BACKGROUNDS/AIMS: Liver hemangioma, the most common benign liver tumor, can be safely managed by clinical observation. However, surgical treatment should be considered in a subset of patients with giant hemangioma with abdominal symptoms. We reviewed the feasibility of total laparoscopic liver resection for giant hemangioma of >6 cm in diameter. METHODS: Nine consecutive patients who underwent total laparoscopic liver resection for giant hemangioma between August 2008 to December 2012 were included in this study. Medical records were retrospectively reviewed for demographic data, laboratory findings, and perioperative results. RESULTS: The median age of patients was 36 yrs (range, 31-63). Eight females and 1 male were included in the study. The median size of hemangioma was 11 cm in diameter (range, 6-18) and 5 patients had a hemangioma >10 cm. Indications for surgical treatments were abdominal symptoms in 4 patients, increased size in 5 patients, and uncertain diagnosis in 1 patient. The median operation time was 522 minutes for right hepatectomy, 220 minutes for left lateral sectionectomy, and 90 minutes for wedge resection. The median estimated blood loss was 400 ml (range, 50-900). There was no postoperative morbidity, including Clanvien-Dindo grade I. CONCLUSIONS: The resection of giant hemangioma demands meticulous surgical technique due to high vascularity and the concomitant risk of intraoperative hemorrhage. Laparoscopic liver resection is feasible with minimal operative complication. Therefore, laparoscopic liver resection can be considered as an option for surgical treatment for giant hemangioma.
Diagnosis ; Female ; Hemangioma* ; Hemorrhage ; Hepatectomy ; Humans ; Liver* ; Male ; Medical Records ; Retrospective Studies

No abstract available.
Abscess* ; Eosinophils* ; Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Transplants*

Since the past several decades, remarkable improvements in the management of pediatric liver transplantation was achieved and pediatric transplant surgeons have transformed a once hopeless end-stage liver disease in children into a treatable disease with limited mortality. Biliary atresia, the most common indication of liver transplantation, needs judicious selection of patients and timing of transplantation in order to achieve best results. In fulminant hepatic failure, laboratory data and neurological signs help decide the need for transplantation and determine the prognosis. Various types of transplantation methods are possible, but the living donor liver transplantation using the left lateral section is currently the most widely used. Therapeutic interventions, such as percutaneous transhepatic biliary drainage or balloon angioplasty can be used to manage post-transplant complications with minimal morbidity. Vigilant prophylaxis against viral infections with careful use of balanced immunosuppressive medications can prevent deleterious diseases such as cytomegalovirus infection or post-transplant lymphoproliferative disease. Despite the improved results, more study needs to be done to elucidate the long-term outcome of these young liver recipients.
Angioplasty, Balloon ; Biliary Atresia ; Child ; Cytomegalovirus Infections ; Drainage ; Humans ; Liver Diseases ; Liver Failure, Acute ; Liver Transplantation* ; Liver* ; Living Donors ; Mortality ; Prognosis

Since the first hepatocyte transplantation (HT) was done by Matas and colleagues 3 decades ago in Gunn rats, there has been much development in the field of HT and clinical application to over 70 humans has been performed worldwide ever since. HT has many advantages compared to the conventional liver transplantation (LT) such as lower cost, lower morbidity, possibility of genetic modification, availability of cryopreservation, utilization of inadequate livers for LT and possibility to transplant to multiple recipients from a single donor. HT has been applied as a definitive treatment option in metabolic liver disease or fulminant hepatic failure with marginal results. It has also been used as a bridge to LT in severely ill patients awaiting LT, but it has not yet been widely accepted due to the shortcoming of clinical efficacy compared to LT. Much effort was made over the past several years to improve these results, and we hope that with the help of future research, HT will soon have a clear clinical role in the management of liver diseases. This review article will cover various animal models used for researching HT and methods used for transplanting hepatocytes. It will also briefly introduce the worldwide clinical results in human trials as well as our experience on a successful case with glycogen storage disease and its long term result.
Cryopreservation ; Glycogen Storage Disease ; Hepatocytes ; Humans ; Liver ; Liver Diseases ; Liver Failure, Acute ; Liver Transplantation ; Models, Animal ; Rats, Gunn ; Tissue Donors ; Transplants

