PURPOSE: The aim of this prospective, randomized study was to evaluate the effects and adverse effects of nebulized L-epinephrine compared with nebulized budesonide in children with moderate to severe croup. METHODS: Children were eligible for the study if their croup scores fell in the moderate to severe range(scores>4) in the AMC from May 1995 till May 1996. The patients were randomly assigned to receive either 5ml(1 : 1000) of L-epinephrine aerosols(n=9) or 500microgram of budesonide aerosols (n=8). Croup score, O2 saturation by pulse oximeter, heart rate, and blood pressure were recorded before treatment and at 5, 15, 30, 60, 120 minutes after aerosol treatment. Nine patients were enrolled in the nebulized L-epinephrine group and 8 in the nebulized budesonide group, respectively. There were no statistical differences in age, sex and croup score before treatment between the two groups. RESULTS: Total croup score significantly decreased at 15 minutes after treatment in the L-epinephrine group(P<0.05) but at 120 minutes after treatment in the budesonide group(P<0.05). Treatment failed in 1(1/9) patient in the L-epinephrine group and 2(2/8) patients in the budesonide group, who received intramuscular dexamethasone injections. The rebound phenomenon at 120 minutes after treatment was found in 1 patient from both groups. There were no significant changes of heart rate and blood pressure before and after treatment in both groups. CONCLUSION: The treatment using nebulized L-epinephrine showed a more prompt clinical improvement than the treatment using nebulized budesonide and without any significant adverse effects. So it can be recommended for emergent management in children with moderate to severe croup.
Aerosols* ; Blood Pressure ; Budesonide* ; Child ; Croup* ; Dexamethasone ; Heart Rate ; Humans ; Prospective Studies*

PURPOSE: The aim of this prospective, randomized study was to evaluate the effects and adverse effects of nebulized L-epinephrine compared with nebulized budesonide in children with moderate to severe croup. METHODS: Children were eligible for the study if their croup scores fell in the moderate to severe range(scores>4) in the AMC from May 1995 till May 1996. The patients were randomly assigned to receive either 5ml(1 : 1000) of L-epinephrine aerosols(n=9) or 500microgram of budesonide aerosols (n=8). Croup score, O2 saturation by pulse oximeter, heart rate, and blood pressure were recorded before treatment and at 5, 15, 30, 60, 120 minutes after aerosol treatment. Nine patients were enrolled in the nebulized L-epinephrine group and 8 in the nebulized budesonide group, respectively. There were no statistical differences in age, sex and croup score before treatment between the two groups. RESULTS: Total croup score significantly decreased at 15 minutes after treatment in the L-epinephrine group(P<0.05) but at 120 minutes after treatment in the budesonide group(P<0.05). Treatment failed in 1(1/9) patient in the L-epinephrine group and 2(2/8) patients in the budesonide group, who received intramuscular dexamethasone injections. The rebound phenomenon at 120 minutes after treatment was found in 1 patient from both groups. There were no significant changes of heart rate and blood pressure before and after treatment in both groups. CONCLUSION: The treatment using nebulized L-epinephrine showed a more prompt clinical improvement than the treatment using nebulized budesonide and without any significant adverse effects. So it can be recommended for emergent management in children with moderate to severe croup.
Aerosols* ; Blood Pressure ; Budesonide* ; Child ; Croup* ; Dexamethasone ; Heart Rate ; Humans ; Prospective Studies*

