The year of 2009~2010 brought a number of concepts and new ideas were evaluated with promising results. However, some studies that challenged many beliefs. In acute respiratory distress syndrome (ARDS), recent clinical studies took into consideration of pathophysiologic changes of respiratory system compliance. Meta-analysis of positive end-expiratory pressure trials showed survival benefit of high positive end-expiratory pressure in ARDS. Until now, prone positioning did not show survival benefit in patients with ARDS. Extracorporeal membrane oxygenation (ECMO) based management improved survival in patients with severe ARDS. ECMO can be a management option in severe ARDS. Sedation is a standard practice in critically ill patients needing mechanical ventilation. However, Danish group reported less sedation of critically ill patients receiving mechanical ventilation was associated with an increase in days without ventilation. Although this single center study has some limitations, the overall results are promising. Use of maximal sterile barrier precautions (mask, sterile gown, sterile gloves, and large sterile drapes) with chlorhexidine-impregnated dressing reduced central venous catheter related infection. Selective oropharyngeal decontamination (application of topical antibiotics in the oropharynx) reduced the mortality rate of an intensive care unit (ICU) population. Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial reported intensive glucose control increased mortality among adults in the ICU. Some of the results of above papers are promising. However, some ideas may need for more frequent individual assessment and increase the workload of ICU staffs. Before implementation of new practice in ICU, we should take into consideration of individual hospital situation including human and material resources.
Adult ; Anti-Bacterial Agents ; Bandages ; Central Venous Catheters ; Compliance ; Critical Care ; Critical Illness ; Decontamination ; Extracorporeal Membrane Oxygenation ; Glucose ; Humans ; Critical Care ; Intensive Care Units ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory System ; Ventilation

PURPOSE: To evaluate the prevalence of esophageal reflux-induced symptoms after gastrectomy owing to gastric cancer and assess the relationship between esophageal reflux-induced symptoms and quality of life. MATERIALS AND METHODS: From January 2012 to May 2012, 332 patients were enrolled in this cross-sectional study. The patients had a history of curative resection for gastric cancer at least 6 months previously without recurrence, other malignancy, or ongoing chemotherapy. Esophageal reflux-induced symptoms were evaluated with the GerdQ questionnaire. The quality of life was evaluated with the European Organization for Research and Treatment QLQ-C30 and STO22 questionnaires. RESULTS: Of the 332 patients, 275 had undergone subtotal gastrectomy and 57 had undergone total gastrectomy. The number of GerdQ(+) patients was 58 (21.1%) after subtotal gastrectomy, and 7 (12.3%) after total gastrectomy (P=0.127). GerdQ(+) patients showed significantly worse scores compared to those for GerdQ(-) patients in nearly all functional and symptom QLQ-C30 scales, with the difference in the mean score of global health status/quality of life and diarrhea symptoms being higher than in the minimal important difference. Additionally, in the QLQ STO22, GerdQ(+) patients had significantly worse scores in every symptom scale. The GerdQ score was negatively correlated with the global quality of life score (r=-0.170, P=0.002). CONCLUSIONS: Esophageal reflux-induced symptoms may develop at a similar rate or more frequently after subtotal gastrectomy compared to that after total gastrectomy, and decrease quality of life in gastric cancer patients. To improve quality of life after gastrectomy, new strategies are required to prevent or reduce esophageal reflux.
Cross-Sectional Studies ; Diarrhea ; Drug Therapy ; Gastrectomy* ; Gastroesophageal Reflux ; Humans ; Prevalence ; Quality of Life* ; Recurrence ; Stomach Neoplasms* ; Weights and Measures ; Surveys and Questionnaires

Sertoli-Leydig cell tumors of the ovary are one of the sex cord-stromal tumors. They are very rare, account for less than 0.5% of all ovarian tumor. These tumors are almost unilateral, and occur predominantly at premenopausal state and rarely at postmenopausal and prepubertal. The most specific symptoms are virilization due to hyperandrogenism but it presents only in 40-50% of the patients, and vast majority of the patients complain for non-specific abdominal symptoms and menstrual disorder including vaginal bleeding. Prognosis and treatment modalities for Sertoli-Leydig cell tumors remain controversial as they are rare and only a few studies have been published. Treatment varies with patients age, tumor stage, and differentiation from unilateral salpingo-oophrectomy and total hysterectomy concomitant with pelvic lymph node dissection, and in occasion, adjuvant chemotherapy. Prognosis is generally favorable with 5-year survival rate of 70-90%. Recurrence is rare. We have experienced three cases of Sertoli-Leydig cell tumor, each of them showed different clinical presentation and histologic findings, so we present them with a brief review of literature.
Chemotherapy, Adjuvant ; Female ; Humans ; Hyperandrogenism ; Hysterectomy ; Lymph Node Excision ; Ovary ; Prognosis ; Recurrence ; Sertoli-Leydig Cell Tumor* ; Sex Cord-Gonadal Stromal Tumors ; Survival Rate ; Uterine Hemorrhage ; Virilism