BACKGROUND: Appendicitis is one of the most common causes of abdominal emergency with a life time risk of 6-8%. Children are unable to give an accurate history, and since acute nonspecific abdominal pain is more common than appendicitis at this age, diagnosis and management of appendicitis are often delayed. This results in more frequent complications and difficult management. In order to evaluate whether pediatric appendicitis should be thought as more urgent and serious because of the delay in its diagnosis, we compared the clinical characteristics and outcomes of appendicitis in children with those of adults. METHODS: We retrospectively reviewed 106 adults and 43 children who were pathologically verified with appendicitis after an appendectomy. RESULTS: There was no difference in the duration of symptoms. Advanced appendicitis was more frequent in children (60.5% vs. 53.7%). In children, the symptom durations of advanced appendicitis were similar to those that of early appendicitis, but were significantly longer in adults. Children showed no increase in cumulative rate of advanced appendicitis in relation with prolonged symptom duration whereas adults showed a steady increase after 72 hours of onset. The complication rate was higher in advanced cases in both, but children had a lower complication rate than adults. The postoperative hospital stay was significantly longer in advanced cases in both, but children had a relatively shorter hospital stay. CONCLUSIONS: Pediatric appendicitis was more prone to early perforation with a relatively higher perforation rate. However, children had a lower morbidity rate and a shorter admission stay. Therefore, appendicitis in children is not necessarily more serious and urgent than in adults.
Abdominal Pain ; Adult* ; Appendectomy ; Appendicitis* ; Child* ; Diagnosis ; Emergencies ; Humans ; Length of Stay ; Retrospective Studies

PURPOSE: This is a trial attempting to show that the addition of mycophenolate mofetil (MMF) can reduce toxicity without impacting efficacy in patients undergoing adult living donor liver transplantation (LDLT) who experience adverse events on tacrolimus (Tac). METHODS: Between February 1999 and December 2002, 47 cases of adult LDLT were administered Tac as a first-line immunosuppressive agents. Patients were categorized to a Tac Group (Tac+steroid; n=24) or a Tac/MMF Group (Tac+steroid+MMF; n=23). RESULTS: The actuarial 2-year patient survival rate was similar in the two groups (91.3% vs. 87.0%, P=0.591), and the 2-year rejection-free survival rate was also comparable (95.2% vs. 90.0%, P=0.672). In 14 patients with nephrotoxicity, mean creatinine levels decreased significantly from 1.80+/-0.24 mg/dL to 1.31+/-0.30 (P=0.001) within 3 months of adding of MMF. Of two patients with neurotoxicity, the clinical symptoms of one patient improved after adding MMF. In 7 patients with a lower therapeutic level, the mean Tac doses could be reduced from 6.4+/-4.0 mg at study entry to 2.4+/-1.4 mg 12 months after adding MMF. CONCLUSION: The addition of MMF to Tac is a potent immunosuppressive agent to reduce the Tac-induced toxicity, and which does not increase the risk of allograft rejection in LDLT.
Adult* ; Allografts ; Creatinine ; Humans ; Immunosuppressive Agents ; Liver Transplantation ; Liver* ; Living Donors* ; Survival Rate ; Tacrolimus* ; Transplantation*

PURPOSE: The varied morphology of the umbilical ring and its surrounding structures, such as the ligamentum teres hepatis, and the median and medial umbilical ligaments, has not been thoroughly investigated. Hence, this study was undertaken to clarify the morphologic variations of these structures. MATERIALS AND METHODS: The anterior abdominal walls were removed en bloc from 57 adult cadavers and dissected under a surgical microscope. RESULTS: One case of umbilical hernia was observed, and the remaining 56 umbilical rings were classified into 3 types: oval or round in 33 cases (Type A, 59.0%), obliterated or slitted in 12 cases (Type B, 21.4%), and completely covered by a connecting band between the ligamentum teres hepatis and umbilical ligaments in 11 cases (Type C, 19.6%). The median and medial umbilical ligaments were classified into four types based on their interrelationships. The most common type was the median umbilical ligament terminated by joining one or both medial umbilical ligaments (Type II, 41.1%). The ligamentum teres hepatis frequently ended by dividing into several branches in the area cranial to the umbilical ring, some of which crossed the umbilical ring. The umbilical fascia covered the umbilical ring in 50.0% of cases, and the rest either not covering the ring or not existing. CONCLUSION: These results are expected to improve our understanding of the anatomy of the umbilical area, and further improve treatments of the umbilical hernia.
Adult ; Aged ; Aged, 80 and over ; Autopsy ; Female ; Hernia, Umbilical/pathology ; Humans ; Ligaments/anatomy & histology/pathology ; Male ; Middle Aged ; Umbilicus/*anatomy & histology/pathology