PURPOSE: This study was designed to analyze the prognosis following segmental bile duct resection (BDR) versus pancreatoduodenectomy (PD) for mid bile duct (mBD) cancer. METHODS: During the 4 years between 2003 and 2006, 55 patients underwent surgical resection for mBD cancer in our institution. Medical records were reviewed retrospectively. They were divided into two groups, a BDR group (n=24) and a PD group (n=31) according to the extent of resection. RESULTS: Median follow-up was 43 months. Overall 3- and 5-year survival rates were 56.0% and 33.8%, respectively. The BDR group had lower tumor stages than the PD group (p=0.011). R0 resection was achieved in 17 (70.8%) of the BDR group and 30 (96.8%) of the PD group. Median survival periods were 43 and 34 months after R0 and R1 resections, respectively (p=0.715). Recurrence occurred in 41 patients after a mean period of 18 months. Three- and 5-year survival rates were 62.5% and 27.2% after BDR, respectively, and 51.5% and 34% after PD, respectively (p=0.715). No significant risk factors for shorter patient survival times was identified. Aggressive treatment of recurrence did not appear to prolong patient survival. CONCLUSION: The extent of resection for mBD cancer did not affect the survival outcome when R0 resection was achieved. Considering the operative risk in patients with older ages or co-morbidities, PD should be considered only after obtainment of simultaneous tumor-free radial and proximal longitudinal resection margins.
Bile ; Bile Duct Neoplasms ; Bile Ducts ; Follow-Up Studies ; Humans ; Medical Records ; Pancreaticoduodenectomy ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate

PURPOSE: Although curative resection of hilar cholangiocarcinoma (HCCC) remains a difficult challenge, only curative resection with tumor free margins can guarantee a favorable outcome. In this report, we retrospectively analyzed the survival data after surgical resection of HCCC to determine the survival rate and the related factors at a single, large-volume medical institute. METHODS: Between June 1989 and June 2005, surgical intervention with curative intent was performed on 301 patients. We retrospectively analyzed the survival data via a review of the medical record. RESULTS: Among the 259 cases of resection, curative (R0) resection with tumor-free margins was achieved in 186 cases (71.8%). Of these 186 cases, 177 patients underwent various types of hepatectomy with caudate lobectomy and bile duct resection. Combined pancreatoduodenectomy was performed in 19 patients and portal vein resection was performed in 51 patients. In-hospital mortality developed in 11(4.3%) of the 259 patients who underwent resection. The 1-, 3- and 5-year survival rates of patients who underwent R0 resection were 83.3, 42.0 and 29.3%, respectively. Univariate analysis revealed that curability, T stage, lymph node involvement, histologic differentiation and perineural invasion were associated with patient survival. Multivariate analysis showed that curability and lymph node involvement were statistically significant prognostic factors. CONCLUSION: Tumor-positive margins and lymph node involvement resulted in poor outcomes. Intensive perioperative management and a surgeon's aggressive efforts to attain clearance of tumor can minimize the postoperative mortality and maximize survival for patients with HCCC.
Bile Ducts ; Cholangiocarcinoma* ; Hepatectomy ; Hospital Mortality ; Humans ; Klatskin's Tumor ; Lymph Nodes ; Medical Records ; Mortality ; Multivariate Analysis ; Pancreaticoduodenectomy ; Portal Vein ; Retrospective Studies ; Survival Rate

BACKGROUNDS/AIMS: This study is intended to investigate the clinicopathological features of the intraductal papillary neoplasms of the intrahepatic bile duct (IPNB), especially focused on malignant changes. METHODS: From the institutional database of liver resection cases (Asan Medical Center, University of Ulsan College of Medicine), 18 patients who met the definition of IPNB were selected. They had undergone liver resection between February 2002 and October 2006; thus, the follow-up period was more than 5 years. RESULTS: Of the 18 patients, 11 patients were male. Their mean age was 61.3+/-6.7 years. There were no differences between the non-malignant and malignant lesions, in the comparison of the CEA levels (5.6+/-2.7 vs.12.6+/-31.1 ng/ml, p=0.439) and the CA19-9 levels (29.2+/-34.7 vs.31.9+/-30.2 ng/ml, p=0.871). The common radiologic findings were: intraductal growing mass in 10; bile duct dilatation in 6; and saccular duct dilatation in 2. Left and right hepatectomies were performed in 15 and 3, respectively. Five patients showed benign lesions of IPNB, and 13 patients revealed malignant lesions of intraductal papillary adnocarcinoma or cholangiocarcinoma. All 4 patients with benign lesions survived for a mean period of 53 months without recurrence. In 13 patients with the malignant lesions, 1-year, 3-year, and 5-year survival rates were 100%, 84.6%, and 59.2%, respectively. CONCLUSIONS: We concluded that intrahepatic IPNB is a rare type of biliary neoplasm which includes a histological spectrum, ranging from benign disease to invasive malignancy. The long-term survival was anticipated after complete curative resection.
Academic Medical Centers ; Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; Dilatation ; Follow-Up Studies ; Hepatectomy ; Humans ; Liver ; Male ; Recurrence ; Survival Rate

