Intrahepatic portosystemic venous shunt(IPVS) is an uncommon pathologic condition which occurs mostly in adult patients with portal hypertension and cirrhosis of the liver with only scattered reports are on children. However, asymptomatic IPVS have been detected in an increasing number of patients with recent advances in imaging techniques, such as sonography, CT, MR imaging, and color Doppler sonography. The cause of IPVS remains unknown, but two probable origins have been proposed, congenital and acquired origin. In the congenital origin, it has been proposed that the IPVS develops from embryologic vascular remnants. Acquired IPVS can develop into intrahepatic collateral pathway in the presence of portal hypertension and cirrhosis of the liver. We report a case of congenital IPVS with suspicious sepsis in a 6-day-old female patient. An abdominal ultrasonography and color Doppler sonography demonstrated an aneurysmal type of anomalous shunt connecting the right portal vein to the right hepatic vein. The patient continued to be symptomatic after discharge and a follow-up ultrasonography 3 months later revealed the disappearance of the previous IPVS.
Adult ; Aneurysm ; Child ; Female ; Fibrosis ; Follow-Up Studies ; Hepatic Veins ; Humans ; Hypertension, Portal ; Liver ; Magnetic Resonance Imaging ; Portal Vein ; Sepsis ; Ultrasonography

PURPOSE: To evaluate the efficacy of computed tomography(CT) in detecting pericardial adhesion. MATERIALS AND METHODS: CT of 32 patients with 'redo-valve surgery' was retrospectively evaluated for the location and appearance of their surgically confirmed pericardial adhesion. CT of 20 cases without cardiac or pericardial disease was reviewed as normal control. RESULTS: Nodular increased density at the site of adhesion between the sternum and the right atrium(RA) or ascending aorta(n=10), retrosternal dirty fat(n=10), obliteration of the pericardial fat(n=28), cardiac contour change with or without nodular epicardial fat accumulation(n=10), diffuse pericardial thickening(n=14), and pericardial calcification(n=13) were considered to be important findings. We also noticed an additional findings of beak-like projection of RA appendage(n=13), but was considered less significant because they were also observed in 4 normal subjects. CONCLUSION: CT scan is an effective, simple, and noninvasive method for predicting pericardial adhesion that may be occurred after redo-valve surgery.
Humans ; Retrospective Studies ; Sternum ; Tomography, X-Ray Computed

Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 +/- 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P < 0.001), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the ORs were 1.7 (95% CI, 1.08-3.69; P = 0.12) and 3.9 (95% CI, 1.27-5.02; P < 0.001), respectively. These findings suggest that severe tooth loss may be a predictor of silent cerebral infarcts and cerebral white matter changes in community-dwelling, stroke- and dementia-free adults.
Age Factors ; Aged ; Alzheimer Disease/diagnosis ; Brain/*radiography ; Cross-Sectional Studies ; Dementia/pathology/prevention & control ; Diabetes Complications/diagnosis ; Female ; Humans ; Hyperlipidemias/complications ; Hypertension/complications ; Interviews as Topic ; Male ; Middle Aged ; Odds Ratio ; Periodontal Diseases/complications/*diagnosis ; Predictive Value of Tests ; Risk Factors ; Stroke/pathology/prevention & control ; Tomography, X-Ray Computed ; Tooth Loss

