Development of Pre-discharge Group Education Program for Liver Transplant Patients / 대한이식학회지

BACKGROUND: This study was conducted to develop a pre-discharge group education program for liver transplant patients, and to contribute to improving the knowledge and performance of self-management after discharge. METHODS: This investigation was a methodological study consisting of analysis, design, development, operation, and evaluation stages. RESULTS: The constituent items of the pre-discharge group education program for liver transplant patients include medication management, infection management, emergency management, outpatient management, complication management, nutrition management, exercise management, wound and drainage management, disability registration, and sex life. The pre-discharge group education program for liver transplant patients was conducted once a week, 30 minutes for the coordinator, 40 minutes for the clinical nurse specialist (including 10 minutes for wound and drainage management), 30 minutes for pharmacists, 20 minutes for the nutritionist, and 20 minutes for social workers. Additionally, the contents of the lecture announced by PowerPoint were made the same as the booklet. The overall knowledge level before and 3 months after the pre-discharge group education program for liver transplantation patients increased significantly from 17.32±1.53 to 19.74±0.89. At the 3-month time point, the overall compliance was 77.39±3.04 out of 80. Overall satisfaction was 9.32±0.93 on a scale of 10. Finally, the need for medication was the highest at 3 months. CONCLUSIONS: It is expected that this program can be utilized in the clinical field as an effective nursing education intervention.

Kidney Transplantation from the Deceased Donor Who Need Continuous Renal Replace Therapy / 대한이식학회지

BACKGROUND: Brain death donors may require continuous renal replacement therapy (CRRT) in severe acute renal failure (ARF) during management. To maximize donor organ usage we performed renal transplantation from deceased donors requiring CTTR with informed consent. This single-center study reviewed the clinical outcomes of kidney transplant recipients from extreme marginal donors requiring CRRT. METHODS: Medical records of all patients using a graft from extreme marginal donors who underwent CRRT in Asan Medical Center between June 2007 and September 2014 were reviewed retrospectively. RESULTS: Between June 2007 and September 2014, 27 kidneys were transplanted from 19 CRRT donors. Mean donor age was 35.1 years (range; 16~56), male donors were 14 (74%). The causes of brain death included head trauma in 6, hypoxia in 5, stroke in 4, and others in 4. The main causes of CRRT were anuria in 14, electrolyte imbalance or acidosis in 5, and mean duration of donor CRRT was 3.6 days (range; 1~11). Delayed graft function (DGF) developed in 24 (88.9%), but all recovered renal function; they can be free from dialysis 11 days after transplantation. Mean serum creatinine level at 1 month, 1 year, and 5 years was 1.85, 1.26, and 1.31 mg/dL, respectively. CONCLUSIONS: Five-year follow-up data showed that renal transplantation from severe ARF donor has an excellent outcome. Although CRRT donor kidney transplants have a higher rate of DGF, the presence of DGF, unlike other donation after brain death donor kidney transplants, does not portend a worse prognosis.

Outcomes of Pancreas Transplantation: Single-Center Experience in Korea / 대한내과학회지

BACKGROUND/AIMS: Pancreas transplantation (PT) as the ultimate treatment for insulin-dependent diabetes has been the subject of debate clinically. Marked improvements in patient and graft survival, and decreases in postoperative morbidity have been achieved due to technical refinements, improved immunosuppressants, and better postoperative management. Here, we report our 18-year experience with PT performed at our institute. METHODS: All recipients who underwent deceased donor or living donor PT between July 1992 and December 2009 were included. We reviewed the medical records, including operation records, progress, and laboratory findings during follow-up. Graft and patient survival were analyzed using the Kaplan-Meier method. RESULTS: In total, 119 cases of pancreas transplantation were performed between July 1992 and December 2009 at our institute. Indications for pancreas transplantation were type I diabetes in 93 (78.2%) patients and type II diabetes in 16 (13.4%) patients. The transplanted pancreas was obtained from a deceased donor in 108 cases (90.8%) and a living donor in 11 cases (9.2%). Median follow-up duration was 39.3 months posttransplantation (range 0~176 months). Overall graft survival rates at 1, 5, and 10 years were 81.6%, 63.4%, and 57.1%, respectively. Following the introduction of tacrolimus as an immunosuppressant in 1999, graft survival at 1, 5, and 10 years was 89.1%, 72.9%, and 66.2%, and overall patient survival at 1, 5, and 10 years was 93.0%, 86.0%, and 86.%, respectively. CONCLUSIONS: Considering the quality of life and long-term patient survival, PT is an effective treatment strategy in non-obese diabetic patients requiring insulin regardless of the type of diabetes.

