With advance of diagnostic imaging technics, the detection rate of small hepatocellular carcinoma (HCC) has become much increased, but the questions whether the growth pattern and histologic nature of the HCC keep maintain the original gross and microscopic features with its advancement of tumor size remain still unclear. We reviewed 39 surgically resected hepatocellular carcinomas(HCCs) with a tumor size less than or equal to 3 cm in diameter(s-HCC), and their gross and microscopic features were compared with the HCCs bigger than 3 cm (i-HCC, 199 cases). Single nodular type(SN) was the most common gross type(60%) in s-HCCs, and was followed by single nodular type with perinodular extension(SNPE; 15.4%), multinodular-discrete type(10.3%) and multinodular-confluent type(5.1%). These figures contrasted to SNPE(42.2%) and SN(20.6%) in the i-HCCs. Of the 39 s-HCCs, 25 cases(64.1%) were encapsulated, and 14 cases(36%) demonstrated intratumoral fibrous septations, being contrasted to the i-HCCs in which fibrous septa formation was mord prominent but complete capsule formation was found only in 40.2% of the larger ones. Microscopically, the trabecular type was the most frequent one(53.9%), and increased with their size while the compact type transformed into trabecular one. Thirty three cases(84.6%) were associated with macronodular cirrhosis. Seropositivity for HBsAg was found in 26 cases(66.6%), and high serum alpha-fetoprotein level over 500 IU/L was found in 15 s-HCC cases(38.4%), while 53.3% in i-HCC. The above results suggest that HCCs change their pathologic features by increase of their size, and a comparison of the details with regard to the possible mechanisms involved is discussed.
Carcinoma, Hepatocellular

BACKGROUND: The purpose of this study was to measure and compare the optimum depth of the internal jugular venous catheterization between the right and left side. METHODS: Forty-four patients were enrolled for this study and divided into two groups (22 patients each). The optimum depth of the catheterization was calculated using the sum of two component (A and B); the advanced length of the catheter from the level of the cricoid cartilage (A) and the distance from the catheter tip to the junction of the superier vena cava and right atrium (B). RESULT: The optimum depths of the internal jugular venous catheterization were 16.0 1.0 cm (right) and 18.4 1.5 cm (left) respectively. Left side was significantly longer than right side (p<0.05). In this study, we experienced some complications; arterial punctures (5 cases) and migration of the catheter to the opposite subclavian vein (1 case). Five complications were associated with left internal jugular venous cannulation and one was associated with the right side cannulation. CONCLUSION: We concluded that the optimum depth of the internal jugular venous catheterization was longer in the left side than in the right side.
Catheterization* ; Catheters* ; Cricoid Cartilage ; Heart Atria ; Humans ; Punctures ; Subclavian Vein

Glans penis augmentation (GPA) has received little attention from experts despite the existence of a subset of patients who may be dissatisfied with a small glans or poor tumescence of the glans during erection. Recently, GPA using an injectable filler or implantation of a graft or filler has been developed. Despite a demanding injection technique and inevitable uneven undulation of the glandular surface, GPA using injectable hyaluronic acid (HA) gel is a novel and useful therapy and an effective and safe procedure for soft tissue enhancement. For long-term presence of implants, timed supplementation can be used similar to that for fascial plasty. In complications such as mucosal necrosis of the glans penis, most cases occur from the use of non-HA gel or an unpurified form and misunderstanding of the management protocol for immediate side effects. Currently, GPA using injectable HA gel is not recommended in the International Society for Sexual Medicine guideline due to possible sensory loss. In a 5-year long-term follow-up of GPA by subcutaneous injection of HA gel, the residual volume of implants decreased by 15% of the maximal glandular circumference, but was still effective for alleviating the hypersensitivity of the glans penis in premature ejaculation patients. For efficacy in premature ejaculation, selection of appropriate candidates is the most important factor for success. GPA does not harm erectile function and is less invasive and irreversible compared to dorsal neurectomy. To refine the procedure, more interest and well-designed studies are required for the establishment of the procedure.
Follow-Up Studies ; Humans ; Hyaluronic Acid* ; Hypersensitivity ; Injections, Subcutaneous ; Male ; Necrosis ; Penis* ; Plastics ; Premature Ejaculation ; Residual Volume ; Transplants

