No abstract available.
Clonidine ; Horner Syndrome ; Meningitis, Viral

PURPOSE: A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds. METHODS: The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation. RESULTS: The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days. CONCLUSION: This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation.
Hemodynamics ; Humans ; Laparotomy ; Length of Stay ; Medical Records ; Multiple Trauma ; Omentum ; Retrospective Studies ; Schools, Medical ; Trauma Centers ; Wounds, Stab

PURPOSE: It has been known that the incidence of post-transplant diabetes mellitus (PTDM) is variable according to the immunosuppressant used. The goals of this study are to uncover the factors associated with the development of PTDM and to clarify the fate of PTDM. METHODS: The medical records of 267 patients who underwent renal transplant between 1996 and December 2002 at Seoul National University Hospital were retrospectively reviewed. Patients were divided into three groups: cyclosporine group (CsA, n=179), high tacrolimus group (HFK, mean trough level during post-transplant 2 week>15 ng/m, n=33) and low tacrolimus group (LFK, mean trough level during post- transplant 2 week< or =15 ng/mL, n=55). The incidence, risk factors of PTDM and clinical fate were analyzed. RESULTS: PTDM developed in 46 (17.2%) patients. PTDM incidence of HFK group (60.6%) was significantly higher than CsA group (10.1%) and LFK group (14.5%) (P=0.000). Tacrolimus use, age at the time of transplantation (>40year), family history of diabetes and obesity (BMI>25) were the risk factors for PTDM development. Incidences of associated clinical events, such as acute rejection, cerebrovascular accident, myocardial infarction, or infection were not different between PTDM and non-PTDM group. PTDM was resolved in 13 out of 46 patients (28.3%). Only 7 out of 33 patients (21.2%) in whom PTDM persisted lost their graft. CONCLUSION: PTDM incidence was higher in HFK group. So, LFK protocol is considered to be safe and beneficial, at least in terms of PTDM. Tacrolimus as immunosuppressant, recipient, family history of DM and obesity were the risk factors of PTDM development. PTDM was reversible in 28.3% of patients. PTDM had little impact on clinical outcomes during mid-term period.
Cyclosporine ; Diabetes Mellitus* ; Humans ; Immunosuppression ; Incidence ; Medical Records ; Myocardial Infarction ; Obesity ; Retrospective Studies ; Risk Factors ; Seoul ; Stroke ; Tacrolimus ; Transplants

PURPOSE: Although cyclosporine (CsA) improves short-term renal graft outcomes, many paradigms reduce or withdraw this drug because of its nephrotoxicity. However, inadequate immunosuppression with azathioprine led to little success. We conducted a prospective study to define the prolonged effect of CsA reduction in stable renal transplant recipients with mycophenolate mofetil (MMF). METHODS: Thirty-nine primary renal transplant recipients were divided into two cohorts, the AZA (N=13) and the MMF cohort (N=26). Both cohorts were allowed to reduce the CsA dose up to 50% of baseline within 3 to 4 months of conversion to AZA or MMF. Graft function, clinical parameters, and adverse events were monitored for up to 3 years. RESULTS: Ccr gradually deteriorated in the AZA cohort, but was stable in the MMF cohort. There was no episode of acute rejection or graft loss observed in either cohort. CONCLUSION: The CsA dose can be reduced in combination with MMF treatment in stable renal transplant recipients after 2 years of transplantation, resulting in beneficial effects on Ccr, lipid profiles, and blood pressure.
Azathioprine ; Cohort Studies ; Cyclosporine ; Immunosuppression ; Kidney Transplantation ; Mycophenolic Acid ; Prospective Studies ; Rejection (Psychology) ; Transplants

PURPOSE: Heptaplatin (Sunpla) is a cisplatin derivative. A phase IIb trial using heptaplatin resulted in a 34% response rate with mild nephrotoxicity. We conducted a randomized phase III trial of heptaplatin plus 5-FU compared with cisplatin plus 5-FU in patients with advanced gastric cancer. MATERIALS AND METHODS: One hundred seventy-four patients (heptaplatin, n=88; cisplatin, n=86) from 13 centers were enrolled. The eligibility criteria were as follows: patients with pathologically-proven adenocarcinoma, chemonaive patients, or patients who had received only single adjuvant chemotherapy, and who had a measurable or evaluable lesion. On day 1, heptaplatin (400 mg/m2) or cisplatin (60 mg/m2) was given over 1 hour with 5-FU (1 gm/m2) on days 1~5 every 4 weeks. RESULTS: At the time of survival analysis, the median overall survival was 7.3 months in the 5-FU + heptaplatin (FH) arm and 7.9 months in the 5-FU + cisplatin (FP) arm (p=0.24). Of the FH patients, 34.2% (complete response [CR], 1.3%; partial response [PR], 32.9%) experienced a confirmed objective response compared with 35.9% (CR 0%, PR 35.9%) of FP patients (p=0.78). The median-time-to-progression was 2.5 months in the FH arm and 2.3 months in the FP arm. The incidence of neutropenia was higher with FP (28%) than with FH (16%; p=0.06); grade 3~4 nausea and vomiting were more frequent in the FP than in the FH arm (p=0.01 and p=0.05, respectively). The incidence of increased proteinuria and creatininemia was higher with FH than with FP; however, there was no statistical difference. There were no treatment-related deaths. CONCLUSION: Heptaplatin showed similar effects to cisplatin when combined with 5-FU in advanced gastric cancer patients with tolerable toxicities.
Adenocarcinoma ; Arm ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy, Combination ; Fluorouracil ; Humans ; Incidence ; Malonates ; Nausea ; Neutropenia ; Organoplatinum Compounds ; Proteinuria ; Stomach Neoplasms ; Vomiting