Hughes-Stovin syndrome is an extremely rare entity. We present a case of a 42-year-old man, who developed deep vein and inferior vena cava (IVC) thrombosis, repeated internal bleeding and pulmonary artery aneurysms (PAAs). The patient presented with massive hemoptysis and with PAAs of a 2.5 cm maximum diameter. We describe the successful percutaneous transhepatic venous embolization of the PAAs due to occluded common vascular pathways to the pulmonary artery.
Adult ; Aneurysm* ; Hemoptysis ; Hemorrhage ; Humans ; Pulmonary Artery* ; Thrombosis ; Veins ; Vena Cava, Inferior

PURPOSE:The primary biliary carcinoma is usually unresectable at presentation, because of early lymphatic spread. To determine the incidence and the spread pattern of lymph node metastases according to the location of the primary tumor, we analyzed the CT scans of the patients with primary biliary adenocarcinome. MATERIALS AND METHODS: We reviewed the CT scans of 92 patients with pathologically proven primary biliary adenocarcinoma, including 45 peripheral cholangiocarcinomas, 22 hilar cholangiocarcinomas, 18 gallbladder carcinomas, and 7 common bile duct carcinomas. Positive adenopathy was diagnosed when the node exceeded 10 mm in short axis. RESULTS:The overall incidence of nodal metastases was 59.8 % (55/92); 66.7 % in peripheral cholangiocarcinoma, 54.5 % in hilar cholangiocarcinoma, 55.6 % in gallbladder carcinoma, and 42.9 % in common bile duct carcinoma. The most commonly involved nodal group was the lesser omentum, followed by the celiac, periaortic, and peripancreatic group. The phrenic node group was only involved in the cases with the peripheral or hilar cholangiocarci nome. CONCLUSION:The primary biliary carcinoma has a high incidence of lymph node metastases at the time of diagnosis, and shows different nodal spread pattern according to the location of the primary tumor. Involvement of the phrenic node was limited to the peripheral and hilar cholangiocarcinoma.
Adenocarcinoma ; Axis, Cervical Vertebra ; Biliary Tract* ; Cholangiocarcinoma ; Common Bile Duct ; Diagnosis ; Gallbladder ; Humans ; Incidence ; Lymph Nodes* ; Neoplasm Metastasis* ; Omentum ; Tomography, X-Ray Computed

Purpose: To investigate the clinical characteristics and dacryoendoscopic findings and clinical efficacy of silicone tube intubation (STI) in the patients who referred to our center due to failed with conventional STI. Methods: We retrospectively reviewed the medical records of 61 cases from 50 patients who underwent STI or endoscopic dacryocystorhinostomy using dacryoendoscopy from January 2016 to May 2021. Clinical characteristics, tear meniscus height, lacrimal irrigation test, dacryocystographic findings, dacryoendoscopic findings and surgical outcomes were evaluated. Results: The study included 12 male and 38 female patients (mean age, 64.1 ± 13.2 years). In the preoperative lacrimal irrigation test, passage was found in 33 eyes (54.1%) and no passage in 28 eyes (45.9%). The causes of lacrimal duct obstruction were in the order of stenosis (31.1%), mucus (27.9%), membrane (24.6%), granulation (13.1%), and stone (3.3%), and the location were in the order of nasolacrimal duct (39.3%), lacrimal sac (36.1%), canaliculus (21.3%), and inferior meatus (3.3%). As for the characteristics of obstruction, the secretory type was 21 eyes (34.4%), and structural change type was 40 eyes (65.6%). The STI group consisted of 57 eyes (93.4%) and endoscopic dacryocystorhinostomy consisted of four eyes (6.6%). The overall success rate was 83.9%. Clinical results were correlated with dacryoendoscopic finding (p = 0.015), but not with lacrimal irrigation test or dacryocystography. The structural change type had a higher surgical success rate than the secretory type (84.4% vs. 66.7%, p = 0.015). In particular, the structural change type showed higher success rate than the secretory type below the lacrimal sac (95.5% vs. 61.9%, p = 0.034). Conclusions STI using dacryoendoscopy has a higher surgical success rate than conventional STI since dacryoendoscopy provides direct visualization of nasolacrimal duct obstruction. It could be useful in increasing the surgical success rate in patients with structural changes below lacrimal sac.

