Living donor liver transplantation (LDLT) has been an established treatment modality for patients with end- stage liver diseases, especially in countries with scarcity of deceased donors. The annual number of LDLT cases in Korea has been steeply increasing, exceeding that of Japan and even doubling that of United States in 2007. When comparing LDLT and deceased donor liver transplantation (DDLT), the timely availability and quality of liver grafts are superior in LDLT, but there are definite drawbacks from anatomical sharing of 1 liver organ by 2 individuals as well as potential donor risk. Biliary complications seem to be the most intractable problems following adult LDLT. The indications for LDLT are nearly identical to those of DDLT. The optimal timing for performing LDLT is not clearly defined, but an earlier transplantation is often recommended before serious worsening of general conditions. The post - transplant management following LDLT is often more difficult than that of DDLT although early liver regeneration makes the liver graft large enough. Current situation in Korea requires a heavy demand on DDLT, but it is still very difficult to expect a rapid rise of deceased donor number within a few years. Thus, LDLT may continue to play the pivotal role to compensate for the serious shortage of deceased donor organs. Coercion to living donors should be prohibited in any situation. The medical team and our whole society should pay special attention to caring of living donors in order to encourage organ donation.
Adult ; Coercion ; Hepatitis B ; Humans ; Japan ; Korea ; Liver ; Liver Diseases ; Liver Regeneration ; Liver Transplantation ; Living Donors ; Tissue Donors ; Transplants ; United States

Purpose: We explored the relationship between dry eye syndrome (DES) and parity in women over 20 years of age. Methods: We retrieved data from the Fifth Korean National Health and Nutrition Examination Survey. Of women over 20 years of age, 7,573 diagnosed with DES by ophthalmologists and 7,347 who self-diagnosed DES were included. We used logistic regression to explore the relationship between DES prevalence and parity, and the chi-squared test to compare differences in DES prevalence by someo children. Results: On univariate logistic regression, the DES incidence was significantly affected by residential status, educational level, hours of sleep, and hyperlipidemia, osteoarthritis, thyroid disorder, and menopause status. We subjected these parameters (and age) to multivariate logistic regression. We found no significant relationship between the doctor-diagnosed DES rate and the number of children. Subjectively, the number of children significantly reduced the prevalence of self-diagnosed DES but not that diagnosed by ophthalmologists. The self-diagnosed DES prevalence was significantly lower in women with than without children. Conclusions The KNHANES-V data showed that the prevalence of self-diagnosed DES decreased with the number of children in women aged over 20 years. The prevalence of self-diagnosed DES in women with children was significantly less than that in women without children. However, we found no significant correlation between the number of children and DES status, because DES does not simply reflect poor tear secretion, being rather multifactorial.

Sweet's syndrome was originally described as an "acute febrile neutrophilic dermatosis". Sweet's syndrome presents in three clinically settings: (1) classical or idiopathic Sweet's syndrome, (2) malignancyassociated or paraneoplastic Sweet's syndrome, (3) drug-induced Sweet's syndrome. Sweet's syndrome is known to respond well to systemic corticosteroids, and mortal case associated without any other predisposing factors is hardly found. Twenty-nine year old male was transferred from local clinic with the chief complaint of recurrent thrombophlebitis which occurred 10 days ago after IV treatment of antibiotics for burn. The symptom did not get well with conventional treatment for the thrombophlebitis such as antibiotics or drainage. After several days of pyrexia, the patient died suddenly. Grossly abnormal findings including pulmonary thrombus which could explain sudden death were not found. Disseminated intravascular microthrombi was the most peculiar finding. It was prominent in small sized vein, and lung was the most severely affected. Heart and liver were also involved. Large thrombi within deep vein of the legs were also noted. Minor collections of inflammatory cells, even apart from the main lesion, were noted in skin adnexa or small vessles within aorta wall. No tumorous area was found. The disseminated intravascular coagulation, which was associated with vasculitis was thought to be the direct cause of death. Several points about the Sweet's syndrome including the unusualness of this case were discussed.
Adrenal Cortex Hormones ; Anti-Bacterial Agents ; Aorta ; Burns ; Causality ; Cause of Death ; Death, Sudden ; Disseminated Intravascular Coagulation ; Drainage ; Fever ; Heart ; Humans ; Leg ; Liver ; Lung ; Male ; Neutrophils ; Skin ; Sweet Syndrome* ; Thrombophlebitis ; Thrombosis ; Vasculitis ; Veins

