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Incisional Hernia in Adult Liver Transplant Recipients
( Ji Soo Lee ),( Kyeong Sik Kim ),( Chan Woo Cho ),( Kyo Won Lee ),( Gyu-seoung Choi ),( Jong Man Kim ),( Choon Hyuck David Kwon ),( Jae-won Joh ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Incisional hernia is one of the complication following abdominal operation. Patients undergoing liver transplantation have a high risk of developing an incisional hernia because of immunosuppression. The purpose of this study is to review incisional hernia cases after liver transplantation and to identify the risk factors for hernia formation. Methods: We retrospectively reviewed and analyzed the medical records of the ninety-four incisional hernia patients after liver transplant recipients from January 2000 to December 2015 in single center institution. Results: 1463 underwent adult liver transplantation during the study period. 94 Incisional hernia patients were found among them. The overall incisional hernia rate was 6.4 %. Mean age was 54 years old and 76.6 % were men. No significant difference was observed for sex, diagnosis, smoking, alcohol, albumin, Child-Pugh score, MELD score, intensive care unit stay, hepatorenal syndrome, ventilator, spontaneous bacterial peritonitis, diabetes, bile leakage, wound problems between patients with incisional hernia and patients without incisional hernia. The characteristics of patients with incisional hernia showed old recipient, more body weight, higher body mass index, living donor recipient compared with patients without incisional hernia. Hypertension, tuberculosis, rejection, postoperative complication event before hernia were significant risk factor (p<0.05). Conclusions: Present study identifies the risk factors for incisional hernia. Surgeons should strive to reduce the risk of incisional hernia after adult liver transplantation.
Integration of Adults with Mental Handicaps into the Community of Hong Kong
David Ping-Pui,Tak-wah yeung,Man-hung Ngan,Chau-Kiu Cheung,Kin-yin Li BK21 Project Force of Special Education Deagu Univ 2001 Journal of Asia-Pacific Special Education Vol.1 No.3
The exten and factors of the integration of adults with mental handicaps into the community of Hong Kong is an uncharted area for rigorous investigation. To conduct the investigation, this study surveyed a representative sample of 692 adults, aged 15 or above, from the end of 1998 through early 1999. The survey sapmle sufficient numbers of adults of the three levels of handicaps, mild(n=234), moderate(n=337), and severe grades(n=121). To measure community intergration, the study employed a comprehensive set of scales, which demonstrated satisfactory reliability. With data weighted to best represent the population adults with mental handicaps in Hong Kong, the study found that being accepred was the highest.
Primary hepatic neuroendocrine carcinoma
Jong Man Kim,Se Yeong Kim,Choon Hyuck David Kwon,Jae-Won Joh,Jae Berm Park,Joon Hyeok Lee,Sung Joo Kim,Cheol-Keun Park 한국간담췌외과학회 2013 한국간담췌외과학회지 Vol.17 No.1
A 67-year-old woman was admitted to our hospital under suspicion of a hepatic tumor, which had been previously diagnosed to be an adenocarcinoma by fine needle aspiration. Computed tomography and magnetic resonance imaging revealed a large tumor measuring 9 cm in diameter in Couinaud’s hepatic segments 4, 5, and 8. We diagnosed the patient to have primary liver cancer, and suspected intrahepatic cholangiocarcinoma preoperatively. We performed a central hepatectomy. According to the immunohistochemical findings of the resected specimen, the tumor was diagnosed to be a primary neuroendocrine carcinoma in the liver. The patient is presently alive without recurrence at 3 months after hepatic resection.
( Jong Man Kim ),( Hyun Jung Kim ),( Hyunjin Lim ),( Hyo Jung Park ),( Sanghoon Lee ),( Won Hyuk Chang ),( Moon Seok Choi ),( Choon Hyuck ),( David Kwon ),( Jeong Meen Seo ),( Jae-won Joh ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Many patients were died after deceased donor liver transplantation (DDLT) because of poor nutritional status by end-stage liver disease. Purpose of present study is to compare the mortality in the period without nutritional support (NST) and that in the period with NST. Methods: Forty-six patient underwent DDLT in Samsung Medical Center at the 2016. All recipients routinely underwent enteral feeding after liver transplantation. NST consist of transplant surgeon, hepatologist, rehabilitation doctor, dietitian, pharmacist, and nurse. NST has cared for twenty-one patients after September 2016. Results: There were no statistically significant differences in baseline and perioperative characteristics between the two groups. The median MELD scores are 36 (range, 21-40) in the period without NST group and 36 (range, 23-40) in the period with NST group, respectively (P=0.596). The incidence of in-hospital mortality in the period without NST group was 24.0% (6/25), but that in the period of NST group was 4.8% (1/20), respectively. In-hospital mortality in the period with NST group was lower than that in the period without NST group, but there was no statistically significant between the groups (P=0.070). Conclusions: Present study suggests that NST approach in the DDLT patients with high MELD score should be required for preventing in-hospital mortality.