Purpose: This study aimed to assess the difference in the vascular parameters of perfusion in the optic nerve head in normal tension glaucoma (NTG) across disease stages using optical coherence tomography angiography and its correlation with peripapillary retinal nerve fiber layer (RNFL) thickness. Methods: In this retrospective study, 83 eyes with varying stages of NTG (25 mild, 31 moderate, and 27 severe) and 90 healthy eyes were enrolled. The perfusion density (PD) and flux index (FI) of the optic nerve head divided into four sectors were determined. We compared the vascular, structural, and functional parameters between normal and glaucomatous eyes and performed a subgroup analysis among the NTG stages. Pearson correlation coefficient was used to assess the topographic correlation between vascular parameters and RNFL thickness. Results: PD and FI were significantly decreased in the NTG group. Subgroup analysis revealed a significant decrease in vascular parameters in most regions in the NTG group, except for the nasal PD and temporal FI. Post hoc analysis showed a significant decrease in PD in the inferior region across all severity levels (mild vs. moderate, p = 0.012; moderate vs. severe, p = 0.012; mild vs. severe, p < 0.001). PD and FI were strongly correlated with RNFL thickness in all quadrants (all p < 0.001), with the strongest correlation observed in the inferior region. Conclusions Vascular parameters were significantly decreased in glaucomatous eyes, and the degree of decrease in vascular parameters was proportional to glaucoma severity. Peripapillary perfusion analysis using optical coherence tomography angiography may complement other measurements used for glaucoma diagnosis.

PURPOSE: To evaluate the effects and complications of self-expandable metallic stent for the treatment of malignant esophagogastric strictures. MATERIALS AND METHODS: From September 1991 to March 1995, 110 stents were placed under fluoroscopic guidance in 103 patients. Of the 103 patients, there were 73 patients with esophageal cancer, 14 patients with gastric cancer, 12 patients with recurrence after surgery, three patients with esophageal compression by metastatic mediastinal lymphadenopathy, and one patient with esophageal invasion by lung cancer. Seventeen patients had esophagorespiratory fistulas. Under fluoroscopic guidance, 113 self-expandable metallic stents (99 Song stents, 14 Strecker stents) were placed in 103 patients. RESULTS: After stent placement, 68 (66%) of the patients could ingest solid food, 26 (25.2%) could ingest soft food, whereas three (2.9%) were not able to have food. Esophagorespiratory fistulas were occluded immediately after stent insertion. All stents were placed without any technical failures or procedural morbidity or mortality. Complications included restenosis in 13, gastroesophageal reflux in 11, stent tube migration in eight, massive bleeding in four, delayed esophageal perforation in one, stent obstruction by food impaction in one patient. CONCLUSION: Self-expandable metallic stent seems to be relatively safe and effective procedure in the palliative treatment of malignant esophagogastric stricture.
Constriction, Pathologic* ; Esophageal Neoplasms ; Esophageal Perforation ; Fistula ; Gastroesophageal Reflux ; Hemorrhage ; Humans ; Lung Neoplasms ; Lymphatic Diseases ; Mortality ; Music ; Palliative Care* ; Recurrence ; Stents* ; Stomach Neoplasms

