BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
Adult ; Blood Transfusion ; Bloodless Medical and Surgical Procedures* ; Heart Valves* ; Humans ; Jehovah's Witnesses* ; Mortality ; Perioperative Care ; Survival Rate

No abstract available.
Mediastinal Emphysema*

Here, we report the case of a 43-year-old female who was diagnosed with a cotyledonoid dissecting leiomyoma (CDL) of the uterus. CDL is a recently described and extremely rare variant of a benign leiomyoma that can grossly masquerade as a malignancy. The 13-cm sized tumor was located primarily on the extrauterine surface as an intrauterine continuity, which showed dark red, congested, bulbous protuberances. It was multinodular appearance, encasing the bilateral adnexae and the left iliac vein. Microscopically, the nodules were separated by extensive hydropic degeneration. The nodules were composed of cigar-shaped spindle cells with no mitosis, cellular pleomorphism or coagulation necrosis. They also showed an intravascular luminal growth pattern. CDL with intravascular growth was diagnosed after excluding intravascular leiomyomatosis, disseminated peritoneal leiomyomatosis, and benign metastasizing leiomyoma. The present case is the second reported case of CDL in Korea. Recognition of this rare and bizarre, malignancy-mimicking leiomyoma is crucial to prevent inappropriate treatment.
Adult ; Estrogens, Conjugated (USP) ; Female ; Humans ; Iliac Vein ; Korea ; Leiomyoma* ; Leiomyomatosis ; Mitosis ; Necrosis ; Phenobarbital* ; Uterus*

BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
Adult ; Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Heart Valves ; Humans ; Jehovah's Witnesses ; Mortality ; Perioperative Care ; Survival Rate

Indication for extracorporeal membrane oxygenation (ECMO) has been extended as the experience of ECMO in various clinical settings accumulates and the outcome after ECMO installation improves. We report two cases of successful mitral valve surgery for severe ischemic mitral regurgitation in patients on ECMO support for cardiogenic shock which developed upon coronary angiography.
Coronary Angiography ; Coronary Artery Disease ; Extracorporeal Membrane Oxygenation ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Shock, Cardiogenic

Hand-foot-mouth disease (HFMD) is an infectious viral disease that is common among children. It is clinically characterized by vesicular eruptions on the palms and soles and a maculopapular rash. Onychomadesis is a periodic idiopathic shedding of the nails at their proximal ends and results from arrest of the proliferative function of the nail matrix. Recently, a few reports described onychomadesis following HFMD, although the mechanism remains unclear. To our knowledge, this association has not been reported in Korea. Herein, we report two cases of onychomadesis following HFMD and review the published data.
Child ; Exanthema ; Humans ; Korea ; Virus Diseases

PURPOSE: FK506 (Tacrolimus) has been widely used as an immunosuppressant. We examined the effects of FK506 on the activation, proliferation and expression of cytotoxic effector molecules of Jurkat human T-lymphocytes. METHODS: We investigated the effects of this compound on cell viability, the production of reactive oxygen species and mitochondrial dysfunction. The cells were cultured in the presence or absence of FK506. Flow cytometric analysis was performed after staining with PI. The viability of the Jurkat cells was decreased by the addition of FK506 in a dose-and time-dependent manners. RESULTS: FK506-induced cytotoxicity was characterized by G0/G1 phase cell-cycle arrest. FK506 induced cell death was confirmed by the caspase-3 protease activation. In addition, the pharmacologic scavenging study of reactive oxygen species (ROS), including H2O2, revealed that cytotoxicity was achieved by the generation of ROS, which might modulate the mitochondrial dysfunction. CONCLUSION: These results suggest that FK506 functions in CDK4-cyclin D1 mediated cell-cycle arrest of Jurkat cells via generation of ROS and mitochondrial dysfunction.
Caspase 3 ; Cell Death ; Cell Survival ; Humans* ; Jurkat Cells ; Reactive Oxygen Species ; T-Lymphocytes* ; Tacrolimus*

