PURPOSE: Surgical excision has been the primary treatment for hepatoblastoma and hepat-ocellular carcinoma. However, at presentation, only one third of such tumors are surgically resectable. Without operation, the disease is fatal. Therefore, neoadjuvant chemotherapy has been introduced for conversion of the unresectable tumors into the resectable ones. We studied th e effects of chemotherapy for hepatic malignancy in children. METHODS: Between November 1986 and August 1993, 30 children presented with hepatoblastomas or heptocellular carcinoma, which were diagnosed by histology. We analysed the laboratory findings of hepatic tumors and the outcome of chemotherapy. RESULTS: Laboratory findings revealed mild anemia, elevated SGOT/SGPT, and extremely increased AFP level. Twenty-six among 30 patients entered into surgery or neoadjuvant chemotherapy. Initial complete resection of tumor was attempted in 11 case, and was successful in 9 cases. Fifteen cases with initially unresectable tumors were treated with chemotherapy including cisplatin and/or doxorubicin. Nine of 15 showed significant reduction in tumor size, and delayed resection of the primary lesion was possible. But one case did not respond to chemotherapy, and 5 cases was droped out due to death(n=2) and refusal of chemotherapy(n=3). Twenty p atients were enrolled in survival analysis. Over-all 3 year survival rate was 61%, and 2 year survival rates of hepatoblastoma and hepatocellular carcinoma were 85% and 33% respectively(P=0.06). According to the stage, 2 year survival rate of stage I and III were 87% and 75% respectively. None of patient with metastasis survived at 16 months. Chemotherapy was tolerable in most patients and its principal toxicities were myelosuppression and fever. Three patients developed decreased left ventricular shortening fraction and their cumulative dose of doxorubicin were 771mg/m2, 557mg/ m2, and 390mg/ m2. CONCLUSIONS: Chemotherapy including cisplatin and/or doxorubicin is an effective treatment in inducing surgical resectability in hepatoblastomas which are unresectable at diagnosis.
Anemia ; Carcinoma, Hepatocellular* ; Child* ; Cisplatin ; Diagnosis ; Disulfiram ; Doxorubicin ; Drug Therapy* ; Fever ; Hepatoblastoma* ; Humans ; Neoplasm Metastasis ; Survival Rate

BACKGOUND: The purpose of this study was to evaluate characteristics and mortality rates of patients admitted to the post-anesthesia care unit (PACU) for obtaining the better clinical guidances and more advanced therapeutic plan in the future. METHODS: The medical records of total 425 patients admitted to the PACU from January to December 1998 were reviewed and analyzed according to age, sex, department, duration of stay, mechanical ventilator care, and mortality rates. RESULTS: Patients admitted PACU were 6% of total anesthesia patients. The ratio of male to female was 1.5:1. Patients of manhood aged from 45 to 64 were 37%, pediatric patients under 15 year-old were 23%. and elderly patients over 64 year-old were 18% of total PACU patients. The ratio of patients with ventilatory support was 42%. Mortality rate of neonate under 1 month of age was about 47%. Total mortality rate was 12%. CONCLUSIONS: To improve the outcome of the patients in PACU, continuous nutritional and medical support, cardiovascular and pulmonary monitoring, appropriate nursing care, and availability of medical staff were needed.
Adolescent ; Aged ; Anesthesia ; Female ; Humans ; Infant, Newborn ; Critical Care ; Male ; Medical Records ; Medical Staff ; Middle Aged ; Mortality ; Nursing Care ; Ventilators, Mechanical

BACKGROUND: A management protocol for hepatitis C virus (HCV) after liver transplantation (LT) has not been established in Korea. We therefore investigated HCV transplant protocols and post-transplant results from liver transplant centers in Korea. METHODS: The HCV protocol and medical data of individual cases from eight major liver transplant centers were compiled and analyzed. RESULTS: A post-transplant protocol biopsy was performed in only three centers. In these centers, HCV treatment was considered when pathological abnormalities were confirmed on the protocol biopsy (irrespective of liver function). In the other five centers, biopsies were performed when biochemical parameters were aggravated. Only two out of the eight centers performed preemptive or prophylactic therapy. A total of 5,663 adult LTs were performed between 2000 and 2010. HCV-related liver disease was responsible for 277 LTs (4.9%). Pre-transplant data were not available in many patients, including HCV genotype and serum HCV RNA level. Tacrolimus was more frequently used for initial maintenance immunosuppression than cyclosporine A (61.7% vs. 36.8%). Post-transplant HCV treatment was performed in 135 patients (48.7%). Sixty-seven recipients (24.2%) died during follow-up after LT and 11 HCV-related graft loss (4.0%) developed. The cumulative patient survival rate was 74.7% at 5 years and 67.9% at 10 years after LT. CONCLUSIONS: The HCV management protocol after LT varied markedly between the eight Korean transplant centers and a standard protocol did not exist. A nationwide multicenter study is required to investigate the most effective treatment for HCV after LT, with the goal of establishing the most effective standard protocol.
Adult ; Biopsy ; Cyclosporine ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis ; Hepatitis C ; Humans ; Immunosuppression ; Korea ; Liver ; Liver Diseases ; Liver Transplantation ; RNA ; Survival Rate ; Tacrolimus ; Transplants

