BACKGROUND: We analyzed the clinical characteristics of trauma involving the liver and/or the spleen to evaluate the safety of nonoperative management. METHODS: A retrospective study was conducted on 78 cases who were treated with operative (37 cases) and nonoperative (41 cases) management at Wonkwang University Hospital from January 1995 to June 1998. Nonoperative management was done in hemodynamically stable patients. RESULTS: Three cases in the operative group (OG) and 5 cases in the nonoperative group (NOG) were children. Causes of injury were traffic accidents (66.6%), falls (15.4%), penetrating injuries (11.4%), and assaults (6.4%). Associated intraabdominal injuries were renal contusions (42%), pancreatic injuries (18%), mesenteric tearing (12%), diaphragm ruptures (9%). Associated extraabdominal injuries were chest injuries (56.5%), long bone fractures (15.2%), pelvic bone fractures (9.8%), and CNS injuries (8.7%). Mean total blood requirements were 7.0 units in the OG and 1.2 units in the NOG. Complications were 35 cases in the OG (pleural effusion, 6 cases; intraabdominal abscess, 4 cases; pneumonia, 4 cases; biloma, 3 cases) and 15 cases in the NOG (pleural effusion, 5 cases; pneumonia, 5 cases; intraabdominal abscess, 2 cases). Causes of 8 delayed operations were bowel perforations (small bowel 2 cases, and colon, 1 case), bile peritonitis (2 cases), and hemodynamically instability (3 cases). The hospitalization period was 16 days in the OG and 14 days in the NOG. Six patients in the OG died and the causes were multiple organ failures (4 cases), hypovolemic shock (1 case), and ARDS (1 case). No patient died in the delayed operation cases and the NOG, even in major injury cases aquired respiratory distress syndrom. CONCLUSIONS: Nonoperative management of traumatic liver and/or spleen injury is safe and can be tried initially under the conditions of stable hemodynamics, feasible abdominal CT, and feasible immediate operation.
Abscess ; Accidents, Traffic ; Bile ; Child ; Colon ; Contusions ; Diaphragm ; Fractures, Bone ; Hemodynamics ; Hospitalization ; Humans ; Liver* ; Multiple Organ Failure ; Pelvic Bones ; Peritonitis ; Pneumonia ; Retrospective Studies ; Rupture ; Shock ; Spleen* ; Thoracic Injuries ; Tomography, X-Ray Computed

Aortic saddle embolus accounts for approximately 10% of all peripheral arterial emboli. The most common sources of emboli are left atrial thrombi associated with atrial fibrillation and vegetation. A 22-year-old male patient was admitted due to acute onset of orthopnea, tachypea and cough. Transthoracic and transeophageal echocardiography showed huge vegetation (3X2cm) of the posterior mitral valve leaflet which was associated with severe mitral regurgitation. On 14th hospital day, he suffered from sudden onset of weakness, pain, and coldness on both lower extremities. Follow-up echocardiography showed marked size reduction of the original mitral valve vegetation. Angiography showed aortic saddle embolus. The embolectomy of aortic saddle embolus was performed through the transfemoral approach with a Forgarty catheter. At the same time, removal of the infected mitral valve and mitral valve replacement were performed.
Angiography ; Atrial Fibrillation ; Catheters ; Cough ; Echocardiography ; Embolectomy ; Embolism* ; Follow-Up Studies ; Humans ; Lower Extremity ; Male ; Mitral Valve Insufficiency ; Mitral Valve* ; Young Adult

Postoperative rhabdomyolysis with acute renal failure (ARF) is a rare complication of laparoscopic urologic surgery. It is associated with lateral decubitus surgical position, long operative time, and increased body mass. We report a case of a 49-year-old-man with right renal cell carcinoma who underwent a laparoscopic right radical nephrectomy for 7 hours in left decubitus position and was complicated by ARF due to postoperative rhabdomyolysis. Laparoscopic renal surgery is performed in many surgical renal diseases and heightened suspicion may help early recognition of postoperative rhabdomyolysis. Vigorous hydration and hemodialysis are also helpful in treating ARF secondary to rhabdomyolysis
Acute Kidney Injury ; Carcinoma, Renal Cell ; Laparoscopy ; Nephrectomy ; Operative Time ; Renal Dialysis ; Rhabdomyolysis