Analysis of Maternal and Neonatal Factors Affecting Hematopoietic Parameters of Cord Blood / 대한수혈학회지

BACKGROUND: Cord blood (CB) is a useful source of hematopoietic stem cells. In public CB banks, only CB units with good hematopoietic potential are processed and stored because the processing and storage of CB are cost-consuming and labor-intensive procedures. Presently, we sought to determine factors correlated with, and influential to, hematopoietic parameters of CB units donated from Korean neonates and their mothers. METHODS: A total of 1,696 CB units that were donated and processed from August 1 - December 31, 2007 were enrolled. Donated CB volume, total nucleated cells (TNC), total mononucleated cells (MNC), CD34+ cells after processing, and cell viability before and after processing were analyzed according to sex and delivery method. We also determined whether maternal age, neonatal factors (gestational age, birth weight, sex, delivery method), CB volume, and processing time were correlated with hematopoietic parameters of CB. RESULTS: CB of female neonates had significantly higher mean TNC and CB obtained from vaginal delivery had significantly higher mean TNC, MNC, and CD34+ cells. The counts of TNC, MNC, and CD34+ cells were significantly positively correlated with CB volume, gestational age, and birth weight. Counts of TNC, MNC, and CD34+ cells, and pre- and post-viability of CB were significantly negatively correlated with processing time. CONCLUSION: The present data provide a baseline for standard methods of collection, processing, and storage in cord blood banking.

Cord Blood Volume Reduction Using the Automated Devices Sepax(R) S-100 and AXP(TM) AutoXpress Platform / 대한수혈학회지

BACKGROUND: A successful cord blood (CB) bank requires long-term storage of a large number of CB units with good quality. To provide an optimal storage condition and to solve issues of space, many techniques have been developed to remove the plasma and RBC with maintenance of the quality and cell dose. We compared the results of the use of two different automated systems with the hydroxyethyl starch (HES) sedimentation method used in routine manual processing. METHODS: A total of 38 donated CB units with informed consent (18 June 2007~16 July 2007) were randomly selected and enrolled. We performed volume reduction of 20 units with the Sepax(R) S-100 (Sepax), 18 units with the AXP(TM) AutoXpress Platform (AXP), and compared the levels of nucleated cell recoveries, viability, and CD34+ cell/total nucleated cells (TNC) with the levels of 20 units processed using the HES method in the same period. The correlations of the initial TNC with cell recoveries were also evaluated. RESULTS: The mean values of the TNC recoveries, viabilities, and CD34+ cell/TNC among the three methods were similar (P=0.75; P=0.13; P=0.75). However, the MNC recovery was significantly higher with the use of the AXP system (89.2%, P<0.001) than the other methods. The Sepax system also showed a reduced SD for TNC recovery. Moreover, cell recovery rates were independent of the initial TNC counts. CONCLUSION: The Sepax and AXP automated cord blood process systems allow similar cell recoveries and viability as compared with the HES method. With the results of this study, a cord blood bank may be able to use an automated system considering the facility, personnel and the workload.

Psychosocial Adjustment of the Organ Transplantation Recipients in Korea / 대한이식학회지

PURPOSE: This study was aimed to understand the experience and adjustment process of organ transplantation recipients in Korea, using grounded theory method. METHODS: Eight patients after liver transplantation and two patients after heart transplantation were selected for this study, for whom minimum follow-up duration was at least 6 months after transplantation. Data was collected from July to November 2005 through in-depth individual interviews either at home or hospital. The data were analyzed using a constant comparative method in which new data was continuously coded into categories and properties. RESULTS: Data analysis revealed that "safekeeping the graft" was the core category in experience of organ transplantation recipients. In order to safekeep transplanted organ, recipients used seven different strategies to deal with various problems and conflicts which occurred during the recovery process: 1) altering the role function of family, 2) complying the treatment regimen, 3) developing the know-how for self-care, 4) returning to the normal life, 5) keeping the positive thinking, 6) concerning for the donor, and 7) improving the self-fulfillment. CONCLUSION: The results of this study provided deep understanding on the recovery process after organ transplantation and these would help establishing more appropriate intervention to improve quality of life for organ transplantation recipients.

