Takayasu arteritis is a chronic non-specific inflammatory arteriopathy that involves primarily the first branches of aortic arch but may also affect the aorta and any of its primary branches. A characteristic trait of the disease is that most of the patients are young females of mainly Asian and South American origin. Recently, we experienced a rare case of Takayasu arteritis which showed a cord-like atresia of abdominal aorta just below renal arteries in 52-year-old woman. We performed a side to side bypass graft from descending thoracic aorta to abdominal aorta just above the aortic bifurcation with a 18mm PTFE(polytetrafluoroethylene) vascular graft. The postoperative course was uneventful.
Aorta ; Aorta, Abdominal* ; Aorta, Thoracic ; Asian Continental Ancestry Group ; Female ; Humans ; Middle Aged* ; Renal Artery ; Takayasu Arteritis* ; Transplants

BACKGROUND: The high pressure zone(HPZ) at the gastroesophageal junction is an important barrier for prevention of gastroesophageal reflux. Smooth muscle layers in the lower esophageal sphincter mainly contributes to HPZ at the throacoabdominal junction. The purpose of this study was to investigate the manometric characteristics of the thoracoabdominal junction in patients after surgical removal of the lower esophageal sphincter. MATERIAL AND METHOD: Twenty two patients with prior esophagogastrectomy(10 Ivor-Lewis method and 12 left thoracotomy) and 30 normal adults(control group) were studied manometrically. RESULT: Esophageal manometry showed a HPZ and pressure inversion point distal to the anastomosis in 12 of 22 patients(2 of 10 patients with Ivor-Lewis method and 10 of 12 patients with left thoracotomy) and a HPZ in 30 of 30 normal adults. The location of HPZ from nostril was not significant different between the two groups(42.5+/-0.9cm in patients and 43.9+/-2.1cm in the control), while the length of HPZ was shorter in patients than in the control(2.13+/-0.6cm vs 2.83+/-0.59cm). By SPT and RPT, pressures of HPZ at rest were lower in patients(13.78+/-1.63mmHg, 28.58+/-6.06mmHg) than in control(20.3+/-4.95mmHg, 42.80+/-15.91mmHg). The HPZ relaxed partially in response to deglutition(84.4% in patient, 90.5% in control group) and contracted in response to increased intra- abdominal pressure induced by leg lifts(HPZ/ Intra-abdominal pressure= 1.81+/-0.23 in patient, 2.13+/-0.58 in control group). CONCLUSION: This study shows an HPZ at thoracoabdominal junction after surgical removal of the lower esophageal sphincter. It may be important to perform a crural myoplasty during esophageal reconstruction after esophagogastrectomy because crural diaphragm acts as sphincter like HPZ at the thoracoabdominal junction.
Adult ; Diaphragm* ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Gastroesophageal Reflux ; Humans ; Leg ; Manometry ; Muscle, Smooth

BACKGROUND: Cyclin E plays a pivotal role in the regulation of G1-S transition and could consequently be a deregulated molecule in tumors. The activity of the cdk2-cyclin E complex is increased by degradation of cdk inhibitor p27kip1. Little is known about the expression and prognostic significance of cyclin E and p27 in non-small cell lung cancer(NSCLC). MATERIAL AND METHOD: The expression of cyclin E and p27 in eighty-one cases of resected stage I NSCLC tissues and its relation to major clinico-pathological factors, including histology, differentiation, size of tumor, pleural invasion and survival rate were studied and analyzed. Immunohistochemical analysis with monoclonal antibodies specific for cyclin E and p27 were performed by ABC method. RESULT: Expression rates of cyclin E and p27 in stage I NSCLC tissues were 29.6% and 28.4% respectively. Cyclin E was expressed higher in cases of pleural invasion(p=0.04), and p27 was expressed higher in diameter of tumor less than 3cm(p=0.015). The 5-years survival rate was lower in cases of positive expression of cyclin E than in cases of negative expression of cyclin E(44.4% vs 68.2%, p=0.015), and the 5-years survival rate was 72.2% in positive expression of p27 and 56.2% in negative expression of p27(p=0.09). The 5-years survival rate was higher in negative expression of cyclin E and positive expression of p27 than in cases of positive expression of cyclin E and negative expression of p27 (73.5% vs 36.3%, p=0.0029). In multivariate analysis, expression of cyclin E was an unfavorable prognostic factor(RR=3.578, p=0.006) and p27 was a favorable prognostic factor(RR=0.183, p=0.019) independently. CONCLUSION: Cyclin E and p27 may play a pivotal role for the biological behavior of stage I NSCLC, so that the expressions of cyclin E and p27 may be new prognostic markers.
Antibodies, Monoclonal ; Carcinoma, Non-Small-Cell Lung* ; Cyclin E* ; Cyclins* ; Lung ; Multivariate Analysis ; Survival Rate

No abstract available.
Diskectomy* ; Dust* ; Transplants*

No abstract available.
Ligamentum Flavum* ; Spinal Cord Diseases*

Familial intracranial aneurysm is rare. We have clipped two posterior circulation intracranial aneurysms in mother and son. Mother was 48 years old and presented with severe headache and drowsy mentality. A basilar artery bifurcation aneurysm was found on DSA(digital subtraction angiography) and successfully clipped with transsylvian pterional approach. Her son was 24-year-old and presented with seizure and drowsy mentality. An aneurysmal sac was found on the bifurcation of vertebral artery and posterior inferior cerebellar artery. We have clipped it successfully with far lateral suboccipital approach. The authors recommended the use of screening test, such as MRIand high resolution CT, on the group of patients with the characteristic features of familial intracranial aneurysm.
Aneurysm* ; Arteries ; Basilar Artery ; Headache ; Humans ; Intracranial Aneurysm ; Mass Screening ; Middle Aged ; Mothers* ; Seizures ; Vertebral Artery ; Young Adult

