PURPOSE: This study was designed to review the results of 2nd and 3rd kidney transplantation at our center. METHODS: Total 1,500 patients who had undergone kidney transplantation from 1968 to Aug 2005 at the Catholic Medical Center were retrospectively analyzed. The graft and patient survival were determined using Kaplan-Meier actuarial survival curves, compared with those of first transplant and assessed for significance using the log rank test. RESULTS: The patient of 2nd transplantation was 77 cases (male 55, female 22, mean age: 48.9+/-2.4 years) and 3rd transplantation was 5 patients (male 4, female 1, mean age 46.8+/-6.0 years). The 82 kidneys included from living donors in 67 patients and from cadaveric donors in 15 patients. The most common cause of renal failure of retransplanted kidney was chronic GN (2nd: 62 cases (80.5%), 3rd: 5 cases (100%)). The immunosuppressive regimen was mainly based on cyclosporine (2nd: 61 cases (79.2%), 3rd: 3 cases (60%)). The mean duration of the second transplantation from the first was 89.0 months and the third transplantation from the second was 32.7 months. There were 16 cases of death patients and the main cause of death was infection and cardiovascular events. The graft survival of 2nd & 3rd transplantation in 1 year were over 80%. CONCLUSION: Renal retransplantation is safe, effective, and the treatment of choice in patients with failed previous kidney transplantation for patient's quality of life and not associated with increased mortality retransplantation. The results of graft survival for retransplantation seem to be excellent for primary transplantation under cyclosporine or tacrolimus-based immunosuppression. The use of the potent and appropriate immunosuppression and surgical technique for retransplantation could help to improve better results.
Cadaver ; Cause of Death ; Cyclosporine ; Female ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Kidney* ; Living Donors ; Mortality ; Organ Transplantation* ; Quality of Life ; Renal Insufficiency ; Retrospective Studies ; Tissue Donors ; Transplants*

Pleomorphic adenoma is the most common salivary neoplasm and occurs mainly in major salivary glands, especially the parotid gland. It is characterized by a variable histopathologic appearance, and a high recurrence rate with malignant transformation depending on previous surgical treatment method used. A benign mixed tumor occurring in minor salivary glands is believed to show the same clinicopathologic appearance and a relatively low recurrence rate as in major salivary glands. Pleomorphic adenoma is the most common intraoral salivary gland tumor and characteristically presents as a slow, painless growth. Herein, we report a case of a patient with pleomorphic adenoma that affected the upper lip.
Adenoma, Pleomorphic* ; Humans ; Lip* ; Parotid Gland ; Recurrence ; Salivary Glands ; Salivary Glands, Minor

Purpose: The incidence of gallstone disease and cholecystectomy is increasing worldwide. The aim of this study was to determine trends in the incidence of cholecystectomy in Korea. Methods: The National Health Insurance Services database was used to determine patterns in proportion of cholecystectomy and cholecystostomy in the total population of Korea from 2003 to 2017. The age-standardized rate (ASR) was calculated to compare the cholecystectomy and cholecystostomy according to changes in the population structure over time. The ASR was investigated according to patient age, sex, socioeconomic status, use of computed tomography, and type of hospital to identify trends. Results: The ASR per 100,000 based on the 2010 population of cholecystectomy cases increased markedly from 67.7 to 211.4 between 2003 and 2017. The ASR was consistently higher in female than male (71.9 vs. 63.6 in 2003, 221.8 vs. 201.8 in 2017). Furthermore, the ASR for cholecystectomy increased with age, and surgery for gallstone disease was performed more often at a specialized center than at other medical facilities. The length of hospital stay of cholecystectomy decreased steadily from 10.6 days in 2003 to 6.9 days in 2017. Conclusion This study shows that the incidence of cholecystectomy and cholecystostomy has steadily increased over the years in Korea, with a trend toward older age and higher socioeconomic status in patients undergoing cholecystectomy. Increasing use of computed tomography investigations could be a primary cause for this trend. An integrated strategy is needed to manage the increase in older patients undergoing cholecystectomy and shorten their hospital stay with medical safety.

