Diabetic ketoacidosis (DKA) is an acute complication related to severe hyperglycemia. While the mortality rate for DKA is low with appropriate therapy, several complications may lead to deterioration of the clinical course. Here, we report a case of a 23-year-old patient with DKA who suffered from a rare but hemodynamically unstable cardiac arrhythmia, polymorphic ventricular tachycardia with prolonged QT interval, or Torsades de Pointes. During the recovery phase of DKA, three episodes of Torsades de Pointes suddenly occurred, and were recovered by immediate defibrillation. The patient did not have structural heart disease or a genetic predisposition. To the best of our knowledge, this is the first report of an adult with DKA complicated with QT prolongation related to Torsades de Points after correction of ketosis. To manage DKA, more attention may be needed on changes in the QT interval as well as risk factors for Torsades de Points.

PURPOSE: The purpose of this study is to evaluate the effectiveness and the adverse events of high dose insulin/euglycemia therapy in acute calcium channel blocker (CCB) poisoning. METHODS: We developed a systematic search strategy and applied it to 4 electronic reference databases. We searched medical journals as well as the bibliographies of relevant articles. All forms of literature relevant to human use of high dose insulin for acute CCB poisoning were included. The literature search was conducted by two investigators in August, 2015 with publication language restricted to English and Korean. Case reports were divided between CCB overdose alone and multi-drug overdose including CCB. The effect and adverse event of high dose insulin and clinical outcome of each case were analyzed. RESULTS: Among 55 searched studies, 20 studies were included. A prospective study, a retrospective study, a systematic review study, and 17 case reports were identified. Case reports consisted of 11 CCB alone and 12 multidrug overdose cases including CCB. Although most cases described significant clinical improvements, one of them showed no beneficial effect. Several adverse events including hypoglycemia and hypokalemia were reported. No significant sequalae from adverse events was reported. CONCLUSION: Although there were many case reports demonstrating successful use of high dose insulin for CCB poisoning, the effect cannot be estimated due to a possibility of publication bias. Therefore, high dose insulin/euglycemia therapy might be considered adjunctive therapy in cases of CCB intoxication refractory for standard therapy.
Calcium Channel Blockers ; Calcium Channels* ; Calcium* ; Humans ; Hypoglycemia ; Hypokalemia ; Insulin ; Poisoning ; Prospective Studies ; Publication Bias ; Publications ; Research Personnel ; Retrospective Studies

PURPOSE: One of the major drawbacks of peritoneal dialysis (PD) is catheter migration and dysfunction. Preventing catheter migration is one of the main concerns. We compared laparoscopic internal fixation method with open surgical method for catheter migration rates. METHODS: From January 2008 to August 2009, PD catheters were inserted by laparoscopic fixation (LF) method in 22 patients and by open surgery (OS) in 32 patients. Clinical data were reviewed retrospectively. The frequency of migration, peritonitis, and other complications were compared. Catheter and patient survival rates were also compared. RESULTS: The mean age and sex ratio were not different between groups. Mean follow-up duration was 29.1 months in LF group and 26.1 months in OS group. More patients in LF group (27.3%) had history of laparotomy than in OS group (3.1%) (P = 0.01). The mean operation time was significantly longer in LF group (101.6 +/- 30.4 minutes) than in OS group (72.4 +/- 26.03 minutes) (P = 0.00). The cumulative incidence of catheter migration was 65.6% in OS group and 13.6% in LF group (P = 0.00). Migration-free catheter survival was higher in LF group (P = 0.001). There were no differences in complication rates between groups. Overall catheter survival was similar (P = 0.93). Patient survival rate at 2 years was not different (P = 0.13). CONCLUSION: Laparoscopic internal fixation of continuous ambulatory peritoneal dialysis catheter significantly reduces migration rates without any addition of complications. Also, laparoscopic technique did not incur patient morbidity or mortality despite the requirement for general endotracheal anesthesia and longer operation time. Therefore, internal fixation can be afforded safely in patients with previous abdominal surgery as either a salvage or preventive measure in patients with repeated catheter migration.
Anesthesia ; Catheters ; Follow-Up Studies ; Humans ; Incidence ; Laparoscopy ; Laparotomy ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Retrospective Studies ; Sex Ratio ; Survival Rate

PURPOSE: A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds. METHODS: The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation. RESULTS: The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days. CONCLUSION: This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation.
Hemodynamics ; Humans ; Laparotomy ; Length of Stay ; Medical Records ; Multiple Trauma ; Omentum ; Retrospective Studies ; Schools, Medical ; Trauma Centers ; Wounds, Stab

