OBJECTIVE: The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high mortality rate during the perioperative period. We considered the appropriate methods of treatment that are most essential in the overall management of traumatic dural venous sinus injuries. METHODS: We conducted a retrospective review of all cases involving patients with dural venous sinus injury who presented to our hospital between January 1999 and December 2014. RESULTS: Between January 1999 and December 2014, 20 patients with a dural venous sinus injury out of the 1,200 patients with severe head injuries who had been operated upon in our clinic were reviewed retrospectively. There were 17 male and 3 female patients. In 11 out of the 13 patients with a linear skull fracture crossing the dural venous sinus, massive blood loss from the injured sinus wall could be controlled by simple digital pressure using Gelfoam. All 5 patients with a linear skull fracture parallel to the sinus over the venous sinus developed massive sinus bleeding that could not be controlled by simple digital pressure. CONCLUSION: When there is a linear skull fracture parallel to the sinus over the dural venous sinus or a depressed skull fracture penetrating the sinus, the surgeon should be prepared for the possibility of potentially fatal venous sinus injury, even in the absence of a hematoma.
Craniocerebral Trauma ; Emergencies ; Female ; Gelatin Sponge, Absorbable ; Hematoma ; Hemorrhage ; Humans ; Male ; Mortality ; Perioperative Period ; Retrospective Studies ; Skull Fracture, Depressed ; Skull Fractures ; Superior Sagittal Sinus

Human ovarian follicles reduce rapidly in number throughout fetal and adult life. Throughout the menstrual cycles, primordial follicles grow into mature follicles and then ovulate to form corpus luteum. Apoptosis has been implicated in several events that occur during the process of follicular growth, atresia and the regression of the corpus luteum. By the use of immunohistochemistry, we clarified the involvement of apoptosis in the human ovary during follicular growth, regression and atresia by investigating the expression of Fas, Fas-ligand, Bcl-2 and Bad in primordial follicles, primary follicles and mature follicles. Fas immunostaining was present in primordial oocytes, both oocytes and granulosa cells of primary follicles, preantral follicles and all follicular cells of mature follicles. Fas-ligand and Bad immunostaining patterns were similar to those of Fas except for theca cells. Bcl-2 immunostaining was present in both oocytes and granulosa cells of primary, preantral and mature follicles. In corpus luteum, Fas, Fas-ligand, Bcl-2 and Bad immunostaining were observed and decreased in the regressing corpus luteum. In postmenopausal ovary, Fas, Fas-ligand, Bcl-2 and Bad immunostaining were entirely negative. Bad immunostaining was observed but Bcl-2 was not in atretic follicle. These results suggest that Fas, Fas-ligand, Bcl-2 and Bad may play important roles in human ovary during follicular growth, regression and atresia simultaneously. Further studies should be required to elucidate the underlying mechanism and apoptosis of the disease associated with normal and abnormal ovarian aging.
Adult ; Aging ; Apoptosis ; Corpus Luteum ; Female ; Granulosa Cells ; Humans* ; Immunohistochemistry ; Menstrual Cycle ; Oocytes ; Ovarian Follicle* ; Ovary ; Theca Cells