Development of Organ Transplantation Information System Associated with Hospital Order Communicating System (OCS) and Korean Networking for Organ Sharing (KONOS) / 대한이식학회지

A well designed transplant software program with its database is a valuable tool in the management of transplant patients and transplant associated works. PURPOSE: The purpose of this study is to make the organ transplantation information system associated with Hospital Order Communicating System (OCS) and Korean Networking for Organ Sharing (KONOS) METHODS: We used the Hospital Order Communicating System in Asan Medical Center as a data capture source. Web EDI system was going to be used to connect the Korean Networking for Organ Sharing. RESULTS: Electronic link to Order Communicating System in our hospital can eliminate the necessity of double entry of data and eliminates the manual entry errors while increasing the efficacy of service. Multicentric accessibility to this new software system makes the data entry be easy. This program can capture the necessary data including text, numeric, scanned data at all stages of treatments, from the pretransplant to posttransplant follow-up using data transmission with Order Communicating System. The built-in tools for data analysis and other services can assist the coordinators in performing their daily tasks. Complying with timely reporting demanded by KONOS overburdened the transplant center staff and coordinators. We are already prepared to connect to KONOS reporting system using EDI system, and we are waiting for response of KONOS. CONCLUSION: Even though it was not simple to make the well designed transplant software because it involves several concerns, we were able to make the organ transplant information system linked to OCS successfully. We hope this system can be connected to KONOS in the near future.

A Case of Toxic Epidermal Necrolysis / 대한피부과학회지

A case of Toxic epidermal necrolysis in 19 th years old man is presented. This patient has been suffering from erythematous patches and bullae over entire body including vesicles, erosions, and fissures on both lips since 2 days ago after taking some drugs (analgetics, aspirin, chloramphenicol, sulfisoxazole, erythromycine.) for treatment of tonsillitis. Furthermore, it is very difficult for us to say why the disease has occured. Toxic Epidermal Necrolysis (TEN) by talking drugs or Staphylococcal Scalded Skin Syndrpme (4S) by staphylococcus aurues because staphylococcus aureus was found on bacteriai culture from his throat swab. He was treated with corticosteroid, antibiotics and fluids for 20 days with good result. Literature was briefly reviewed.

Report of Two Cases of Hypomelanosis of Vitiligo Type Probably due to Benoquin / 대한피부과학회지

Two cases of vitiligo-type hypomelanosis followed by the local application of Benoquin ointment for the treatment for the treatment of melasma are reported. These two cases of hypomelanosis are unwanted and unintended side effects probably caused by the application of monobenzyl ethers of hydrcquinone (monobenzone). Monobenzone blocks the enzyme tyrosinase and thereby prevents the conversion of tyrosine to dihydroxyphenylanine, a precursor of melanin, and since this does not destroy melanocyte or facilitate the loss of melanin. The skin contact with the material will not occur, repigmentation will slow but eventuaIly complete.

Dupuytren's Contracture associated with Dlabetes Mellitus / 대한피부과학회지

Dupuytren's contracture is a idiopathic hypertrophy of palmar aponeurosis and consequent flexion deformity of distal palms and fingers. This patient is a 58-year-old man who has been suffering from diabetes mllitus since last 20 years. Skin lesion developed from one year ago. Skin lesion is a well defined, yellowish brown, nontender, firm, pea-sized nodule at distal palmar crease proximal to ring finger on both hands. On physical examination, he is within normal limit except skin lesion and flexion deformity on both hands. Skin biopsy on nodule revealed non-specific fibrosis. Literature was briefly reviewed.

Psychodynamic Approaches of Alopecia Totalis in Sisters / 대한피부과학회지

Alopecia totalis is a varient of alopecia areata which is a depilated, round or oval patch, which developed on scalp, eye lashes, eye brows, and beared areas. There is two sisters, elder is 7 year -3month-old, younger is 5-year 7-month-old. Hair loss began to developed on scalp (especially on forehead) 2 months and and 14 months prior to visit to our OPD. We consult the psychiatric department, and concluded that the etiology of our cases are suggested to have emotional disturbances which are ambivalent mother and fear of loss

A Case of Lupus Vulgaris on the Patella Region of the Right Knee Joint / 대한피부과학회지

A case of lupus vulgaris who has the typical skin lesion on the patella region of the right knee was presented. The patient is 9 years old, the generally healthy male, and is no special finding of chest X-ray but tuberculin test was strong positive. The skin lesion started about 2 years ago as baby's palm sized erythematous patch with apple jelly nodule on the right knee joint region. Diagnosis was made by characteristic of clinical appearance and histulagial finding including other laboratory data. The treatment was done with INAH, PAS, streptomycin and pyridoxine for 3 months. Now,The skin lesion is almost healed and still continue treatment and observation go on.