PURPOSE: This study aimed to compare the results of laparoscopic resection with those of open resection for consecutive colorectal cancer patients who underwent surgery at a single center. METHODS: During the thirty-month period between January 2003 and August 2005, patients with a colorectal adenocarcinoma admitted to our hospital were assessed. Cancers related with FAP or HNPCC, cancers treated with endoscopy or local excision, and recurrent cancers were excluded from the study. Three hundred two laparoscopic resection patients were matched to 302 open resection patients. RESULTS: The mean age of the laparoscopic resection group was 59.5 years while that of the open resection group was 59.4 years. Patients in two groups were similar in terms of gender distribution, level of CEA and ASA, and location and size of tumor. The modified Dukes' stages showed 51 patients in stage A, 33 in stage B1, 62 in stage B2, 17 in stage C1, and 139 in stage C2 for the laparoscopic resection group and 33 in stage A, 52 in stage B1, 82 in stage B2, 18 in stage C1, and 117 in stage C2 for the open resection group (P=0.024). The operative time averaged 9.6 minutes longer in the laparoscopic group (188.9 vs. 179.3 min, P<0.0001). The rate of stoma formation for protection of anastomosis in the laparoscopic group was 4.9% (5.8% in open group). There were significant differences in blood loss (556.2 vs. 952.8 ml, P<0.0001), the amount of intraoperative blood transfusion (1.6 vs. 2.3 unit, P=0.004), the number of harvested lymph nodes (21.1 vs. 16.9, P<0.0001), and the rate of high ligation of IMA (91.7 vs. 75.5%, P<0.0001). The length of the distal resection margins from cancer was longer in the open group (2.9 vs. 3.5 cm, P=0.037). Patients in the laparoscopic group had a faster recovery of bowel function (P<0.0001) and a significant reduction in the mean length of hospital stay (11.5 vs. 16.8 days, P<0.0001). There was no mortality in either group. Early and late complications were comparable. The conversion rate was 1.6 percent. CONSLUSIONS: The benefits of a laparoscopic resection for colorectal cancers are less blood loss and transfusion, faster postoperative bowel motion, a shorter hospital stay, low morbidity, and a large number of harvested lymph nodes. In conclusion, a laparoscopic resection for colorectal cancers can be done safely and effectively and is an acceptable alternative to a conventional open resection.
Adenocarcinoma ; Blood Transfusion ; Colorectal Neoplasms* ; Endoscopy ; Humans ; Length of Stay ; Ligation ; Lymph Nodes ; Mortality ; Operative Time

No abstract available.
Embryonic Development* ; Embryonic Structures* ; Female ; Nitric Oxide* ; Pregnancy

Angiomyofibroblastoma is a rare, benign mesenchymal tumor of the vulva. Since it was described in 1992 by Fletcher, 15 cases have been reported in literature. We recently experienced a recurred angiomyofibroblastoma of the vulva. A 45-year-old woman was presented initially in 1991 with a mass of labium major and local excision of tumor mass had been performed. A histologic diagnosis was made of angiomyxoma, but this diagnosis was revised to angiomyofibroblastoma by the authors. The recurred mass was well circumscribed, measuring 2.5x1.6x1.5cm in dimensions. Microscopically the tumor was characterized by high cellularity, numerous blood vessels(which lack prominent hyalinization), and plump stromal cells. Immunohistochemically, the stromal cells were reactive for vimentin and desmin, but not alpha-smooth muscle actin, or S-100 protein. We thought that this case was a recurred angiomyofibrblastoma of the vulva due to incomplete surgical excision.
Female ; Humans

BACKGROUND: Hybrid coronary revascularization (HCR) was developed to combine the advantages of coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI). However, it is still controversial whether it is more optimal to perform CABG or PCI first. The purpose of this study was to compare the clinical outcomes of these 2 approaches. METHODS: Eighty patients who underwent HCR from May 2010 to December 2015 were enrolled in this retrospective analysis. The CABG-first group comprised 12 patients and the PCI-first group comprised 68 patients. Outcomes of interest included in-hospital perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and the incidence of repeated revascularization, especially for the target vessel lesion. RESULTS: No significant difference was found in the amount of postoperative bleeding (p=0.239). The incidence of MACCEs was similar between the CABG-first and PCI-first groups (1 of 12 [8.3%] vs. 5 of 68 [7.4%], p>0.999). Repeated revascularization was performed on 3 patients (25%) in the CABG-first and 9 patients (13.2%) in the PCI-first group (p=0.376). CONCLUSION: There were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR.
Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Hemorrhage ; Humans ; Incidence ; Percutaneous Coronary Intervention ; Retrospective Studies ; Transplants

