• Journal of Chest Surgery
• /
• v.55 no.2
• /
• pp.158-167
• /
• 2022

Background: This study investigated mortality and morbidity in patients requiring postcardiotomy extracorporeal membrane oxygenation (ECMO) support after operations for congenital heart disease (CHD). Methods: CHD patients requiring postoperative ECMO support between May 2011 and May 2021 were retrospectively reviewed. Patients were divided into non-survivors and survivors to hospital discharge. Survival outcomes and associations of various factors with in-hospital death were analyzed. Results: Fifty patients required postoperative ECMO support. Patients' median age and weight at the time of ECMO insertion were 1.85 months (interquartile range [IQR], 0.23-14.5 months) and 3.84 kg (IQR, 3.08-7.88 kg), respectively. Twenty-nine patients (58%) were male. The median duration of ECMO support was 6 days (IQR, 3-12 days). Twenty-nine patients (58%) died on ECMO support or after ECMO weaning, and 21 (42%) survived to hospital discharge. Postoperative complications included renal failure (n=33, 66%), bleeding (n=11, 22%), and sepsis (n=15, 30%). Prolonged ECMO support (p=0.017), renal failure (p=0.005), continuous renal replacement therapy (CRRT) application (p=0.001), sepsis (p=0.012), bleeding (p=0.032), and high serum lactate (p=0.002) and total bilirubin (p=0.017) levels during ECMO support were associated with higher mortality risk in a univariate analysis. A multivariable analysis identified CRRT application (p=0.013) and a high serum total bilirubin level (p=0.001) as independent risk factors for death. Conclusion: Postcardiotomy ECMO should be considered as an important therapeutic modality for patients unresponsive to conventional management. ECMO implementation strategies and management in appropriate patients without severe complications, particularly renal failure and/or liver failure, are crucial for achieving positive outcomes.

• Journal of Trauma and Injury
• /
• v.35 no.1
• /
• pp.25-33
• /
• 2022

Purpose: The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods: The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0-1 (age and Injury Severity Score) or 0-3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0-11 points). Results: The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P<0.001). A value of 5 points was used as the threshold to distinguish low-risk (<5) from high-risk (≥5) patients. Multivariate analysis using the generalized estimating equation in the logistic regression model indicated that the SSTLI score was an independent predictor of mortality (odds ratio, 1.027; 95% confidence interval, 1.018-1.036; P<0.001). Conclusions: The SSTLI was verified to predict mortality in patients with polytrauma and liver injury. A score of ≥5 on the SSTLI indicated a high-risk of post-traumatic mortality.

• The Korea Journal of Herbology
• /
• v.38 no.1
• /
• pp.31-43
• /
• 2023

Objective : Alcoholic liver disease (ALD) is caused by excess alcohol intake. In the liver, alcohol breakdown results formation of toxic byproducts that lead to damage to tissue. This study is to investigate the therapeutic effects of Paeoniae Radix Alba and Puerariae Radix combination (PP) on ALD. Methods : PP was analyzed for polyphenolic compounds and free radical scavenging activity. ALD mouse model was induced by feeding ethanol and water (Control), silymarin (50 mg/kg), low-dose (PP: 100 mg/kg) or high-dose (PP: 200 mg/kg) was orally administrated to ALD mice for 14 days. The serum was assessed with levels of AST, ALT, total bilirubin, total cholesterol, and triglyceride. Liver tissues were evaluated for ROS levels, degree of liver damage and protein expression. Results : The 3:1 (Paeoniae Radix Alba:Puerariae Radix) ratio showed the best antioxidant values for the experiment. In ALD model, levels of AST, ALT, total bilirubin, total cholesterol, and triglyceride were significantly increased in the Control and the levels were decreased by treatment of PP. In addition, increased ROS, ONOO^- and MDA levels in the Control were reduced in the PP groups. Western blot analysis figured out that proteins related to ROS and cholesterol metabolism were higher in ALD than in PP-treated ALD. Antioxidant enzyme expression was low in the control group and increased by PP treatment. Conclusion : Our results suggest that PP has the potential to be a medicine in ALD in terms of regulating oxidative stress and adjusting lipid metabolism.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.27 no.4
• /
• pp.224-235
• /
• 2024