PURPOSE: The efficacy of adjuvant chemotherapy (AC) in stage IIa colon cancer is controversial. This study aimed to investigate the factors influencing survival in patients with stage IIa colon cancer, the role of AC, and the indications for AC utilization by surgical oncologists. METHODS: Between January 2004 and December 2010, 736 patients with stage IIa colon cancer underwent curative resection in 1 of 6 participating hospitals. Factors related to survival were identified and analyzed according to whether AC was administered or not. After high- and low-risk groups were identified, their respective results were analyzed. RESULTS: The 5-year overall survival (OS) of stage IIa colon cancer was 90.3%. With the exception of poorly differentiated histology, indications for AC did not include typical high-risk factors. The indications for AC were significantly younger patients, higher body mass index (BMI), lower American Society of Anesthesiologists (ASA) physical status classification, and higher histologic grade. BMI, preoperative carcinoembryonic antigen, and harvested lymph node (LN) count were significant factors for disease-free survival, while BMI and ASA physical status classification were significant factors for OS in the chemotherapy group. In the high-risk group, AC was associated with increased OS in univariate analysis. BMI and harvested LN count were statistically significant in multivariate analysis. CONCLUSION: Surgical oncologists consider the patient's condition and postoperative course rather than high-risk factors to determine use of AC. Regardless of AC use, both the extent of surgery and the patient's subsequent status affected the survival rate in the high-risk group. None of the factors identified influenced survival rate in the low-risk group.
Body Mass Index ; Carcinoembryonic Antigen ; Chemotherapy, Adjuvant ; Classification ; Colon ; Colonic Neoplasms ; Disease-Free Survival ; Drug Therapy ; Humans ; Lymph Nodes ; Multivariate Analysis ; Surgeons ; Survival Rate

Complex regional pain syndrome (CRPS) is a chronically painful and disabling disorder. However, no data are available even on the epidemiology of CRPS in Korea. This study was undertaken to retrospectively assess the epidemiologic characteristics of CRPS in 150 consecutive patients at a tertiary chronic pain center from March 2002 to February 2006. Information was obtained regarding patients' demographics, nature of injury, and treatment modalities. Seventy-one percent of patients had CRPS type I. The mean 11-point verbal numerical rating scale score at initial examinations and at the time of study were 8.0 and 5.7, respectively. Thirty-two percent of patients showed no change or increase in pain intensity during follow-up at our pain center. The mean duration of CRPS symptoms prior to our pain center evaluation and prior to the time of study were 27 months and 50 months, respectively. These patients had seen on average 5 different physicians before being referred to our center. This study shows that the majority of CRPS patients were referred to our center after more than 2 yr of symptoms. The clinical implication of such delayed transfer and strategies to avoid this problem are discussed.
Adult ; Complex Regional Pain Syndromes/*diagnosis/*epidemiology/therapy ; Female ; Humans ; Korea ; Male ; Middle Aged ; Pain/epidemiology ; Pain Clinics ; Pain Measurement/methods ; Retrospective Studies ; Time Factors ; Wounds and Injuries/complications

Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. Although impaired tissue oxygenation is usually responsible for the rise in lactate production, lactic acidosis could be caused by drugs including metformin and the nucleoside reverse-transcriptase inhibitors. Linezolid, an oxazolidinone antibiotic, is currently indicated to treat serious infections caused by vancomycin-resistant enterococcus and other gram-positive organisms. A 74-year old woman was found to have pyogenic vertebral osteomyelitis and treated with linezolid. Thirty-one days after linezolid therapy, she developed severe lactic acidosis. We report a case of lactic acidosis associated with prolonged linezolid therapy.
Acetamides ; Acidosis ; Acidosis, Lactic ; Enterococcus ; Female ; Humans ; Lactic Acid ; Metformin ; Osteomyelitis ; Oxazolidinones ; Oxygen ; Linezolid

Biliary enteric fistula is fistulous communication between the biliary tract and the gastrointestinal tract due to gallstones, peptic ulcer, malignancy and trauma. The types of fistulas are cholecystoduodenal, cholecystocolonic, choledochoduodenal, cholecystogastric and very rare choledochogastric. The preoperative diagnosis is difficult because their symptoms are usually nonspecific. Pneumobilia on plain film of the abdomen has been considered as a clue. Reflux of contrast media into the biliary tree during a barium study or an endoscopic retrograde cholangiopancreatography is most suggestive finding. We experienced a case of spontaneous choledochogastric fistula. A 62-year-old man was admitted to Chungbuk National University Hospital with epigastric pain. A 5 mm sized orifice of fistula on the prepyloric antrum of the stomach was observed on gastroscopy. Abdominal computed tomography scan showed pneumobilia in the intrahepatic duct of the liver. Upper gastrointestinal series showed the contrast media leaking from the posterior wall of antrum of the stomach into the common bile duct.
Abdomen ; Barium ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Chungcheongbuk-do ; Common Bile Duct ; Contrast Media ; Diagnosis ; Fistula* ; Gallstones ; Gastrointestinal Tract ; Gastroscopy ; Humans ; Liver ; Middle Aged ; Peptic Ulcer ; Stomach