Pneumatosis intestinalis is an uncommon disorder characterized by an accumulation of gas in the bowel wall. We described three cases undertaking liver transplantation. The patients developed diarrhea in three cases and high fever in two. An abdominal X-ray and computed tomography scan demonstrated extensive pneumatosis intestinalis in the colon with pneumoperitoneum mimicking hollow organ perforation. However, the patients had no abdominal symptoms and there was no evidence of peritonitis. The infection work-up was negative except one case with cytomegalovirus antigenemia. After one week of conservative management including bowel rest and antibiotic therapy, their pneumoperitoneum resolved spontaneously without any complication. Pneumatosis intestinalis should be considered as a differential diagnosis after adult liver transplantation with patients suffering from watery diarrhea and fever. Pneumoperitoneum, air-density in mesentery and retroperitoneum in patients with pneumatosis intestinalis without signs of peritonitis improved with conservative management, which included bowel rest and antibiotic therapy.
Adult ; Colon ; Cytomegalovirus ; Diagnosis, Differential ; Diarrhea ; Fever ; Humans ; Liver ; Liver Transplantation ; Mesentery ; Mortuary Practice ; Peritonitis ; Pneumoperitoneum ; Stress, Psychological

PURPOSE: Monoclonal antibodies (mAb) specific for CD45RB as a potent tolerogenic target can prolong allograft survival in several animal models. The mechanisms of CD45RB mAb-mediated tolerance are largely unknown. Therefore, the present studies were performed to determine the immunomodulatory effects of CD45RB mAb on T cells in early or late time after allogenic skin transplantation. METHODS: Skin grafts and bone marrows from BALB/c donor mice were transplanted on C57BL/6 recipient mice and Busulfan was administerd. Group 1 was composed of anti-CD154 mAb administerd mice, group 2 was composed of anti-CD154 and anti-CD45RBB mAb administerd mice, and group 3 consisted of anti-CD154 mAb and CTLA4-Ig administerd mice. The proportion of splenic CD4+ and CD8+ T cell and range of CD45RB was observed by flow cytometry. Cytokines secreted by CD4+ T cell were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: CD45RB mAb in combination with CD154 mAb enhanced graft survival in allogenic skin transplantation model where CD45RB mAb specific for CD45RB, which was proven mainly expressed by CD8+ T cells, had inhibitory effects on the proportion of splenocyte-derived CD8+ and CD4+CD45RB(high) T cells in early or late time posttransplant. CONCLUSION: The combined therapy showed decreases in the proliferation of CD8+ T cells in vivo and allospecific responses of IFN-gamma-producing cells. Such immunomodulatory effects may be associated with the tolerogenic ability of CD45RB mAb in allogenic skin transplantation.
Abatacept ; Allografts ; Animals ; Antibodies, Monoclonal ; Bone Marrow ; Busulfan ; Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Graft Survival ; Humans ; Immune Tolerance* ; Lymphocytes* ; Mice* ; Models, Animal ; Skin ; Skin Transplantation ; T-Lymphocytes ; Tissue Donors ; Transplants

The disparity between patients awaiting transplantation and available organs forced many patients to go overseas to receive a transplant. Few data concerning overseas transplantation in Korea are available and the Korea Society for Transplantation conducted a survey to evaluate the trend and outcome of overseas transplantation. The survey, conducted on June 2006, included 25 hospitals nationwide that followed up patients after receiving kidney transplant (KT) or liver transplant (LT) overseas. The number of KT increased from 6 in 2001 to 206 in 2005 and for LT from 1 to 261. The information about overseas transplant came mostly from other patients (57%). The mean cost for KT was dollar 21,000 and for LT dollar 47,000. Patients were admitted for 18.5 days for KT and 43.4 days for LT. Graft and patient survival was 96.8% and 96.5% for KT (median follow up 23.1 months). Complication occurred in 42.5% including surgical complication (5.3%), acute rejection (9.7%) and infection (21.5%). Patient survival for LT was 91.8% (median follow up 21.2 months). Complication occurred in 44.7% including 19.4% biliary complication. Overseas KT and LT increased rapidly from 2001 to 2005. Survival of patients and grafts was comparable to domestic organ transplantation, but had a high complication rate.
Graft Rejection/complications ; Graft Survival ; Humans ; Kidney Transplantation/adverse effects/economics/trends ; Liver Transplantation/adverse effects/economics/trends ; Organ Transplantation/adverse effects/economics/*trends ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea