PURPOSE: We designed this study to find out the risk factors affecting the patency rate after creation of arteriovenous fistula (AVF) for maintenance hemodialysis. METHODS: From March 1997 to April 1999, a total of 206 AVF creation operations [126 of radiocephalic fistula (RCF), 59 of brachiocephalic fistula (BCF), and 21 of grafted fistula] in 165 patients were undertaken by single surgeon under the same surgical technique and principles. In 128 cases (62.1%), operation was performed for the first time and in 42 cases (20.4%), the trial was second time. However in remaining 36 cases (17.5%), the operation was three or more than three times. RESULTS: After a mean follow-up of 9 months, 27 patient death and 53 fistula failure were identified. The overall patency rate at 1- and 2-year were 72.6% and 61.1%. The success patency rate, excluding the early failure cases, at 1-and 2-year were 78.4% and 65.9%. In multivariate analysis, the presence of 2 or more than 2 times failed AVF episodes was the significant risk factor forecasting the poor fistula patency (p<0.05, odd ratio=2.72). Although the odd ratio in patients with grafted fistula or in diabetic patients was 1.39 or 1.48 in multivariate analysis, these factors did not reach the statistical significance in multivariate analysis (P>0.05). In univariate analysis, the 1- and 2 year patency rate of more than third AVF trial group were 53.2% and 25.3%, which showed significant poor patency rate comparing with the ones of first or second AVF trial group (76.73% in 1- and 67.9% in 2-year) (p=0.0197). CONCLUSION: In conclusion, repeated trial of AVF creation (= or >3) in itself was the most powerful significant risk factor affecting the patency rate after AVF creation. The successful first or second trial is very important to expect a long-term patency. Well designed surgery under delicate surgical technique in early referred patient should promise the long-term patency even in patients with diabetes or patients requiring grafted fistula.
Arteriovenous Fistula* ; Fistula ; Follow-Up Studies ; Forecasting ; Humans ; Multivariate Analysis ; Renal Dialysis* ; Risk Factors* ; Transplants

PURPOSE: Fournier's disease is polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas. The objective of this study was to investigate patients with Fournier's gangrene and to determine risk factors that affect mortality. METHODS: This study was a retrospective clinical study. Clinical presentations and outcomes of surgical treatments were evaluated in 27 patients with Fournier's gangrene that were treated in a single institution from January 2000 to March 2009. RESULTS: The mean age of patients was 52.8+/-14.4 yr, and the male-to-female ratio was 25:2. Among the predisposing factors, diabetes mellitus was the most common (n=8, 29.6%). The most common infection source was anorectal (n=16, 59.3%). Sepsis on admission was detected in 16 cases (59.3%). Four patients died during treatment, for an overall mortality of 14.8%. A logistic regression test showed a Fournier's gangrene severity index greater than 9 and sepsis on admission to be prognostic factors. CONCLUSION: The mortality rate was higher in patients with sepsis on admission and with a Fournier's gangrene severity index greater than nine.
Diabetes Mellitus ; Fasciitis, Necrotizing ; Fournier Gangrene ; Humans ; Logistic Models ; Retrospective Studies ; Risk Factors ; Sepsis

PURPOSE: Spontaneous hemoperitoneum is not a common disease but may cause a fatal outcome. Warfarin is a coumarin anticoagulant, used widely for therapeutic and prophylactic anticoagulation. Although, it is considered a life saving medicine, it is associated with significant adverse effects including intraabdominal bleeding. Literatures about spontaneous hemoperitoneum in patients taking anticoagulants have been reported, but until now there have not been a definite establishment in diagnostic criteria and treatment strategy. METHODS: Among 209 patients who were diagnosed hemoperitoneum from Jan 2005 through May 2009, we identified 9 patients with spontaneous hemoperitoneum without any trauma history or solid organ abnormalities. All 9 patients were taking warfarin for various durations. Initially, we evaluated vital signs, laboratory, CT findings, and clinical course, retrospectively. In addition, we analyzed risk factors potentiating the pharmacologic effect of anticoagulants. RESULTS: One of the most prominent features in this study is that all patients showed prolonged international normalized ratio (6.36~15.11). One patient received an exploratory laparotomy for hemoperitoneum secondary to warfarin, presenting as a localized peritonitis in the right lower quadrant of the abdomen. Mean hospital stay was 15.2 days. Five patients were transfused with packed red blood cells (500~1,000 ml) and fresh frozen plasma (300~900 ml). All patients were discharged without any mortality. CONCLUSION: It is important to identify and confirm the factors that can potentiate the pharmacologic effect of anticoagulants, when acute abdomen is suspected in patients taking anticoagulants. If the patients are hemodynamically stable, they can be treated without surgical intervention.
Abdomen ; Abdomen, Acute ; Anticoagulants ; Coumarins ; Erythrocytes ; Fatal Outcome ; Hemoperitoneum ; Hemorrhage ; Humans ; International Normalized Ratio ; Laparotomy ; Length of Stay ; Peritonitis ; Plasma ; Retrospective Studies ; Risk Factors ; Vital Signs ; Warfarin