PURPOSE: The purpose of this study was to evaluate the responses and toxicities of risk-adapted chemotherapy in pediatric intracranial germ cell tumors(IC-GCT). METHODS: Fourteen patients who were diagnosed as IC-GCT from October 2002 to December 2003 received chemotherapy as an initial treatment modality. The low risk(LR) group was defined as follows: Pure germinoma and normal AFP level. Beta-hCG level 50 mIU/mL or less. The others belonged to the high risk(HR) group. Chemotherapy was composed of cisplatin, cyclophosphamide, etoposide and vincristine. Double doses of cisplatin and cyclophosphamide was used in HR patients. RESULTS: Pathologic confirmation was done in all but one. Median age at diagnosis was 11.6 yr (1.2-18.7 yr), and nine patients belonged to the HR group. Tumor markers were normalized after chemotherapy in all patients whose tumor markers had been elevated. Four LR patients(80 percent) and seven HR patients(77.8 percent) showed complete response(CR) at the end of chemotherapy. An additional two of the three patients with partial response(PR) achieved CR after radiation therapy (RT), and the remaining one relapsed before RT. Four LR and all HR patients experienced infectious episodes that required hospitalization. Four of the nine HR patients(44.4 percent) suffered from tinnitus, three of whom developed sensorineural hearing loss. All but one are surviving, event-free, with a median follow-up of 13.9 mo(8.1-22.3 mo). CONCLUSION: Risk-adapted cisplatin-based chemotherapy was effective even in HR patients, but regimen modification seems to be necessary to avoid an unacceptably high toxicity rate.
Cisplatin ; Cyclophosphamide ; Diagnosis ; Drug Therapy* ; Etoposide ; Follow-Up Studies ; Germ Cells* ; Germinoma ; Hearing Loss, Sensorineural ; Hospitalization ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Tinnitus ; Biomarkers, Tumor ; Vincristine

PURPOSE: The purpose of this study was to evaluate the outcome of children with juvenile myelomonocytic leukemia(JMML) treated with allogeneic hematopoietic stem cell transplantation(allo- HSCT). METHODS: Eleven JMML patients aged 8-39 months underwent allo-HSCT. The sources of grafts were unrelated donors(n=7), HLA-matched siblings(n=3) and an HLA 1-antigen mismatched familial donor. All patients had received chemotherapy +/- 13-cis-retinoic acid(CRA) before transplant, and CRA was used, posttransplant, in six patients. RESULTS: Only three patients were in complete remission(CR) at the time of transplantation. Initial chimeric status revealed complete donor chimerism(CC) in five patients, mixed chimerism(MC) in five and autologous recovery(AR) in one. One patient with MC having persistent splenomegaly eventually turned to CC and CR after rapid tapering of cyclosporine, combined with daily use of CRA. An AR case relapsed shortly after transplant but was rescued with second, unrelated cord blood transplantation. Ultimately, six patients are alive, event-free, with a median follow-up of 15.5 months posttransplant. All three deaths occurred in patients who failed to achieve CC, leading to disease progression. CONCLUSION: We suggest that graft-versus-leukemia effect play an important role and CRA a possible role in posttransplant leukemic involution in JMML. In patients whose leukemic burden is still high with MC after transplant, early tapering of immunosuppressants and introduction of CRA might provide a chance of a cure for some patients.
Child ; Cyclosporine ; Disease Progression ; Drug Therapy ; Fetal Blood ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunosuppressive Agents ; Isotretinoin ; Leukemia* ; Leukemia, Myelomonocytic, Juvenile ; Splenomegaly ; Tissue Donors ; Transplants

PURPOSE: Burkitt lymphoma (BL) occurs mainly in pediatric populations. Data on the clinical characteristics and treatment results are scarce in Korea. We report our single center experience on BL in children to improve the treatment efficacy while minimizing treatment-related toxicities. METHODS: We undertook a retrospective analysis of 15 patients diagnosed as BL or Burkitt leukemia-lymphoma (BLL) between Aug., 1995 and Feb., 2002. Several induction chemotherapy regimens were used including CCG 106B (prednisolone, cyclophosphamide, daunorubicin, vincristine, L-asparaginase; N=10). Post-induction regimens consisted of CCG 106B (N=12), high dose chemotherapy and autologous stem cell transplantation (N=1), and others (N= 2). RESULTS: The incidence of BL and BLL was 27.2% of Non-Hodgkin's lymphoma diagnosed at our institution. Abdominal mass was the most common presentation (80%) and many patients had advanced stage diseases. Six patients suffered from tumor lysis syndrome, all of whom eventually improved. None died from infection or bleeding. All patients are alive disease-free for median 20 months (range 2~26 months) of follow-up duration except for one who is alive with a residual liver mass. CONCLUSION: Though recent therapeutic trials of repeated intensified chemotherapy including high dose cytarabine and methotrexate led to improvement of survival in patients with BL, many patients suffers from therapy-related toxicities. We successfully treated pediatric BL patients with tolerable toxicities using CCG 106B regimen which is known to be highly effective in high-risk acute lymphoblastic leukemia. More experiences are needed to establish the optimal duration of therapy.
Burkitt Lymphoma* ; Child ; Cyclophosphamide ; Cytarabine ; Daunorubicin ; Drug Therapy ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Induction Chemotherapy ; Korea ; Liver ; Lymphoma, Non-Hodgkin ; Methotrexate ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Stem Cell Transplantation ; Treatment Outcome* ; Tumor Lysis Syndrome ; Vincristine

