Sulfite is commonly used in pharmaceuticals as a preservative. We report a unique clinical presentation of localized periorbital edema on the left eye after administration of sulfite-containing dexamethasone. The patient's sulfite sensitivity was confirmed by sulfite oral provocation test: periorbital edema on the same site developed after ingestion of 200 mg sodium bisulfite. She was non-atopic and did not complain of any respiratory symptoms. Allergy skin prick test with 100 mg/ml sodium bisulfite showed a negative result. She also has aspirin-sensitive urticaria which was confirmed by oral provocation test. In conclusion, sulfite can induce a localized periorbital edema, an uncommon manifestation in sensitive patients. Further investigations are needed to clarify the pathogenetic mechanisms.
Allergens/*therapeutic use ; Case Report ; Edema/*etiology ; Female ; Human ; Middle Age ; Orbital Diseases/*etiology ; Skin Diseases/drug therapy ; Sulfites/*therapeutic use

PURPOSE: Femorofemoral crossover bypass (FCB) is a good procedure for patients with unilateral iliac artery disease. There are many articles about the results of FCB, but most of them were limited to 5 years follow-up. The purpose of our study was to analysis the results of FCB with a 10-year follow-up period. MATERIALS AND METHODS: Between January 1995 and December 2010, 133 patients were operated in Samsung Medical Center (median follow-up: 58.8 months). We retrospectively analysed patient characteristics, the preoperative treatment, the operative procedure, and material used. RESULTS: The indications for FCB were claudication in 110 and critical limb ischemia in 23 patients. Three patients were died due to myocardiac infarction, intracranial hemorrhage, and acute respiratory failure within 30 days after surgery. The one-year primary and secondary patency rates were 89% and 97%, the 5-year primary and secondary patency rates were 70% and 85%, and the 10-year primary and secondary patency rates were 31% and 67%. The 5-year and 10-year limb salvage rates were 97% and 95%, respectively. CONCLUSION: Our long term analysis suggests that FCB might be a valuable alternative treatment modality in patients with unilateral iliac artery disease.
Extremities ; Follow-Up Studies ; Humans ; Iliac Artery ; Infarction ; Intracranial Hemorrhages ; Ischemia ; Limb Salvage ; Respiratory Insufficiency ; Retrospective Studies ; Surgical Procedures, Operative ; Transplants* ; Vascular Patency

Mucoepidermoid carcinoma of the liver is a rare variant of cholangiocarcinoma which contains both mucus-secreting glandular cells and squamous cells mixed in nests. We diagnosed a case of mucoepidermoid carcinoma of the liver in a 69-year-old woman who visited hospital because of fever, chill, right flank pain for one week. On admission, she was not jaundiced. Under a provisional diagnosis of liver abscess, a pigtail catheter was inserted to the abscess cavity. One month after the admission, despite conservative treatment, the abscess cavity remained. For a curative treatment and possible hiden malignancy, right hepatectomy of the liver and excision of partial diaphragm were done. Microscopically, the tumor mass composed of solid and invasive nests of epidermoid and mucin-producing cells with desmoplastic stroma. Alcian blue, Periodic-Acid Schiff (PAS) stainings confirmed the presence of mucin in the cytoplasm of mucus-secreting cells. Electron micrographs showed the presence of tonofilaments and confirmed the squamous nature of the tumor cells. The tumor cells, intrahepatic bile ducts and ductules were consistently reactive with cytokeratin 7. Adjacent nonneoplastic liver cells were negative to cytokeratin 7. In the present case, the tumor was diagnosed as mucoepidermoid carcinoma, which was arisen from the intrahepatic bile duct.
Abscess ; Aged ; Alcian Blue ; Bile Ducts, Intrahepatic ; Carcinoma, Mucoepidermoid* ; Catheters ; Cholangiocarcinoma ; Cytoplasm ; Diagnosis ; Diaphragm ; Female ; Fever ; Flank Pain ; Hepatectomy ; Humans ; Intermediate Filaments ; Keratin-7 ; Liver Abscess* ; Liver* ; Mucins

BACKGROUND/AIMS: The diagnosis and treatment of benign hepatic lesions remain controversal. The widespread availability of ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI), and their frequent application in evaluating abdominal pain, has resulted in more frequent discovery of incidental benign hepatic lesions. To address these points, the clinical data of patients with benign hepatic lesions treated with surgical resections at our hospital were reviewed retrospectively. METHODS: We reviewed the clinical records of thirty nine patients with benign hepatic lesions who had undergone hepatic resection from January, 1985 to August, 2002 at Hanyang University Hospital. RESULTS: There were 39 patients, whose mean age was 47.0 years. The ages ranged from 24~74 years. There were 14 male patients and 25 female patients. The ratio of male and female was 1:1.8. Major symptoms were right upper quadrant pain, mass, epigastric pain, and non-specific GI symptoms. 22 cases of anatomical resections (10 right lobectomy, 5 left lobectomy, 7 left lateral segmentectomy) and 17 non anatomical resections were done. There were no postoperative deaths in this series. Fourteen patients (35.9%) developed operative complications. All of them were minor complications. During the mean follow up time, symptomatic relief was achieved in patients out of patients who we could contact with opd follow up or telephone interview. Three patients died of massive pleural effusion 4 years after operation, myocardial infarction 14 months after operation, alcoholic liver cirrhosis and diabetes mellitus 33 months after operation. CONCLUSION: Hepatic resection in patients who had benign hepatic lesions in the liver was safe and effective treatment modality if patients were selected with suitable indications.
Abdominal Pain ; Diabetes Mellitus ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Interviews as Topic ; Liver ; Liver Cirrhosis, Alcoholic ; Magnetic Resonance Imaging ; Male ; Myocardial Infarction ; Pleural Effusion ; Retrospective Studies ; Ultrasonography

PURPOSE: Multiple primary cancers are not a rare disease. The clinicopathologic characteristics of a hepatocellular carcinoma with extrahepatic malignancies, have not been identified. To address these points, the clinical data of patients with a hepatocellular carcinoma, with extrahepatic malignancies, treated with surgical resections at our hospital, were retrospectively reviewed. METHODS: We reviewed the clinical records of ten hepatocellular carcinoma patients, with extrahepatic malignancies, who had undergone an operation between January, 1986 and December, 2002 at the Hanyang University Hospital. RESULTS: 10 patients were comprised of 9 males and 1 female, with a mean age of 58.6 years, ranging from 34 to 75. There were 9 stomach cancers and 1 rectal cancer extrahepatic malignancies associated with the hepatocellular carcinomas. Four of these were synchronous type and six were metachronous type. The treatments used for the HCCs were: 1 extended right lobectomy, 6 right lobectomies, 1 each of a TAE with RFTA, a segmentectomy with RFTA, and a segmentectomy. The operations for the extrahepatic malignancies included 1 low anterior resection, for the rectal cancer and 9 subtotal gastrectomies, for the stomach cancers. During the mean follow up time of 66.1 months, five patients survived and five died. CONCLUSION: Patients who have a hepatocellular carcinoma, associated with extrahepatic malignancies, have been treated with aggressive operations and combination therapies. Stomach cancer is the most common extrahepatic malignancy associated with a hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Male ; Mastectomy, Segmental ; Rare Diseases ; Rectal Neoplasms ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: Here we showed that human umbilical cord blood (hUCB)-derived cells, when cultured under defined conditions, generated insulin-producing cells (IPCs). METHODS: hUCB mononuclear cells (MNCs) were cultured in serum-free low (5.5 mM glucose) DMEM at a cell density of 3x10(6)/cm2 in the presence of 1% DMSO for 3 days followed by high (25 mM glucose) DMEM supplemented with 10% FBS for 7 additional days. They were plated in plastic six well plates on slide coverslips (22x22 mm2) coated with 0.006% type I collagen. RESULTS: These IPCs formed clusters similar to islets of Langerhans. We confirmed these clusters were positive for insulin and C-peptide by immunohistochemistry. CONCLUSION: Our data demonstrated that in vitro hUCB-derived cells generated IPCs, which can be a potential source for the treatment of diabetes via a stem cell therapy approach.
C-Peptide ; Cell Count ; Collagen Type I ; Dimethyl Sulfoxide ; Fetal Blood ; Humans* ; Immunohistochemistry ; Insulin ; Islets of Langerhans ; Plastics ; Stem Cells ; Umbilical Cord*

