BACKGROUND: Living related liver transplantation (LRLT) has gained acceptance as treatment modality for children with end-stage liver disease. The left lobe used in LRLT doesn't provide adequate parenchymal mass for its application to adults. We have used right lobe for LRLT in adults. Some criticism has been aroused becuase of the potential significant risk to the donors. METHODS: We analyzed the surgical risk and the stress to 20 donors in a right lobectomy for LRLT. We also analyzed anatomical points for safe harvest, and we describe techincal points based on anatomical variations. RESULTS: There were no deaths, and 6 major complications (3 bleeding, 1 perihepatic fluid collection, 1 pleural effusion, and 1 bile peritonitis after removal of the T-tube) occurred in 6 patients. Liver function was normalized within 2 weeks. There were anatomical variations in the hepatic vein, the portal vein, and the bile duct, especially the right inferior hepatic vein (55%), trifurcation of the portal vein (10%), low inserion of the right posterior bile duct into the common hepatic duct (10%), and separate insertion of the right anterior bile duct and right posterior bile duct into the hepatic duct (10%). We made a vena cava patch for the right inferior hepatic vein. In cases of the low insertion of the right posterior hepatic duct into the common hepatic duct, the cholecystectomy should be done carefully so as not to injure the right posterior hepatic duct. We ligated and divided the right posterior bile duct before dissection of the hepatic artery and the portal vein. In cases of trifurcation of the portal vein, closure of the left portal vein should be done to prevent the narrowing of the left portal vein lumen. CONCLUSIONS: Our results suggest that a right lobectomy for LRLT is safe for donors. However, anatomical variations in the bile duct, the hepatic vein, and the portal vein should be kept in mind to ensure a safe and successful operation.
Adult* ; Bile ; Bile Ducts ; Child ; Cholecystectomy ; Hemorrhage ; Hepatic Artery ; Hepatic Duct, Common ; Hepatic Veins ; Humans ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors* ; Peritonitis ; Pleural Effusion ; Portal Vein ; Tissue Donors

Rhabdomyolysis is a common clinical and laboratory syndrome resulting from reversible skeletal muscle injury, with release of muscle cell contents into the plasma. Cardioversion, and cardiopulmonary resuscitation may produce rhabdomyolysis and myoglobinuria. We report a 5-year-old boy surviving after cardiopulmonary resuscitation and repeated 5 times of cardioversion. He showed elevated serum BUN and creatinine levels, requiring hemodialysis treatment. We had tried 5 times of intermittent hemodialysis, but oliguria was continued and there was no change of serum BUN and creatinine. His urine output was less than 100 cc per day and he showed severe edema and weight gain of 7 kg, and so we started the continuous renal replacement therapy (Prismaflex(R), gambro). After 12 days of continuous venovenous hemodiafiltration (CVVHDF), his urine output recovered and his BUN, creatinine, liver enzyme, creatine kinase, and lactate dehydrogenase levels returned to normal. During the treatment of CVVHDF, he had shown persistent hypercalcemia, and so we changed dialysate and replacement solution from hemosol B0 to calcium free solution. The hypercalcemia was controlled successfully using this calcium free pharmacy-made bicarbonate solution.
Calcium ; Cardiopulmonary Resuscitation ; Creatine Kinase ; Creatinine ; Edema ; Electric Countershock ; Hemodiafiltration ; Humans ; Hypercalcemia ; L-Lactate Dehydrogenase ; Liver ; Muscle Cells ; Muscle, Skeletal ; Myoglobinuria ; Oliguria ; Plasma ; Preschool Child ; Renal Dialysis ; Renal Replacement Therapy ; Rhabdomyolysis ; Weight Gain