Biliary-enteric fistula is in 0.5% to 5% of patients undergoing biliary tract surgery. The most common cause of biliary-enteric fistula is gallstones and their complications, Much less common causes are complieation of peptic ulcer, malignancy, trauma, and rarely, Crohns, disease. The most common type of biliary-enteric fistula is cholecysto-duadenal. Cholecysto-colic, cholecysto-gastric, and choledocho-duodenal fistula are reported much less frequently. The combination of cholecysto-duodenal fistula with cholecysto-colic fistula is a very rare. Symptoms are generally nonspecific, so diagnosis has depended on plain film of abdomen and barium studies. Recently, endoscopic examination and cannulation of the fistula for precise radiographic delineation will help to make a diagnosis. A 78-year-old man was admitted our hospital because of epigastric discomfort, indigestion, nausea and vomiting for 10 days. He was confirmed as cholecysto-duodeno-colic fistula by gastroduodenoscopy, colonoscopy, and endoscopic cholangio-graphic techniques. So, we report a case of cholecysto-duodeno-colic fistula of the patient with a review of relevant literatures.
Abdomen ; Aged ; Barium ; Biliary Tract ; Catheterization ; Colic* ; Colonoscopy ; Diagnosis ; Dyspepsia ; Fistula* ; Gallstones ; Humans ; Nausea ; Peptic Ulcer ; Vomiting

Verotoxin-producing Escherichia coli O157 is a primary cause of severe and bloody diarrhea. Campylobacter spp. are one of the commonly reported bacterial cause of gastrointestinal infections throughout the world. Only a few cases involving both E. coli O157 and Campylobacter species have been reported. The authors simultaneously isolated verotoxin-producing E. coli O157 and Campylobacter species from the stool of a 3 year-old male with bloody diarrhea, fever and abdominal pain.
Abdominal Pain ; Campylobacter* ; Child, Preschool ; Diarrhea ; Escherichia coli O157* ; Escherichia coli* ; Escherichia* ; Fever ; Gastroenteritis* ; Humans ; Male ; Shiga Toxins ; Shiga-Toxigenic Escherichia coli

Purpose: To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) for graft failure after re-penetrating keratoplasty (PK).Case summary: A 33-year-old man of Indian nationality who had developed right eye amoeba keratitis and had received two penetrating keratoplasties and allogeneic kerato-limbal transplant in India sought treatment at our hospital. During the follow-up, Ahmed valve transplantation was performed under the diagnosis of secondary glaucoma in his right eye; the patient also underwent conjunctival recession and conjunctival permanent amniotic membrane transplantation as corneal neovascularization had progressed. Subsequently, the corneal transplantation failed and DSAEK was performed. At 7 months after the operation, the right-eye visual acuity was 20/320 without any complications. Conclusions DSAEK may restore good vision without complications in patients with repeated corneal graft failure after PK from corneal endothelial cell failure followed by corneal neovascularization and glaucoma surgery but with good stromal conditions. We present this case, along with a review of the literature. Future studies will require more surgical patients.

Purpose: To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) for graft failure after re-penetrating keratoplasty (PK).Case summary: A 33-year-old man of Indian nationality who had developed right eye amoeba keratitis and had received two penetrating keratoplasties and allogeneic kerato-limbal transplant in India sought treatment at our hospital. During the follow-up, Ahmed valve transplantation was performed under the diagnosis of secondary glaucoma in his right eye; the patient also underwent conjunctival recession and conjunctival permanent amniotic membrane transplantation as corneal neovascularization had progressed. Subsequently, the corneal transplantation failed and DSAEK was performed. At 7 months after the operation, the right-eye visual acuity was 20/320 without any complications. Conclusions DSAEK may restore good vision without complications in patients with repeated corneal graft failure after PK from corneal endothelial cell failure followed by corneal neovascularization and glaucoma surgery but with good stromal conditions. We present this case, along with a review of the literature. Future studies will require more surgical patients.

Anomalous portal vein (PV) branching of the donor liver is uncommon and usually makes two, or rarely, more separate PV branches at the right liver graft. Autologous PV Y-graft interposition has long been regarded as the standard procedure, but is currently replaced with the newly developed technique of conjoined unification venoplasty (CUV) due to its superior results. Herein, we presented a case of CUV application to three PV openings of a right liver graft. The recipient was a 32-year-old male patient with hepatitis B virus-associated liver cirrhosis. The living liver donor was his 33-year-old sister who had a type III PV anomaly, but the right posterior PV branch was bifurcated early into separate branches of the segments VI and VII, thus three right liver PV branches were cut separately. We used the CUV technique consisting of placement of a small vein unification patch between three PV orifices, followed by overlying coverage with a crotch-opened autologous portal Y-graft. The portal Y-graft was excised and its crotches were incised to make a wide common orifice. Three bidirectional running sutures were required to attach the crotch-opened autologous portal Y-graft. After portal reperfusion, the conjoined PV portion bulged like a tennis ball, providing a wide range of alignment tolerance. The patient recovered uneventfully from the liver transplantation operation. The CUV technique enabled uneventful reconstruction of triple donor PV orifices. Thus, CUV can be a useful and effective technical option for reconstruction of right liver grafts with various anomalous PVs.
Adult ; Hepatitis B ; Humans ; Liver Cirrhosis ; Liver Transplantation ; Liver* ; Male ; Portal Vein* ; Reperfusion ; Running ; Siblings ; Sutures ; Tennis ; Tissue Donors ; Transplants* ; Veins