PURPOSE: The objective of this study was to investigate whether proton magnetic resonance spectroscopy (1H-MRS) is useful in the prediction of the neurological outcome for comatose patients after successful cardiopumonary resuscitation (CPR). METHODS: We prospectively studied 22 patients with a comatose mentality existing for longer than 1 day after cardiac arrest. 1H-MRS examinations were scheduled to be performed within 5 days after restoration of spontaneous circulation (ROSC). All 1H-MRS readings were performed by a neuro-radiologist blindly. The best cerebral performance category (CPC) during 6 months after ROSC was used as the final outcome and classified as good (CPC 1-2) or poor (CPC 3-5). RESULTS: Elevated cerebral lactate resonances were found in 14 patients. All of the 14 lactate-positive patients experienced a poor outcome. Five of the 8 lactate-negative patients recovered without neurologic defects, but three of them suffered from severe neurologic defects. The elevated cerebral lactate resonance distinguished between good out-comes (n=5) and poor outcomes (n=17) with three false negatives (sensitivity 82%) and no false positives (specificit y 100%). Demonstration of brain lactate in 1H-MRS (p < 0.05) proved to be significant in terms of a poor prognosis. CONCLUSION: 1H-MRS is of great benefit in the prognostic evaluation of comatose patients with anoxic-ischemic encephalopathy after successful CPR.
Brain ; Cardiopulmonary Resuscitation* ; Coma* ; Heart Arrest ; Humans ; Hypoxia-Ischemia, Brain ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Prognosis ; Prospective Studies ; Protons* ; Reading ; Resuscitation

OBJECTIVES: Our study examined the dose-response relationship between smoking amounts (pack-years) and the risk of developing pancreatic cancer in Korean men. METHODS: Of 125,743 participants who underwent medical health checkups in 2009, 121,408 were included in the final analysis and observed for the development of pancreatic cancer. We evaluated the associations between smoking amounts and incident pancreatic cancer in 4 groups classified by pack-year amounts. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of incident pancreatic cancer by comparing groups 2 (<20 pack-year smokers), 3 (20-≤40 pack-year smokers), and 4 (>40 pack-year smokers) with group 1 (never smokers). RESULTS: During 527,974.5 person-years of follow-up, 245 incident cases of pancreatic cancer developed between 2009 and 2013. The multivariate-adjusted HRs (95% CIs) for incident pancreatic cancer in groups 2, 3, and 4 were 1.05 (0.76 to 1.45), 1.28 (0.91 to 1.80), and 1.57 (1.00 to 2.46), respectively (p for trend=0.025). The HR (95% CI) of former smokers showed a dose-response relationship in the unadjusted model, but did not show a statistically significant association in the multivariate-adjusted model. The HR (95% CI) of current smokers showed a dose-response relationship in both the unadjusted (p for trend=0.020) and multivariate-adjusted models (p for trend=0.050). CONCLUSIONS The risk of developing pancreatic cancer was higher in current smokers status than in former smokers among Korean men, indicating that smoking cessation may have a protective effect.

Abiotrophia defectiva, a nutritionally variant streptococci can cause bacteremia, brain abscess, septic arthritis and in rare cases, infective endocarditis, which accounts for 5-6% of all cases. A. defectiva is characteristically difficult to diagnose and the mortality, morbidity and complication rates are high. Here, we discuss a case of infective endocarditis caused by A. defectiva. A 62-year-old female had previously undergone prosthetic valve replacement 6 years prior to admission. She developed infective endocarditis after tooth extraction. Her endocarditis was successfully treated with antimicrobial therapy and mitral valve replacement surgery. This is the first case of infective endocarditis caused by A. defectiva reported in Korea. This case shows that A. defectiva could be considered as a causative organism of infective endocarditis in Korea.
Abiotrophia* ; Arthritis, Infectious ; Bacteremia ; Brain Abscess ; Endocarditis* ; Female ; Humans ; Korea* ; Middle Aged ; Mitral Valve ; Mortality ; Tooth Extraction

Background/Aims: To compare the effects of abatacept and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) on the progression and development of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Methods: This multi-center retrospective study included RA patients receiving abatacept or csDMARDs who underwent at least two pulmonary function tests and/or chest high-resolution computed tomography (HRCT). We compared the following outcomes between the groups: progression of RA-ILD, development of new ILD in RA patients without ILD at baseline, 28-joint Disease Activity Score with the erythrocyte sedimentation rate (DAS28-ESR), and safety. Longitudinal changes were compared between the groups by using a generalized estimating equation. Results: The study included 123 patients who were treated with abatacept (n = 59) or csDMARDs (n = 64). Nineteen (32.2%) and 38 (59.4%) patients treated with abatacept and csDMARDs, respectively, presented with RA-ILD at baseline. Newly developed ILD occurred in one patient receiving triple csDMARDs for 32 months. Among patients with RA-ILD at baseline, ILD progressed in 21.1% of cases treated with abatacept and 34.2% of cases treated with csDMARDs during a median 21-month follow-up. Longitudinal changes in forced vital capacity and diffusing capacity for carbon monoxide were comparable between the two groups. However, the abatacept group showed a more significant decrease in DAS28-ESR and glucocorticoid doses than csDMARDs group during the follow-up. The safety of both regimens was comparable. Conclusions Abatacept and csDMARDs showed comparable effects on the development and stabilization of RA-ILD. Nevertheless, compared to csDMARDs, abatacept demonstrated a significant improvement in disease activity and led to reduced glucocorticoid use.