OBJECTIVES: The aim of this study was to investigate the relationship between job stress and the willingness of male workers in small and medium scale industry to cease smoking. METHODS: A structured self-reported questionnaire was used to assess each respondent's socio-demographics, job stress, and the will to cease smoking. A KOSS (Korean Occupational Stress Scale)- based questionnaire survey was conducted which targeted 4,435 male workers at 69 small and medium scale industries. 2,840 men returned these questionnaires with 1,663 of them being smokers. We analyzed 1,345 of the smoker returns. We estimated the relationship between the will to cease smoking and the employee job stress factors using logistic regression analyses. RESULTS: After adjusting for education, exercise, and tobacco use per day, the logistic regression analysis revealed a significantly positive association with the will to cease smoking and job stress. The odds ratios regarding insufficient job control were at 1.69 (95% CI, 1.26~2.27), organizational system at 1.37 (95% CI, 1.03~1.82), and lack of reward at 1.37 (95% CI, 1.03~1.82). CONCLUSIONS: These results indicated that job stress may play a significant role in the will to cease smoking. Further preventive efforts and studies are needed in order to reduce job stress.
Humans ; Logistic Models ; Male ; Odds Ratio ; Questionnaires ; Reward ; Smoke ; Smoking ; Smoking Cessation ; Tobacco

Background and Objectives: Protein-losing enteropathy (PLE) is a devastating complication after the Fontan operation. This study aimed to investigate the clinical characteristics, treatment response, and outcomes of Fontan-associated PLE. Methods: We reviewed the medical records of 38 patients with Fontan-associated PLE from 1992 to 2018 in 2 institutions in Korea. Results: PLE occurred in 4.6% of the total 832 patients after the Fontan operation. After a mean period of 7.7 years after Fontan operation, PLE was diagnosed at a mean age of 11.6years. The mean follow-up period was 8.9 years. The survival rates were 81.6% at 5 years and 76.5% at 10 years. In the multivariate analysis, New York Heart Association Functional classification III or IV (p=0.002), low aortic oxygen saturation (<90%) (p=0.003), and ventricular dysfunction (p=0.032) at the time of PLE diagnosis were found as predictors of mortality. PLE was resolved in 10 of the 38 patients after treatment. Among medical managements, an initial heparin response was associated with survival (p=0.043). Heparin treatment resulted in resolution in 4 patients. We found no evidence on pulmonary vasodilator therapy alone. PLE was also resolved after surgical Fontan fenestration (2/6), aortopulmonary collateral ligation (1/1), and transplantation (1/1). Conclusions The survival rate of patients with Fontan-associated PLE has improved with the advancement of conservative care. Although there is no definitive method, some treatments led to the resolution of PLE in one-fourth of the patients. Further investigations are needed to develop the best prevention and therapeutic strategies for PLE.

Amyloidoses are disorders for which homogeneous amorphous fibrillar proteins accumulate in multiple organs. These diseases are classified into systemic and localized disease by their extent, the primary disease and their association with multiple myeloma, and the secondary and familial disease are classified by their association with the underlying diseases. Amyloidoses can develop in association with multiple myeloma, but only rare cases have been reported on that involve the gastroesophageal tract. Amyloidosis can involve the kidney, heart, liver, skin, gastrointestinal tract and nervous system, and they can involve the small intestine, duodenum, stomach, colon, rectum and esophagus when there is disease of the gastrointestinal tract. We may overlook gastrointestinal involvement of amyloidoses if there are few symptoms and laboratory abnormalities because of the diverse clinical courses and features. Amyloidoses can manifest abdominal pain, diarrhea, vomiting and perforation, but gastrointestinal hemorrhages are rare. We report here on a case of gastroesophageal amyloidosis with upper gastrointestinal hemorrhage and paralytic ileus due to multiple myeloma.
Abdominal Pain ; Amyloidosis* ; Colon ; Diarrhea ; Duodenum ; Esophagus ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Heart ; Hemorrhage* ; Humans ; Intestinal Pseudo-Obstruction ; Intestine, Small ; Kidney ; Liver ; Multiple Myeloma* ; Nervous System ; Rectum ; Skin ; Stomach ; Vomiting

Choledocho-duodenal fistula is a rare condition. It is usually developed as a complication of the gallstone disease, and rarely developed by penetrating peptic ulcer, trauma and neoplasm. Tuberculosis as a etiology of choledocho-duodenal fistula is very rare, and only a few cases were reported. We experienced a case of choledocho-duodenal fistula due to tuberculous lymphadenitis in a 26 year-old man presented with epigastric pain. After 6 months of anti-tuberculous medication, He was free of symptom and the fistula was closed spontaneously. We report the case with a review of literatures.
Adult ; Fistula* ; Gallstones ; Humans ; Peptic Ulcer ; Tuberculosis* ; Tuberculosis, Lymph Node

