No abstract available.
Humans ; Stroke*

No abstract available.
Humans ; Hypertension* ; Perindopril*

PURPOSE: A conventional thyroidectomy requires a wide transverse incision on the anterior neck, which can cause significant scaring. We developed an endoscopic thyroid lobectomy using the breast approach and a low carbon dioxide pressure in order to produce better cosmetic results. We reports the clinical analysis of endoscopic thyroid lobectomy and compare the result with those from a conventional thyroid lobectomy. METHOD: From July 2003 and December 2004, 55 consecutive patients with benign thyroid nodules, who underwent endoscopic thyroid lobectomy, and 51 consecutive patients with benign thyroid nodules, who underwent a conventional thyroid lobectomy, were retrospectively reviewed. The preoperative diagnosis of the thyroid nodules was performed using high-resolution ultrasonography and fine- needle aspiration cytology. The clinical results of endoscopic thyroid lobectomy were analyzed and compared with those from a conventional thyroid lobectomy. RESULTS: There were no significant differences between the two groups in terms of the patients' gender, size of tumor, preoperative diagnosis (follicular tumor/adenomatous nodule), postoperative diagnosis (cancer/benign), level of postoperative discomfort, length of hospital stay. The patients who underwent endoscopic thyroidectomy were significantly younger than those underwent conventional thryoidectomy (37.4+/-10.3 years vs. 48.8+/-13.0 years; P<0.001). The operation time for the endoscopic group was significantly longer than that for the conventional group (171.9+/-35.6 min vs. 92.5+/-26.5 min; P<0.001). The length of closed drainage in the endoscopic group was longer than that in the conventional group (2.8+/-0.8 days vs. 1.4+/-1.3 days; P<0.001). However, these factors did not affect the length of the hospital stay, and the number of intraoperative complications. CONCLUSION: Endoscopic thyroid lobectomy using the breast approach and a low carbon dioxide pressure has cosmetic benefits and is a feasible and safe procedure.
Breast ; Carbon Dioxide ; Diagnosis ; Drainage ; Humans ; Intraoperative Complications ; Length of Stay ; Neck ; Needles ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule ; Thyroidectomy ; Ultrasonography

Diabetic nephropathy is a common and serious complication in diabetic patients. Renal diseases other than diabetic nephropathy (non-diabetic nephropathy) can occur in diabetic patients with nephrosis. The presence of non-diabetic nephropathy is noted in type 2 diabetes patients, but no data exists for type 1 diabetes. In this report we describe the case of a 15-year-old girl with type 1 diabetes mellitus, who presented with an acute elevation of urinary microalbumin excretion, general edema, and liver enzyme elevation. She had shown microalbuminuria about 3 years earlier, as well as an uncontrolled hemoglobin A1c level, but she had no diabetic retinopathy and neuropathy. A renal biopsy was conducted, and she was diagnosed with primary focal segmental glomerulosclerosis. She was treated with corticosteroids and an angiotensin converting enzyme inhibitor.
Adolescent ; Adrenal Cortex Hormones ; Biopsy ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies ; Diabetic Retinopathy ; Edema ; Glomerulosclerosis, Focal Segmental ; Hemoglobins ; Humans ; Liver ; Nephrosis ; Peptidyl-Dipeptidase A

Hereditary hemorrhagic telangiectasia (HHT) is an uncommon autosomal dominant disorder resulting in vascular malformation, such as pulmonary arteriovenous malformation (PAVM). Here, we report a rare case of pulmonary arteriovenous malformation caused by HHT in a hemodialysis (HD) patient. A 34-year-old man receiving maintenance HD via radiocephalic arteriovenous fistula developed progressive dyspnea without definite pulmonary edema. His mother had been diagnosed with HHT. He had experienced multiple episodes of epistaxis and had been intermittently treated with blood transfusions because of severe anemia. Blood gas analysis showed hypoxia. Chest computed tomography revealed multiple dilated vessels of variable sizes, continuous with the pulmonary artery throughout both lung fields, consistent with PAVM. After treating pulmonary artery embolization at the largest PAVM, he recovered from his dyspnea symptoms and hypoxia.

Hereditary hemorrhagic telangiectasia (HHT) is an uncommon autosomal dominant disorder resulting in vascular malformation, such as pulmonary arteriovenous malformation (PAVM). Here, we report a rare case of pulmonary arteriovenous malformation caused by HHT in a hemodialysis (HD) patient. A 34-year-old man receiving maintenance HD via radiocephalic arteriovenous fistula developed progressive dyspnea without definite pulmonary edema. His mother had been diagnosed with HHT. He had experienced multiple episodes of epistaxis and had been intermittently treated with blood transfusions because of severe anemia. Blood gas analysis showed hypoxia. Chest computed tomography revealed multiple dilated vessels of variable sizes, continuous with the pulmonary artery throughout both lung fields, consistent with PAVM. After treating pulmonary artery embolization at the largest PAVM, he recovered from his dyspnea symptoms and hypoxia.