PURPOSE: Right middle lobe syndrome is defined as chronic atelectasis of the middle lobe of the right lung. The purpose of this study was to analyze the etiologies, radiologic findings, bronchoscopic findings, and clinical manifestations of right middle lobe syndrome in children. METHODS: We retrospectively reviewed the medical records of 28 children, who were admitted to the Samsung Medical Center from June 1998 to January 2003. These children had persistent atelectasis in the right middle lobe in plain chest radiography for more than a month. RESULTS: In 28 children, the most common etiology was pneumonia, followed by tuberculosis, bronchiectasis, and asthma. Most of the patients manifested nonspecific respiratory symptoms, such as coughing. The computerized tomography showed various findings including atelectasis, air bronchogram, or bronchietasis. While normal patent airway was found in 50% of the patients by bronchoscopy, narrowing of bronchus, large amount of secretion, and granulation nodules were noted in another half of the patients. In comparison with tuberculosis, atelectasis caused by pneumonia was relived more frequently by bronchoscopic therapeutic intervention (P=0.008), but there was no significant difference between them after approximately 2 years of follow-up. (P=0.232) Final outcomes in patients whose duration of atelectasis was 2 months or less tended to be better than 12 months or more, but it was not statistically significant. (P= 0.067) CONCLUSION: Common causes of right middle lobe syndrome in Korean children are pneumonia and tuberculosis. A high index of suspicion is required for early diagnosis and proper treatment which leading to better outcomes.
Asthma ; Bronchi ; Bronchiectasis ; Bronchoscopy ; Child* ; Cough ; Early Diagnosis ; Follow-Up Studies ; Humans ; Lung ; Medical Records ; Middle Lobe Syndrome* ; Pneumonia ; Pulmonary Atelectasis ; Radiography ; Retrospective Studies ; Thorax ; Tuberculosis

Primary squamous cell carcinoma (SCC) of the stomach is a very rare disease. However, the pathogenesis, clinical characteristics, and prognosis of gastric SCC are controversial and remain to be elucidated. Herein, we report a case of primary gastric SCC of the remnant stomach after subtotal gastrectomy. A 65-year-old man was admitted to our hospital due to epigastric discomfort and dizziness. He had undergone subtotal gastrectomy 40 years previously for gastric ulcer perforation. Endoscopy revealed a normal esophagus and a large mass in the remnant stomach. Abdominal computed tomography revealed enhanced wall thickening of the anastomotic site and suspected metachronous gastric cancer. Endoscopic biopsy revealed SCC. Total gastrectomy was performed with Roux-en-Y esophagojejunostomy. A 10-cm tumor was located at the remnant stomach just proximal to the previous area of anastomosis. Pathologic examination showed well-differentiated SCC extended into the subserosa without lymph node involvement (T3N0M0). The patient received adjuvant systemic chemotherapy with 6 cycles of 5-FU and cisplatin regimen, and he is still alive at the 54-month follow-up. According to the treatment principles of gastric cancer, early detection and radical surgical resection can improve the prognosis.
Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Cisplatin ; Dizziness ; Drug Therapy ; Endoscopy ; Epithelial Cells* ; Esophagus ; Fluorouracil ; Follow-Up Studies ; Gastrectomy* ; Gastric Stump* ; Humans ; Lymph Nodes ; Prognosis ; Rare Diseases ; Stomach ; Stomach Neoplasms ; Stomach Ulcer

