BACKGROUND/AIMS: Intrahepatic duct stone (IHDS) present serious health problem in East Asian countries including Korea because of recurrent or residual stones and stones induced hepatic damage. Hepatic resection is known as most definitive procedure especially in patients with ductal stricture, but postoperative morbidity and residual or recurrent stones are still high. METHODS: We analyzed early and late complication according to type of hepatic resection in IHDs (38 cases) and also determined the predisposing factors related to complication. RESULTS: Location of IHDs was left in 30 cases (78.9%), right in 1 case (2.7%), both in 7 cases (18.4%), and 28 cases (73.7%) had concomitant extrahepatic duct stone. The type of hepatic resection was left lateral segmentectomy in 24 cases (63.2%), left lobectomy in 11 cases (28.9%) and right lobectomy in 3 cases (7.9%). Overall complication rate was 44.7% and it was increased by extension of resection (p<0.05). Overall incidence of residual or recurrent stone was 36.8% and it was higher in patients with left lateral segmentectomy and without biliary drainage procedure although statistically not significant. The postoperative mortality was 11.8% (2 cases). CONCLUSIONS: Hepatic resection can be a curative therapy in IHDS and routine use of intraoperative choledochoscopy and additional drainage procedures are recommended to minimize the incidence of residual or recurrent stones.
Asian Continental Ancestry Group ; Causality ; Constriction, Pathologic ; Drainage ; Humans ; Incidence ; Korea ; Mastectomy, Segmental ; Mortality

A hepatic angiosarcoma is a rare primary malignant neoplasm, which accounts for only 2% of all primary hepatic tumors. The prognosis of a hepatic angiosarcoma is very poor, and most patients die within a year of the initial diagnosis. We report a case of a hepatic angiosarcoma in a 57-year-old man. Although a dynamic CT had suggested a carvenous hemangioma 12 months earlier, the tumor size increased and spontaneously ruptured, so surgical resection was mandatory. A pathological examination, including immunohistochemical studies, showed positive staining for CD34 and Factor VIII, which confirmed the diagnosis of an angiosarcoma. Although dynamic CT is an excellent modality for the diagnosis of a cavernous hemangioma of the liver, hepatic angiosarcomas should be ruled out in selected cases, because they may present with very similar CT findings to benign hemangioma.
Diagnosis ; Factor VIII ; Hemangioma ; Hemangioma, Cavernous* ; Hemangiosarcoma* ; Humans ; Liver ; Middle Aged ; Prognosis ; Rupture, Spontaneous

Huntington's disease(HD) is an autosomal dominantly inherited neurodegenerative disease, which is characterized by choreic movement and progressive dementia. HD is a disease caused by CAG repeat expansion of huntintin gene and definitely diagnosed or is excluded by molecular genetic analysis. Juvenile HD, of which onset is in children or young adult, is the most severely disabled type and shows several distinct clinical and genetic features in contrast to usual late-onset type. We report a 10 year-old girl who presented with involuntary movement, seizure and moderate dysarthria confirmed by molecular genetic analysis.
Child ; Chorea ; Dementia ; Dysarthria ; Dyskinesias ; Female ; Humans ; Molecular Biology ; Neurodegenerative Diseases ; Seizures ; Young Adult

BACKGROUND/AIMS: We studied the patterns of recurrence after resection of relatively small hepatocellular carcinoma, defined as less than 5 cm in diameter, with tumor-free margin, and risk factor for recurrence were re-evaluated for these group. METHODS: The subjects were 25 patients who had undergone tumor removal with tumor-free margin for hepatocellular carcinoma at our department from 1995 to 1998. Tumor-free survival rates of patients with various risk factors were calculated and differences between groups were evaluated. RESULTS: The tumors recurred in 17 patients (68.0%), with 11 patients (64.7% of recurrences) recurring within 1 year of surgery. Recurrent disease was nearly intrahepatic. Univariate retrospective analysis in this study showed the absence of tumor capsule to be significant risk factor. But there is no significant difference in survival rate between capsule (+) groups and capsule (-) groups. CONCLUSION: It was concluded that small hepatocellular carcinoma has no significant difference in clinicopathologic variables except tumor capsule.
Carcinoma, Hepatocellular* ; Humans ; Recurrence* ; Retrospective Studies ; Risk Factors ; Survival Rate

