A Case of surgically corrected congenital Bochdalek's hernia is reported. A 6months old female baby was admitted with chief complaints of mild dyspnea, cyanosis and vomiting with irritability. The diagnosis was confirmed by physical finding of the audible peristaltic sounds on the left chest and radiological characteristic finding of barium study. The review of literature is made briefly.
Barium ; Cyanosis ; Diagnosis ; Dyspnea ; Female ; Hernia* ; Hernia, Diaphragmatic ; Humans ; Thorax ; Vomiting

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate changes in the adjacent segment after posterior instrumentation and fusion in thoracolumbar spinal fractures. SUMMARY OF LITERATURE REVIEW: The incidence of adjacent-segment disease is increasing as spinal surgery becomes more common. Many studies have been conducted on the risk factors for adjacent-segment changes in the lumbar spine, but few articles have been published on this topic in the thoracolumbar spine. MATERIALS AND METHODS: The records of 50 patients who received treatment from 2000 to 2013 were reviewed retrospectively. They underwent posterior instrumentation and fusion due to thoracolumbar fracture and were followed up for more than 2 years. To evaluate changes in the adjacent segment, immediate postoperative and last follow-up values of the sagittal angle, disc height, and disc angle were compared between groups divided by age (more or less than 50 years), laminectomy, and fusion levels. The Pfirrmann grade of the discs proximal and distal to the fusion level was also measured using preoperative magnetic resonance imaging. RESULTS: Thirty-six patients were male and 14 were female. The average age of the 50 patients was 45.6 years, and the mean follow-up period was 4.3 years. There were no cases of adjacent-segment disease. The mean kyphotic sagittal angle progression was 6.8° (range, −11° to 28.5°, p=0.000). The mean change of disc height of the proximal adjacent segment was 0.3 mm (range, −1.6 to 3.4 mm, p=0.013) and 0.6 mm (range, −4.1 to 5.8 mm, p=0.013) in the distal adjacent segment. Laminectomy did not make a significant difference. In the group below 50 years of age, the angle of the adjacent segment discs increased by 0.8° (range, −3.1° to 5.1°, p=0.004) at the proximal adjacent segment and by 0.5°(range, −4.8° to 2.9°, p=0.016) at the distal adjacent segment. Proximal adjacent disc height decreased as the fusion levels increased. As the preoperative Pfirrmann grade increased, degenerative changes in the proximal adjacent segment disc tended to accelerate. CONCLUSIONS: Adjacent-segment disease after lumbar fusion surgery was not found in adjacent segments of the thoracolumbar spine. This seems to be due to the anatomical characteristics of the lumbar spine, which is more flexible than the thoracolumbar vertebra. The mobile segments of the lumbar spine may account for this difference, rather than the instrumentation and fusion procedure itself.
Female ; Follow-Up Studies ; Humans ; Incidence ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Risk Factors ; Spinal Fractures ; Spine

Background/Aims: To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population. Methods: This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes. Results: A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence. Conclusions This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications.

Background/Aims: To analyze the incidence and risk factors of outcomes after liver transplantation (LT) in the Korean population. Methods: This study analyzed data from the liver cohort of Korean Organ Transplantation Registry (KOTRY) who had LT between May 2014 and December 2017. Study measures included the incidence of post-LT outcomes in recipients of living donor LT (LDLT) and deceased donor LT (DDLT). Cox multivariate proportional hazards model was used to determine the potential risk factors predicting the outcomes. Results: A total of 2,563 adult recipients with LT (LDLT, n=1,956; DDLT, n=607) were included, with mean±standard deviation age of 53.9±8.9 years, and 72.2% were male. The post-LT outcomes observed in each LDLT and DDLT recipients were death (4.0% and 14.7%), graft loss (5.0% and 16.1%), rejection (7.0% and 12.0%), renal failure (2.7% and 13.8%), new onset of diabetes (12.5% and 15.4%), and hepatocellular carcinoma (HCC) recurrence (both 6.7%). In both LDLT and DDLT recipients, the most common post-LT complications were renal dysfunction (33.6% and 51.4%), infection (26.7% and 48.4%), and surgical complication (22.5% and 23.9%). Incidence of these outcomes were generally higher among recipients of DDLT than LDLT. Multivariate analysis indicated recipient age and DDLT as significant risk factors associated with death and graft loss. DDLT and ABO incompatible transplant were prognostic factors for rejection, and HCC beyond Milan criteria at pre-transplant was a strong predictor of HCC recurrence. Conclusions This study is a good indicator of the post-LT prognosis in the Korean population and suggests a significant burden of post-LT complications.

BACKGROUND: Pathologic diagnosis of central nervous system (CNS) neoplasms is made by comparing light microscopic, immunohistochemical, and molecular cytogenetic findings with clinicoradiologic observations. Intraoperative frozen cytology smears can improve the diagnostic accuracy for CNS neoplasms. Here, we evaluate the diagnostic value of cytology in frozen diagnoses of CNS neoplasms. METHODS: Cases were selected from patients undergoing both frozen cytology and frozen sections. Diagnostic accuracy was evaluated. RESULTS: Four hundred and fifty-four cases were included in this retrospective single-center review study covering a span of 10 years. Five discrepant cases (1.1%) were found after excluding 53 deferred cases (31 cases of tentative diagnosis, 22 cases of inadequate frozen sampling). A total of 346 cases of complete concordance and 50 cases of partial concordance were classified as not discordant cases in the present study. Diagnostic accuracy of intraoperative frozen diagnosis was 87.2%, and the accuracy was 98.8% after excluding deferred cases. Discrepancies between frozen and permanent diagnoses (n = 5, 1.1%) were found in cases of nonrepresentative sampling (n = 2) and misinterpretation (n = 3). High concordance was observed more frequently in meningeal tumors (97/98, 99%), metastatic brain tumors (51/52, 98.1%), pituitary adenomas (86/89, 96.6%), schwannomas (45/47, 95.8%), high-grade astrocytic tumors (47/58, 81%), low grade astrocytic tumors (10/13, 76.9%), non-neoplastic lesions (23/36, 63.9%), in decreasing frequency. CONCLUSIONS: Using intraoperative cytology and frozen sections of CNS tumors is a highly accurate diagnostic ancillary method, providing subtyping of CNS neoplasms, especially in frequently encountered entities.
Brain Neoplasms ; Central Nervous System Neoplasms ; Central Nervous System ; Cytogenetics ; Diagnosis ; Frozen Sections ; Humans ; Meningeal Neoplasms ; Methods ; Neurilemmoma ; Pituitary Neoplasms ; Retrospective Studies