presented with respiratory symptom cough. Diagnosis of issues taken from materials which were used for bronchoscopic biopsy and prostate biopsy and immunohistochemical staining for prostate specific antigen(PSA) confirmed a case of endobronchial metastasis from prostatic carcinoma. Hormonal therapy(LHRH agonist) was applied to this patient.
Aged ; Biopsy ; Bronchi ; Carcinoma, Bronchogenic ; Cough ; Diagnosis ; Humans ; Lung ; Male ; Neoplasm Metastasis* ; Prostate ; Prostatic Neoplasms

Pheochromocytoma with pregnancy is very uncommon but it is associated with very high maternal and fetal morbidity and mortality. Antepartum diagnosis and proper management can prevent mother and fetus from potentially lethal outcome. Since pheochromocytoma produces and secretes catecholamines, hemodynamic instability can be brought. The aim of anesthetic management is the avoidance of drugs and episodes that will result in hypertensive crisis, and the selection of safe anesthetic measures and anesthetics to mother and fetus. We report a case of pheochromocytoma with pregnancy managed with combined anesthetic technique-epidural anesthesia for cesarean section and general anesthesia for resection of pheochromocytoma 3 weeks after cesarean section. ?
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Catecholamines ; Cesarean Section ; Diagnosis ; Female ; Fetus ; Hemodynamics ; Humans ; Mortality ; Mothers ; Pheochromocytoma* ; Pregnancy*

The temporomandibular joint can be dislocated during anesthesia as a result of excessive oral opening and direct laryngoscope handling. Occasionally, yawning can be observed during the induction of anesthesia with propofol. The forceful and voluntary yawning after a propofol injection can lead to a dislocation of the temporomandibular joint. We report a case of an anterior dislocation of the temporomandibular joint upon induction with propofol, which caused difficulties in mask ventilation and endotracheal intubation. Although intubation had been carried out successfully in this case, an unanticipated difficult airway can be confronted at anytime. Therefore, anesthesiologists should be aware of the management of a difficult airway and practice various methods according to a difficult airway algorithm.
Anesthesia* ; Dislocations ; Intubation ; Intubation, Intratracheal ; Jaw* ; Laryngoscopes ; Masks ; Propofol ; Temporomandibular Joint ; Ventilation ; Yawning

Although the most of mushroom poisoning have a clinical menifestation of mild to moderate gastroenteritis, some mushroom may cause a serious illness; acute renal failure, hepatic necrosis. We experienced two cases of acute renal failure complicated by the poisoning of amanita virosa. Amanita virosa have a amatoxin. Amatoxin deteriorate hepatocytes, renal tubular cells, intestinal mucosal cells, and pancreas. They were transferred from local hospital for renal failure management. On admission, blood urea nitrogen and serum creatinine were highly elevated. We diagnosed acute renal failure complicated by poisoning of amanita virosa. In one case, renal function was further deteriorated compared with initial laboratory findings after creatinine was normalized at fifth day. Thus, we did a kidney biopsy. Light microscopy and EM showed interstitial inflammation and moderate tubular atrophy. They were recovered with the supportive management. We report two cases of mushroom poisoning-induced acute renal failure with review of literature.
Acute Kidney Injury* ; Agaricales ; Amanita* ; Atrophy ; Biopsy ; Blood Urea Nitrogen ; Creatinine ; Gastroenteritis ; Hepatocytes ; Inflammation ; Kidney ; Microscopy ; Mushroom Poisoning ; Necrosis ; Pancreas ; Poisoning* ; Renal Insufficiency

BACKGROUND: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. METHODS: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. RESULTS: Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026). CONCLUSIONS: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.
Adult ; APACHE ; Critical Illness ; Health Facility Size ; Humans ; Influenza, Human ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Pandemics ; Retrospective Studies ; Risk Factors

BACKGROUND/OBJECTIVES: Irisin, a newly identified hormone, is associated with energy homeostasis. We investigated whether aged garlic extract (AGE) and exercise training intervention could improve body weight, insulin sensitivity, skeletal muscle fibronectin domain containing protein 5 (FNDC-5) levels, and plasma irisin in high-fat diet (HFD). MATERIALS/METHODS: Male Sprague Dawley rats were fed a ND (normal diet, n = 5) or HFD (n = 28) for 6 weeks. After 6 weeks, all rats were divided into 5 groups for the next 4 weeks: ND, (normal diet, n = 5), HFD (high-fat diet, n = 7), HFDA (high-fat diet + aged garlic extract, n = 7), HFDE (high-fat diet + exercise, n = 7), and HFDEA (high-fat diet + exercise + aged garlic extract, n = 7). Exercise groups performed treadmill exercises for 15-60 min, 5 days/week, and AGE groups received AGE (2.86 g/kg, orally injected) for 4 weeks. RESULTS: Significant decreases in body weight were observed in the ND, HFDE, and HFDEA groups, as compared with the HFD group. Neither intervention affected the masses of the gastrocnemius muscle or liver. There were no significant differences in glucose levels across the groups. The homeostatic model assessments of insulin resistance were significantly higher in the HFD group, as compared with the ND, HFDA, HFDE, and HFDEA groups. However, skeletal muscle FNDC-5 levels and plasma irisin concentrations were unaffected by AGE or exercise in obese rats. AGE supplementation and exercise training did not affect skeletal muscle FNDC-5 or plasma irisin, which are associated with insulin sensitivity in obese rats. CONCLUSION: Our results suggest that the protection against HFD-induced increases in body fat/weight and insulin resistance that are provided by AGE supplementation and exercise training may not be mediated by the regulation of FNDC-5 or irisin.
Animals ; Body Weight ; Diet ; Diet, High-Fat ; Exercise ; Fibronectins ; Garlic* ; Glucose ; Homeostasis ; Humans ; Insulin Resistance ; Liver ; Male ; Models, Animal* ; Muscle, Skeletal* ; Plasma ; Rats* ; Rats, Sprague-Dawley

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.