Purpose: Biliary atresia (BA) is the leading cause of neonatal cholestasis (25-45%). The primary treatment is hepatic portoenterostomy (Kasai procedure), but only 20-40% provide long-term benefits. This study aimed to develop a predictive model for surgical efficacy by comparing preoperative and early postoperative indicators in infants with different outcomes. Methods: We enrolled 166 infants with BA (93 girls, 73 boys) who underwent the Kasai procedure between September 2002 and December 2021, dividing them into favorable or adverse outcome groups. Over 40 parameters were measured, and the diagnostic significance of the prognostic model was evaluated. Results: Kasai surgery was efficacious in 69 patients (42%) and non-efficacious in 97 (58%). Our model assesses efficacy by day 14 after surgery, improving on the <34 µmol/L direct bilirubin threshold established for 3-6 months after the procedure. Including the Desmet fibrosis score refined the model. Conclusion: Blood cholesterol below 5.41 mmol/L, direct bilirubin below 56.3 µmol/L on postoperative days 14±3, and a low Desmet score indicate a high probability of efficacious Kasai surgery in infants with BA.

• Clinical Endoscopy
• /
• v.55 no.2
• /
• pp.263-269
• /
• 2022

Background/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP. Methods: This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses. Results: Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS. Conclusions: Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

• Journal of Korean Medical Ki-Gong Academy
• /
• v.23 no.1
• /
• pp.30-43
• /
• 2024

Objective : The purpose of this study is to report a case of treating alcoholic liver disease patients with jaundice and eating disorder through Korean Medicine treatment. Methods : The patient was administered with additional Gagampyeongwi-san and Sinseonbulchuidan for 30 days. For acupuncture, the colonic reducing method (大腸勝格, LI-) and spleen tonifying method (脾正格, SP+) of hand acupuncture were applied. 內關 (PC6), 公孫 (SP4), 三陰交 (SP6), and 足三里 (ST36) were basically collected, and additional 率谷 (GB8), 合谷 (LI4), and 百會 (GV20) were additionally drained and collected by body acupuncture. During the inpatient treatment period, three liver function tests were performed. Results : AST and ALT were restored to the normal range, and γ-GTP and CPK were also reduced, indicating that alcoholic hepatitis was greatly recovered. Total bilirubin and direct bilirubin were also recovered close to normal, and it was predictable that the liver excretion capacity due to hepatocellular damage was also restored, and the findings of biliary obstruction were alleviated close to normal values. When looking at the rise of eGFR along with BUN and uric acid, it seems that kidney function was recovered and improved. Conclusions : Through the combination treatment of Korean Medicine and fluid treatment, it was effective in recovering jaundice and eating disorder for alcoholic liver disease.

• Clinical and Experimental Pediatrics
• /
• v.49 no.12
• /
• pp.1296-1300
• /
• 2006

Purpose : We studied the usefulness of transcutaneous bilirubinometers in follow-up of bilirubin levels during phototherapy in neonatal jaundice patients. Methods : Transcutaneous bilirubin (TcB) was measured twice per day on 90 neonatal jaundice patients without risk factors of jaundice by transcutaneous bilirubinometer JM-103(Minolta/Hill-Rom Air-shields, Japan). TcB was measured simultaneously on the patched-forehead (TcB-PF), patchedchest(TcB-PC), unpatched-forehead (TcB-UF) and unpatched-chest (TcB-UC) of infants with neonatal jaundice. Plasma bilirubin (PB) was measured by American Optical bilirubinometer (American Optical Co, Buffalo, USA) within 30 minutes after transcutaneous bilirubinometer measurement. Each TcB was compared with PB. Results : In the study group, the mean gestational age was $38.6{\pm}1.3wk$, the mean birthweight was $3,207.0{\pm}472.1g$, the mean age at start of phototherapy was $4.9{\pm}0.9days$ and the mean duration of phototherapy was $1.3{\pm}0.6days$. The correlation between TcB and PB level was observed. The correlation between TcB of the patched part (TcB-PF, TcB-PC) and PB was more significant than that of the unpatched part (TcB-UF, TcB-UC) and PB. The most significant correlation was between PB and TcB-PC. Conclusion : TcB was useful in the follow-up of jaundice during phototherapy as well the screening of jaundice in neonatal jaundice patients. TcB of patched-chest area was the most reliable site in transcutaneous bilirubinometer examination in neonatal jaundice patients.