Jong Man Kim,Hyojun Park,Hye Ryoun Jang,Jae Berm Park,Choon Hyuck David Kwon,Wooseong Huh,Joon Hyeok Lee,Sung Joo Kim,Jae-Won Joh 대한외과학회 2014 Annals of Surgical Treatment and Research(ASRT) Vol.86 No.5
Purpose: HBsAg-positive kidney recipients are at increased risk for mortality and graft failure. The aims of this study were to identify the outcomes of HBsAg-positive recipients who received preemptive antiviral agents after successful kidney transplantation and to analyze risk factors for HBV reactivation. Methods: We retrospectively reviewed the medical records of 944 patients performed kidney transplantation between 1999 and 2010. Results: HBsAg-negative recipients were 902 patients and HBsAg-positive recipients, 42. Among HBsAg-positive recipients, HBV reactivation was detected in 7 patients and well controlled by switch or combination therapy. Graft failure developed in only one patient due to chronic rejection regardless of HBV reactivation but no deaths occurred. All patients were alive at the end of follow-up and none developed end-stage liver disease or hepatocellular carcinoma. There was statistically significant difference in graft survival between HBsAg-positive recipients and HBsAg-negative. Multivariate analysis identified increased HBV DNA levels (>5 × 10<SUP>4</SUP> IU/mL) in the HBsAg-positive kidney transplant recipients as a risk factor for HBV reactivation (P = 0.007). Conclusion: Effective viral suppression with antiviral agents in HBsAg-positive renal transplant recipients improves patient outcome and allograft survival. Antiviral therapy may be especially beneficial in patients with high HBV DNA levels prior to transplantation.
( Jong Man Kim ),( Choon Hyuck David Kwon ),( Jae Won Joh ),( Jae Berm Park ),( Sung Joo Kim ),( Suk Koo Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background: Hepatocellular carcinoma (HCC) has a high predilection for portal vein invasion. The objective of this study was to investigate clinicopathologic characteristics and outcomes of HCC patients with pathological portal vein invasion. Methods: We retrospectively reviewed the clinicopathologic data and outcomes of 83 HCC patients with portal vein invasion and 1056 patients without portal vein invasion who underwent liver resection. Results: Increased serum alkaline phosphatase (ALP) levels, increased maximum tumor size, and intrahepatic metastasis were predisposing factors for portal vein invasion by multivariate analysis. The median disease-free survival and overall survival of HCC patients with portal vein invasion was 4.5 months and 25 months, respectively. The 1-year, 2-year, and 3-year disease-free survival rates were 30.6%, 26.1%, and 21.2%, respectively, and overall survival rates in HCC patients with portal vein invasion were 68.6%, 54.2%, and 41.6%, respectively. The first detection site was lung in HCC patients with portal vein invasion and liver in HCC patients without portal vein invasion. C-reactive protein (CRP) was a significant independent predictor of tumor recurrence in HCC with portal vein invasion after surgery. Conclusions: Increased ALP levels, increased maximum tumor size, and intrahepatic metastasis were independent predictors of portal vein invasion in HCC. CRP level was closely associated with the predisposing factor of tumor recurrence in HCC patients with portal vein invasion after surgical resection, and lung metastasis was common.
Aspergillosis in Liver Transplant Recipients
Jong Man Kim,Choon Hyuck David Kwon,Jae-Won Joh,Sanghyun Song,Milljae Shin,Sung Joo Kim,Seung Heui Hong,Bok Nyeo Kim,Suk-Koo Lee 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.4
Purpose: The aim of this study was to review the epidemiology, clinical features, diagnosis, and effect of treatments of aspergillosis infections in adult liver transplantation patients. Methods: We retrospectively studied the cases of aspergillosis among 625 (164 deceased donor liver transplantation (DDLT), 461 living donor liver transplantation (LDLT)) adult liver transplantation recipients (≥18 yrs old) operated between May 1996 to May 2008. Results: Fourteen cases of aspergillosis infection were detected, which consisted of 9 cases of invasive aspergillosis, 5 cases of aspergilloma in maxillary sinuses which occurred before the transplantation. One patient with invasive aspergillosis, who had received liver transplantation overseas and had post-operation care in our center, was also included. Among the 8 cases (1.28%) of invasive aspergillosis (excluding one case operated overseas), 6 cases (3.7%) were DDLT and 2 cases (0.4%) LDLT (P-value<0.05). Among the 6 patients with early onset of invasive aspergillosis, 5 patients (1.8%) had fluconazole and only 1 patient (0.3%) had itraconazole as prophylactic antifungal agent (P-value<0.05). The three cases with localized lesions in the lung survived after lobectomy, but the disseminated and inoperable cases died. Conclusion: The incidence of invasive aspergillosis was lower in LDLT cases and prophylactic itraconazole might be more effective than fluconazole. Paranasal aspergilloma, detected before transplantation had no relation with posttransplant invasive aspergillosis infection. Patients who had localized lesion in the lung, and underwent surgery had better survival than who could not.