Although ERCP has been widely used to diagnose and occasionally treat chronic pancreatitis, it is not always easy to differentiate between malignancy and benign disease by ERCP alone. So peroral pancreatoscopy(PPS) using mother and baby type scopes was developed and several types of peroral pancreatoscopes with various diameters have been used at several institutes. To assess the clinical usefulness of ultrathin-caliber pancreatoscopy on diagnosis of various pancreatic diseases, we performed peroral pancreatoscopy with PF 8P (Olympus, external diameter: 0.8 mm) in 12 cases(6 cases of chronic pancreatitis, 5 cases of pancreatic tumor, and 1 case of mucinous ductal ectasia) of pancreatic diseases. The pancreatoscope was successfully inserted into main pancreatic duct in 11 cases and permitted satisfactory endoscopic observation. The endoscopic findings of chronic pancreatitis were smooth stenosis, protein plug, and stones in pancreatic duct. Peroral pancreatoscopic findings of pancreatic cancer were characteristically seen as stenosis with irregular mucosal protrusion. In the mucin-producing tumor cases, the lesions were generally not clearly visualized due to the presence of copious amount of mucin. We conclude that pancreatoscopy is a valuable alternative or supplementary procedure to diagnostic imaging method of arriving at a more definite diagnosis in difficult cases. But several limitations, such as poor visual field, absence of biopsy channel and controllable tip, and poor durability of endoscope will be overcomed to serve as essential diagnosic tool for pancratic diseases.
Academies and Institutes ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Diagnosis* ; Diagnostic Imaging ; Endoscopes ; Humans ; Mothers ; Mucins ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis, Chronic ; Visual Fields

Bleeding from gastric varices greater than 2cm in diameter represents a major limitation for endoscopic hemostasis. The endoscopic injection sclerotherapy (EIS) using conventional sclerosing agents is not satisfactory for the control of acute bleeding from gastric varices which have large diameter, fast blood flow and abundant collateral circulations. Endoscopic ligation using small rubber bands, known to be alternative to EIS, never obliterate large gastric varices greater than 2 cm in diameter. Obliteration therapy using Histoacryl (n-buty1-2-cyanoacrylate), known to be more satisfactory, has some drawback such as embolization. We per formed endoscopic ligation using detachable snares and rubber bands in 22 patients who had recently bleeding from gastric varices larger than 2 cm in diameter. For ligation of gastric varices larger than 2 cm in diameter, the detachable snares were used, and then for ligation of adjacent small gastric varices, rubber bands were used. In seven patients active bleedings were noted at initial endoscopy; 6 of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands, but one patient who was uncontrolled by it died from bleeding and multiple organ failure. In remaining 15 patients, there were no active bleeding but red color signs on large gastric varices; all of them were successfully controlled by endoscopic ligation using detachable snares and rubber bands. Early rebleeding, fol lowing initial treatment, occurred in two patients (9.5%). So overall hemostatic rate of endoscopic ligation using the detachable snares and the rubber bands was 86.4% (19/22). Varices were nearly eradicated in 18 (85.7%) of the 21 survivors by ligation of 1-3 detachable snares (mean, l.3 snares) and 4-30 rubber bands (mean, 16,2 bands) in 2-6 sessions (mean, 3.2 sessions). During or after ligation, there were no serious complications, except transient epigastric pain or discomfort in 14.7% and fever in 1.3%. These results suggest that endoscopic ligation therapy with detachable snares and rubber bands is a safe and effective method for treatment of acute bleeding of gastric varices, especially gastric varices larger than 2 cm in diameter, which can not he controlled by conventional scleratherapy or variceal band ligation.
Collateral Circulation ; Enbucrilate ; Endoscopy ; Esophageal and Gastric Varices* ; Fever ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Ligation* ; Multiple Organ Failure ; Rubber* ; Sclerosing Solutions ; Sclerotherapy ; SNARE Proteins* ; Survivors ; Varicose Veins