Essential thrombocytosis (ET) is a myeloproliferative disorder characterized by an anomalous increase in platelet production. Many patients with ET are asymptomatic. Few studies have reported ET-associated thromboembolism in large vessels such as the aorta. We report a patient with ET who presented with peripheral embolism from an abdominal aortic thrombus and developed acute limb ischemia. The patient underwent aortic replacement successfully. The patient’s platelet count was controlled with hydroxyurea, and no recurrence was noted over 2 years of follow-up.
Aorta ; Aorta, Abdominal* ; Blood Platelets ; Embolism ; Extremities ; Follow-Up Studies ; Humans ; Hydroxyurea ; Ischemia ; Myeloproliferative Disorders ; Platelet Count ; Recurrence ; Thrombocythemia, Essential ; Thrombocytosis ; Thromboembolism* ; Thrombosis

Forty eight cases of spontaneous thalamic hemorrhage diagnosed by brain CT scan, were analyzed clinically. The age incidence was highest in the 6th decade. We have classified the thalamic hemorrhage by location of hematoma and arterial blood supply. The anteromedial types were 12 cases(25%) and the posterolateral types were 14 cases(29%), the superomedial types were 10cases(21%), the posteromedial types were 5cases(10%), the globe types were 7cases(15%). The sites of hemorrhage were highest in the thalamogeniculate artery territories. In the aspect of clinical symptoms, ocular signs were more common in the posteromedial and the globe type. Motor weakness and sensory symptoms were developed in the all types, almostly. Speech involvements were developed in 14% of Lt.side thalamic hemorrhages. Mental symptoms(confusion, disorientation) appeared in the large amount of hemorrhage exclusively. The mortality rate was 10.4%. Prognosis was correlated with the extent of involvement and the amount of hematoma, not the location.
Arteries ; Brain ; Hematoma ; Hemorrhage* ; Incidence ; Mortality ; Prognosis ; Thalamus ; Tomography, X-Ray Computed

Thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare combination of aortic diseases, the surgical management of which has not been described to date. We report the successful treatment of one such case through open surgical repair of the thoracoabdominal aorta.
Aorta ; Aortic Aneurysm, Thoracic* ; Aortic Diseases ; Arterial Occlusive Diseases ; Blood Coagulation Disorders ; Leriche Syndrome* ; Thrombosis

Two strains of non-O group 1 Vibrio cholerae (non-0:1V. cholerae) were isolated from blood of a woman who had undergone a gastrectomy and from peritoneal fluid of a man with an impaired liver function. Microbiology laboratories in countries where raw fish and shellfish are frequently consumed should consider the possibility of non-0:1 V. cholerae when they identify vibrios from extraintestinal sources.
Adult ; Cholera/complications* ; Female ; Human ; Male ; Middle Age ; Peritonitis/etiology* ; Septicemia/etiology* ; Vibrio cholerae/isolation & purification

In this study, We evaluated the safety and efficacy of mycophenolate mofetil (MMF) for the prevention of acute rejection episodes when given in combination with cyclosporine and corticosteroids during the postoperative period in living donor kidney transplantation. 212 patients were enrolled; 106 patients received triple therapy with azathioprine (control group) and another 106 patients received triple regimen with MMF 2 g/day (study group). There was two subgroup in the study group. Of the study group, one subgroup was 90 patients treated MMF after acute rejection episode or an increase in serum creatinine level above 2.0 mg/dl (MMF conversion) and another group was 16 patients with primary MMF therapy. We made no demographic difference between study and control groups with patient selection for reducing bias. There was no statistical differences in serum creatinine level between two groups at 2 years after transplantation. There were 12 (13.3%), 3 (18.8%) acute rejection episodes in the MMF conversion and primary MMF therapy groups and 36 (33.7%) in the control group with statistic difference (p=0.01). 5 patients (5.6%) in the MMF-treated group lost their graft versus 16 patiens (15%) in the AZA-treated group. The 2-year graft survival rate was 97.4% in the study group and 83.9% in the control group. There was signficant difference in 2-year graft survival (p=0.003). The adverse effects of MMF were opportunistic infection, leukopenia, abdominal pain and diarrhea. MMF in combination with cyclosporine and prednisone was superior to a standard immunosuppressive regimen including azathioprine. Taken together, the data indicated that MMF will be a valuable addition to the list of immunosuppressants available for the prevention and treatment of acute renal rejection after renal transplantation. Its final place in clinical transplantation will be determined by further analysis of future, randomized-prospective studies, and by broadening experience with this important addition to the immunosuppressive regimen.
Abdominal Pain ; Adrenal Cortex Hormones ; Azathioprine ; Bias (Epidemiology) ; Creatinine ; Cyclosporine ; Diarrhea ; Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation* ; Leukopenia ; Living Donors ; Opportunistic Infections ; Patient Selection ; Postoperative Period ; Prednisone ; Transplants*

The formation of aortic thrombi is an extremely rare complication of acute pancreatitis. Here we report a case of acute pancreatitis complicated by a paraesophageal pseudocyst, necrotizing mediastinitis, and the formation of multiple thrombi in the ascending aorta. The patient was successfully treated by surgical therapy, which included extensive debridement of the mediastinum and removal of the aortic thrombi under cardiopulmonary bypass. Although esophageal resection was not carried out concomitantly, the lesions were resolved and the patient remained free of complications over 2 years of follow-up care.
Aorta ; Cardiopulmonary Bypass ; Debridement ; Esophageal Diseases ; Follow-Up Studies ; Humans ; Mediastinitis* ; Mediastinum ; Pancreatitis* ; Pancreatitis, Acute Necrotizing ; Thrombosis

