There are reports showing considerable morphological abnormalities in the lumbosacral region, which are usually caused by certain diseases or simply by anatomical variations. It is possible that if a caudal block is performed in patients with these anatomical abnormalities it will either fail or another unexpected difficult situation will result. However, there is no case report regarding such issues. We experienced two cases of an unexpected dural puncture during a trial of caudal block, and one case in whom the dural puncture would most likely have been caused by a trial of caudal block. The dural punture was caused by morphological abnormalities in the lumbosacral region i.e., diffuse ectasia of the lumbosacral dura and a posterior sacral meningocele with an enlargement of the lumbosacral canal. The dural termination was located more distally in the potential dural puncture case than in the normal cases.
Dilatation, Pathologic ; Humans ; Lumbosacral Region ; Meningocele ; Punctures*

Numerous medications have the potential to induce acute pancreatitis. However, isoniazid-induced acute pancreatitis is extremely rare. Drug-induced acute pancreatitis can be diagnosed by improvement after stopping the drug and recurrence of pancreatitis when rechallenged. We present a case of severe acute pancreatitis accompanied by multiple large pseudocysts after isoniazid treatment for pulmonary tuberculosis. We confirmed that isoniazid induced pancreatitis by rechallenging after treatment cessation. Most previous reports of isoniazid-induced pancreatitis have been clinically mild forms, and the patient fully recovered with supportive management. However, this case presents severe and permanent pancreatic damage that developed with 5 weeks of isoniazid treatment. When a patient presents with manifestations of pancreatitis during treatment of tuberculosis that includes isoniazid, the physician should consider isoniazid-induced pancreatitis.
Humans ; Isoniazid ; Pancreatitis ; Recurrence ; Tuberculosis ; Tuberculosis, Pulmonary ; Withholding Treatment

Benign symmetric lipomatosis (BSL) is a pathologic condition characterized by symmetric and diffuse growth of mature adipose tissue. It usually affects the posterior neck and upper trunk. However, BSL involving the tongue is extremely rare condition. A 70-year-old man visited our clinic and complained of his swollen tongue with intermittent burning pain. The tongue lesion was treated by surgical excision and was confirmed with BSL. During a one-year follow-up period, there was no recurrence. We report this rare case of BSL on tongue with a previous literature review.
Adipose Tissue ; Aged ; Burns ; Follow-Up Studies ; Humans ; Lipomatosis ; Neck ; Recurrence ; Tongue

Formalin-fixed, paraffin-embedded samples of 32 brain tumors(8 meningiomas, 10 astrocytomas(low grade 5, anaplastic 5), 8 glioblastoma multiforme, 6 oligodendrogliomas(low grade 2, anaplastic 3) were investigated by immunocytochemistry with monoclonal antibodies against p53 protein and proliferating cell nuclear antigen(PCNA). Expression of p53 protein was detected in 1 of 5 cases(20%) of low grade astrocytomas, 2 of 5 cases(40%) of anaplastic astrocytoma, 4 of 8 cases(50%) of glioblastoma multiforme and 4 of 4 cases(100%) of malignant oligodendroglioma. All low grade oligodendrogliomas, meningiomas fail to express p53. Expression of PCNA was detected in 3 of 8 cases of meningioma with very low labeling index(0-0.3), 2 of 5 cases of low grade astrocytoma with low labeling index(0-11.3), 3 of 5 cases of anaplastic astrocytoma with middle labeling index(0-28.2), 6 of 8 cases of glioblastoma multiforme and 4 of 4 cases of malignant oligodendroglioma with high labelling index(0-92.3, 7.6-48.1). Expression of PCNA was not detected in low grade oligodendrogliomas. Tumor group with high expression of p53 protein showed increment of PCNA expression. A strong positive correlation between tumor grade and extent of p53 protein and PCNA expression was found(p<0.002) .
Antibodies, Monoclonal ; Astrocytoma ; Brain Neoplasms* ; Brain* ; Glioblastoma ; Immunochemistry ; Immunohistochemistry ; Meningioma ; Oligodendroglioma ; Proliferating Cell Nuclear Antigen*

The author reviewed 294 cases of surgically treated cerebral aneurysms during the period from January, 1987 to December, 1992. The results were as follow: The sex ratio between male and female was 1:1.53 and the mean age was 51.3 years. 2) At admission, 220 patients were in relatively good neurologic condition and functional recovery was obtained in 229 patients(78%). 3) The most common site was anterior communicating artery and the number of posterior circulation aneurysms was 12(4%). 4) The incidence of multiple aneurysms was 4% and clinical vasospasm was observed in 19% of the patients. 5) Operative mortality was 8.8% and the prognostic factors were related with age, sex, history of hypertension, amount of SAH, size and site of aneurysm, preoperative neurologic state, clinical vasospasm, and timing of operation.
Aneurysm ; Arteries ; Female ; Humans ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Sex Ratio

