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Immune-enhancing Oral supplement after Gastric Cancer Surgery
( Eunmi Gil ),( Dae Sang Lee ),( Chi Min Park ),( Jeong Meen Seo ),( Min Gew Choi ),( Jun Ho Lee ),( Tae Sung Sohn ),( Jae Moon Bae ),( Sung Kim ),( Miyong Rha ),( Soyoung Yu ),( Ji Won Baek ) 한국정맥경장영양학회 2015 한국정맥경장영양학회 학술대회집 Vol.2015 No.-
Objectives: The aim of this study was to evaluate the effect of immune-enhancing oral supplement including glutamine, arginine, and leucine on the immunological change after gastric cancer surgery. Methods: Patients undergoing subtotal gastrectomy were randomized to control and study group. Study group received immune-enhancing supplement including glutamine, arginine, and leucine (Curact®) and control group received placebo supplement including same calories dextrose. Postoperative supplements were started at the postoperative day (POD) 7th and continued for 3 weeks after discharge. Immunological data were collected included count of White blood cell (WBC), C-reactive protein (CRP), immunoglobulin (Ig), CD4, and CD8 at preoperative, POD 5th and POD 28th, respectively. Nutritional data were collected included albumin, prealbumin, cholesterol, and patient-generated subjective global assessment (PG-SGA). Results: 60 patients were randomized, of whom 15 patients were dropped and 45 patients were analyzed (control 23 patients, study 22 patients). Characteristics, nutrition and immune related factors at preoperative and POD 5th were not different between two groups. At POD 28th, mean CRP and count of WBC were significantly lower in study group, and mean level of Ig M was significantly higher in study group than the control group (137.9 vs. 108.7, p=0.021). Ig G, CD4 and CD8 tended to be preserved in the study group, however, there was no statistical difference between two groups. PG-SGA became significantly worse after surgery in both group, however there was no difference between two groups. Conclusions: Immune-enhancing oral supplement might have positive effect on immune preservation and decreasing inflammation after gastric cancer surgery.
( Eunmi Gil ),( Choon Hyuck D. Kwon ),( Jong Man Kim ),( Gyu-seong Choi ),( Jin Seok Heo ),( Wontae Cho ),( Seung Hwan Lee ),( Jin Yong Choi ),( Mi Sook Gwak ),( Geum-youn Gwak ),( Jae-won Joh ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Although laparoscopic liver resection has developed rapidly, its usefulness for the treatment of large tumors is less clear, due to concerns about compromising oncological principles and patient safety. The purpose of this study was to explore the feasibility and safety of laparoscopic liver resection for the treatment of hepatocellular carcinoma (HCC) with a tumor size larger than 5 cm. Methods: From January 2007 to December 2014, we performed laparoscopic liver resection in 45 patients with HCC with a tumor size ≥ 5 cm. Perioperative outcome, tumor recurrence and overall patient survival were analyzed. Results: Median age was 60 years old (IQR 52-68) and 64.4% (29/45) was male. Seven patients (15.6%) had larger than 10cm of HCC. No operative deaths occurred and six of the laparoscopic procedures were converted to open resection (conversion rate 13.3%). Median operation time was 365 minutes (IQR 277-443) and median estimated blood loss (EBL) was 400.0 ml (IQR 275-600). There was no R1 or R2 resection and median resection margin was 19.0 mm (IQR 8.0-33.0). Complications above Clavien-Dindo classification grade III occurred in four patients (8.9%). The median overall follow-up time was 10.7 month (range 1.1-62.1). 1-year recurrence free survival (RFS) and overall survival (OS) were 86.0% and 95.5%, and 3-year RFS and OS were 70.7% and 86.0%. Conclusions: Laparoscopic liver resection seems safe and feasible in patients with HCC with a tumor size larger than 5 cm. Expansion of indication for laparoscopic liver resection in patients with HCC may be considered.
Impact of Recipient Age on Mortality after Liver Transplantation: A Population-Based Cohort Study
( Eunmi Gil ),( Jong Man Kim ),( Jae-won Joh ),( Gee Young Suh ),( Dong Hyun Sinn ),( Kyeongman Jeon ),( Jeong Hoon Yang ),( Jinkyeong Park ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Mortality after liver transplantation (LT) depends on many factors. Our aim was to assess short-term outcomes after first LT in a cohort of adult recipients form the national wide database in Korea and identify predictors of in-hospital mortality that could avoid futile LT. Methods: We analyzed data from Health Insurance Review and Assessment Service (HIRA) which is a government-affiliated organization that reviews claim accuracy and assess the quality for the National Health Insurance (NHI) between Aug, 2009 and July, 2014. The patients who had procedural codes of the Korea NHI concerning LT (Q8040-Q8050, Q8140-Q8150) were categorized as patients who received LT. We analyzed the effect of several risk factors on survival by multivariable logistic models. Results: Total 5375 patients had first liver transplantation in this period (1433 received from deceased donor (DD) and 3942 received form living donor (LD)). Mean age was 52.3±8.9 years old and 72.8% (n = 3913) was male. Most common underlying cause of LT was viral hepatitis (46.9 %) due to hepatitis B or C virus, with or without malignant neoplasm of liver. Total 346 patients (6.4%) were died after liver transplantation before hospital discharge. DDLT recipients’ mortality was 14.0% (n = 200) and LDLT recipients’ mortality was 3.7% (n = 146) (p < 0.001). Multiple logistic analysis identified four variables associated with patient survival: recipient age older than 65 years old, recipient on mechanical ventilation more than 3 days, recipients on perioperative hemodialysis, and vasopressor support more than 2 days. Conclusions: Our data shows recipient age, mechanical ventilation, dialysis, and shock had an ability to predict short term outcome. Our results can be used to identify futile cases in which expected outcomes is too poor to justify transplantation.