The incidence of all transverse vaginal septum is 1:2,100 - 1:72,000. The transverse vaginal septum is a developmental defect of vagina which may be fused incompletely between the Mullerian duct component and the urogenital sinus component of vagina. Serious complications may be hematocolpos, hematometra and hematosalpinx. Simple surgical excision or simple incision have been developed to treat congenital transverse vaginal septa, but also caused common complications such as secondary tissue contracture. Garcia technique using eight vaginal mucosa flaps was developed to avoid common complication of secondary vaginal stenosis. Here, we present a case of contracted transverse vaginal septum who has been performed a simple incision 13 years ago, successfully performed the modified Garcia technique without serious postoperative complication.
Constriction, Pathologic ; Contracture ; Female ; Hematocolpos ; Hematometra ; Incidence ; Mucous Membrane ; Postoperative Complications ; Vagina

In this study, antioxidant and free radical scavenging activities of the natural antioxidative compound, pyrogallol-phloroglucinol-6,6'-bieckol (PPB) isolated from brown algae, Ecklonia cava was assessed in vitro by measuring the radical scavenging activities (DPPH, alkyl, hydroxyl, and superoxide) using electron spin resonance (ESR) spectrometry, intracellular reactive oxygen species (ROS) scavenging activity, and DNA damage assay. According to the results of these experiments, the scavenging activity PPB against difference radicals was in the following order: DPPH, alkyl, hydroxyl, and superoxide radicals (IC50; 0.90, 2.54, 62.93 and 109.05 microM). The antioxidant activities of PPB were higher than that of the commercial antioxidant, ascorbic acid. Furthermore, PPB effectively inhibited DNA damage induced by H2O2. These results suggest that the natural antioxidative compound, PPB, can be used by the natural food industry.
Ascorbic Acid ; DNA Damage ; Electron Spin Resonance Spectroscopy ; Food Industry ; Phaeophyta ; Reactive Oxygen Species ; Spectrum Analysis ; Superoxides

The peneicillin binding protein gene(mecA gene) is present in the methicillin-resistant Staphylococcus strains but not in the susceptible ones. The goal of the present study was to establish experimental evidences which might use polymerase chain reaction(PCR) for culture confirmation and eventually clinical diagnosis of methicillin resistant Staphylococcui. Two primers (5'-AAAATCGATGGTAAAGGTTGGC-3', 5'-AGTTCTGCAGTACCGGATTTGC-3') based on the known DNA sequence of the mecA gene from methicillin-resistant Staphylococcus aureus were used in PCRs to screen for the presence of this gene in Staphylococcal isolates from various clinical settings. When the primers were used to copy the DNA of the mecA gene, only 533 base-pair DNA fragment was appeared. The product indicates a positive PCR result for methicillin-resistant Staphylococcal isolates. In contrast, from the DNA of the methicillin-sensitive Staphylococcal isolates the 533bp was not amplified. Results obtained with PCR were generally consistent with those of standard microbiological assays. The mecA gene in methicillin-high resistant Staphylococci was located on the approximately 5.56kb Hind III restriction fragment. The 533bp probe was hybridized to the 5.56kb Hind III restriction fragment of mecA-positive S. aureus. No hybridization was occured in the mecA-negative strain. The mecA gene was cloned, named pHL-1201 and verified by colony hyhridization. The 533bp probe was hybridized to the approximately 5.56kb Hind III restriction fragment of the DNA obtained from pHL-1201. PCRs with the primers successfully distinguished methicillin-resistants from methicillin-susceptible strains of S. aureus and S. epidermidis.
Base Sequence ; Carrier Proteins ; Clone Cells* ; Cloning, Organism* ; Diagnosis ; DNA ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus ; Polymerase Chain Reaction* ; Staphylococcus aureus ; Staphylococcus*