No abstract available.
Choledocholithiasis*

No abstract available.
Female* ; Humans ; Transplants*

Purpose: Three years of adjuvant imatinib is the standard treatment for resected gastrointestinal stromal tumors (GISTs) with rupture, but the recurrence rate is prominently high. We aimed to investigate the efficacy and safety of 5-year adjuvant imatinib compared with 3-year treatment in patients with a ruptured GIST following surgical resection. Materials and Methods: A total of 51 patients were included in the analysis. The assessment of GIST rupture was based on Nishida’s classification. Twenty patients who were diagnosed before November 2013 were treated with 5 years of imatinib, and 31 patients who were diagnosed after November 2013 were treated with 3 years of imatinib. We retrospectively compared the clinical outcomes of the two groups. Results: Baseline characteristics and the incidence of the adverse events were generally comparable between the two groups. During a median follow-up duration of 43.8 months and 104.2 months in the 3- and 5-year group, 8 and 9 patients had a disease recurrence, respectively. The 5-year group showed better recurrence-free survival (RFS) than the 3-year group. In multivariate analysis, low mitotic index was a significant independent favorable prognostic factor for RFS, while 5-year imatinib treatment was marginally associated with a favorable RFS. Conclusion Five years of adjuvant imatinib treatment in patients with ruptured GIST was associated with favorable survival outcomes with manageable toxicity profiles. Our findings warrant validation and confirmation in future studies.

BACKGROUND: To evaluate the effects of severe hypoglycemia without hypokalemia on the electrocardiogram in patients with type 2 diabetes in real-life conditions. METHODS: Electrocardiograms of adult type 2 diabetic patients during the episodes of severe hypoglycemia and the recovered stage were obtained and analysed between October 1, 2011 and May 31, 2012. Patients who maintained the normal serum sodium and potassium levels during the episodes of severe hypoglycemia were only selected as the subjects of this study. Severe hypoglycemia was defined, in this study, as the condition requiring active medical assistance such as administering carbohydrate when serum glucose level was less than 60 mg/dL. RESULTS: Nine type 2 diabetes patients (seven men, two women) were included in the study. The mean subject age was 73.2+/-7.7 years. The mean hemoglobin A1c level was 6.07%+/-1.19%. The median duration of diabetes was 10 years (range, 3.5 to 30 years). Corrected QT (QTc) intervals were significantly increased during the episodes of severe hypoglycemia compared to the recovered stage (447.6+/-18.2 ms vs. 417.2+/-30.6 ms; P<0.05). However, the morphology and the amplitude of the T waves were not changed and ST-segment elevation and/or depression were not found during the episodes of severe hypoglycemia. CONCLUSION: In this study, QTc interval prolongation during the episodes of severe hypoglycemia was observed without hypokalemia. Therefore, the distinct alterations in cardiac repolarization during the episodes of severe hypoglycemia may not be associated with hypokalemia.
Adult ; Depression ; Diabetes Mellitus, Type 2 ; Electrocardiography ; Glucose ; Hemoglobins ; Humans ; Hypoglycemia ; Hypokalemia ; Male ; Medical Assistance ; Potassium ; Sodium

The majority of small bowel perforations are caused by an abdominal trauma. However, non-traumatic causes should not be ignored. The etiology of a non-traumatic small bowel perforation is varies and has chronological characteristics. This retrospective study was undertaken to investigate the chronological changes in non-traumatic small bowel perforations over the past twenty years, according to the clinical features, surgical methods, and the prognosis of those with a non-traumatic small bowel perforation. The results of this study showed that the incidence of a bacterial enteritis induced small bowel perforation has significantly decreased, and inflammatory bowel disease or collagen disease has become the major causes of a non-traumatic small bowel perforation. Moreover, geriatric patients over 70 years of age are more vulnerable to a non-traumatic small bowel perforation.
Collagen Diseases ; Enteritis ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Prognosis ; Retrospective Studies

A liposarcoma is the most common soft tissue sarcoma in adults with an incidence of betwen 9.8 and 16% of all soft tissue sarcomas. Among the various histological types, a dedifferentiated liposarcoma has rarely been reported. We experienced a case of a giant 7 kg dedifferentiated liposarcoma arising in the mesentery of a 57-year old male patient. Abdominal computed tomography showed a huge lipoid mass occupying the whole abdomen. A surgical excision was carried out. Histologically, the tumor was composed of a well-differentiated liposarcomatous area and a leiomyosarcoma-like dedifferentiated area. The authors reviewed the prognostic factors and treatments for a liposarcoma.
Abdomen ; Adult ; Humans ; Incidence ; Liposarcoma* ; Male ; Mesentery* ; Sarcoma