PURPOSE: Heptaplatin (Sunpla) is a cisplatin derivative. A phase IIb trial using heptaplatin resulted in a 34% response rate with mild nephrotoxicity. We conducted a randomized phase III trial of heptaplatin plus 5-FU compared with cisplatin plus 5-FU in patients with advanced gastric cancer. MATERIALS AND METHODS: One hundred seventy-four patients (heptaplatin, n=88; cisplatin, n=86) from 13 centers were enrolled. The eligibility criteria were as follows: patients with pathologically-proven adenocarcinoma, chemonaive patients, or patients who had received only single adjuvant chemotherapy, and who had a measurable or evaluable lesion. On day 1, heptaplatin (400 mg/m2) or cisplatin (60 mg/m2) was given over 1 hour with 5-FU (1 gm/m2) on days 1~5 every 4 weeks. RESULTS: At the time of survival analysis, the median overall survival was 7.3 months in the 5-FU + heptaplatin (FH) arm and 7.9 months in the 5-FU + cisplatin (FP) arm (p=0.24). Of the FH patients, 34.2% (complete response [CR], 1.3%; partial response [PR], 32.9%) experienced a confirmed objective response compared with 35.9% (CR 0%, PR 35.9%) of FP patients (p=0.78). The median-time-to-progression was 2.5 months in the FH arm and 2.3 months in the FP arm. The incidence of neutropenia was higher with FP (28%) than with FH (16%; p=0.06); grade 3~4 nausea and vomiting were more frequent in the FP than in the FH arm (p=0.01 and p=0.05, respectively). The incidence of increased proteinuria and creatininemia was higher with FH than with FP; however, there was no statistical difference. There were no treatment-related deaths. CONCLUSION: Heptaplatin showed similar effects to cisplatin when combined with 5-FU in advanced gastric cancer patients with tolerable toxicities.
Adenocarcinoma ; Arm ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy, Combination ; Fluorouracil ; Humans ; Incidence ; Malonates ; Nausea ; Neutropenia ; Organoplatinum Compounds ; Proteinuria ; Stomach Neoplasms ; Vomiting

PURPOSE: Although cyclosporine (CsA) improves short-term renal graft outcomes, many paradigms reduce or withdraw this drug because of its nephrotoxicity. However, inadequate immunosuppression with azathioprine led to little success. We conducted a prospective study to define the prolonged effect of CsA reduction in stable renal transplant recipients with mycophenolate mofetil (MMF). METHODS: Thirty-nine primary renal transplant recipients were divided into two cohorts, the AZA (N=13) and the MMF cohort (N=26). Both cohorts were allowed to reduce the CsA dose up to 50% of baseline within 3 to 4 months of conversion to AZA or MMF. Graft function, clinical parameters, and adverse events were monitored for up to 3 years. RESULTS: Ccr gradually deteriorated in the AZA cohort, but was stable in the MMF cohort. There was no episode of acute rejection or graft loss observed in either cohort. CONCLUSION: The CsA dose can be reduced in combination with MMF treatment in stable renal transplant recipients after 2 years of transplantation, resulting in beneficial effects on Ccr, lipid profiles, and blood pressure.
Azathioprine ; Cohort Studies ; Cyclosporine ; Immunosuppression ; Kidney Transplantation ; Mycophenolic Acid ; Prospective Studies ; Rejection (Psychology) ; Transplants

PURPOSE: It has been known that the incidence of post-transplant diabetes mellitus (PTDM) is variable according to the immunosuppressant used. The goals of this study are to uncover the factors associated with the development of PTDM and to clarify the fate of PTDM. METHODS: The medical records of 267 patients who underwent renal transplant between 1996 and December 2002 at Seoul National University Hospital were retrospectively reviewed. Patients were divided into three groups: cyclosporine group (CsA, n=179), high tacrolimus group (HFK, mean trough level during post-transplant 2 week>15 ng/m, n=33) and low tacrolimus group (LFK, mean trough level during post- transplant 2 week< or =15 ng/mL, n=55). The incidence, risk factors of PTDM and clinical fate were analyzed. RESULTS: PTDM developed in 46 (17.2%) patients. PTDM incidence of HFK group (60.6%) was significantly higher than CsA group (10.1%) and LFK group (14.5%) (P=0.000). Tacrolimus use, age at the time of transplantation (>40year), family history of diabetes and obesity (BMI>25) were the risk factors for PTDM development. Incidences of associated clinical events, such as acute rejection, cerebrovascular accident, myocardial infarction, or infection were not different between PTDM and non-PTDM group. PTDM was resolved in 13 out of 46 patients (28.3%). Only 7 out of 33 patients (21.2%) in whom PTDM persisted lost their graft. CONCLUSION: PTDM incidence was higher in HFK group. So, LFK protocol is considered to be safe and beneficial, at least in terms of PTDM. Tacrolimus as immunosuppressant, recipient, family history of DM and obesity were the risk factors of PTDM development. PTDM was reversible in 28.3% of patients. PTDM had little impact on clinical outcomes during mid-term period.
Cyclosporine ; Diabetes Mellitus* ; Humans ; Immunosuppression ; Incidence ; Medical Records ; Myocardial Infarction ; Obesity ; Retrospective Studies ; Risk Factors ; Seoul ; Stroke ; Tacrolimus ; Transplants