Budd-Chiari syndrome (BCS) represents a spectrum of disease states resulting in hepatic venous outflow occlusion. Prothrombotic disorders, such as protein S deficiency may cause thrombosis of the portal and hepatic veins. We report the management of a 30-year-old BCS primigravida with protein S deficiency and destroyed lung by the pulmonary tuberculosis scheduled for Cesarean section. Moreover, patient's lungs were destroyed by the pulmonary tuberculosis. Spinal anesthesia was selected for the anesthetic management. The patient recovered without any complication and discharged from hospital on the fifth postoperative day.
Adult ; Anesthesia, Spinal ; Budd-Chiari Syndrome ; Cesarean Section ; Female ; Hepatic Veins ; Humans ; Lung ; Pregnancy ; Protein S Deficiency ; Thrombosis ; Tuberculosis, Pulmonary

Gastric cancer (GC) is the fourth most common cause of cancer-related death globally. The classification of advanced GC (AGC) according to molecular features has recently led to effective personalized cancer therapy for some patients. Specifically, AGC patients whose tumor cells express high levels of human epidermal growth factor receptor 2 (HER2) can now benefit from trastuzumab, a humanized monoclonal Ab that targets HER2. However, patients with HER2negative AGC receive limited clinical benefit from this treatment. To identify potential immune therapeutic targets in HER2negative AGC, we obtained 40 fresh AGC specimens immediately after surgical resections and subjected the CD45 + immune cells in the tumor microenvironment to multi-channel/multi-panel flow cytometry analysis. Here, we report that HER2 negativity associated with reduced overall survival (OS) and greater tumor infiltration with neutrophils and non-classical monocytes. The potential pro-tumoral activities of these cell types were confirmed by the fact that high expression of neutrophil or non-classical monocyte signature genes in the gastrointestinal tumors in The Cancer Genome Atlas, Genotype-Tissue Expression and Gene Expression Omnibus databases associated with worse OS on Kaplan-Meir plots relative to tumors with low expression of these signature genes. Moreover, advanced stage disease in the AGCs of our patients associated with greater tumor frequencies of neutrophils and non-classical monocytes than early stage disease. Thus, our study suggests that these 2 myeloid populations may serve as novel therapeutic targets for HER2negative AGC.

The introduction of device-assisted enteroscopy (DAE) in the beginning of 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of the small bowel diseases, DAE has the unique advantages of observing the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how to perform it and what technical factors should be considered. In response to these needs, the Korean Association for the Study of Intestinal Diseases developed an expert consensus statement on the performance of DAE by reviewing the current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.

BACKGROUND/AIMS: Helicobacter pylori is a distinctive pathogen that lives in the gastric mucosa and is a well known risk factor of gastric adenocarcinoma. Iron deficiency aggravates the development of H. pylori-induced premalignant and malignant lesions in a cagA-dependent manner, enhancing H. pylori virulence. The aim of this study was to identify the relationship between iron deficiency and H. pylori eradication rates. MATERIALS AND METHODS: Participants who received 7 days of first-line triple therapy with serum iron level measured in parallel were retrospectively investigated between 2005 and 2014. H. pylori eradication was confirmed by the rapid urease test or 13C-urea breath test at least 4 weeks after completion of triple therapy. Iron deficiency was defined as either a serum iron level less than 50 µg/dL or a serum ferritin level less than 12 ng/mL. RESULTS: A total of 194 patients received 7 days of first-line triple therapy along with parallel serum iron level measurements over the 10-year period. The mean average age was 53.3 years (range, 21~86 years), and 135 patients (69.6%) were male. The overall H. pylori eradication rate was 83.5%. Proportions of eradication success with ferritin level less than 12 ng/mL and iron less than 50 µg/dL were 90.5% and 88.6%, respectively. However, there was no statistical difference in eradication rates according to iron deficiency. CONCLUSIONS: Iron deficiency might not be related with H. pylori eradication rates in this study. Further large-scale studies are needed to confirm this result.
Adenocarcinoma ; Breath Tests ; Disease Eradication ; Ferritins ; Gastric Mucosa ; Helicobacter pylori* ; Helicobacter* ; Humans ; Iron* ; Male ; Retrospective Studies ; Risk Factors ; Urease ; Virulence