Intravenous leiomyomatosis is a rare disease entity of benign smooth muscle invading into the lumen of veins. We describe a case of intravenous leiomyomatosis originating from the uterus, growing in the inferior vena cava, and extending into the right ventricle association with multiple pulmonary metastasis. A 53-year-old woman with chest discomfort and several times attacks of syncope was treated at our hospital. The tumor was successfully removed with moderate hypothermic cardiopulmonary bypass after total hysterectomy with a bilateral salphingo-oophorectomy, and multiple pulmonary metastasis under simultaneous sternotomy and laparotomy was confirmed.
Cardiopulmonary Bypass ; Female ; Heart Ventricles* ; Humans ; Hysterectomy ; Laparotomy ; Leiomyomatosis* ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis* ; Rare Diseases ; Sternotomy ; Syncope ; Thorax ; Uterus ; Veins ; Vena Cava, Inferior

Intravenous leiomyomatosis is a rare disease entity of benign smooth muscle invading into the lumen of veins. We describe a case of intravenous leiomyomatosis originating from the uterus, growing in the inferior vena cava, and extending into the right ventricle association with multiple pulmonary metastasis. A 53-year-old woman with chest discomfort and several times attacks of syncope was treated at our hospital. The tumor was successfully removed with moderate hypothermic cardiopulmonary bypass after total hysterectomy with a bilateral salphingo-oophorectomy, and multiple pulmonary metastasis under simultaneous sternotomy and laparotomy was confirmed.
Cardiopulmonary Bypass ; Female ; Heart Ventricles* ; Humans ; Hysterectomy ; Laparotomy ; Leiomyomatosis* ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis* ; Rare Diseases ; Sternotomy ; Syncope ; Thorax ; Uterus ; Veins ; Vena Cava, Inferior

OBJECTIVES: There is continuing controversy about the benefits of decompressive craniectomy in massive cerebral edema following space occupying hemispheric cerebral infarction. The aims of this study are to determine the effectiveness and to confirm the life-saving nature of decompressive craniectomy with dural augmentation for massive cerebral infarction. PATIENTS AND METHODS: We present twelve patients with medically uncontrollable hemispheric cerebral infarction. All were treated with extensive craniectomy and duroplasty without resection of necrotic tissue. We evaluated various characteristics(size of hemispheric infarction, Glasgow Coma Scale, volume of low density and midline shift in CT) at three different periods(preoperative, immediate postoperative and 3-4weeks after operation) and evaluated effectiveness of hemicraniectomy for massive cerebral edema after large hemispheric infarction. RESULTS: All patients have survived from surgery. Nine patients with nondominant hemispheric infarction showed significant functional recovery with minimal assistance, and remaining two patients with dominant hemispheric infarction and one patient with nondominant hemispheric infarction have functionally dependent. The volume of low density and midline shift in CT were significantly reduced after decompressive craniectomy. CONCLUSIONS: Our results indicate that decompressive craniectomy with dural augmentation without resection of necrotic tissue for massive cerebral hemispheric infarction not only reduce the mortality and infarction size but also significantly improve the outcome, especially for nondominant hemispheric infarction.
Brain Edema ; Cerebral Infarction* ; Decompressive Craniectomy* ; Glasgow Coma Scale ; Humans ; Infarction ; Mortality

BACKGROUND: It has been reported that p53 regulates the G2-M checkpoint transition through cyclin B1, and it has been suggested that p53 plays an important role in the development and progression of various malignancies. The aim of this study is to clarify the role of the cell cycle regulators, cyclin B1 and p53 in patients with esophageal squamous cell carcinoma (ESCC). MATERIAL AND METHOD: Tissue samples from 46 patients with ESCC were included in this study. Expression levels of cyclin B1 and p53 in samples of normal squamous epithelium, dysplasia, and tumor cells from patients with ESCC were analyzed by immunohistochemical study. RESULT: Several cells in the basement layer of normal epithelium expressed cyclin B1. The number of cyclin B1 positive cells tended to increase as the degree of dysplasia increased from low grade to high grade. More than 10% of tumor cells were cyclin B1 positive in 19 patients (41.3%). Several clinicopathologic parameters, including tumor stage (p<0.05), pathologic lymph node status (p<0.05) and invasion of lymphatic vessels (p<0.05), were correlated with the overexpression of cyclin B1. Elevated expression levels of cyclin B1 also correlated with a poor prognosis in patient with ESCC in univariate analysis (p<0.05) and multivariate analysis (p<0.05). In contrast, p53 expression exhibited significant correlation with the level of cyclin B1 expression, but was not associated with prognostic parameters in patients with ESCC. CONCLUSION: These findings suggest that cyclin B1 is involved in the pathogenesis of carcinoma of the esophagus and that elevated levels of cyclin B1 expression, but not p53 expression, may indicate a poor prognosis for patients with ESCC.
Carcinoma, Squamous Cell* ; Cell Cycle ; Cyclin B1* ; Cyclins* ; Epithelium ; Esophageal Neoplasms ; Esophagus ; Humans ; Lymph Nodes ; Lymphatic Vessels ; Multivariate Analysis ; Prognosis