As the incidence of victims of traumatic craniocerebral injury in children has increased in modern times, we retrospectively analyzed 103 cases of surgically treated craniocerebral injuries among patients under the age of 15 who were admitted from January 1991 to December 1994. We classified the materials, i.e. 1) cause and incidence of craniocerebral injury, 2) clinical symptoms, 3) diagnosis and operation, 4) outcome and complication, and 5) period of hospitalization. The results were as follows: 1) The male to female ratio was 1.9:1(male patients 68, female patients 35). 2) The incidence peaked at the age of 6 and was mostly distributed from the age of 6 to 10. 3) As for time distribution most of the accidents occurred between 3 and 6 in the afternoon. 4) The main cause of craniocerebral injuries was attributed to traffic accidents (54 cases, 52.4%) and the second most common cause was falls from heights(30 cases, 29.1%). 5) In 85 cases, the Glasgow coma scale 13-15 before operation was observed. 6) Depression fractures were found to be the most common lesion in our cases. 7) In 48 cases(46.6%) a craniotomy was the operative procedure performed and in 40 cases(38.8%) an elevation of the depressed bone was performed. 8) In 93 cases, the Glasgow outcome scale 4-5 after operation was observed. 9) The many sequelae of operation were neurological deficit, cognitive impairent, and post-traumtic seizure. 10) The average period of hospitalization was 18.7 days(s.d=18.1). The cause and incidence of surgically treated pediatric head injuries were similar to those of total pediatric head injuries. A high GCS score at admission predicts a good outcome and fewer sequelae. However, papillary abnormalities and a neurological deficit at admission were poor prognostic factors. This study confirms that pediatric head injuries treated surgically provide better results than in adults.
Accidents, Traffic ; Adult ; Child ; Craniocerebral Trauma* ; Craniotomy ; Depression ; Diagnosis ; Female ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Head* ; Hospitalization ; Humans ; Incidence ; Male ; Retrospective Studies ; Seizures ; Surgical Procedures, Operative

Secretory carcinoma is an uncommon type of carcinoma and the only well-documented type that may arise in children and adults of both sexes. Secretory carcinomas do not occur with any particular frequency in any part of the breast. Usually, the primary symptom is a painless mass that may be present for years before biopsy. We encountered a case of a secretory carcinoma of the breast. The patient was a 34-year-old woman. She visited our hospital due to a painless mass located in the upper portion of the left breast in the direction of 11 o,clock and at a distance of 1 cm from the areola. On palpation, it showed a firm and fixed tumor mass. A secretory carcinoma was diagnosed based on excisional biopsy. The patient underwent an Auchincloss, modified radical mastectomy. Multistep cross sections showed an ill-defined brownish, white tumor mass with a gritty sensation and measuring 2.0 1.4 cm in size. Metastasis was found in 1 of 8 axillary lymph nodes. Compared with typical breast cancer, the prognosis is better, but a similar therapeutic strategy may be necessary.
Adult ; Biopsy ; Breast Neoplasms ; Breast* ; Child ; Female ; Humans ; Lymph Nodes ; Mastectomy, Modified Radical ; Neoplasm Metastasis ; Palpation ; Prognosis ; Sensation