PURPOSE: Previous studies concerning the ischemic priapism revealed that hypoxia alter the erectile and contractile responses of penis. But the effects of accompaning acidosis on the trabecular smooth muscle contractility have not been fully evaluated or understood yet. We performed this study to elucidate the role of acidosis on the trabecular smooth muscle contractility like in ischemic priapism. MATERIALS AND METHODS: Under the general anesthesia, 55 mature male cats were conditioned to systemic metabolic acidosis by hypoventilation with animal ventilator. The changes of intracavernous pressure to erectics(acetylcholine, L-arginine, PGE1), erectolytics(epinephrine, TXA2), K+-channel-related drugs (pinacidil, 4-aminopyridine, TEA, glibenclamide) and calcium ionophore were monitored at Set 1 (PO2>60mmHg, pH>7.25), Set 2(PO2 <30mmHg,7.25>pH>7.0), Set 3(PO2<30mmHg, pH<7.0), and Set 4(PO2>60mmHg, pH<7.0) in vivo. RESULTS: At Set 1 and Set 2, the acetylcholine or PGE1-induced relaxations were suppressed by epinephrine, TXA2 or ionomycin(n=9, p<0.01). The contractility was in order of epinephrine, TXA2 and ionomycin. Cavernous relaxations to acetylcholine or PGE1 were reduced by acidosis(n=8, p<0.01). TXA2 or ionomycin did not produced contraction even with higher concentration but epinephrine maintained contractility with higher concentration at acidosis (n=7, p<0.05). Acidosis-induced relaxation was not prevented by 4-aminopyridine, TEA, or glibenclamide(n=6, p<0.05). Pinacidil did not induced relaxation at acidosis(n=6, p<0.01). CONCLUSIONS: Acidosis impairs the contractile response of cavernous smooth muscle to submaximal stimulation with erectolytics. It may be the results of the interference by(H+) with the intra and extracellular mechanisms that regulate the homeostasis of(Ca2+). Conclusively, acidosis is another limiting factor of trabecular smooth muscle contractility like in ischemic priapism.
4-Aminopyridine ; Acetylcholine ; Acidosis* ; Alprostadil ; Anesthesia, General ; Animals ; Anoxia ; Arginine ; Calcium ; Cats ; Epinephrine ; Homeostasis ; Humans ; Hypoventilation ; Ionomycin ; Male ; Muscle, Smooth* ; Penis ; Pinacidil ; Priapism ; Relaxation ; Tea ; Ventilators, Mechanical

Aconite, derived from the roots of certain aconitum species (Racunculaceae), is widely distributed in Korea. Aconitine, an extremely toxic substance present in aconite, has pharmacological effects, including anti-inflammatory, analgesic, and positive inotropic actions. Due to its relatively low safe dose, we sometimes encounter cases of serious aconite intoxication. The toxic compound mainly affects the CNS, heart, and muscle tissues, resulting primarily in cardiovascular complications. Aconite poisoning presents with a combination of neurological, cardiovascular, and gastrointestinal features. The main cause of death is severe cardiotoxicity causing refractory ventricular tachyarrhythmias and asystole. As there is no specific antidote, management of aconite poisoning is supportive. All patients require close monitoring of blood pressure and cardiac rhythm since ventricular arrhythmias may occur during the first 24 hours of poisoning, resulting in sudden deterioration in the patient's clinical condition. Extracorporeal membrane oxygenation (ECMO) has traditionally been utilized for perioperative cardiac failure and cardiomyopathies. More recently, the indications for ECMO have expanded to patients with acute cardiovascular decompression including intractable arrhythmias. We report on a patient who developed life threatening ventricular tachyarrhythmia after ingestion of herbal tablets containing aconite alkaloids. Our patient was resuscitated with intravenous infusion of amiodarone, repeated cardioversion/defibrillation, and mechanical circulatory support with ECMO.
Aconitine ; Aconitum* ; Alkaloids ; Amiodarone ; Arrhythmias, Cardiac* ; Blood Pressure ; Cardiomyopathies ; Cause of Death ; Decompression ; Eating ; Extracorporeal Membrane Oxygenation* ; Heart ; Heart Arrest ; Heart Failure ; Humans ; Infusions, Intravenous ; Korea ; Poisoning ; Tablets ; Tachycardia ; Tachycardia, Ventricular