Over 60 different types of human papillomavirus (HPV) have been identified, and they are classified into high and low risk groups based on the risk for malignant progression of HPV associated lesions. HPVs belonging to a high risk group have been shown to express two major transforming proteins, E6 and E7. With respect to the transforming activity of these proteins, many investigators have reported the location of these proteins in the cell, but their results are still controversial. In the present study, HPV type 16 E6 or E7 open reading frame (ORF) proteins were expressed and localized in human epidermal keratinocytes (RHEK-1) using the vaccinia virus as an expression vector. Immunofluorescence detection using monoclonal antibodies against E6 or E7 ORF proteins revealed that E6 or E7 proteins of HPV type 16 were located in the cytoplasm of RHEK-1 cells. These results suggest that E6 and E7 proteins bind to the tumor suppressor counterparts, thereby preventing transport of these proteins into the nucleus. These antioncogene products that fail to be rapidly transported out of the cytosol may be degraded by certain proteases such as the ubiquitin dependent system. In this way, the precise function of antioncogene products in the regulation of cell growth could be destroyed, and abnormal cell growth could occur.
Animal ; Base Sequence ; Cell Line ; Fluorescent Antibody Technique ; Haplorhini ; Human ; Keratinocytes/metabolism ; Molecular Sequence Data ; Oncogene Proteins, Viral/*biosynthesis ; Open Reading Frames/*physiology ; Papillomavirus, Human/*chemistry ; Plaque Assay ; Polymerase Chain Reaction ; Recombinant Proteins/biosynthesis ; Support, Non-U.S. Gov't ; Vaccinia virus/genetics

Purpose: This study developed a protocol for nursing care after death for adult patients in hospitals. Methods: This was a methodological study to develop a care after death protocol. The preliminary protocol was developed based on a literature review, guidelines, and practice recommendations from groups of experts and clinical nurses. Content validity was evaluated by a group of experts (n=6) and nurses (n=30) in two hospitals. Results: The preliminary protocol recommendations were modified by validation and the open-question analysis results. The final protocol comprised three general recommendations and 43 recommendations in five steps that are verification and notification of a death, personal care of the body, viewing the patient, patient transfer, and documentation and self-care. Conclusion This study result provides nurses with a consensus information on patient care after death and family support in a hospital setting. This nursing protocol is expected to improve the quality of care after death for adult patients and their families, and can be used for developing educational and emotional support for nurses to accomplish their important role.

OBJECTIVE: The authors compare peridural scar formation and adhesion with and without the use of Antiadhesion Barrier Gel(Adba) in an animal model of laminectomy. METHODS: Forty-five Sprague-Dawley rats underwent a two level lumbar laminectomy. The Adba was applied to randomly assigned 30 rats around the dura. Remaining 15 rats underwent same operation without the use of Adba. The rats were sacrificed 2, 4, 8 weeks after surgery by 15 numbers. A gross anatomic assessment of scar formation was done using microdissection by an observer blinded to treatment. Amount of scar formation and tenacity were compared between experimental and control group by a numerical rating system. The histological comparing was also performed. RESULTS: The amount of scar tissue and tenacity were reduced grossly and histologically at postoperative 2, 4, 8 weeks in animal model using Adba. Adba material was absorbed around 4 weeks of postoperative period in model. No special inflammatory reaction was observed, and the healing of wound was not affected by Adba. CONCLUSION: Adba significantly reduces the amount of scar formation and tenacity in rat laminectomy model without impacting the healing of operation wound and other complications.
Animals ; Cicatrix ; Fibrosis* ; Laminectomy* ; Microdissection ; Models, Animal ; Postoperative Period ; Rats* ; Rats, Sprague-Dawley ; Wounds and Injuries

Sinus histiocytosis with massive lymphadenopathy known as Rosai-Dorfman disease is characterized by painless bilateral cervical lymphadenopathy. Extranodal manifestations are uncommon and spinal involvement is rare. A 15-year-old man presented with intermittent midthoracic back pain only. He had no specific findings on neurologic examinations, hematologic and biochemical laboratory tests. Radiological examination of thoracic spine revealed collapse of T6 vertebrae with thoracic kyphosis and osteolytic lesion of T12 vertebra body. He underwent a removal of bone tumor, anterior reconstruction with mesh and pedicle screw fixation via posterior approach for pathologic confirmation and stabilization. Histopathologic study of the lesion revealed focal infiltration of large histiocytes showing emperipolesis. Immunochemistry stain of histiocytes was positive for CD68 and S-100 but negative for CD1a. This report presents a rare case and literature review of extranodal Rosai-dorfman disease in thoracic spine.
Adolescent ; Back Pain ; Emperipolesis ; Fractures, Compression* ; Histiocytes ; Histiocytosis, Sinus* ; Humans ; Immunochemistry ; Kyphosis ; Lymphatic Diseases ; Neurologic Examination ; Spine*