Incontinentia pigmenti (IP) is an uncommon genodermatosis that usually occurs in female infants. It is characterized by ectodermal, mesodermal, neurological, ocular, and dental manifestations. The aim of this study was to clarify clinical symptoms, accompanying diseases, and complications of IP. Forty cases of IP have been reviewed by their medical records, laboratory data, clinical photographs, and telephone survey. Male-to-female ratio was 1 to 19 and their onsets were mostly in utero. They were usually diagnosed during the neonatal period owing to their early expression of skin manifestation. Central nervous system anomalies were found in 46.7%. Ocular disorders and dental defects were detected in 66.7% and 72.7% respectively. The most commonly diagnosed anomalies were hypodontia, retinopathy, and seizure. For better understanding of IP, long term and close cooperation between dermatologists, pediatricians, neuroscientists, genentic counselors, and even dentists is crucial.
Stomatognathic Diseases/complications ; Skin Diseases/complications ; Male ; Magnetic Resonance Imaging/methods ; Korea ; Infant, Newborn ; Infant ; Incontinentia Pigmenti/*diagnosis/pathology ; Humans ; Female ; Eye Diseases/complications ; Eosinophilia/complications ; Child, Preschool ; Child ; Central Nervous System Diseases/complications

PURPOSE: To assess the utility of 2-[18F] fluoro-2-deoxy-D-glucose (FDG) PET in differentiating malignant and benign diffuse pleural disease, and to compare it with CT. MATERIALS AND METHODS: Both FDG PET and CT scans were performed in 20 consecutive patients with diffuse pleural disease (13 malignant and seven benign cases). In FDG PET, peak standardized uptake value (SUV) as well as visual assessment of abnormally increased uptake in the pleura was evaluated. The results were compared with CT findings. RESULTS: With only visual assessment of PET images, sensitivity, specificity, and accuracy for malignancy were 92%, 43%, and 75%, respectively. With peak SUV of 4.8 or more, the corresponding figures were 100%, 57%, and 85%, respectively, and on CT interpretation, were100%, 57%, and 85%, respectively. Tuberculous empyema simulated malignant pleural disease both on FDG PET (3/6 patients with peak SUV more than 4.8) and CT (3/6 patients). CONCLUSION: For the differentiation of malignant and benign diffuse pleural disease, FDG PET and CT are equally accurate. Combined visual and quantitative assessments of PET images enhance discriminatory ability. Tuberculous empyema simulates malignant pleural disease both on FDG PET and CT.
Diagnosis, Differential* ; Empyema, Tuberculous ; Fluorine ; Humans ; Pleura ; Pleural Diseases* ; Sensitivity and Specificity ; Tomography, X-Ray Computed

BACKGROUND: Generalization of standardized surgical techniques to treat aortic valve (AV) and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR). METHODS: We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years) who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. RESULTS: Emergency surgeries comprised 43.9% (n=29). Indications for the redo-ARR were aneurysm (n=12), pseudoaneurysm (n=1), or dissection (n=6) of the residual native aortic sinus in 19 patients (28.8%), native AV dysfunction in 8 patients (12.1%), structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%), and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%). There were 3 early deaths (4.5%). During follow-up (median, 54.65 months; quartile 1–3, 17.93 to 95.71 months), there were 14 late deaths (21.2%), and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. CONCLUSION: Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients.
Aneurysm ; Aneurysm, False ; Aorta ; Aorta, Thoracic ; Aortic Valve* ; Disease-Free Survival ; Emergencies ; Endocarditis ; Follow-Up Studies ; Generalization (Psychology) ; Humans ; Male ; Reoperation ; Retrospective Studies ; Sinus of Valsalva ; Surgeons ; Transplants

BACKGROUND: The purpose of this study is to evaluate the patients' general perception about the analgesics and the effects of the preoperative education about analgesics and patient-controlled analgesia (PCA). METHODS: One hundred patients scheduled for elective gastrectomy were randomly allocated into two groups. In control group (n = 50), patients were given conventional preanesthetic visit with questionnaire survey on PCA one day before operation. In study group (n = 50), patients were sufficiently explained about postoperative analgesia and PCA by anesthesiologist and given precise explanation sheet about PCA. Total amounts of drug used in PCA as well as rescue analgesics, the pain scores, and side effects were compared. RESULTS: 62.2% of patients had much information from various sources that analgesics effects positively in the recovery phase, but actually 73.7% of patients considered that analgesics do not seem to have any influence on the recovery after operation. There was no difference between the amounts of total PCA used, rescue analgesics, and the pain scores. However, the educated patients complained less dizziness at postoperative days (POD) one. Also, the number of patients excluded from study due to the PCA discontinuation secondary to related side effects was less in educated patients (P = 0.025). CONCLUSIONS: Preoperative education about analgesics and PCA failed to demonstrate significant decrease in the amount of analgesics and of pain scores. However, it lowered the incidence of PCA discontinuation due to side effects.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics* ; Dizziness ; Education* ; Gastrectomy ; Humans ; Incidence ; Passive Cutaneous Anaphylaxis ; Postoperative Care