Four strains of fowl adenovirus (FAdV) were isolated from 4 flocks of broiler or layer chickens affected by hydropericardium syndrome in Korea. These FAdVs were classified as serotype 4 by restriction fragment length polymorphism patterns of hexon genes and whole genomes. The virus exhibited cytopathic effects consisting of rounding, ballooning and clustering in primary chicken embryo liver cell cultures. In transmission electron microscopy, virus particles in hexagonal shape aggregated exclusively in the nuclei of hepatocytes of the chickens as the typical appearances in adenovirus infections. Buoyant density of the virus in cesium chloride (CsCl) was 1.34 g/mL. The virus was stable to chloroform, ether, 50~70% ethanol, acidic condition at pH 3, 0.25% trypsin (1 : 250), heat at 50degrees C for 30 min, but labile to 100% ethanol, heat at 52~60degrees C for 30 min, 1 M MgCl2 at 50degrees C for 1 h, 1 : 2,000 formalin (37%). All of the physicochemical properties pertained to the characteristics of adenoviruses. Eight viral polypeptides were determined in CsCl-purified virus by sodium dodecyl sulfate-polyacrylamide gel electrophoresis.
Adenoviridae ; Adenoviridae Infections ; Cell Culture Techniques ; Cesium ; Chickens ; Chlorides ; Chloroform ; Electrophoresis ; Embryonic Structures ; Ethanol ; Ether, Ethyl ; Formaldehyde ; Genome ; Hepatocytes ; Hot Temperature ; Hydrogen-Ion Concentration ; Korea ; Liver ; Magnesium Chloride ; Microscopy, Electron, Transmission ; Peptides ; Polymorphism, Restriction Fragment Length ; Sodium ; Trypsin ; Virion ; Viruses

There is a more urgent call for educational methods of machine learning in medical education, and therefore, new approaches of teaching and researching machine learning in medicine are needed. This paper presents a case using machine learning through text analysis. Topic modeling of news articles with the keyword ‘asbestos’ were examined. Two hypotheses were tested using this method, and the process of machine learning of texts is illustrated through this example. Using an automated text analysis method, all the news articles published from January 1, 1990 to November 15, 2016 in South Korea which included ‘asbestos’ in the title and the body were collected by web scraping. Differences in topics were analyzed by structured topic modelling (STM) and compared by press companies and periods. More articles were found in liberal media outlets. Differences were found in the number and types of topics in the articles according to the partisanship and period. STM showed that the conservative press views asbestos as a personal problem, while the progressive press views asbestos as a social problem. A divergence in the perspective for emphasizing the issues of asbestos between the conservative press and progressive press was also found. Social perspective influences the main topics of news stories. Thus, the patients' uneasiness and pain are not presented by both sources of media. In addition, topics differ between news media sources based on partisanship, and therefore cause divergence in readers' framing. The method of text analysis and its strengths and weaknesses are explained, and an application for the teaching and researching of machine learning in medical education using the methodology of text analysis is considered. An educational method of machine learning in medical education is urgent for future generations.
Asbestos ; Education, Medical ; Humans ; Korea ; Machine Learning ; Methods ; Social Problems ; Social Responsibility