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatograpy (ERCP) is often used for the diagnosis and treatment of pancreaticobiliary diseases in the elderly patients. However, few studies have assessed its efficacy and safety in the very elderly. The purpose of this study was to evaluate the clinical outcomes of ERCP in the very elderly patients. METHODS: Eight hundreds two patients who underwent ERCP at Seoul National University Bundang hospital were enrolled retrospectively. They were divided into three groups according to their ages (non-elderly group, elderly group and very-elderly group; <65, 65-79 and > or =80, respectively). The indications and clinical outcomes including the complications of ERCP were compared among groups. RESULTS: The most common indication of ERCP was acute cholangitis in all the three groups. Periampullary diverticulum was more frequently observed in elderly and very-elderly patients than in younger patients. Mean duration of hospitalization was not different among three groups. ERCP success rate in all enrolled patients was approximately 90%, and there was no difference in terms of technical success rate between groups (p=0.1). However, the number of ERCP sessions was significantly higher in the very-elderly patients compared to in the non-elderly and elderly (1.38 vs. 1.13 and 1.18 respectively; p<0.001). There was no difference in mortality and complication rate between groups. CONCLUSIONS: ERCP can be performed safely in very-elderly patients. Therefore, only age should not be regarded as one of the major determining factors whether to perform ERCP.
Acute Disease ; Age Factors ; Aged ; Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects/*methods ; Cholangitis/diagnosis ; Common Bile Duct Diseases/diagnosis ; Diverticulum/diagnosis ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Pancreatic Diseases/*diagnosis/therapy ; Retrospective Studies

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatograpy (ERCP) is often used for the diagnosis and treatment of pancreaticobiliary diseases in the elderly patients. However, few studies have assessed its efficacy and safety in the very elderly. The purpose of this study was to evaluate the clinical outcomes of ERCP in the very elderly patients. METHODS: Eight hundreds two patients who underwent ERCP at Seoul National University Bundang hospital were enrolled retrospectively. They were divided into three groups according to their ages (non-elderly group, elderly group and very-elderly group; <65, 65-79 and > or =80, respectively). The indications and clinical outcomes including the complications of ERCP were compared among groups. RESULTS: The most common indication of ERCP was acute cholangitis in all the three groups. Periampullary diverticulum was more frequently observed in elderly and very-elderly patients than in younger patients. Mean duration of hospitalization was not different among three groups. ERCP success rate in all enrolled patients was approximately 90%, and there was no difference in terms of technical success rate between groups (p=0.1). However, the number of ERCP sessions was significantly higher in the very-elderly patients compared to in the non-elderly and elderly (1.38 vs. 1.13 and 1.18 respectively; p<0.001). There was no difference in mortality and complication rate between groups. CONCLUSIONS: ERCP can be performed safely in very-elderly patients. Therefore, only age should not be regarded as one of the major determining factors whether to perform ERCP.
Acute Disease ; Age Factors ; Aged ; Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects/*methods ; Cholangitis/diagnosis ; Common Bile Duct Diseases/diagnosis ; Diverticulum/diagnosis ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Pancreatic Diseases/*diagnosis/therapy ; Retrospective Studies

Purpose: Data on subsequent arm lymphedema (SAL) after salvage treatment for locoregional recurrence (LRR) of breast cancer are limited. We conducted a study to evaluate the risk of SAL in patients with LRR. Methods: We reviewed the data of patients with breast cancer who had LRR and were initially diagnosed between January 2003 and December 2017. Among the 214 patients who received curative salvage treatment, most had local (n = 125, 57.9%), followed by regional (n = 73, 34.1%), and locoregional (n = 16, 7.9%) recurrences. A competing risk analysis considering the factors of death and a second LRR were performed to exclude potential malignant lymphedema. We used the Fine-Gray subdistribution hazards model to estimate the hazard ratio (HR) for comparing the risk of SAL. Results: With a median follow-up duration of 41.4 months (interquartile range, 25.6–65.1), 51 patients (23.8%) experienced SAL with a median interval of 9.9 months after treatment.The two-year cumulative incidence of SAL was 12.7%. Among the 18 patients with initial lymphedema, nine (50.0%) developed SAL. Multivariate analysis revealed that a history of lymphedema (HR, 4.61; p < 0.001) and taxane-based salvage chemotherapy (HR, 2.38; p = 0.009) were significantly associated with SAL development. Conclusion Salvage treatment for LRR-induced SAL was performed in 24% of the patients.A history of initial lymphedema and salvage taxane-based chemotherapy increases the risk of developing SAL. Therefore, close surveillance for the incidence of SAL is required in patients opting for salvage treatment for LRR.

Many previous studies have shown reduced glucose uptake in the ischemic brain. In contrast, in a permanent unilateral common carotid artery occlusion (UCCAO) mouse model, our pilot experiments using 18F-fluorodeoxyglucose positron emission tomography (FDG PET) revealed that a subset of mice exhibited conspicuously high uptake of glucose in the ipsilateral hemisphere at 1 week post-occlusion (asymmetric group), whereas other mice showed symmetric uptake in both hemispheres (symmetric group). Thus, we aimed to understand the discrepancy between the two groups. Cerebral blood flow and histological/metabolic changes were analyzed using laser Doppler flowmetry and immunohistochemistry/Western blotting, respectively. Contrary to the increased glucose uptake observed in the ischemic cerebral hemisphere on FDG PET (p<0.001), cerebral blood flow tended to be lower in the asymmetric group than in the symmetric group (right to left ratio [%], 36.4±21.8 vs. 58.0±24.8, p=0.059). Neuronal death was observed only in the ischemic hemisphere of the asymmetric group. In contrast, astrocytes were more activated in the asymmetric group than in the symmetric group (p<0.05). Glucose transporter-1, and monocarboxylate transporter-1 were also upregulated in the asymmetric group, compared with the symmetric group (p<0.05, respectively). These results suggest that the increased FDG uptake was associated with relatively severe ischemia, and glucose transporter-1 upregulation and astrocyte activation. Glucose metabolism may thus be a compensatory mechanism in the moderately severe ischemic brain.