PURPOSE: Embryonic stem (ES) cells have been regarded as a powerful resource in cell replacement therapy. In recent reports, mouse ES cells have been successfully applied to the treatment of spinal cord injuries, hereditary myelin disorders of the central nervous system and diabetes mellitus. Various liver diseases are another group that could benefit from the availability of stem cell therapy; however, no previous demonstration has been made that shows the differentiation of ES cells into hepatocytes. METHODS: To investigate the in vivo differentiation potential of mouse ES cells, we injected ES cells into the splenic cortex of immuno-suppressed nude mice. RESULTS: In a histological analysis of the teratomas derived from injected ES cells some areas were shown, due to their morphology, to contain typical hepatocytes. The hepatic nature of these cells was further confirmed by immunohistochemical assays using the antibody against alpha-fetoprotein and hepatocyte-specific antibodies. In addition, periodic acid-Shiff staining revealed a small portion of hepatic area in the ES-derived teratoma produced glycogen, implying these cells are functional hepatocytes. CONCLUSION: Our case demonstrated for the first time that mouse ES cells can differentiate in vivo into a mixed population of hepatocytes with different maturation stati, which could potentially extend the usage of ES cells in cell replacement therapy for various liver diseases.
alpha-Fetoproteins ; Animals ; Antibodies ; Cell Differentiation ; Central Nervous System ; Diabetes Mellitus ; Embryonic Stem Cells* ; Glycogen ; Hepatocytes* ; Liver Diseases ; Mice* ; Mice, Nude ; Myelin Sheath ; Spinal Cord Injuries ; Stem Cell Transplantation ; Stem Cells ; Teratoma

A primary hepatic sarcoma is a rare tumor, that most frequently arises from hepatic connective tissue or vascular channels, and is usually located in the intrahepatic area. Pedunculated, or bulging, lesions have also been reported. We encountered a pedunculated primary hepatic leiomyosarcoma occurring in a 61-year-old woman. A giant exophytic hepatic mass measuring 15x10cm in size, was located in the left lateral segment of the liver, which was compressing the stomach. A left lateral segmentectomy was performed. Microscopically, the tumor was composed of spindle cells reactive to muscle specific actin. The mitotic figures were 5/10 high power fields indicating the tumor was malignant. No other primary sites were recognized from clinical studies.
Actins ; Connective Tissue ; Female ; Humans ; Leiomyosarcoma* ; Liver ; Mastectomy, Segmental ; Middle Aged ; Sarcoma ; Stomach

BACKGROUND/AIMS: Cancer is known to be a disease by many factors. However, specific results of reprogramming by pluripotency-related transcription factors remain to be scarcely reported. Here, we verified potential effects of pluripotent-related genes in hepatocellular carcinoma cancer cells. METHODS: To better understand reprogramming of cancer cells in different genetic backgrounds, we used four liver cancer cell lines representing different states of p53 (HepG2, Hep3B, Huh7 and PLC). Retroviral-mediated introduction of reprogramming related genes (KLF4, Oct4, Sox2, and Myc) was used to induce the expression of proteins related to a pluripotent status in liver cancer cells. RESULTS: Hep3B cells (null p53) exhibited a higher efficiency of reprogramming in comparison to the other liver cancer cell lines. The reprogrammed Hep3B cells acquired similar characteristics to pluripotent stem cells. However, loss of stemness in Hep3B-iPCs was detected during continual passage. CONCLUSIONS: We demonstrated that reprogramming was achieved in tumor cells through retroviral induction of genes associated with reprogramming. Interestingly, the reprogrammed pluripotent cancer cells (iPCs) were very different from original cancer cells in terms of colony shape and expressed markers. The induction of pluripotency of liver cancer cells correlated with the status of p53, suggesting that different expression level of p53 in cancer cells may affect their reprogramming.
Carcinoma, Hepatocellular ; Cell Line ; Genetic Background ; Induced Pluripotent Stem Cells* ; Liver Neoplasms* ; Pluripotent Stem Cells ; Transcription Factors ; Zidovudine

Angiomyolipoma is a benign renal tumor composed of thick- walled blood vessels, smooth muscle cells, and adipose tissue. Despite the aggressive biological and histological features associated with angiomyolipoma, the lack of distant metastasis led us to conclude that angiomyolipoma is a benign neoplasm. Epithelioid angiomyolipoma is a recently described variant type of angiomyolipoma of the kidney. Diagnosis is usually made by histological method and immunohistochemical staining with HMB-45. Several reports suggested the presence of malignant epithelioid angiomyolipomas showing multiple metastases and local aggressiveness. We report a case of epithelioid angiomyolipoma with multiple metastases. Local recurrence and liver, bone and lung metastases developed 11 months after radical nephrectomy. Right hepatectomy and wedge resection of left lobe of the liver with radiation therapy were done.
Adipose Tissue ; Angiomyolipoma* ; Blood Vessels ; Diagnosis ; Hepatectomy ; Kidney ; Liver ; Lung ; Myocytes, Smooth Muscle ; Neoplasm Metastasis* ; Nephrectomy ; Recurrence