An ectopic pancreas is the presence of pancreatic tissue outside of its usual location. This condition rarely causes clinical symptoms, and the most commonly reported sites of these lesions are the stomach, the duodenum and jejunum. The presence of this ectopic tissue is not a rare condition, but its unusual locations, clinical symptoms, and complications are of clinical interest. We report a case of a gastric ectopic pancreas with recurrent upper gastrointestinal bleeding in a 20-year-old man.
Choristoma ; Duodenum ; Hemorrhage* ; Humans ; Jejunum ; Pancreas* ; Stomach ; Young Adult

BACKGROUND/AIMS: Recent studies suggest possibility of continuous and prolonged liver ischemia exceeding one hour. We compared mortality rates, liver function, serum Interleukin-6(IL-6) concentration and liver cell necrosis after continuous and intermittent hepatic ischemia in rats. METHODS: Sixty rats were divided into 6 groups to compare 7 day mortality rate. Continuous and intermittent left hepatic inflow occlusion was performed for a total period of 45, 60 and 90 minutes. In a separate study, following 90 minutes continuous or intermittent ischemia, systemic blood was sampled at 0 minute, 6 hours and 24 hours after final clamp release for measurement of SGOT, SGPT and IL-6. Pathologic examination was performed 24 hours or 7 days after reperfusion accordingly. RESULTS: There were no differences in the mortality rates within seven days. There were no differences in the level of SGOT, SGPT and IL-6 between each experimental group. In a pathologic examination, similar liver cell necrosis was found in each group until 24 hours of reperfusion. However, at 7 days after reperfusion, significantly higher grade of hepatic necrosis was noted in the group having continuous ischemia compared with intermittent ischemia of 90 minutes(p<0.05). CONCLUSION: Continuous ischemia is associated with significant risk in the aspect of pathologic study, although it did not affect short term mortality rates.
Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Interleukin-6 ; Ischemia ; Liver ; Mortality ; Necrosis ; Rats* ; Reperfusion ; Reperfusion Injury*

PURPOSE: Small-sized carcinoids, less than 1 cm, are easily detected using flexible sigmoidoscopy or total colonoscopy and can be treated by local excision. Recently, there has been many advances in the technique of endoscopic resection. The aim of this study was to determine the endoscopic findings of a rectal carcinoid and to evaluate the effectiveness of endoscopic resection. METHODS: We experienced 22 rectal carcinoids in 21 patients who were treated by endoscopic resection from June 1996 to February 1999. Nineteen cases were followed for an average of 21 months. Follow-up studies consisted of chest P-A, hepatic ultrasonography, and total colonoscopy. RESULTS: The male-to-female ratio was 1.6 to 1. The most common age group was the 4th decade. The tumor was located at the lower rectum in 10 patients, at the upper rectum in 10 patients, and at the rectosigmoid junction in 2 patients. The tumor sizes ranged from 3 to 12 mm in diameter and were smaller than 10 mm in 20 cases (90.1%). Endoscopic finding revealed that the tumors were covered by a normally appearing mucosa in 12 cases, were yellow-discolored polyps in 17 cases, and were sessile-type tumors in 19 cases. The method of treatment was an endoscopic mucosal resection (EMR, 14 cases) or a snare polypectomy (8 cases). Microscopically positive margins were noticed in four cases, two cases of EMR (2/14, 14%) and two cases of snare polypectomy (2/8, 25%). All the patients were alive and clinically free of disease; however, the duration of the follow-up is short. CONCLUSIONS: Endoscopic resection for rectal carcinoid tumors smaller than 1 cm in diameter is a safe, functional, time-saving, and effective treatment. If the tumor suggests a carcinoid, EMR is advised rather than a polypectomy even though the tumor is small. Microscopically positive margins are not absolute indications for further surgery in the treatment of carcinoids smaller than 1 cm in diameter. It is much more important for an endoscopist to be confident that the endoscopic resection is done completely. It is necessary to identify the factors influencing the malignancy potential and to have a longer follow-up.
Carcinoid Tumor* ; Colonoscopy ; Follow-Up Studies ; Humans ; Mucous Membrane ; Polyps ; Rectum ; Sigmoidoscopy ; SNARE Proteins ; Thorax ; Ultrasonography

PURPOSE: Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. It usually occurs after a period of weight loss, nausea or vomiting due to a partial obstruction of the third portion of the duodenum. If conservative management fails, then a laparotomy, with a duodenojejunostomy, is indicated. A minimally invasive laparoscopic approach to the retroperitoneum, or duodenal, operation has recently been introduced. Although the role of laparoscopy in the management of SMA syndrome is not clearly defined, a laparoscopic duodenojejunostomy may be an alternative approach for its surgical treatment. METHODS: We retrospectively reviewed and analysed our experience of 8 cases of SMA syndrome, and included another 45 cases that had previously been reported in the Korean literature since 1967. RESULTS: There was no gender predominance, but SMA syndrome was more common in younger patients. There were several diseases, or underlying conditions, associated with gastrointestinal, or other general conditions, in SMA syndrome. With respect to its surgical management, most cases in Korea were treated with a duodenojejunostomy. We recently experienced two cases of superior mesenteric artery syndrome, which were treated laparoscopically. The operation time and lenghth of hospital stay were acceptable, with no complications. CONCLUSION: SMA syndrome shows a greater predominance in young age, and is associated with many other diseases, or conditions, in Korea. A duodenojejunostomy is the best choice of operative procedure for the treatment of SMA syndrome. A laparoscopic duodenojejunostomy is also a feasible, alternative option in the treatment of SMA syndrome, providing the benefits of a definitive and minimally invasive surgical technique for a duodenal obstruction.
Arteries* ; Duodenal Obstruction ; Duodenum ; Humans ; Korea ; Laparoscopy ; Laparotomy ; Length of Stay ; Mesenteric Artery, Superior ; Mesentery* ; Nausea ; Retrospective Studies ; Superior Mesenteric Artery Syndrome ; Surgical Procedures, Operative ; Vomiting ; Weight Loss

PURPOSE: Mycoplasma pneumoniae is an extracellular pathogen that attaches to and destroys the ciliated epithelial cells of the respiratory tract. The vascular endothelial growth factor (VEGF) is a critical angiogenic factor that manages the formation and function of vascular networks. Thus, we examined whether M. pneumoniae lysate (MPL) induces VEGF and MPL-induced VEGF expression is regulated by the activation of mitogen-activated protein kinase (MAPK) pathways in airway epithelial cells. METHODS: Cells were treated with MPL in dose and time dependent manners or pretreated with chemical inhibitors of MAPK signaling molecules before the addition of MPL. The supernatants were measured by a specific human VEGF enzyme-linked immunosorbent assay (ELISA). The RNAs were extracted and synthesized into cDNAs for VEGF gene expression by polymerase chain reaction. RESULTS: MPL considerably increased VEGF mRNA 2 hours after treatment, which was gradually reduced thereafter. On the other hand, VEGF protein was continuously amplified for 12 hours after both 5 and 10 microg/mL MPL treatment. Pretreatment with U0126 (a specific extracellular signal-regulated kinase inhibitor) and SB202190 (a specific p38 inhibitor) abolished MPL-stimulated VEGF protein close to basal level (-85%), whereas JNK inhibitor II (a specific c-Jun N-terminal kinase inhibitor) partially decreased VEGF protein (57%). CONCLUSION: We concluded that MPL induces VEGF expression through the activation of MAPK signaling molecules (ERK, p38 and JNK) in airway epithelial cells.
Angiogenesis Inducing Agents ; Butadienes ; DNA, Complementary ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells ; Gene Expression ; Hand ; Humans ; Imidazoles ; JNK Mitogen-Activated Protein Kinases ; Mycoplasma ; Mycoplasma pneumoniae ; Nitriles ; Phosphotransferases ; Pneumonia ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction ; Protein Kinases ; Pyridines ; Respiratory System ; RNA ; RNA, Messenger ; Vascular Endothelial Growth Factor A

PURPOSE: In Korea, pregnancy termination is frequently reported among women who took medications for an acute or chronic disease during pregnancy, for fear of teratogenic risk. We have previously shown that a service providing evidence-based information is helpful for women who week counseling to make a rational decision regarding their pregnancies. This study aimed to evaluate whether termination of pregnancy based on such perceptions, is justified using the 'DRug Exposure and risk Assessment in Moms' (DREAM) registry. METHODS: The study included 5,032 consenting pregnant women from the clinic and call center at the Korean Motherisk Program, from November 1999 to October 2008. The DREAM registry recorded the pregnancy outcomes (preterm birth, low birth weight, intrauterine fetal death, and congenital anomaly) of 3,328 women. RESULTS: Among women exposed to medications, time of exposure ranged from 3.5-4.6 weeks of gestation. There were 1,308 different drugs prescribed to these women. The drug most frequently prescribed was acetaminophen followed by chlorpheniramine maleate, and pseudoephedrine. There were 4.7% (n=156/3,328) women who underwent a voluntary abortion for fear of birth defects. We compared frequency of birth defects between exposed women and unexposed pregnant women in our institution during gestation. The frequency of major congenital malformations was 2.5% (n=74/2,977) in exposed group and 2.9% (n=75/2,573) in unexposed group (P=0.32). There was no statistically significant difference between exposed and control group in the rate of preterm births, intrauterine fetal death and low-birth weight babies. CONCLUSION: We did not observe increased risk of congenital malformations and adverse pregnancy outcomes in a population of pregnant women exposed to a variety of medications. Therefore these medications are not considered teratogen.
Acetaminophen ; Chlorpheniramine ; Chronic Disease ; Congenital Abnormalities ; Counseling ; Female ; Fetal Death ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Korea ; Maleates ; Parturition ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Premature Birth ; Pseudoephedrine ; Risk Assessment

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.