• Clinical and Experimental Pediatrics
• /
• v.49 no.1
• /
• pp.34-39
• /
• 2006

Purpose : The incidence of neonatal hyperbilirubinemia is twice as high in East Asians as in Caucasians. However, its metabolic basis has not been clearly explained. The UDP-glucuronosyltransferase gene(UGT1A1) mutation was found to be a risk factor of neonatal hyperbilirubinemia. We studied whether neonatal hyperbilirubinemia is associated with the 1828G>A(rs 10929303) polymorphism of the UGT1A1 gene, which encodes for a key enzyme of bilirubin metabolism. Methods : The genomic DNA was isolated from 80 Korean full term neonates who had greater than a 12 mg/dL level of serum bilirubin with no obvious cause, and the genomic DNA was also isolated from 164 Korean neonates of the control population. We studied a single nucleotide polymorphism (SNP) of 1828G>A in the untranslated region of the UGT1A1 gene by direct sequencing. Results : Three of the 80 neonates with a serum bilirubin level above 12 mg/dL had homozygous mutations and 10 of the 80 neonates with a serum bilirubin level above 12 mg/dL had heterozygous mutations. Thirteen of the 164 neonates of the control group had homozygous mutations and 16 neonates of the control group had heterozygous mutations. The allele frequency of 1828G>A polymorphism of UGT1A1 in the hyperbilirubinemia group was 10.0 percent, which was not significantly different from the allele frequency of 12.8 percent in the control group. Conclusion : In this study, the 1828G>A polymorphism of the UGT1A1 gene was detected in the Korean neonates with neonatal hyperbilirubinemia. Our results indicated that this SNP is not associated with the prevalence of hyperbilirubinemia in Koreans.

• Clinical and Experimental Pediatrics
• /
• v.49 no.8
• /
• pp.851-856
• /
• 2006

Purpose : The purpose of this study is to find out the diagnostic significance of serum bile acid on total parenteral nutrition induced cholestasis in premature infants. Methods : Infants without cholestasis were classified into postnatal days and each change of serum bile acid was measured and analyzed. Also, the serum direct bilirubin, serum bile acid, ${\gamma}$-glutamic acid transferase, and alkaline phosphatase of premature infants with total parenteral nutrition induced cholestasis were measured for comparison and analysis of their correlation. Results : Changes of serum bile acid analysis after birth showed no significant difference between boys and girls, between premature infants and term infants without cholestasis. Serum bile acid levels are constant after two weeks after birth in neonates without cholestasis. In premature infants with total parenteral nutrition induced cholestasis, the increase of serum direct bilirubin over 2 mg/dL was $34.9{\pm}18.3$ days after birth, and the increase of serum bile acid was $28.1{\pm}18.3$ days. Its increase was about 1 week faster than serum direct bilirubin, however, there was no statistical significance(P=0.114). Comparing analysis of serum bile acid, ${\gamma}$-glutamic acid transferase, and alkaline phosphatase, serum bile acid showed the highest correlation to serum direct bilirubin(r=0.487, P=0.000). Conclusion : Serum bile acid is an important parameter of total parenteral nutrition induced cholestasis in premature infants and will be useful for early diagnosis and treatment.

• Applied Microscopy
• /
• v.36 no.3
• /
• pp.173-182
• /
• 2006

Recently, the pomegranate seed oil (PSO) has been reported to have various efforts including anti-cancer effect. In this study, we examined the liver-protecting effect of the PSO on the hepatotoxicity induced by $CCl_4$ using the BALB/c mice. The PSO was made from dried seeds of black pomegranate (Punica grantum) by heating and squeezing. The expreimental animals were divided into 3 groups; control group treated with olive oil only, experimental group 1 treated with $CCl_4$ only, and experimental group 2 treated with PSO and $CCl_4$. 24 hours after injection of $CCl_4$ into the peritoneal cavity, we collected the blood samples to measure the level of serological factors; aspartate aminotransferase(AST), alanine aminotransferase (ALT), total protein, albumin, total bilirubin, direct bilirubin and alkaline phosphatase. Simultaneously we observed the histological change of liver under the light and electron microscope. As the result, AST and ALT showed $88.7{\pm}14.9IU/L\;and\;22.0{\pm}3.12IU/L$ in the control group, $1963.7{\pm}1212.9IU/L\;and\;4495.4{\pm}2803.6IU/L$ in the experimental group 1, and $432.2{\pm}260.1IU/L\;and\;692.3{\pm}433.1IU/L$ in the experimental group 2. The experimental group 2 showed significant difference as compared with experimental group 1 (P<0.005). In histological study, the experimental group 2 was recovered than experimental group 1 which had abnormal mitochondria, increase of lysosomes, and severe necrosis at the central vein zones. These results indicated that the PSO had the liver protecting effect. However, The further study on the relationship between ingredients of pomegranate seed and liver protecting effect is in need.