염색체 이상과 동반된 원발성 알도스테론증 환자의 8년 후 추적 관찰 1예 보고
임석아,남은미,박시훈,신길자,이우형,심봉석 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.1
8년전 양측성 부신증식에 의한 원발성 알토스테론증으로 진단받고 spironolactone 및 칼슘차단제를 투여하여 혈압이 조절되던 환제에서 최근 혈압이 조절되지 않아 전산화 단층 촬영을 제디행한 결과 부신선종이 동반된 것을 발견하고 부신 적출술 후 소량의 항고혈압제로 혈압이 조절되었던 1예를 보고하는 바이다. We describe an unusual 30-year-old female patient with a history of refractory hypertension and hypokalemia. She was diagnosed as primary aldosteronoism with bilateral adrenal hyperplasia 8 years age and blood pressure has been controlled with spironolactone 200mg/day, nifedipine 40mg/day, Cardura 4mg/day and oral potassium supplement till these days. Recently refractory high blood pressure was developed and about 5*4*4.5cm sized left a-drenal mass was observed by abdominal CT. The hypertension and hypokalemia was controlled by left adrenalectomy.
Kyoung Won Yoon,Kyoungjin Choi,Keesang Yoo,Eunmi Gil,Chi-Min Park 대한외과학회 2023 Annals of Surgical Treatment and Research(ASRT) Vol.104 No.1
Purpose: Acute care surgery (ACS) has been practiced in several tertiary hospitals in South Korea since the late 2000s. The medical emergency team (MET) has improved the management of patients with clinical deterioration during hospitalization. This study aimed to identify the clinical effectiveness of collaboration between ACS and MET in hospitalized patients. Methods: This was an observational before-and-after study. Emergency surgical cases of hospitalized patients were included in this study. Patients hospitalized in the Department of Emergency Medicine or Department of Surgery, directly comanaged by ACS were excluded. The primary outcome was in-hospital mortality rate. The secondary outcome was the alarm-to-operation interval, as recorded by a Modified Early Warning Score (MEWS) of >4. Results: In total, 240 patients were included in the analysis (131 in the pre-ACS group and 109 in the post-ACS group). The in-hospital mortality rates in the pre- and post-ACS groups were 17.6% and 22.9%, respectively (P = 0.300). MEWS of >4 within 72 hours was recorded in 62 cases (31 in each group), and the median alarm-to-operation intervals of each group were 11 hours 16 minutes and 6 hours 41 minutes, respectively (P = 0.040). Conclusion: Implementation of the ACS system resulted in faster surgical intervention in hospitalized patients, the need for which was detected early by the MET. The in-hospital mortality rates before and after ACS implementation were not significantly different.
Emergency gastrointestinal tract operation associated with cytomegalovirus infection
Seijong Kim,Kyoung Won Yoon,Eunmi Gil,Keesang Yoo,Kyung Jin Choi,Chi-Min Park 대한외과학회 2023 Annals of Surgical Treatment and Research(ASRT) Vol.104 No.2
Purpose: Cytomegalovirus (CMV) infection is common in immunocompromised patients. Enterocolitis caused by CMV infection can lead to perforation and bleeding of the gastrointestinal (GI) tract, which requires emergency operation. We investigated the demographics and outcomes of patients who underwent emergency operation for CMV infection of the GI tract. Methods: This retrospective study was conducted between January 2010 and December 2020. Patients who underwent emergency GI operation and were diagnosed with CMV infection through a pathologic examination of the surgical specimen were included. The diagnosis was confirmed using immunohistochemical staining and evaluated by experienced pathologists. Results: A total of 27 patients who underwent operation for CMV infection were included, 18 of whom were male with a median age of 63 years. Twenty-two patients were in an immunocompromised state. Colon (37.0%) and small bowel (37.0%) were the most infected organs. CMV antigenemia testing was performed in 19 patients; 13 of whom showed positive results. The time to diagnose CMV infection from operation and time to start ganciclovir treatment were median of 9 days. The reoperation rate was 22.2% and perforation was the most common cause of reoperation. In-hospital mortality rate was 25.9%. Conclusion: CMV infection in the GI tract causes severe effects, such as hemorrhage or perforation, in immunocompromised patients. When these outcomes are observed in immunocompromised patients, suspicion of CMV infection and further evaluation for CMV detection in tissue specimens is required for proper treatment.