Primary non-Hodgkin' lymphomas of the liver, an organ normally devoid of a native lymphoid tissue, are very rare. We recently experienced a case of a primary low-grade hepatic B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type in a 36-year-old woman. The ultrasonography revealed a 5 cm sized mass in the right lobe of the liver. A right segmentectomy of the liver was done and showed a relatively well-circumscribed brownish yellow lobulated homogenous mass, measuring 5.5x4.5 cm in size. Histologic sections of liver mass revealed large lymphoid follicles with reactive germinal centers, follicular colonization by centrocyte-like cells (CCL cells), and lymphoepithelial lesions. The CCL cells were positive for B-cell (CD20), LCA (CD45RA), Bcl-2 oncoprotein, and lambda light chain.
Adult ; B-Lymphocytes ; Colon ; Female ; Germinal Center ; Humans ; Liver* ; Lymphoid Tissue ; Lymphoma* ; Lymphoma, B-Cell ; Mastectomy, Segmental ; Ultrasonography

BACKGROUND/AIMS: Idiopathic pulmonary arterial hypertension (IPAH) is an incurable disease with high mortality. Although most studies recommend anticoagulation treatment for IPAH, the benefits are uncertain, particularly in Korea, where it has not been studied. The purpose of this study was to evaluate survival outcomes of Korean patients with IPAH treated with warfarin. METHODS: We performed a retrospective cohort study of patients diagnosed previously with pulmonary arterial hypertension (PAH) at the Asan Medical Center in Korea, between January 1994 and February 2013. We excluded patients with associated PAH, patients who did not undergo right heart catheterization (RHC), and patients with a positive vasoreactivity test. Patients in the study cohort were classified into a "warfarin group" and a "non-warfarin group," according to the treatment they received during the first year after diagnosis. RESULTS: We identified 31 patients with IPAH and a negative vasoreactivity test on RHC. Median patient age was 36.0 years, and 23 patients (74.2%) were female. The median time from the onset of symptoms to diagnosis was 19.0 months, and the most common presenting symptom was dyspnea. Survival rates of the patients at 1, 3, 5, and 10 years were 90.2%, 79.5%, 62.7%, and 34.8%, respectively. The mean survival period was 12.0 years in the warfarin group and 6.1 years in the non-warfarin group. Warfarin treatment had significant survival benefits in patients with IPAH (p = 0.023). CONCLUSIONS: Warfarin treatment substantially improved survival outcomes in Korean cases of IPAH.
Adult ; Anticoagulants/*therapeutic use ; Asian Continental Ancestry Group ; Familial Primary Pulmonary Hypertension/diagnosis/*drug therapy/ethnology/mortality ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Proportional Hazards Models ; Protective Factors ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Warfarin/*therapeutic use

STUDY DESIGN: A retrospective study OBJECTIVES: To examine the mid term clinical and radiologic findings of patients treated by Posterior Lumbar Interbody Fusion (PLIF) with cages in spondylolisthesis. LITERATURE REVIEW: The clinical result of PLIF with cages is satisfactory. PLIF with cages is a useful treatment for spondylolisthesis. MATERIALS AND METHODS: Forty-two patients were followed up for more than 5 years. Their mean age was 53 years and the mean follow-up period was 68 months. Twenty-one cases were the isthmic type, and 21 cases were the degenerative type. The low back pain score, Lin s clinical result, perioperative value of slippage, anterior intervertebral disc space height, radiological change in the adjacent level and complications were evaluated. RESULTS: The preoperative lower back pain score improved from 46.7 to 86.4 points at the last follow-up (p.0.05). Thirty-eight patients (91%) showed excellent or good results. The preoperative value of slippage improved from 17.5% to 5.7% (p.0.05). The anterior intervertebral disc space height increased from 10.0 to 14.5 mm (p.0.05). There were changes in the above and lower adjacent segments in 12 cases (28%). Two of these cases required surgery. CONCLUSIONS: PLIF with cages might be an effective method in spondylolisthesis. However, the long-term follow-up showed changes in the adjacent segment.
Follow-Up Studies ; Humans ; Intervertebral Disc ; Low Back Pain ; Retrospective Studies ; Spondylolisthesis*