BACKGROUND: With increasing use of digital cameras, it is needed to develop a better method of taking photographs that meet the dermatologists' demand. Recent digital cameras have super-macro mode capability, but that mode is only available in very bright conditions such as sun shining locations because flashing is unavailable. OBJECTIVE: To develop a better method of taking delicate and reproducible super-macro mode photographs using digital cameras under ordinary hospital or clinic settings. METHODS: We planned to develop an illuminator with a high brightness light emitting diode for the super-macro mode of a digital camera. To be economical, convenient, and lightweight, the illuminator was designed to plug into the USB port of a personal computer for the power source. We have applied the illuminator to three different camera models. The light emitting diodes were arranged in some different ways for better results. RESULTS: When we took super-macro photographs with this device, patients felt no discomfort, such as dazzling, which they have experienced with a camera flash. And, the photographs showed more delicate zoomed-in images and were reproducible. The image quality was enhanced with the more optimal arrangement of diodes. We named the small space in front of the camera lens, `micro studio', because we can modify the lighting method for better illumination. The users may maximize the capability of the digital camera using this device. CONCLUSION: We developed an economically appealing and flexible digital camera device that enables us to take super-macro mode images of a much more enhanced quality. It may be useful for many dermatologists who use digital cameras.

Eosinophilic gastroenteritis is an unusual disease that is associated with various clinical gastrointestinal manifestations. Its severity depends on the area involved as well as the wall layer involved. Eosinophilic gastroenteritis often causes abdominal pain, nausea, vomiting and diarrhea. To date, there has been an extremely rare case of eosinophilic gastroenteritis with systemic symptoms, such as fever or lymphadenopathy (LAP). We experienced a case of a 68-year-old-woman with fever and abdominal pain. Abdominal computed tomography revealed diffuse wall thickening of the gastric antrum as linitis plastica. Multiple hot uptakes of lymph nodes were visualized on fludeoxyglucose-positron emission tomography. The gastric biopsy pathological report demonstrated eosinophilic infiltration without malignant cells. We could not exclude malignancy and performed an exploratory laparoscopy. A lymph node specimen showed reactive hyperplasia, and her illness was finally diagnosed as eosinophilic gastroenteritis. Herein, we report the case with a brief review.
Abdominal Pain ; Biopsy ; Diarrhea ; Enteritis ; Eosinophilia ; Eosinophils ; Fever ; Gastritis ; Gastroenteritis ; Hyperplasia ; Laparoscopy ; Linitis Plastica ; Lymph Nodes ; Lymphatic Diseases ; Nausea ; Pyloric Antrum ; Vomiting

OBJECTIVE: To compare the effect of radio frequency ablation (RFA) on the dimensions of radio frequency coagulation necrosis in a rabbit lung using a wet electrode in monopolar mode with that in dual electrode bipolar mode at different infusion rates (15 mm/hr versus 30 ml/hr) and saline concentrations (0.9% normal versus 5.8% hypertonic saline) . MATERIALS AND METHODS: Fifty ablation zones (one ablation zone in each rabbit) were produced in 50 rabbits using one or two 16-guage wet electrodes with a 1-cm active tip. The RFA system used in the monopolar and dual electrode wet bipolar RFA consisted of a 375-kHz generator (Elektrotom HiTT 106, Berchtold, Medizinelektronik, Germany). The power used was 30 watts and the exposure time was 5 minutes. The rabbits were assigned to one of five groups. Group A (n = 10) was infused with 0.9% NaCl used at a rate of 30 ml/hr in a monopolar mode. Groups B (n = 10) and C (n = 10) were infused with 0.9% NaCl at a rate of 15 and 30 ml/hr, respectively in dual electrode bipolar mode; groups D (n = 10) and E (n = 10) were infused with 5.8% NaCl at a rate of 15 and 30 ml/hr, respectively in a dual electrode bipolar mode. The dimensions of the ablation zones in the gross specimens from the groups were compared using one-way analysis of variance by means of the Scheffe test (post-hoc testing). RESULTS: The mean largest diameter of the ablation zones was larger in dual electrode bipolar mode (30.9+/-4.4 mm) than in monopolar mode (22.5+/-3.5 mm). The mean smallest diameter of the ablation zones was larger in dual electrode bipolar mode (22.3+/-2.5 mm) than in monopolar mode (19.5+/-3.5 mm). There were significant differences in the largest and smallest dimension between the monopolar (group A) and dual electrode wet bipolar mode (groups B-E). In dual electrode bipolar mode, the mean largest diameter of the ablation zones was larger at an infusion rate of 15 ml/hr (34.2+/-4.0 mm) than at 30 ml/hr (27.6+/-0.1 mm), and the mean smallest diameter of the ablation zones was larger at an infusion rate of 15 ml/hr (27.2+/-7.5 mm) than at an infusion rate of 30 ml/hr (24+/-2.9 mm). CONCLUSION: Using a wet electrode, dual electrode bipolar RFA can create a larger ablation zone more efficiently than monopolar RFA.
Sodium Chloride/administration & dosage ; Rabbits ; Pulmonary Alveoli/pathology ; Necrosis ; Lung Neoplasms/surgery ; Equipment Design ; *Electrodes ; Catheter Ablation/*instrumentation/methods ; Animals