Heterotopic bone formation is a very rare event in the gastrointestinal tract including in the appendix. Here we report three cases of heterotopic ossification in appendiceal mucinous neoplasms, one occurring in an appendiceal mucinous cystadenoma, another in a low-grade appendiceal mucinous neoplasm, and the third occurring in an appendiceal mucinous adenocarcinoma. The clinicopathologic characteristics of these three present cases and two previously reported cases are discussed in detail. The mechanism of heterotopic ossification in appendiceal mucinous neoplasm is still unclear, but mucin extravasation and subsequent calcification may be predisposing events.

Basilic vein transposition is a feasible and a good method to make AVF with autogenous vein. Small incision can be applied to basilic vein transposition, which can be less painful and more comfortable to the patients.

PURPOSE: To determine whether patient factors (pre-fitting patient's data) before reverse-geometry lens (RGL) use could be predicting factors for the increase in visual acuity after RGL use. METHODS: The authors reviewed out patient records of 805 eyes of 423 patients wearing RGLs from March 2003 to May 2009. The relationship between patient factors on UVA before wearing a RGL examined at follow-ups and the IVA after wearing a RGL were analyzed. RESULTS: The spherical refractive errors and the cylindrical refractive errors showed statistically significant results (p < 0.05). The lower was the refractive error, the greater were the UVA and IVA results. Correlations existed between the corneal astigmatism and UVA or IVA at three months (p < 0.05). The lower was the corneal astigmatism, the greater were the UVA and IVA results. Correlations were observed between the initial visual acuity and IVA, although the initial visual acuity cannot be a predictor. The other factors evaluated did not show statistically significant results (p > 0.05). CONCLUSIONS: The refractive error and the corneal astigmatism may be strong predictors of UVA and IVA after RGL use.
Astigmatism ; Eye ; Follow-Up Studies ; Humans ; Refractive Errors ; Visual Acuity

PURPOSE: Acute renal failure remains a potentially devastating clinical problem. This study aimed to examine whether the expression of TGF-beta-induced gene product, betaig-h3, is altered in ischemia- reperfusion (I/R) injury and urinary excretion of betaig-h3 is changed in I/R injury. METHODS: I/R injury was performed by clamping both renal arteries. Daily urine output, serum creatinine and urinary TGF-beta and betaig-h3 were measured after I/R injury. Also, the renal expression of betaig-h3 by western blotting and immunohistochemistry were investigated. In the second step, urinary betaig-h3 was measured at 4, 10, 16, and 24 hours after I/R injury to investigate whether it could be used as an early and sensitive marker for detecting I/R injury. RESULTS: Urinary betaig-h3 was significantly elevated at 24 hours and maintained higher than the controls until 2 days after I/R injury. In contrast, western blotting did not reveal any changes of betaig-h3 expression. Immunohistochemistry showed that labeling of betaig-h3 was seen at the basement membranes of proximal tubule cells mainly located at the medullary ray (S3 segment) in both groups. Following I/R injury, the labeling was also seen in the basement membrane of injured or regenerated proximal tubular epithelial cells. Within 24 hours, urinary betaig-h3 was significantly increased at 4 hours after I/R injury. Importantly, the urinary appearance of betaig-h3 preceded that of N-acetyl-beta-D-glucosaminidase. CONCLUSION: These results suggest that endogenous renal betaig-h3 may serve to promote tissue regeneration in I/R injury and urinary betaig-h3 could be used as an early and sensitive marker demonstrating I/R injury.
Acetylglucosaminidase ; Acute Kidney Injury* ; Basement Membrane ; Blotting, Western ; Constriction ; Creatinine ; Epithelial Cells ; Immunohistochemistry ; Regeneration ; Renal Artery ; Reperfusion ; Reperfusion Injury ; Transforming Growth Factor beta

C4d deposition in peritubular capillaries in renal allograft biopsies is a significant marker for diagnosis of antibody-mediated rejection. However, it is unclear whether C4d deposition could be derived from BK virus infection. We present a case of BK virus nephropathy with strong C4d deposition 10 months after kidney transplantation. The diagnosis of BK virus nephropathy was missed out, whereas strong C4d deposition was noted in the first biopsy and therefore anti-rejection therapy was started. The deterioration of renal function led to a evaluate the possibility of BK virus nephropathy with second graft biopsy and further studies of BK virus replication status. Second graft biopsy revealed BK virus nephropathy without rejection. Finally, discontinuation of immunosuppressants and addition of anti-viral therapy for BK virus resulted in recovery of renal function, despite development of pancytopenia and subsequent fungal infection after leflunomide therapy. As in this case, initial focal pathologic changes from BK virus nephropathy could be overlooked by light microscopy. In addition, even though C4d positivity in peritubular capillaries is a good marker for diagnosis of antibody-mediated rejection, the meticulous examinations of the localization of C4d is needed, considering BK virus activates complement pathways and therefore leads to deposition of C4d mainly in tubular basement membrane. Based on our case of BK virus nephropathy with strong C4d deposition, we suggest that C4d deposition could be derived from BK virus nephropathy and therefore, it should be differentiated from acute antibody- mediated rejection in a renal allograft recipient.
Basement Membrane ; Biopsy ; BK Virus ; Capillaries ; Complement C4b ; Complement System Proteins ; Immunosuppression ; Immunosuppressive Agents ; Isoxazoles ; Kidney Transplantation ; Light ; Microscopy ; Pancytopenia ; Peptide Fragments ; Rejection (Psychology) ; Transplantation, Homologous ; Transplants