BACKGROUND: A collagenoma or connective tissue nevus of the collagen type is a hamartoma consisting predominantly of collagen. Collagenomas are divided into the inherited and acquired types. The acquired forms include eruptive and isolated collagenoma. However, few studies have assessed the characteristics of patients with acquired collagenoma. OBJECTIVE: The aim of this study was to analyze the clinical characteristics of patients with acquired collagenoma. METHODS: We reviewed the medical records and clinical photographs of 23 patients who had been diagnosed histopathologically with acquired collagenoma by biopsy during the last 12 years, from January 2002 to December 2013. In addition, 11 cases of eruptive or isolated collagenomas previously reported in the Korean literature were added. RESULTS: In total, 34 cases of acquired collagenoma were assessed. Of the 34 cases, 53% were men and 47% were women. The mean age at diagnosis was 20.0 years for the patients with eruptive collagenoma and 29.1 years for the patients with isolated collagenoma. In the cases of eruptive collagenoma, multiple, flesh-colored or whitish papules on the trunk were predominant. On the other hand, in the cases of isolated collagenoma, solitary, flesh-colored plaques on the palms or soles were common features. Collagenomas in most cases were asymptomatic (79.4%). However, some patients with collagenomas had other symptoms such as tenderness or pruritus. There was no traumatic history in any case. CONCLUSION: Our study showed that the clinical features of patients with acquired collagenoma share many similarities with those in previously reported studies, with some differences. This study is expected to help us understand and obtain more information on the clinical diagnosis of acquired collagenoma.
Biopsy ; Collagen ; Collagen Type I ; Connective Tissue ; Diagnosis ; Female ; Hamartoma ; Hand ; Humans ; Male ; Medical Records ; Nevus ; Pruritus

BACKGROUND: Epidermal cyst is a common acquired skin cyst. When such cysts may be inflamed, they are often referred to as being infected. To clarify the etiology of inflamed epidermal cysts, several studies have carried bacteriology of inflamed and uninflamed epidermal cyst and sought to identify the role of micro-organisms. OBJECTIVE: The aim of this study is to evaluate the bacterial influences on inflammatory process of epidermal cysts and the antibiotic sensitivity of cultured aerobic bacteria in epidermal cysts. METHODS: We carried out the bacterial cultures using sterile swabbing internal materials in each cyst which has been incised after surgical removals of epidermal cyst. An inflamed epidermal cyst was defined as a known cyst that developed a fluctuant soft-tissue swelling surrounded by the erythema and contained a localized collection of purulent material. For the aerobic culture, samples were cultured on blood agar plates, McConkey agar plate and chocolate agar plates in 5% CO2 at 35degrees C for 5 days. Colonies formed were identified based on VITEK2 system. Then antimicrobial susceptibility test were also done on VITEK2 system. RESULTS: Total of 100 epidermal cyst specimens from 96 patients (67 men and 29 women) were involved had confirmed histopathological findings by dermatologists. Seventy were from face and neck, 24 from trunk, 4 from the extremities, 2 from buttock. Of the 53 inflamed cysts, 30 (56.6%) yielded bacterial growth. On the other hand, from the 47 uninflamed cysts, 15 (31.9%) cyst resulted in bacterial growth (p=0.013). The predominant bacteria from inflamed and uninflamed cyst were coagulase-negative Staphylococci (32 isolate of 45 specimens, 71.1%). All cultured bacteria were susceptible to almost all of antibiotics except amoxicillin/clavulanic acid, ampicillin, benzylpenicillin, cefoxitin, cephalothin, fucidic acid, piperacillin, piperacillin/Tazobactam. CONCLUSION: Our study showed that CoNS was predominant in inflamed cysts, which strongly suggests that aerobic bacteria play a role in the inflammatory process and treatment with antibiotics is necessary for epidermal cyst.
Agar ; Ampicillin ; Anti-Bacterial Agents ; Bacteria ; Bacteria, Aerobic ; Bacteriology ; Buttocks ; Cacao ; Cefoxitin ; Cephalothin ; Epidermal Cyst ; Erythema ; Extremities ; Hand ; Humans ; Male ; Neck ; Penicillin G ; Piperacillin ; Skin

The Heterotopic pancreas is defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the main body of pancreas. Heterotopic pancreas or ectopic pancreas is found in 0.55% to 13.7% of autopsy series and also found one in approximately every 500 operations in abdominal surgery. The most common sites are the antrum of stomach, duodenum, and proximal jejunum. Most masses of heterotopic pancreas in stomach were encountered in the distal one third, usually within 5 or 6 cm of pylorus. We have recently experienced a case of hetertopic pancreas that was located in fundus which is not the usual site. Gastrofiberscopy revealed a 2 2.5 cm sized protruding mass on the fundus. There was apperared an umbilical shaped dimple on the center with a relatively normal mucosa. Endoscopic ultrasonography revealed a 2.5 cm sized hypoechoic mass of fundus, originating from submucosal and muscular layer. It was considered a submucosal tumor, such as leiomyoma, and subsequently wedge resection was performed. Histologic finding showed pancreatic acni.
Autopsy ; Duodenum ; Endosonography ; Jejunum ; Leiomyoma ; Mucous Membrane ; Pancreas* ; Pylorus ; Stomach*