PURPOSE: Crohn's disease is chronic, nonspecific inflammatory process and the incidence is becoming larger recently. The authors studied the clinical course of the Crohn's disease by reviewing the clinical characteristics, anatomical distribution, operative indications, operative procedures and postoperative results. METHODS: We reviewed medical records of 30 patients who had treatment at the Chonbuk national university hospital from June 1988 to December 1997. We analyzed their age, sex distribution, clinical symptoms, anatomical distribution, operative indication, operative procedure, postoperative recurrence rate and postoperative results. RESULTS: Sex ratio was 1.5:1 (male:female) and average age of onset was 33 year. Thirteen patients (43%) underwent operation but there was no remarkable difference between the groups that received operation and that had medical treatment. Abdominal pain and diarrhea were common but there were no extraintestinal symptoms. The most common site of involvement was ileocecum and the next was small intestine, followed by large intestine. Intestinal obstruction was the most common indication for surgery and fistula, abscess formation and palpable abdominal mass in order. Three cases out of 13 patients who had undergone primary resection needed second operation, and 2 cases of the 3 recurrent cases underwent the third operation. During the follow up period, there were two cases of re-operation due to anastomotic leak or ileus. The patient who received the third operation (right hemicolectomy, retroperitoneal abscess drainage and jejunal resection) died of anastomotic leak, enterocutaneus fistula, sepsis and respiratory failure. CONCLUSIONS: The incidence of Crohn's disease in Korea is gradually increasing and the disease has been challenging problems to most surgeonsfor its frequent surgical indication, high recurrence rate, complication and poor surgical results. The above results suggest that Crohn's disease needs follow-up even after the operation.
Abdominal Pain ; Abscess ; Age of Onset ; Anastomotic Leak ; Crohn Disease* ; Diarrhea ; Drainage ; Fistula ; Follow-Up Studies ; Humans ; Ileus ; Incidence ; Intestinal Obstruction ; Intestine, Large ; Intestine, Small ; Jeollabuk-do ; Korea ; Medical Records ; Recurrence ; Respiratory Insufficiency ; Sepsis ; Sex Distribution ; Sex Ratio ; Surgical Procedures, Operative

Posttransplant erythrocytosis (PTE) is a common complication of renal transplantation. It afflicts 5-15 % of renal transplant recipients with good renal function and is associated with an increased incidence of thromboembolic events. Traditional therapies for PTE include serial phlebotomy and native nephrectomy, neither of which has proved optimal. Recently, angiotensin converting enzyme (ACE) inhibitors have been developed as an alternative for PTE treatment. The aim of the study was to evaluate the therapeutic effect of an ACE inhibitor, enalapril, on PTE by the measurement of serum erythropoietin (EPO) level. Ninety consecutive cyclosporine (CsA)-treated recipients who have received living donor kidneys were investigated during the first two years. Eleven recipients (12.2%) had developed PTE, and ten of them were prospectively treated with enalapril (5-10 mg/day) for 1 year for PTE. The average age for the nine men and one woman was 32+/-7.8 years . All retained their native kidneys. Seven recipents were hypertensive, 5 on diuretics, and 2 were smokers. Serum creatinine was 1.4+/-0.3 mg/dl. Onset of PTE occured 9.8+/-5.5 months posttransplant. Duration of PTE was 7.7+/-6.8 mos (range 1-24 mos). Three had undergone 1-2 phlebotomies during the previous year. None had experienced thromboembolic event. In 10 recipients, hematocrit (HCT) during 3 clinic visits before treatment was 55.8+/-3.4 %. After the application of enalapril, HCT in all recipients decreased. Mean HCT at 3 months was decresed to 44.1+/-3.3 % (p<0.001 vs. pre-enalapril values). One patient became anemic (HCT<40 %). One patient who had initially responsed to enalapril stopped using the drug due to dry cough and suffered a recurrence of PTE. Serum EPO levels (RIA) decresed significantly, from a mean of 15.6+/-6.7 to 8.7+/-3.8 mU/ml at 2 month (p<0.05), although the values were within the normal range for our laboratory. Regardless of pre-enalapril EPO level, the HCT normalized in all patients. Mean arterial pressure decreased (105.2+/-14 vs. 97.2+/-12 mmHg, p<0.05) at 12th month. Serum creatinine did not change (1.4+/-0.3 vs. 1.5+/-0.4 mg/dl) during the study period. No patient required phlebotomy after starting enalapril. We conclude that enalapril administration resulted in a reversible decline of HCT to normal levels in renal transplant recipients with PTE. Clinically, enalapril is a safe and effective alternative to traditional treatment of PTE.
Ambulatory Care ; Arterial Pressure ; Cough ; Creatinine ; Cyclosporine ; Diuretics ; Enalapril* ; Erythropoietin ; Female ; Hematocrit ; Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Living Donors ; Male ; Nephrectomy ; Peptidyl-Dipeptidase A ; Phlebotomy ; Polycythemia* ; Prospective Studies ; Recurrence ; Reference Values ; Transplantation

PURPOSE: The purpose of this study is to understand the relations of demographic and clinical characteristics, psychopathology and ways of coping with psychosocial adjustment of epileptic patients. METHODS: The participants were 200 epileptic outpatients. They completed Korean version of Washington Psychosocial Seizure Inventory (K-WPSI), Symptom Check List-90-Revised (SCL-90-R) and The Ways of Coping Checklist (WCC). RESULTS: The results showed that frequency of seizure, education level, socioeconomic level, occupation, all of subscales in SCL-90-R and passive coping styles were significantly related to overall psychosocial functioning of epileptic patients. The global severity index score that indicated present psychopathology of SCL-90-R best explained overall psychosocial functioning. And the frequency of seizure, education level, socioeconomic level, occupation, and somatization were also significant factors. The global severity index score was explained by emotional focused coping, socioeconomic level, frequency of seizure, and problem focused coping. CONCLUSIONS: The results of this study suggested that psychosocial adjustment of epileptic patients showed a significant relations with psychopathology, clinical and socioeconomic factors and the ways of coping.
Checklist ; Education ; Epilepsy ; Humans ; Occupations ; Outpatients ; Psychopathology ; Seizures ; Socioeconomic Factors ; Washington

A 69-year-old male was admitted to the neurosurgery department for traumatic intracra-nial hemorrhage in both frontal lobes. After 2 months, he complained of epigastric dis-comfort, nausea, vomiting, and loose stools. The gastric endoscopic examination found acute hemorrhagic gastritis and there were rhabditoid nematode larvae in the gastric fluid and biopsy sections. The filariform larvae of Strongyloides sp. were discovered from a fecal culture. The patient was treated with albendazole (200 mg, po bid, for 4 weeks). The epigastric discomfort disappeared and endoscopic findings improved after treatment.
Aged ; Albendazole ; Biopsy ; Frontal Lobe ; Gastritis* ; Hemorrhage ; Humans ; Larva ; Male ; Nausea ; Neurosurgery ; Strongyloides ; Vomiting