Background: The aim was to compare tunnel widening of autogenous hamstring anterior cruciate ligament reconstruction (ACLR) using cortical button versus cross-pin femoral fixation. Methods: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched from inception to 11 April 2019. The study included all levels of evidence in studies that reported femoral tunnel widening and compared cortical button and cross-pin femoral fixation for ACLR. Results: Six studies were included, covering a total of 344 knees. Using transtibial techniques for ACLR, the mean absolute amount of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross-pin fixation (−0.30 mm; 95% confidence interval (CI) −0.56,−0.05 mm; p= 0.02). Using the transtibial technique, the mean relative percentage of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross pin fixation (−5.73%; 95% CI −10.32, −1.14% ; p= 0.01). Conclusion The present meta-analysis revealed greater widening of the femoral tunnel when using cortical button fixation for hamstring ACLR via the transtibial technique than when using transfemoral cross-pin fixation.

Ovarian primary malignant melanoma is very uncommon with only 44 reported cases in the literature. A 71-year-old woman with an ovarian mass and multiple nodules in the liver presented to our hospital. She was treated with bilateral salpingo-oophorectomy, and malignant melanoma was found in the mature cystic teratoma of the ovary. Malignant melanoma cells were also found in the ascitic fluid. She died 5 months later. Here we report a very uncommon case of malignant melanoma arising in an ovarian mature cystic teratoma with a review of the literature.
Aged ; Ascitic Fluid ; Female ; Humans ; Liver ; Melanoma ; Ovary ; Teratoma

Thyrotoxic periodic paralysis (TPP) is associated with hypokalemia and occurs sporadically and usually in young adult males. We report ten cases with TPP ; all were males, mean onset age was 32.4 years old. The duration of attack. Varied from 10 to 18 hours. The distribution of paralysis was confined to limb muscles; more severe in proximal limbs and lower extremities. Potassium levels during acute attack correlated with the severity of paralysis and ECG changes, but not with the severity of decrease in TSH level. In all cases, administration of potassium salts was successful in treatment of acute attack. A patient had further attack in spite of euthyroid state under the treatment of thyrotoxicosis for one year. Another patient was free from paralytic attacks by chronic administration of the potassium salt and acetazolamide without treatment of thyrotoxicosis.
Acetazolamide ; Age of Onset ; Electrocardiography ; Extremities ; Humans ; Hypokalemia ; Lower Extremity ; Male ; Muscles ; Paralysis* ; Potassium ; Salts ; Thyrotoxicosis ; Young Adult

It is necessary to install ventilation facilities in the laboratory and to regularly monitor harmful gases including formalin for safe environment of the dissection laboratory. However, there are no indicators that can identify the current status of ventilation facilities, safety equipment, and protective equipment in the dissection laboratory. In this study, the status of safety management of anatomical lab at domestic medical, dental, and oriental medical universities are investigated through an online questionnaire. Of the total 32 universities, 7 universities (21.8%) regularly monitor harmful gases such as formalin in the dissection lab, 13 universities (40.6%) do it on an irregular basis, and 12 do not do it at all. Seven universities (21.8%) are using the exhaust-type dissection table, 24 universities (75%) are not using it. Regarding the need for standards for manpower and facilities in the management of the anatomy lab, 7 universities (21.8%) are mediocre, 21 universities are necessary (65.6%), and 4 universities (12.5%) are very necessary. The responsibility for anatomy lab is 27 universities (84.3%) of the schools that responded as head professors of the department of anatomy, 3 universities (9.3%) of technicians, and 2 universities (6.2%) of the dean of the medical school. Regarding the need for standards for the anatomical lab, 7 universities (21.8%) are very necessary, 21 universities (65.6%) are necessary, and 4 universities (12.5%) are mediocre. Based on this data, the standard for the quality improvement and safety of anatomical education should be prepared.