Pneumoperitoneum, free intra-abdominal air, usually results from the perforation of a hollow viscous. In approximately 10% of cases, however, pneumoperitoneum is not caused by gastrointestinal perforation. These cases of "spontaneous pneumoperitoneum" generally follow more benign course and may not require surgical intervention. Examples include cardiopulmonary resuscitation (CPR), malrotation, mechanical ventilator support, gynecologic manipulation, blunt abdominal trauma, and chronic intestinal pseudoobstruction in infancy (Sieber syndrome). But, it is extremely rare of spontaneous pneumoperitoneum secondary to idiopathic intestinal pseudoobstuction in adult. We herein report a patient with chronic idiopathic intestinal pseudoobstuction who developed a pneumoperitoneum.
Adult ; Chronic Disease ; Humans ; Intestinal Pseudo-Obstruction/complications/*diagnosis/surgery ; Intestine, Small/pathology ; Male ; Pneumoperitoneum/*diagnosis/etiology/radiography ; Tomography, X-Ray Computed

Thiamine-responsive megaloblastic anemia (TRMA) syndrome is an early-onset autosomal recessive disorder characterized by megaloblastic anemia with ringed sideroblasts, diabetes mellitus and progressive sensorineural deafness, all of which respond in varying degrees to the administration of thiamine, in pharmacologic doses. TRMA syndrome has been reported in less than 30 families, but has never been reported in Korea. It has been demonstrated recently that TRMA is consistently associated with a defect in thiamine transport across cellular membranes and with impaired intracellular pyrophosphorylation. The TRMA syndrome gene, SCL19A2, locates on chromosome 1q23.2-23.3, and encodes a high-affinity thiamine transporter protein. We recently experienced 6 cases of thiamine-responsive megaloblastic anemia syndrome in a family, including a mother and five daughters. All the six cases revealed megaloblastic anemia refractory to vitamin B12 and folic acid therapy but responded to thiamine. We report the cases with a brief review of the literature.
Anemia, Megaloblastic* ; Deafness ; Diabetes Mellitus ; Folic Acid ; Humans ; Korea ; Megaloblasts* ; Membranes ; Mothers* ; Nuclear Family* ; Thiamine ; Vitamin B 12

BACKGROUND: Pulmonary embolism (PE) is a common clinical problem in the West that is associated with substantial morbidity and mortality. The diagnostic modality has been changed since 2001. This study retrospectively reviewed the PE mortality with the aim of identifying the risk factors associated with mortality since the multidetector computed tomography (MDCT) was introduced. METHODS: We analyzed 105 patients with acute PE proven by multidetector CT or ventilation perfusion scan. The primary outcome measure was the all-cause mortality at 3 months. The prognostic effect of the baseline factors on survival was assessed by multivariate analysis. RESULTS: The main risk factors were prolonged immobilization, stroke, cancer and obesity. Forty nine percent of patients had 3 or more risk factors. The overall mortality at 3 months was 18.1%. Multivariate analysis revealed low diastolic blood pressure and the existence of cancer to be independent factors significantly associated with mortality. Forty two PE patients were examined for the coagulation inhibitors. Four of these patients had a protein C deficiency (9.5%), and 11 had a protein S deficiency (26%). CONCLUSION: PE is an important clinical problem with a high mortality rate. Close monitoring may be necessary in patients with the risk factors.
Blood Pressure ; Hospitals, Teaching ; Humans ; Immobilization ; Multidetector Computed Tomography ; Multivariate Analysis ; Obesity ; Outcome Assessment (Health Care) ; Perfusion ; Prognosis ; Protein C Deficiency ; Protein S Deficiency ; Pulmonary Embolism ; Retrospective Studies ; Risk Factors ; Stroke ; Thrombophilia ; Venous Thrombosis ; Ventilation

