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: Medical treatment of Peyronie's disease with tamoxifen has been initially proposed as acting upon the early phase of the disease. As recent reports show no significant benefit of tamoxifen, we review the long term results of tamoxifen treatment of Peyronie's disease. MATERIALS AND METHODS: Time to progression during tamoxifen treatment of patients showing acute disease and chronic disease was compared. The acute phase was identified by pain during erection. Progression was defined as enlargement of plaque size or appearance of calcification. RESULTS: The average treatment duration was 15.9+/-13.8 months (range: 3 to 48 months). The median time to progression was 7 months for acute patients and 20 months for chronic patients. Eighty percent of patients in the acute phase showed relief of pain; however, overall progression was 72.1% (78.0% for acute, 66.7% for chronic). Patient history, comorbidities, serum testosterone or initial plaque characteristics, and severity of curvature were not predictive of disease progression. CONCLUSIONS: Tamoxifen showed no significant benefit in slowing the progression of Peyronie's disease in the acute phase over the chronic phase. Peyronie's disease continued to progress, though at a dampened rate for patient's in the chronic phase.
Acute Disease ; Chronic Disease ; Comorbidity ; Humans ; Male ; Penile Induration ; Tamoxifen ; Testosterone

We report magnetic resonance image (MRI) and magnetic resonance spectroscopy (MRS) findings in a patient of cerebral fat embolism (CFE) occurred in a 26-year-old woman after an autologous fat injection into the face. After initial neurologic symptom onset, MRI and MRS data were obtained two times to investigate repeated CFE. We obtained the MRS data in the two different time intervals and two different echo times to compare the lesions with normal brain parenchyma. The results of MRS data showed that a decrease in N-acetyl-aspartate, an increase in lactate and a very high early peak of free lipids between 0.9 and 1.4 ppm were obtained at the acute infarcted lesion as compared with normal brain parenchyma. In addition, these findings were more clearly detected on short echo time spectrum rather than long spectrum. A close relationship between the clinical manifestations and MRI and MRS findings of the brain can helpful to distinguish CFE with other conditions and to evaluate the cause materials of infarctions rather than conventional MRI or diffusion-weighted imaging.
Adult ; Brain ; Embolism, Fat ; Female ; Humans ; Infarction ; Lactic Acid ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Neurologic Manifestations

PURPOSE: Soft-tissue augmentation using hyaluronic acid (HA) gels is widely used in dermatology and plastic surgery. We performed this study to determine the feasibility of using HA gel to augment the glans penis. MATERIALS AND METHODS: In experiment I, 0.2 cc of HA gel was injected into the dermis of the glans penis of 25 New Zealand White rabbits via a 27-gauge needle. At 3, 7, 14, 30, and 90 days after injection, the histologic changes in the penis and systemic adverse effects were evaluated. In experiment II, 0.5 cc of HA gel was injected into the dermis of the glans penis of 14 Beagle dogs. Two weeks later, an additional 0.2 cc was injected in 7 of the dogs. For 6 months, the changes in the injected area were grossly evaluated using a 10-point visual scale, and at the end of the study, histologic changes were also evaluated. At autopsy, lung, liver, and spleen were studied for systemic adverse reactions. RESULTS: In the dogs receiving double injections, 85% to 90% of the initial volume was maintained at 6 months, with HA being identified in the lamina propria of the glans penis. Encapsulated material was confirmed to be HA by alcian blue stain and hyaluronidase immunohistochemical stain. No systemic adverse reaction was noticed in any animal. CONCLUSIONS: Hyaluronic acid gel is safe and effective for augmentation of the glans penis. Booster injection enhances the injected volume and facilitates injection of HA.
Alcian Blue ; Animals ; Autopsy ; Dermatology ; Dermis ; Dogs ; Gels ; Hyaluronic Acid* ; Hyaluronoglucosaminidase ; Liver ; Lung ; Male ; Mucous Membrane ; Needles ; Penis* ; Rabbits ; Spleen ; Surgery, Plastic