PURPOSE: The technique of partial liver transplantation from a living donor was developed to expand the donor pool. However such small grafts may not only be functionally inadequate for the recipient, but will also sustain injury characterized by cholestasis and histological features of ischemia after implantation. Damage to partial liver grafts after reperfusion is frequently observed but the mechanism of injury remains unclear. Injury to partial liver grafts may be related to changes in portal blood flow. In this study, we investigated the histologic changes of the reperfusion of livers after revascularization through the portal vein or hepatic artery following heterotopic partial liver transplantation in rats. METHODS: Inbred Lewis partial liver were transplanted to inbred Brown Norway rats heterotopically in three groups. The first group of transplants, Group I (Portal vein group, n=3) was reperfused firstly through the portal vein. The second group, Group II (Hepatic artery group, n=3) was firstly reperfused through the hepatic artery. The third group, Group III (Control, n=1) was sham-operated. After reperfusion, the liver grafts were procured and fixed in formalin. The reperfusion livers were studied using immunohistochemical staining and in-situ RT PCR. RESULTS: In the H&E staining of the reperfusion livers there were no differences between groups I and II. Using immunohistochemical staining of TNF,R, FAS L, caspase 8 and in-situ RT PCR (NOS mRNA, TNF,R mRNA, FAS mRNA), the hepatic artery first reperfusion liver showed more damage than the portal vein first reperfusion liver. TUNEL staing showed severe apoptosis in hepatic artery reperfusion liver. CONCLUSION: The expression of the apoptosis molecular markers was more prominent in the reperfused liver performed with initial revascularization using the hepatic artery, rather than portal vein. These findings may be due to fact that the high oxygen blood in the hepatic artery is stressful to the reperfusion liver. The routinely used portal vein first revascularization technique decrease reperfusion injury to the graft when compared to hepatic artery first revascularization.
Animals ; Apoptosis ; Arteries ; Caspase 8 ; Cholestasis ; Formaldehyde ; Hepatic Artery* ; Humans ; In Situ Nick-End Labeling ; Ischemia ; Liver Transplantation* ; Liver* ; Living Donors ; Norway ; Oxygen ; Polymerase Chain Reaction ; Portal Vein* ; Rats* ; Reperfusion Injury ; Reperfusion* ; RNA, Messenger ; Tissue Donors ; Transplants ; Veins

BACKGROUND/AIMS: The tolerance of the liver to ischemia during intermittent hepatic pedicle clamping was compared with that during continuous hepatic pedicle clamping, and intermittent hepatic pedicle clamping was thought to more tolerable to ischemia/reperfusion injury. The mechanisms underlying this were unknown. We examined the relationship between ischemia/reperfusion injury and the production of oxygen-derived free radicals using spin resonance spectrometry. METHODS: Adult male Sprague-Dawley rats were subjected to either continuous or intermittent hepatic pedicle clamping. Alpha-(4-pyridyl 1-oxide)-N-tert-butylnitrone was administered to rats as a spin trap agent. Continuous clamping (15, 30, or 60 minutes) or intermittent clamping(four cycles of 15-minutes ischemia and 5 or 15 minutes of reperfusion) of hepatic pedicle was carried out. After reperfusion, blood samples were obtained and measuring liver enzyme to evaluate hepatic injury. Hepatic tissue blood flow was measured using a color Doppler blood flowmeter. RESULTS: When there was a longer period of hepatic pedicle occlusion, increased oxygen-derived free radical generation was detected after reperfusion. There was no significant increase in oxygen-derived free radical production or liver enzymes leakage when the duration of ischemia was 15 minutes. Oxygen-derived free radical generation and liver enzyme leakage were significantly less in intermittent pedicle clamping than in continuous clamping for 60 minutes. CONCLUSION: According this results, there is a oxygen-derived free radicals and liver damage in less in intermittent pedicle clamping than continuous clamping although many oxygen-derived free radicals are produced.
Adult ; Animals ; Constriction* ; Flowmeters ; Free Radicals ; Humans ; Ischemia ; Liver* ; Male ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Spectrum Analysis

