Purpose: Distinguishing a fever caused by infection from the necessary febrile response in injured patients is difficult, because trauma patients often have concomitant obvious infectious origins. In traumatic brain injury, early fever might be associated with worse clinical outcomes; however, few reports on trauma patients without brain injury are available.
Methods: In this retrospective observational study, consecutive trauma patients without brain injury who were admitted to the surgical intensive care unit during a 3 year period were included. The surgical and clinical outcomes were compared according to body temperature. Locally weighted scatterplot smoothing was used to identify the relationship between body temperature and injury severity.
Results: A total of 111 patients were included. Body temperature increased as the injury severity score increased up to 47.717, above which it decreased. Mortality was high in hypothermic patients (72.7%; p < 0.001); however, few differences were observed between normothermic and hyperthermic patients (3.5% and 2.4%, respectively). The nonsurvivors had lower body temperatures on the 1st and 2nd days after admission (36 ˚C and 36.9 ˚C) compared with the survivors (37.3 ˚C and 37.7 ˚C; p < 0.001 and p = 0.006). In severely injured patients, low levels of inflammatory biomarkers and low body temperature were correlated with mortality.
Conclusions Fever in trauma patients without brain injury is correlated with injury severity but not with prognosis. Hypothermia on the 1st and 2nd days after admission was significantly correlated with mortality. In severely injured patients, a decreased inflammatory response might play a certain role in promoting a high mortality rate.

Purpose: Distinguishing a fever caused by infection from the necessary febrile response in injured patients is difficult, because trauma patients often have concomitant obvious infectious origins. In traumatic brain injury, early fever might be associated with worse clinical outcomes; however, few reports on trauma patients without brain injury are available.
Methods: In this retrospective observational study, consecutive trauma patients without brain injury who were admitted to the surgical intensive care unit during a 3 year period were included. The surgical and clinical outcomes were compared according to body temperature. Locally weighted scatterplot smoothing was used to identify the relationship between body temperature and injury severity.
Results: A total of 111 patients were included. Body temperature increased as the injury severity score increased up to 47.717, above which it decreased. Mortality was high in hypothermic patients (72.7%; p < 0.001); however, few differences were observed between normothermic and hyperthermic patients (3.5% and 2.4%, respectively). The nonsurvivors had lower body temperatures on the 1st and 2nd days after admission (36 ˚C and 36.9 ˚C) compared with the survivors (37.3 ˚C and 37.7 ˚C; p < 0.001 and p = 0.006). In severely injured patients, low levels of inflammatory biomarkers and low body temperature were correlated with mortality.
Conclusions Fever in trauma patients without brain injury is correlated with injury severity but not with prognosis. Hypothermia on the 1st and 2nd days after admission was significantly correlated with mortality. In severely injured patients, a decreased inflammatory response might play a certain role in promoting a high mortality rate.

PURPOSE: Despite the reduced incidence and mortality of gastric cancer, this illness still remains the second leading cause of cancer death in Korea. Various adjuvant chemotherapies have been proposed for patients with advanced gastric cancer. Randomized trials comparing chemotherapies with best supportive care have consistently shown that cytotoxic treatment is of some benefit. Nevertheless, there has been no major improvement in the overall prognosis of advanced gastric cancer. METHODS: We have examined the chemotherapy sensitivity of advanced gastric cancer specimens by using an ex vivo ATP based chemosensitivity assay (ATP-TCA). A variety of chemotherapeutic agents were tested. The one hundred and forty specimens we tested were from resection specimens. RESULTS: The histological tumor classification, lymphatic invasion, neural invasion and venous invasion affected the chemosensitivity of some drugs. 5-FU was a more potent drug than cisplatin, doxorubicin, iriontecan and methotrexate. The chemosensitivity of differentiated cancer was different compared to that of undifferentiated cancer. Doxorubicin and iriontecan were more effective in poorly differentiated, signet ring cell and diffuse type cancers. The manner of tumor invasion affected the chemosensitivity to some drugs. CONCLUSISON: Further study is necessary to assess the effectiveness of some chemotherapy drugs on advanced gastric cancer, including their effect on tumor recurrence and patient survival.
Adenosine Triphosphate ; Cisplatin ; Doxorubicin ; Fluorouracil ; Humans ; Incidence ; Korea ; Methotrexate ; Prognosis ; Recurrence ; Stomach Neoplasms

PURPOSE: Recently, laparoscopic appendectomy (LA) has been widely performed in developed countries. In addition, minimally invasive surgery such as LA is a challenge to surgical residents. The aim of this study is to evaluate learning curve of residents in comparison to that of experienced surgeons. METHODS: Fifty cases of LA that were performed by experienced surgeons (group A) and forty-seven cases of LA that were performed by 8 residents (group B) were reviewed retrospectively. RESULTS: Operative time was longer in group B (50.8+/-12 vs. 82.8+/-40 min. P<0.001). Hospital days of group B was shorter (4.8+/-2.4 vs. 3.7+/-2.1 days P=0.021). No other parameters were statistically significant. In group A, wound infection developed in 1 case. In group B, wound infection developed in 4 cases, intraabdominal abscess in 1, subcutaneous emphysema in 1. CONCLUSION: Inexperienced surgeons can perform laparoscopic appendectomy easily in the early days of individual laparoscopic training course.
Abscess ; Appendectomy ; Developed Countries ; Learning Curve ; Operative Time ; Retrospective Studies ; Subcutaneous Emphysema ; Wound Infection

This report is a clinical review of 298 cases of early gastric cancer that were treated at Kosin Medical Hospital during 8 years from 1984 to 1992. In 1962, the Japanese Gastroenterological Endoscopy Society defined early gastric cancer as a lesion confined to the mucosa or submucosa and not related to the presence of lymph-node metastasis. The prognosis for early gastric cancer (EGC) is generally excellent, but the proportion of EGC cases progressing to advanced gastric cancer is steadily increasing nowadays. The presence or absence of lymph-node metastasis in EGC is an important prognostic factor; in other words, the survival rate or recurrence rate of node-negative EGC is known to be much better than that of node-positive EGC. The incidence of EGC among resected gastric cancers was 14.7%, and has been increasing annually. The mean age of the EGC patient was 52.4 years, and the most common type was IIc. The size of the lesion was variable, but the most common range was 1~3 cm. Lymph-node metastasis accurred more frequently with the larger sized lesions. In this study, several factors such as age, sex, tumer location, tumer size, depth of invasion, macroscopic and histologic type were evaluated to determine frequency of lymph node metastasis. In the analysis of these eight facters, sex, tumer size, depth of invasion and Lauren type were statistically correlated with lymp node metastasis.
Asian Continental Ancestry Group ; Endoscopy ; Humans ; Incidence ; Lymph Nodes* ; Mucous Membrane ; Neoplasm Metastasis* ; Prognosis ; Recurrence ; Stomach Neoplasms* ; Survival Rate

OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.

Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.

Xanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory bone disease characterized by the presence of cholesterol-laden foam macrophages, histiocytes, and plasma cells. We report the case of a 41-year-old man with end-stage renal disease who had undergone deceased donor kidney transplantation 4 years earlier. He presented with a chest wall mass that he had first identified 2 weeks prior to admission. Computed tomography revealed a periosseous heterogeneously enhancing soft tissue mass adjacent to the sternal end of the left clavicle, accompanied by irregular and destructive osteolytic lesions on the left side of the sternal manubrium. A total mass resection, which included partial clavicle and sternum removal, was performed. Pathological examination revealed foamy histiocytes along with numerous lymphoplasmacytic cells, confirming the diagnosis of XO. This case underscores the potential for XO to develop following kidney transplantation.