Background/Aims: Although prolonged post-operative ileus (PPOI) is an important factor for the prolonged length of post-operative hospital stay, there is still a lack of effective predictive and therapeutic methods for PPOI. Previous studies reported that increased inflammatory markers, such as C-reactive protein (CRP) level and neutrophil to lymphocyte ratio (NLR), are associated with malignancies. The aim of our study is to elucidate the association between peri-operative inflammatory markers and PPOI after gastrectomy for gastric cancer. Methods: We enrolled patients who received gastrectomy for gastric cancer from June 2013 to January 2016 at a single tertiary referral center in Seoul, Korea. We evaluated peri-operative inflammatory markers, including CRP level, NLR, and platelet to lymphocyte ratio (PLR) of enrolled patients. We compared these data between control group and PPOI group. Results: A total of 390 subjects were enrolled in this study, and 132 patients (33.8%) showed PPOI. In univariate analysis, preoperative CRP level and NLR, post-operative day (POD) 1 CRP level, NLR, and PLR, and POD3 CRP level, NLR, and PLR were significantly associated with PPOI. In multivariate analysis, preoperative NLR (P = 0.014), POD1 NLR (P = 0.019), POD3 CRP (P = 0.004), and POD3 NLR (P = 0.008) were independent risk factors for PPOI. Conclusions Peri-operative inflammatory markers, such as CRP level and NLR, are useful predictive factors for PPOI who received gastrectomy for gastric cancer. Moreover, prophylactic antibiotics and anti-inflammatory drugs can be preventive and therapeutic agents for PPOI.

Background/Aims: Although prolonged post-operative ileus (PPOI) is an important factor for the prolonged length of post-operative hospital stay, there is still a lack of effective predictive and therapeutic methods for PPOI. Previous studies reported that increased inflammatory markers, such as C-reactive protein (CRP) level and neutrophil to lymphocyte ratio (NLR), are associated with malignancies. The aim of our study is to elucidate the association between peri-operative inflammatory markers and PPOI after gastrectomy for gastric cancer. Methods: We enrolled patients who received gastrectomy for gastric cancer from June 2013 to January 2016 at a single tertiary referral center in Seoul, Korea. We evaluated peri-operative inflammatory markers, including CRP level, NLR, and platelet to lymphocyte ratio (PLR) of enrolled patients. We compared these data between control group and PPOI group. Results: A total of 390 subjects were enrolled in this study, and 132 patients (33.8%) showed PPOI. In univariate analysis, preoperative CRP level and NLR, post-operative day (POD) 1 CRP level, NLR, and PLR, and POD3 CRP level, NLR, and PLR were significantly associated with PPOI. In multivariate analysis, preoperative NLR (P = 0.014), POD1 NLR (P = 0.019), POD3 CRP (P = 0.004), and POD3 NLR (P = 0.008) were independent risk factors for PPOI. Conclusions Peri-operative inflammatory markers, such as CRP level and NLR, are useful predictive factors for PPOI who received gastrectomy for gastric cancer. Moreover, prophylactic antibiotics and anti-inflammatory drugs can be preventive and therapeutic agents for PPOI.

Gastric adenocarcinoma may coexist with tumors of other histological types. The synchronous occurrence of gastric adenocarcinoma and gastrointestinal stromal tumor (GIST) has rarely been reported in the literature. It is still not known whether such an association represents an incidental coexistence or indicates a similar pathogenesis in the simultaneous development of tumors of different histological types. Here we report a case of an exoluminal GIST that was confused with a metastatic lymph node in early gastric cancer.
Adenocarcinoma ; Gastrointestinal Stromal Tumors ; Lymph Nodes ; Stomach Neoplasms

Thanks to the introduction of immumomodulators and biologics, therapeutic approaches in Crohn's disease have changed significantly during the past decade. Although new biologic therapy has dramatically improved the treatment of Crohn's disease, a substantial number of patients are refractory to these therapies or lose their initial response. Methotrexate (MTX) is a structural analogue of folic acid that can competitively inhibit the binding of dihydrofolic acid to the enzyme dihydrofolate reductase and has been widely used as immunomodulator in rheumatology area for patients with rheumatoid arthritis and psoriasis. Although MTX has also been shown to be an effective agent for remission induction and maintenance of remission in Crohn's disease, the use of MTX in Crohn's disease has not yet been reported in Korea. Herein, we report a case of Crohn's disease patient who was successfully treated with MTX after treatment failure with thiopurine and anti-tumor necrosis factor.
Adult ; Antibodies, Monoclonal/therapeutic use ; Colonoscopy ; Crohn Disease/diagnosis/*drug therapy ; Humans ; Immunosuppressive Agents/*therapeutic use ; Infliximab/therapeutic use ; Male ; Methotrexate/*therapeutic use ; Remission Induction ; Tomography, X-Ray Computed ; Tumor Necrosis Factor-alpha/immunology