BACKGROUND/AIMS: Sclerosing hepatocellular carcinoma (HCC) is an unusual subtype of HCC that is characterized by an embedded dense fibrous stroma in the tubular neoplastic structures. We aimed to assess the surgical approaches and outcomes of sclerosing HCC. METHODS: We retrospectively analyzed the clinicopathologic features of 6 patients with sclerosing HCC who underwent surgical treatment at Asan Medical Center between July 1989 and December 2005. RESULTS: Six HCC patients with sclerosing HCC were diagnosed out of the total 1390 HCC patients (0.43%) during the study period. The mean age was 58 years and 4 patients were male. Weight loss and abdominal pain were the most common symptoms. The serum calcium and phosphorus levels were normal in all the patients. All of them were hepatitis B surface antigen-positive, but none was positive for hepatitis C. All the lesions were solitary. The tumor size ranged from 45 to 150 mm in diameter (median size: 81 mm). We performed right trisegmentectomy (n=1), central bisegmentectomy (n=1), right anterior segmentectomy (n=1), ex-vivo resection and autotransplantation (n=1) and right posterior segmentectomy (n=2). The median overall survival and disease free-survival periods were 24 months and 9.5 months, respectively. CONCLUSIONS: The incidence of sclerosing HCC was very low. Sclerosing HCC was often not correctly diagnosed before an operation, but performing resection prolonged the patients' survival and their prognosis was not worse than that for ordinary HCC. Our experience implicates that aggressive surgical treatment for sclerosing HCC is beneficial for patient survival.
Adult ; Carcinoma, Hepatocellular/mortality/pathology/*surgery ; Female ; Humans ; Liver/*pathology ; Liver Neoplasms/mortality/pathology/*surgery ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Sclerosis ; Survival Rate

Purpose: Liver transplantation has been performed for recurrent hepatocellular carcinoma (HCC) or deterioration of liver function after prior primary liver resection. Prior major liver resection per se is an unfavorable condition for living donor liver transplantation (LDLT). We analyzed the technical feasibility of prior major hepatectomy-graft combinations for salvage LDLT. Methods: Of the 17 patients who underwent salvage LDLT, 5 underwent prior major liver resection. Results: Two patients with prior left lobectomy received right lobe graft, whereas, of the 3 patients with prior right lobectomy, 2 received right lobe graft and 1 received left lobe graft. During recipient hepatectomy, it was necessary to perform meticulous sharp dissection of the previous liver cut surface to attain full mobilization. Different methods of hepatic vein reconstruction were applied after the recipient inferior vena cava was fully dissected. Reconstruction of the portal vein, hepatic artery and bile duct were performed on case by case basis depending on the remnant hilar structures. Conclusion: In conclusion, every combination of recipient prior right or left lobectomy and living donor right or left liver graft seems to be feasible for salvage LDLT.
Bile Ducts ; Carcinoma, Hepatocellular* ; Hepatectomy ; Hepatic Artery ; Hepatic Veins ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Portal Vein ; Transplants ; Vena Cava, Inferior