PURPOSE: Postoperative hypocalcemia is a common complication of thyroidectomy. This study evaluated the incidence and predisposing risk factors for postoperative permanent hypocalcemia after total thyroidectomy. METHODS: There were 1,247 consecutive patients undergoing total thyroidectomy and complete treatment and observation for differentiated thyroid cancer between January 2012 to December 2012 who were enrolled in this study. Patients were divided into two groups, those remaining normalcalcemic (Group I-824 pts) and those who had hypocalcemia requiring treatment (Groups II-423 pts). Group II was subdivided into a transient hypocalcemic group (Group IIA-409 pts) and a permanent hypocalcemic group (Group IIB-14 pts). RESULTS: Female gender, thyroiditis, preserved parathyroid number, lateral lymph node metastasis, RAI treatment, preoperative parathyroid hormone and preoperative vitamin D were significantly associated with the development of postoperative hypocalcemia by multivariate analysis. Comparing patients with transient versus permanent hypocalcemia, tumor size and multiplicity were significantly related to the development of permanent hypocalcemia by multivariate analysis. RAI treatment and parathyroid hormone level on the postoperative third day were significantly related to recovery from transient hypocalcemia to normo-calcemia. CONCLUSION: Risk factors of postoperative hypocalcemia were associated with preoperative patient factors and advanced thyroid cancer. Advanced thyroid cancer was a risk factor for permanent hypocalcemia. To prevent postoperative hypocalcemia, we should focus on patient condition and need to preserve parathyroid gland more carefully in thyroid surgery.
Female ; Humans ; Hypocalcemia* ; Incidence ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Parathyroid Glands ; Parathyroid Hormone ; Risk Factors* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Thyroiditis ; Vitamin D

BACKGROUND/AIMS: Despite several limitations, percutaneous transhepatic cholangioscopy (PTCS) has been useful in patients with intrahepatic stone, common bile duct stone or intrahepatic bile duct stricture. We investigated the usefulness and limitation of PTCS, and the recurrence rate after stone removal. METHODS: PTCS was performed on 49 patients with intrahepatic duct (IHD) stones or common bile duct (CBD) stones and 11 patients undergoing biopsy who visited Chung Nam university hospital between 1999 and 2003. RESULTS: Complete removal rate of patients with IHD and CBD stones was 75% (21/28) and 91% (19/21), respectively. Biopsy results by PTCS were in agreement with the final result in 86% (6/7). In patients with IHD stones, the PTCS complication rate was 29% (8/28). Bleeding was most common (21%) but was self limited. In patients with CBD stones, the PTCS complication rate was 9% (2/9). One case was bleeding and the other was death by aggravation of general condition. In patients with IHD stones, the recurrence rate was 29% (5/17). CONCLUSIONS: In conclusion, PTCS is useful to treat patients with IHD stones, as well as the few patients with failed CBD stone removal by ERCP and diagnosis of stricture in the bile duct.
Bile Ducts ; Bile Ducts, Intrahepatic ; Bile* ; Biopsy* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Constriction, Pathologic ; Diagnosis* ; Hemorrhage ; Humans ; Recurrence

BACKGROUND: Laparoscopic surgery with reverse Trendelenburg position and carbon dioxide pneumoperitoneum has been known to increase the endotracheal tube (ETT) cuff pressure and the incidence of postoperative sore throat. The purpose of this study was to evaluate the effect of the Trendelenburg position and pneumoperitoneum on the ETT cuff pressure and the effect of adjustment of ETT cuff pressure on the incidence of sore throat during laparoscopic gynecologic surgery. METHODS: One hundred fifty-four female patients undergoing laparoscopic gynecologic surgery were randomly assigned to either control group or adjusted group. In control group, initial cuff pressure was set at 30 cmH2O in the supine position without any adjustment during surgery. Cuff pressure of adjusted group was adjusted to maintain 30 cmH2O throughout the operation. Cuff pressures at intubation (P(imme)), at carbon dioxide insufflation and the Trendelenburg position (P0), and at 10 minute intervals throughout surgery (P10-P60 and P(end)) were checked. Postoperative airway complications including sore throat, hoarseness, dysphagia and cough were compared between the two groups at 2 hours and 24 hours after surgery. RESULTS: In control group, P0 and P10 were significantly higher than P(imme). The cuff pressure decreased with time, thereby; P50 (28.2 +/- 4.3), P60 (27.5 +/- 4.0) and P(end) (25.9 +/- 4.2) were significantly lower than P(imme) (P < 0.05). The incidences and severity of airway complications were not different between two groups. CONCLUSIONS: ETT cuff pressure decreased in laparoscopic gynecologic surgery. Therefore, controlled cuff pressure does not decrease the incidence of postoperative airway complications.
Carbon Dioxide ; Cough ; Deglutition Disorders ; Female ; Gynecologic Surgical Procedures ; Head-Down Tilt ; Hoarseness ; Humans ; Incidence ; Insufflation ; Intubation ; Laparoscopy ; Pharyngitis ; Pneumoperitoneum ; Supine Position