Leiomyosarcoma of the inferior vena cava (IVC) is an uncommon tumor and usually shows poor prognosis. Complete surgical resection is the only proven therapy and the effect of adjuvant therapy on the patient's survival has still not been demonstrated. We recently, experienced a case of IVC leiomyosarcoma that had been surgically resected and the tumor was noted to have spread to the liver on follow up. Metastatic tumor was removed by hepatectomy without any further evidence of necurrence. We report here on this case of the IVC leiomyosarcoma along with conducting a review of the relevant literatures.
Follow-Up Studies ; Hepatectomy ; Leiomyosarcoma* ; Liver ; Prognosis ; Vena Cava, Inferior*

PURPOSE: Venous reflux in primary varicose vein arises from the saphenofemoral junction (SFJ), and the saphenopopliteal junction (SPJ) and it can arise from the non-junctional great saphenous vein (GSV) tributaries and, the non-saphenous veins. Superficial venous surgery (SVS) is associated with a significant improvement in the lower leg venous hemodynamics. We performed a retrospective study to examine the prevalence of the reflux pattern in the primary varicose veins and, to observe any change of non-junctional GSV reflux. METHOD: From May 2004 to July 2005, 481 patients (766 limbs) were diagnosed with venous incompetence by performing a duplex ultrasound examination. A follow-up duplex ultrasound examination was performed for a group of non-junctional GSV reflux patients and for a group of patient having both superficial vein reflux and deep vein reflux. RESULT: The prevalence of SFJ reflux, SPJ reflux, below the knee GSV reflux with competent SFJ and, non saphenous vein reflux was 82%, 13%, 10% and, 4.5% respectively. In the patients with SVS who had deep vein reflux (DVR), DVR was absent in only on two patients (6%). Eight patients (9.1%) of the 88 primary varicose vein patients had asymptomatic left iliac vein obstruction detected by performing an ascending venogram during radiofrequency ablation (RFA). On the duplex findings after SVS, the reflux pattern of left deep venous system was not different from the right deep venous system. CONCLUSION: Varicose veins may occur in any vein, even if junctional reflux is predominant. Careful duplex ultrasound evaluation will delineate the changing pattern of venous reflux with/without SVS. Although superficial venous surgery must fit the patient's map, the results might be variable. Prospective studies are needed to analyze the dynamics of venous reflux after SVS.
Catheter Ablation ; Follow-Up Studies ; Hemodynamics ; Humans ; Iliac Vein ; Knee ; Leg ; Prevalence ; Retrospective Studies ; Saphenous Vein ; Ultrasonography ; Varicose Veins* ; Veins

PURPOSE: Post-transplant diabetes mellitus (PTDM) is believed to cause serious complications. PTDM might be one of the important risk factors of cardiovascular death after renal transplantation. Because the consequence of PTDM is expected to take long time, long-term follow-up is necessary. We performed this study not only to define the prevalence and risk factors of PTDM but also to define the long-term clinical impact of PTDM. METHODS: Among 508 patients who had received renal transplantation at Seoul National University Hospital between July 1969 and December 1995, 431 patients were included. Patients were grouped into PTDM and non-DM groups. The clinical characteristics were compared between two groups. RESULTS: Mean follow-up duration was 121.9 months (2~346 months). PTDM was developed in 68 (15.8%) patients. Recipient age at transplantation (P=0.004), family history of DM (P=0.000) and obesity (P= 0.000) were significant risk factors in multivariate analysis. Complications of PTDM such as cerebrovascular disease (CVD, P=0.040), ischemic heart disease (IHD, P=0.040), and infection (p=0.044) were significantly more frequent in PTDM group. The frequency of chronic allograft nephropathy (CAN) was not different between two groups. Although graft survival rate was not affected by PTDM, patient survival rate was significantly lower in PTDM group (P=0.002). CONCLUSION: PTDM increased complication rates such as CVD, IHD and infection. PTDM seemed not to affect graft survival, but to worsen the patient survival rate.
Allografts ; Cardiovascular Diseases ; Diabetes Mellitus* ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation ; Multivariate Analysis ; Myocardial Ischemia ; Obesity ; Prevalence ; Risk Factors ; Seoul ; Survival Rate ; Transplantation*