PURPOSE: Although a portal vein resection (PVR) can increase the chance for a successful curative resection, there is debate concerning the balance between the risk of the procedure and the effect on survival in patients with hilar cholangiocarcinoma. Therefore, we performed a retrospective study to determine the safety and survival after PVR for hilar cholangiocarcinoma. METHODS: We analyzed the cumulative survival rate and the associated clinical factors in 301 patients undergoing surgical intervention between June 1989 and June 2005. We divided 259 patients undergoing resection into two groups (51 PVR+ and 208 PVR-) and compared the survival and clinicopathological data. RESULTS: The 1-, 3- and 5-year survival rate of 186 patients undergoing curative resection was 83.3, 42.0 and 29.3%, respectively. The Bismuth-Corlette type IV, the infiltrative type, presence of perineural invasion, lymphovascular tumor emboli and lymph node metastases were more frequent in the PVR+ group. The survival rate was significantly lower in the PVR+ group but seven patients have survived for more than 5 years. Five (9.8%) operative mortalities occurred. However, the mortality directly related to the PVR was present in only one case. The morbidity and postoperative liver function were not different in comparisons between the two groups. In the PVR+ group, tumor invasion into the portal vein was observed in 28 of 51 patients. The tumor invasion on pathological examination did not affect survival in the PVR+ group. CONCLUSION: The results of this study showed that PVR in combination with hepatectomy, for hilar cholangiocarcinoma, could be performed with acceptable safety. Although the PVR has a negative impact on survival, a hepatectomy combined with a PVR can offer long-term survival to a few patients with advanced hilar cholangiocarcinoma.
Cholangiocarcinoma* ; Hepatectomy* ; Humans ; Klatskin's Tumor ; Liver ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Portal Vein* ; Retrospective Studies ; Survival Rate

PURPOSE: Orthotopic liver transplantation is considered a standard procedure for patients with end-stage liver disease. Liver transplantation in older patients has increased, with generally acceptable results. In Korea we have an aging population. In this study, we retrospectively reviewed the results of liver transplantation in patients more than 60 years of age at Asan Medical Center. METHODS: Fifty-four patients, age 60 and over, received a liver transplantation at Asan Medical Center between January 1998 and June 2005. We retrospectively reviewed the medical records of these patients. All patients were assessed according to the following variables: age, gender, clinical features, indications for transplantation, surgical findings, the hospital stay following liver transplantation, days in the intensive care unit, complications, and survival. RESULTS: The mean age of the recipients was 62.4 years. The transplant indications were 28 cases of hepatocellular carcinoma and 15 of HBV related cirrhosis. There was postoperative mortality (up to 3 months) in seven patients (13.21%). The mean ICU and hospital stays were 8.04 and 36.8 days, respectively. Overall, the patient survival rates at 1, 3 and 5 years was 83.02%, 75.47% and 75.47%, respectively. CONCLUSIONS: The results of this study showed that chronologic age should not be a contraindication to liver transplantation, especially if the pretransplant evaluation shows no comorbid disease that could increase the mortality rate.
Aging ; Carcinoma, Hepatocellular ; Chungcheongnam-do ; Fibrosis ; Humans ; Intensive Care Units ; Korea ; Length of Stay ; Liver Diseases ; Liver Transplantation* ; Liver* ; Medical Records ; Mortality ; Retrospective Studies ; Survival Rate

PURPOSE: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis after hepatic resection have yet to be clarified. The purpose of this study was to analyze the outcome of sarcomatous HCC patients who underwent surgical resection. METHODS: From January 1997 to May 2005, 11 patients (1.1%) were diagnosed with sarcomatous HCC among 1,005 cases of HCC undergoing resection after pathology and immunohistochemical studies. RESULTS: All of the cases were male and their mean age was 55.8+/-8.1 years. R0 resection was achieved in nine of the 11 patients. The HCC lesions were classified as stage II in three, stage III in four, stage IVa2 in three, and IVb in one, according to the modified pTNM staging system. Extrahepatic metastases as the initial recurrence occurred in eight patients. Among the 11 patients, 10 died of a disease recurrence and only one is still alive. The overall 3-year survival rate was only 18%. CONCLUSIONS: The prognosis of sarcomatous HCC was very poor, showing widespread extrahepatic metastases and frequent early recurrence regardless of the tumor extent. Since some patients showed prolonged survival after a local recurrence, vigorous postoperative systemic surveillance appears to be beneficial for early detection and timely treatment of localized metastases.
Carcinoma, Hepatocellular* ; Humans ; Male ; Neoplasm Metastasis ; Pathology ; Prognosis ; Recurrence ; Survival Rate