PURPOSE: This study was conducted to investigate the relationship between serum total testosterone levels and scores on the Aging Male's Symptom (AMS) scale and the International Index of Erectile Function (IIEF) in men with erectile dysfunction with testosterone deficiency syndrome (TDS). MATERIALS AND METHODS: From January 2005 to July 2008, 134 patients who complained of sexual dysfunction such as erectile dysfunction or decreased libido as the main symptoms of TDS with serum total testosterone levels less than 3.5 ng/ml were evaluated by independent t-test and linear regression analysis, respectively. Patients with treated hypogonadism within 6 months, with a history of taking a PDE5 inhibitor or an antidepressant for a depressive disorder, or who had metabolic syndrome were excluded from this study. RESULTS: The AMS scale and its 3 subdomain scores were not significantly correlated with the total testosterone level. By contrast, the total IIEF score and the score of each IIEF domain except sexual desire showed a weakly significantly positive correlation with serum total testosterone. CONCLUSIONS: In TDS patients with erectile dysfunction, there was a low relationship between serum total testosterone levels and the AMS scale and a weakly positive correlation between total testosterone levels and all IIEF domains except sexual desire. There was a low relationship between the AMS scale, the sexual desire domain score of the IIEF, and total testosterone. We should understand these limitations when evaluating patients with erectile dysfunction with TDS. New scales should be developed for the evaluation of erectile dysfunction in these patients.
Aging ; Depressive Disorder ; Erectile Dysfunction ; Humans ; Hypogonadism ; Libido ; Linear Models ; Male ; Sorbitol ; Testosterone ; Tyramine ; Weights and Measures

Hemangiopericytoma is an uncommon mesenchymal tumor that may be benign or malignant. This tumor is composed of proliferating capillaries and spindle-shaped cells known as the pericytes of Zimmermann. Since all capillaries have pericytes, hemangiopericytoma can be found anywhere In the body. We report a case of malignant hemangiopericytoma in the pelvic cavity which was treated by radical excision and adjutant radiotherapy and discuss the clinicopathological feature, prognosis, and therapy of this lesson.
Capillaries ; Hemangiopericytoma* ; Pericytes ; Prognosis ; Radiotherapy

OBJECTIVE: The purpose of this study was to review the clinical features, treatments and prognosis of the borderline malignant tumors of the ovary. METHODS: Thirty-two patients with borderline malignant tumors of the ovary were admitted, operated and confirmed with postoperative histopathological study at department of obstetrics and gynecology, Yonsei University Wonju Christian Hospital. The data were collected retrospectively and all charts were reviewed. RESULTS: The incidence of borderline malignant ovarian tumor was 19.2% (32/167). Age distribution revealed between 18 and 77 years old, the mean age was 43.1 years old. As for the parity distribution of borderline malignant tumor, nulliparity was most common (43.8%). The most common chief complaint was abdominal distension (34.4%). Histologic subtypes were mucinous in 19 cases (59.4%), serous in 13 cases (40.6%). According to FIGO classification, 28 cases (87.5%) were stage I, 1 case (3.1%) was stage II, 3 cases (9.4%) were stage III. Sixteen cases (50%) underwent conservative surgery (unilateral salpingooophorectomy or cystectomy). Sixteen cases (50%) were treated with total abdominal hysterectomy and bilateral salpingooophorectomy. Fifteen cases (46.9%) received adjuvant postoperative chemotherapy. Excluding 5 cases lost to follow up, patients were alive and were followed from 9 months to 100 months. (mean 36 months).
Age Distribution ; Aged ; Classification ; Drug Therapy ; Female ; Gangwon-do ; Gynecology ; Humans ; Hysterectomy ; Incidence ; Lost to Follow-Up ; Mucins ; Obstetrics ; Ovary* ; Parity ; Prognosis ; Retrospective Studies