A liposarcoma is the most common soft tissue sarcoma in adults with an incidence of betwen 9.8 and 16% of all soft tissue sarcomas. Among the various histological types, a dedifferentiated liposarcoma has rarely been reported. We experienced a case of a giant 7 kg dedifferentiated liposarcoma arising in the mesentery of a 57-year old male patient. Abdominal computed tomography showed a huge lipoid mass occupying the whole abdomen. A surgical excision was carried out. Histologically, the tumor was composed of a well-differentiated liposarcomatous area and a leiomyosarcoma-like dedifferentiated area. The authors reviewed the prognostic factors and treatments for a liposarcoma.
Abdomen ; Adult ; Humans ; Incidence ; Liposarcoma* ; Male ; Mesentery* ; Sarcoma

Appendiceal mucocele is a cystic dilatation of the appendiceal lumen with mucus, which may be caused by either benign or malignant diseases. In this report, five cases of appendiceal mucocele are reported, three of which had a preoperative diagnosis of mucocele, whereas the others were found incidentally during the operation under the diagnosis of intussusception and periappendiceal abscess. All five patients underwent surgical resections, including one ileocecal resection and four right hemicolectomies. Histopathology revealed a mucinous cystadenoma in four cases, and a mucinous cystadenocarcinoma in one. There was no disease-related death during 18 months of follow-up.
Abscess ; Appendix ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Diagnosis ; Dilatation ; Follow-Up Studies ; Humans ; Intussusception ; Mucocele* ; Mucus

BACKGROUND: Cytogenetic abnormalities (CAs) have been reported frequently in patients with otherwise typical aplastic anemia (AA), but their implications in the prognosis and in the evolution to hematologic malignancies are controversial. METHODS: We retrospectively analyzed 127 adult AA patients who had successful cytogenetic analysis at initial diagnosis. RESULTS: The patients were classified into 3 groups according to the initial and follow-up results of cytogenetic profiles. Group 1 included patients who had persistent AA with normal cytogenetic profiles (N=117); Group 2, those who had a normal cytogenetic profile at initial diagnosis but later acquired CA (N=4, 3.1%); and Group 3, those who had CA at the initial diagnosis, regardless of follow-up cytogenetic status (N=6,4.7%). In Group 2, 2 patients later developed CA without progression to acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS); the other 2 patients later progressed to AML. None of the patients in Group 3 progressed to AML or MDS. There was no significant difference in overall survival between Groups 1 and 3. CONCLUSION: AA patients with CA at initial diagnosis or follow-up may not be at greater risk for evolution to AML or MDS, or show shorter survival periods. Prospective studies and a larger patient samples are needed to establish the clinical relevance of CA.
Adult ; Anemia, Aplastic ; Chromosome Aberrations ; Cytogenetic Analysis ; Cytogenetics ; Follow-Up Studies ; Hematologic Neoplasms ; Humans ; Incidence ; Leukemia, Myeloid, Acute ; Myelodysplastic Syndromes ; Prognosis ; Retrospective Studies

Evidence of the ethical appropriateness and clinical benefits of shared decision-making (SDM) are accumulating. This study aimed to not only identify physicians’ perspectives on SDM, and practices related to end-of-life care in particular, but also to gauge the effect of SDM education on physicians in Korea. Methods: A 14-item questionnaire survey using a modified Delphi process was delivered to nephrologists and internal medicine trainees at 17 university hospitals. Results: A total of 309 physicians completed the survey. Although respondents reported that 69.9% of their practical decisions were made using SDM, 59.9% reported that it is not being applied appropriately. Only 12.3% of respondents had received education on SDM as part of their training. The main obstacles to appropriate SDM were identified as lack of time (46.0%), educational materials and tools (29.4%), and education on SDM (24.3%). Although only a few respondents had received training on SDM, the proportion of those who thought they were using SDM appropriately in actual practice was high; the proportion of those who chose lack of time and education as factors that hindered the proper application of SDM was low. Conclusion: The majority of respondents believed that SDM was not being implemented properly in Korea, despite its use in actual practice. To improve the effectiveness of SDM in the Korean medical system, appropriate training programs and supplemental policies that guarantee sufficient application time are required.