PURPOSE: Central venous catheterization is widely used to supply substantial amounts of fluids, total parenteral nutrition and hemodialysis in renal failure patients, as well as for measuring the central venous pressure. The most common complications encountered during central venous catheterization include catheter-related infections and subsequent sepsis. Therefore, when fever exists in patients with a central venous catheter, an immediate blood culture should be performed, and if the fever persists, an infection must be suspected and the catheter immediately removed; a culture of the catheter tip should also be performed. To date, no definite clinical details relating to this matter have been reported. METHODS: Between December 2002 and March 2005, a retrospective study was undertaken using the medical records of 85 patients. In those patients where a fever lasted for more than 8 hours, or when catheterization was no longer needed, the catheter tip cultures were sent to the microbiology laboratory. Blood cultures were also performed on 49 patients with a fever. The Chi-square method using the PC SPSS program, with P value less than 0.05 as statically significant. RESULTS: Of the 85 patients where the catheters were removed, significant microorganisms were detected 20 of the 49 with a fever. Only 5 of the remaining 36 patients had their catheters spontaneously removed. Moreover, 14 of the 20 patients with significant microorganisms were found to have kept their catheter in place for more than 14 days. Of the 49 patients with a fever, in who blood cultures were undertaken, 13 showed specific microorganisms, with 6 of these showing the same results for both their blood and catheter tip cultures, which enabled the definite diagnosis of the catheter-related infection and underlying sepsis. Various microorganisms were detected from the catheter tip cultures, including Staphylococcus species the CNS, with S. aureus being the most common, at 61.6%. CONCLUSION: A central venous catheter should be removed immediately when an infection is suspected, but early broad-spectrum antibiotics therapy should be commenced due to the time required to obtain the culture results. Moreover, even if a fever does not exist in patients with a catheter inserted for more than 14 days, infection and sepsis from the catheter should be of concern, with a more cautious approach being mandatory.
Anti-Bacterial Agents ; Catheter-Related Infections ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters* ; Central Venous Pressure ; Diagnosis ; Fever ; Humans ; Medical Records ; Parenteral Nutrition, Total ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Sepsis ; Staphylococcus

PURPOSE: The portal blood influx appears to be essential for liver regeneration after a liver resection and transplant. It was reported that only grafts with a gastro-pancreatic-splenic portal inflow into the graft portal vein could increase in size. The aim of this study was to investigate the impact of the gastro-pancreatic-splenic portal flow on the regeneration of a graft liver in a microsurgical model of heterotopic partial liver transplantation model. METHODS: Sprague-Dawley rats weighing 200 to 300 grams were used in this study. The rats were fasted for 12 hours prior to surgery. Thirty percent of the liver was heterotopically transplanted, to connect the donor's portal vein and suprahepatic vena cava with the recipient's superior mesenteric vein and the suprarenal vena cava, respectively. The donor and original liver were weighed preoperatively and 1, 2, 3, 7 days postoperatively. In addition, the histology of the donor and recipient's liver were examined using optical microscopy, and H & E staining. The proliferative capacity of the donor and recipient hepatocytes was evaluated using immunohistochemistry. RESULTS: The liver weights of the donor and recipient were measured at serial time points after surgery. Progressive enlargement was observed in the original liver. However, in assessing the liver weight, the weight of the donor liver was significantly lower at 2 days, 3 days, and 7 days after surgery than that of the original liver. During the observation periods, prominent histopathological differences were observed between the donor and recipient liver. There was a markedly higher number of PCNA (+) cells in the original liver than in the donor liver. CONCLUSION: The gastro-pancreatic-splenic portal inflow into the graft appears to play an important role in regenerating a partial liver graft. However, several variables such as the ischemic time, bile duct ligation, a small-for-size graft, and hepatic artery reconstruction in this model should be considered.
Animals ; Bile Ducts ; Hepatectomy ; Hepatic Artery ; Hepatocytes ; Humans ; Immunohistochemistry ; Ligation ; Liver Regeneration* ; Liver Transplantation* ; Liver* ; Mesenteric Veins ; Microscopy ; Portal Vein ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Tissue Donors ; Transplants ; Weights and Measures