Background: Living-donor liver transplantation (LDLT) is a viable alternative to deceased-donor liver transplantation. Enhanced recovery after surgery protocols that include early extubation offer short-term benefits; however, the effect of immediate extubation in the operating room (OR) on long-term outcomes in patients undergoing LDLT remains unknown. We hypothesized that immediate OR extubation is associated with improved long-term outcomes in patients undergoing LDLT. Methods: This retrospective cohort study included 205 patients who underwent LDLT. The patients were classified based on the extubation location as OREX (those extubated in the OR) or NOREX (those extubated in the intensive care unit [ICU]). The primary outcome was overall survival (OS), while secondary outcomes included ICU stay, hospital stay duration, and various postoperative outcomes. Results: Among the 205 patients, 98 (47.8%) underwent extubation in the OR after LDLT. Univariate analysis revealed that OR extubation did not significantly affect OS (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.24–1.05; P = 0.066). Furthermore, multivariate analysis revealed no statistically significant association between OR extubation and OS (HR: 0.79, 95% CI: 0.35–1.80; P = 0.580). However, OR extubation was significantly associated with a lower incidence of 30-day composite complications and shorter ICU and hospital stays. Multivariate analysis indicated that higher preoperative platelet counts, increased serum creatinine levels, and a longer surgery duration were associated with poorer OS. Conclusions Immediate OR extubation following LDLT surgery was associated with fewer 30-day composite complications and shorter ICU and hospital stays; however, it did not significantly improve OS compared with ICU extubation.

Primary retroperitoneal mucinous cystadenocarcinoma is a very rare malignancy, and little is known concerning its pathogenesis, optimal treatment, and prognosis. A 29-year-old pregnant woman (21 weeks) presented with abdominal discomfort. CA 19-9, CA 125, and CEA were normal. Abdominal CT scanning revealed a 19x15x13 cm retroperitoneal tumor. Exploratory laparotomy and tumor excision were performed. Mucinous retroperitoneal implants were removed as completely as possible. Histologically, the tumor showed focal areas of capsular invasion, but free resection margins. The uterus and both ovaries were normal in appearance. No adjuvant therapy was pursued. Six months later, peritoneal and bilateral ovarian metastases were discovered.Hence, we report the details of this case of primary retroperitoneal mucinous cystadeno-carcinoma and present a review of the literature.
Adult ; Cystadenocarcinoma ; Cystadenocarcinoma, Mucinous ; Female ; Humans ; Laparotomy ; Mucins ; Neoplasm Metastasis ; Ovary ; Pregnant Women ; Uterus

Acinar cell carcinoma is a rare tumor that represents 1~2% of all pancreatic cancers. Clinical and radiologic findings are inconclusive in this disease. Acinar cell carcinoma is characterized by rapid progression and early metastasis, which lead to its poor prognosis. A 41-year-old man was admitted to our hospital for abdominal pain. Abdominal computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) showed a splenic mass, which was being invaded by a pancreatic tail mass and which had increased 18F-fluorodeoxyglucose (FDG) uptake. Primary radical distal pancreatectomy and splenectomy were performed. Pathologic findings revealed an acinar cell carcinoma of the pancreas. The patient underwent a total gastrectomy three months later because of gastric recurrence. Four months later, multiple hepatic metastases were discovered, and the patient underwent a left hepatectomy. During treatment with capecitabine, there was no evidence of tumor progression for 14 months. We report a case of metastatic pancreatic acinar cell carcinoma, which did not progress for an extended period while the patient was being treated with capecitabine.
Abdominal Pain ; Acinar Cells ; Adult ; Carcinoma, Acinar Cell ; Deoxycytidine ; Electrons ; Fluorouracil ; Gastrectomy ; Hepatectomy ; Humans ; Neoplasm Metastasis ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Recurrence ; Splenectomy ; Capecitabine

Acute suppurative thryroiditis is a rare disease because the thyroid gland is resistant to infection. Thyroid function tests are usually normal in acute suppurative thryroiditis. We care for a patient with acute suppurative thryroiditis and associated thyrotoxicosis. A 73-year-old diabetic woman presented with pain over the thyroid gland and an elevated serum thyroid hormone level and decreased radioiodine uptake, as occurs in subacute thyroiditis. A neck computed tomography showed an abscess in the right lobe of the thyroid gland. A neutrophilic infiltration was shown in a fine needle aspiration biopsy, and Gram negative Burkholderia gladioli grew from the aspirate culture. Antibiotic treatment ameliorated the symptoms of infection, followed by normalization of thyroid function.
Abscess ; Aged ; Biopsy ; Biopsy, Fine-Needle ; Burkholderia gladioli ; Female ; Humans ; Neck ; Neutrophils ; Rare Diseases ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis, Subacute ; Thyroiditis, Suppurative ; Thyrotoxicosis

OBJECTIVES: Although pregnancy in women who are 35 years old or more is considered a high risk pregnancy, it has occurred more frequently in recent years. The aim of our study was to evaluate the course of delivery and perinatal outcomes in women who are 35 years old or more. METHOD: We have compared 765 cases of the elderly gravida over the age of 35 at the department of Obstetrics and Gynecology, Mokpo, Catholic Hospital, from January 1, 1997 to December 31, 1999, with 800 cases of randomly chosen young pregnant women during the same period. RESULTS: There were 765 cases of the elderly gravida among total 8285 deliveries and the incidence of the elderly gravida for 3 years was 9.2%. The rate of elderly gravida was increased from 8.2% in 1997 to 10.0% in 1999. 46.9% were in the age group of 35 to 36 years. The incidence of primigravida was 13.9%. 93.6% of total cases was vertex presentation breech presentation was 5.2%, and transverse lie was 1.2%. The percentage of preterm pregnancy was 9.5% in elderly gravida, and 4.0% in control group. post-term pregnancy was 2.0% in elderly gravida, and 1.0% in control group.The rate of cesarean section was 48.8%, compared with 26.7% in the control group. Among the indications of cesarean section, the highest incidence was previous cesarean section (40.0%) and elderly primigravida (18.0%), fetal distress (10.7%), cephalopelvic disproportion (7.5%), and abnormal presentation (6.7%). Concerning the prenatal complications, the incidence of hypertensive disorder was 4.3%, and 2.6% in control group. The incidence of low birth weight and macrosomia were 8.9%, 8.8% in elderly gravida, and 5.5%, and 9.3% in control group. The incidence of IUFD was 3.1% in elderly gravida, and 0.63% in control group. Male-to-female sex ratios were 1.12:1 in elderly gravida, 1:1.16 in elderly primigravida, 1.17:1 in elderly multi gravida, and 1.20:1 in control group. CONCLUSION: The rate of elderly gravida increased in recent years, and the cesarean rate was higher compared with the control group. But there was no difference in perinatal mortality. The reasons for increasing rate of cesarean delivery may be due to physician and patient concern over pregnancy outcome in older women. Therefore it is necessary to exert more attention to pregnancies in those over the age of 35.
Adult ; Aged ; Breech Presentation ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Distress ; Gynecology ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Jeollanam-do ; Obstetrics ; Perinatal Mortality ; Pregnancy ; Pregnancy Outcome ; Pregnancy, High-Risk ; Pregnant Women* ; Sex Ratio