A 49-year-old man with drowsy mentality was diagnosed with acute type A aortic dissection; he underwent an emergency operation. When selective antegrade cerebral perfusion was initiated, the right regional cerebral oxygen saturation (rSO2) decreased as compared to the left one. Adequate blood flow was perfused through the branch of the artificial graft, after distal anastomosis, but the right rSO2 did not recover. Angiography revealed another intimal tear on the right common carotid artery. A stent was then inserted. The right rSO2 promptly increased to the same level as that of the left one. The patient was discharged without any neurologic complications.
Angiography ; Carotid Artery, Common ; Cerebral Angiography ; Emergencies ; Humans ; Middle Aged ; Oxygen ; Perfusion ; Stents ; Transplants

A 50-year-old female was admitted to Pusan National University Hospital with complaints of fatigue and sweating. Echocardiography showed a small patent ductus arteriosus (PDA) and highly mobile vegetations on the aortic valve. Emergency operation was performed due to the high risk of embolization and severe aortic regurgitation. When the pulmonary artery opened, we found unexpected fresh vegetation. The tissue of the PDA was fragile and infected. We successfully removed the infected tissue, closed the PDA with a patch, and replaced the aortic valve with a mechanical prosthesis.
Adult* ; Aortic Valve Insufficiency ; Aortic Valve* ; Busan ; Ductus Arteriosus, Patent* ; Echocardiography ; Emergencies ; Endocarditis* ; Fatigue ; Female ; Humans ; Middle Aged ; Prostheses and Implants ; Pulmonary Artery ; Sweat ; Sweating

Since the advent of percutaneous cardiopulmonary support (PCPS), its application has been extended to massively injured patient. Cardiac injury following blunt chest trauma brings out high mortality and morbidity. In our cases, patients had high injury severity score by blunt trauma and presented sudden hemodynamic collapse in emergency room. We quickly detected cardiac tamponade by focused assessment with sonography for trauma and implemented PCPS. As PCPS established, their vital sign restored and then, they were transferred to the operation room (OR) securely. After all injured lesion repaired, PCPS weaned successfully in OR. They were discharged without complication on day 26 and 55, retrospectively.
Cardiac Tamponade ; Emergencies ; Extracorporeal Circulation ; Heart Rupture ; Hemodynamics ; Humans ; Injury Severity Score ; Retrospective Studies ; Thorax ; Vital Signs

BACKGROUND/AIMS: Traumatic aortic injury (TAI) is rarely seen clinically, but is highly fatal. In determining how to treat TAI, there are many factors to consider, due to the complexity of concomitant injuries. The Society of Vascular Surgery recommends that thoracic endovascular aortic repair (TEVAR) should be preferentially performed over open surgical repair. We evaluated the efficacy of TEVAR based on our experiences in TAI treatment. METHODS: Between July 2008 and August 2011, we conducted a retrospective analysis of the patients who underwent TEVAR following TAI and analyzed factors including TAI type and sites, time from injury to repair, Injury Severity Score, and complications. Seven patients with multiple injuries underwent TEVAR in the acute setting. Follow-up was accomplished regularly by computed tomographic angiography (CTA). RESULTS: Type III aortic injury, rib fractures, and hemothorax were found in all patients. TEVAR was successfully performed. Completion angiography demonstrated complete exclusion of pseudoaneurysm without endoleakage, and perfusion of aortic arch vessels was maintained. There was no in-hospital mortality or evidence of spinal cord ischemia. The average follow-up duration was 30.4 +/- 23.9 months, and regular CTA revealed good durability of the stent-graft without late complications such as endoleakage, stent migration, or pseudoaneurysm formation. CONCLUSIONS: Through this study, we were able to identify good mid-term results of TEVAR in our hospital. TEVAR is thought to be a good modality with which to treat acute traumatic aortic injury, especially given the consideration of bleeding risk in trauma patients with multiple injuries.
Aneurysm, False ; Angiography ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Endovascular Procedures ; Follow-Up Studies ; Hemorrhage ; Hemothorax ; Hospital Mortality ; Humans ; Injury Severity Score ; Multiple Trauma ; Perfusion ; Retrospective Studies ; Rib Fractures ; Spinal Cord Ischemia ; Stents ; Thoracic Injuries

No abstract available.
Adult ; Biopsy ; Cholecystitis/diagnostic imaging/*etiology/therapy ; Churg-Strauss Syndrome/*complications/diagnosis/drug therapy ; Diagnosis, Differential ; Female ; Gallstones/diagnostic imaging/*etiology/therapy ; Glucocorticoids/therapeutic use ; Humans ; Lymphadenopathy/diagnostic imaging/*etiology/therapy ; Magnetic Resonance Imaging ; Mediastinum ; Methylprednisolone/therapeutic use ; Predictive Value of Tests ; Tomography, X-Ray Computed ; Treatment Outcome