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Liver transplantation from a non–heart-beating donor
나병곤,황신,홍석경,정동환,Gi-Won Song,하태용,안철수,문덕복,Minjae Kim,Sang Hoon Kim,Sung Gyu Lee 대한이식학회 2020 Korean Journal of Transplantation Vol.34 No.4
Interest in utilizing organs from non–heart-beating donors (NHBDs) has increased because of the organ shortage. However, liver transplantation (LT) from NHBDs has been scarcely performed in Korea because only Maastricht category IV is legally permitted. We present one case of LT from an NHBD with extracorporeal membrane oxygenation (ECMO) support. The case was a 42-year-old male patient with alcoholic liver cirrhosis. The model for end-stage liver disease score was 28. The donor was a 47-year-old female who was diagnosed with brain death due to cerebral infarct, but cardiac arrest occurred before brain death was finally confirmed. Thus, venous-arterial type ECMO was initiated for circulatory support. In the operating room, asystole developed just after ECMO was stopped. After waiting for 5 minutes, cardiac death was declared. It took 6 minutes from skin incision to aorta perfusion. The recipient hepatectomy and graft implantation were performed according to the standard procedures of adult whole LT. The patient recovered from LT uneventfully and has been doing well for 9 years after LT. The use of NHBDs is a method to increase the potential pool of organ donors, thus changes toward enhanced public awareness and acceptance of donating organs, and legal support at the government level are necessary.
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나병곤,배학연,조현진,김권천 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.3
Purpose: Papillary thyroid microcarcinoma (PTMC) is increasing in incidence because of ultrasound-guided fine-needle aspiration cyology (FNA). According to WHO, PTMC is defined as a papillary thyroid cancer of 1 cm or less in diameter. Within the group of patients with PTMC, prognosis is known to be very favorable. This study was carried out to evaluate the clinicohistological characteristics of PTMC and to determine a reasonable extent of surgery for them. Methods: From Mar. 2002 to Dec. 2007, 610 patients with thyroid diseases underwent thyroidectomy at Chosun University hospital. Among these patients, 205 patients (33%) had a thyroid papillary carcinoma less than or equal to 1 cm in great diameter. The clinicopathologic features and treatment outcome of these patients were evaluated retrospectively. Results: In the period 2002-2007, PTMC incidence rate in our institution increased from 10% to 20%. There were 19 men and 186 women with a median age of 46 years (range; 16-74). PTMC diameter ranged from 0.1 to 1 cm. (mean 0.54 cm) 15.7% of patients with PTMC presented with preoperative symptoms (palpable mass, fatigue, pain, hoarseness). Preoperatively 84.3% of these 205 cases were diagnosed by ultrasonography. We performed unilateral lobectomy (41%), near total thyroidectomy (44%), and total thyroidectomy (11%) with or without central compartment neck node dissection. During a mean follow-up of 36 months, 5 patients (2.4%) developed locoregional recurrence with no distant metastasis. There were no significant difference on recurrence rate by size, capsular invasion. But multiplicity of primary tumor has a higher locoregional recurrence rate (p= 0.04). The detection rate of PTMC is increasing due to FNA technique in our hospital. This study shows that PTMC may have capsular invasion, lymph node involvement, multiplicity and locoregional recurrence likely to larger (>1 cm) papillary carcinoma. Conclusion: We suggest that total or near total thyroidectomy with central compartment neck dissection is proper therapeutic operation for PTMC and modified neck dissection shoud be performed if lateral neck lymph node are enlarged or diagnosed as metastatic tumor.
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