Background/Aims: To compare the effects of abatacept and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) on the progression and development of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Methods: This multi-center retrospective study included RA patients receiving abatacept or csDMARDs who underwent at least two pulmonary function tests and/or chest high-resolution computed tomography (HRCT). We compared the following outcomes between the groups: progression of RA-ILD, development of new ILD in RA patients without ILD at baseline, 28-joint Disease Activity Score with the erythrocyte sedimentation rate (DAS28-ESR), and safety. Longitudinal changes were compared between the groups by using a generalized estimating equation. Results: The study included 123 patients who were treated with abatacept (n = 59) or csDMARDs (n = 64). Nineteen (32.2%) and 38 (59.4%) patients treated with abatacept and csDMARDs, respectively, presented with RA-ILD at baseline. Newly developed ILD occurred in one patient receiving triple csDMARDs for 32 months. Among patients with RA-ILD at baseline, ILD progressed in 21.1% of cases treated with abatacept and 34.2% of cases treated with csDMARDs during a median 21-month follow-up. Longitudinal changes in forced vital capacity and diffusing capacity for carbon monoxide were comparable between the two groups. However, the abatacept group showed a more significant decrease in DAS28-ESR and glucocorticoid doses than csDMARDs group during the follow-up. The safety of both regimens was comparable. Conclusions Abatacept and csDMARDs showed comparable effects on the development and stabilization of RA-ILD. Nevertheless, compared to csDMARDs, abatacept demonstrated a significant improvement in disease activity and led to reduced glucocorticoid use.

Background/Aims: To compare the effects of abatacept and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) on the progression and development of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Methods: This multi-center retrospective study included RA patients receiving abatacept or csDMARDs who underwent at least two pulmonary function tests and/or chest high-resolution computed tomography (HRCT). We compared the following outcomes between the groups: progression of RA-ILD, development of new ILD in RA patients without ILD at baseline, 28-joint Disease Activity Score with the erythrocyte sedimentation rate (DAS28-ESR), and safety. Longitudinal changes were compared between the groups by using a generalized estimating equation. Results: The study included 123 patients who were treated with abatacept (n = 59) or csDMARDs (n = 64). Nineteen (32.2%) and 38 (59.4%) patients treated with abatacept and csDMARDs, respectively, presented with RA-ILD at baseline. Newly developed ILD occurred in one patient receiving triple csDMARDs for 32 months. Among patients with RA-ILD at baseline, ILD progressed in 21.1% of cases treated with abatacept and 34.2% of cases treated with csDMARDs during a median 21-month follow-up. Longitudinal changes in forced vital capacity and diffusing capacity for carbon monoxide were comparable between the two groups. However, the abatacept group showed a more significant decrease in DAS28-ESR and glucocorticoid doses than csDMARDs group during the follow-up. The safety of both regimens was comparable. Conclusions Abatacept and csDMARDs showed comparable effects on the development and stabilization of RA-ILD. Nevertheless, compared to csDMARDs, abatacept demonstrated a significant improvement in disease activity and led to reduced glucocorticoid use.

Background/Aims: To compare the effects of abatacept and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) on the progression and development of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Methods: This multi-center retrospective study included RA patients receiving abatacept or csDMARDs who underwent at least two pulmonary function tests and/or chest high-resolution computed tomography (HRCT). We compared the following outcomes between the groups: progression of RA-ILD, development of new ILD in RA patients without ILD at baseline, 28-joint Disease Activity Score with the erythrocyte sedimentation rate (DAS28-ESR), and safety. Longitudinal changes were compared between the groups by using a generalized estimating equation. Results: The study included 123 patients who were treated with abatacept (n = 59) or csDMARDs (n = 64). Nineteen (32.2%) and 38 (59.4%) patients treated with abatacept and csDMARDs, respectively, presented with RA-ILD at baseline. Newly developed ILD occurred in one patient receiving triple csDMARDs for 32 months. Among patients with RA-ILD at baseline, ILD progressed in 21.1% of cases treated with abatacept and 34.2% of cases treated with csDMARDs during a median 21-month follow-up. Longitudinal changes in forced vital capacity and diffusing capacity for carbon monoxide were comparable between the two groups. However, the abatacept group showed a more significant decrease in DAS28-ESR and glucocorticoid doses than csDMARDs group during the follow-up. The safety of both regimens was comparable. Conclusions Abatacept and csDMARDs showed comparable effects on the development and stabilization of RA-ILD. Nevertheless, compared to csDMARDs, abatacept demonstrated a significant improvement in disease activity and led to reduced glucocorticoid use.