Background: There are many studies on the vertebral body-to-canal ratio, the so-called Pavlov’s ratio of the cervical spine. However, there are no studies on its relation with age to clarify each bony component’s contribution to the spinal canal formation and its size. The aim of this study was to investigate differences and changes in the vertebral body-to-canal ratio according to age in an asymptomatic population. Methods: This is a cross-sectional study of 280 asymptomatic individuals. A total of 140 men and 140 women representing each decade of life from the first to the seventh were included in this study. The anteroposterior length of the vertebral body and canal from C3 to C6 was measured on sagittal radiographs to calculate the vertebral body-to-canal ratio. Results: The average Pavlov’s ratio was significantly larger (p < 0.001) in the first decade of life. The average Pavlov’s ratio of the individuals in the first decade of life was 1.09 between C3 and C6 (1.08 at C3, 1.07 at C4, 1.11 at C5, and 1.13 at C6; range, 0.78–1.51). There was no significant difference among the other decades of life. Conclusions We assessed the Pavlov’s ratio of the cervical spine in an asymptomatic population. It is our belief that the spinal canal size is the largest in the first decade of life, and the Pavlov’s ratio becomes almost fixed throughout life after maturity.

BACKGROUND: This study was performed to prove whether a pylorus-preserving pancreatoduodenectomy (PPPD), now widely used in the treatment of not only positive tumors but also negative tumors, is advantageous for recovering the nutritional status and the quality of life of patients with pancreatic cancer and periampullary regions compared with a classical pancreatoduodenectomy (PD). METHODS: A retrospective study of the nutritional status and the quality of life of 200 patients who had undergone a PPPD (n=92) and a PD (n=118) from January 1993 to July 1998 was performed. The nutritional status was measured by using Broca's index, cholesterol, total protein, and albumin. The quality of life was assessed by one question on how the patients felt about their quality of life. RESULTS: The PD was preferred in advanced stages and had a higher recurrence rate. The PPPD had a shorter operative time, less transfused blood, a longer duration of nasogastric tube drainage, and a shorter postoperative hospital stay. In the PPPD, the nutritional status was improved compared with that in the PD. There were no significant differences in operative mortality or morbidity, gastrointestinal symptoms, and the quality of life between patients having a PPPD and a PD. CONCLUSIONS: This study suggests that there are no differences in postoperative subjective symptoms and the quality of life between patients having a PPPD and those having a PD. However, preserving the pylorus allows a better recovery of nutritional status than a pylorus resection dose. The PPPD hasa survival rate similar to that of the PD. Therefore, the PPPD can be recommended for the procedure in the surgical treatment of diseases of the periampullary regions.
Cholesterol ; Drainage ; Humans ; Length of Stay ; Mortality ; Nutritional Status* ; Operative Time ; Pancreatic Neoplasms ; Pancreaticoduodenectomy* ; Pylorus ; Quality of Life* ; Recurrence ; Retrospective Studies ; Survival Rate

Since the first case was diagnosed on May 20, 2015, there were 186 confirmed cases of Middle East Respiratory Syndrome (MERS) until the end of outbreak in South Korea. Although medical institutions were the most identifiable sources of MERS transmission in South Korea, similar to other countries, in-depth epidemiological investigation was required for some confirmed cases with indefinite contact history or hospital visit records. The subject of epidemiological investigation in the present study was a 35 year-old male patient diagnosed with MERS (#119) who lived in Asan-city and worked in Pyeongtaek-city. Various potential sources of transmission were carefully investigated. While he could have been exposed to MERS through a friend from Saudi Arabia or confirmed MERS cases in his workplace, neighboring areas, and medical institutions, as well as contacts in his home, the chances of transmission were low; however, the potential for transmission through his local community could not be excluded. Practically, it was difficult to determine the modes of transmission for all outbreak cases in communicable disease that occurred in this short period of time. The investigation to identify the mode of transmission in this case was ultimately unsuccessful. However, the various data collected and analyzed to reveal modes of transmission provided detailed information that could not be collected using only interview surveys.
Chungcheongnam-do ; Communicable Diseases ; Community-Acquired Infections ; Coronavirus* ; Disease Outbreaks ; Disease Transmission, Infectious ; Friends ; Gyeonggi-do* ; Humans ; Korea* ; Male ; Middle East* ; Republic of Korea ; Saudi Arabia

OBJECTIVE: Our purpose was to evaluate the clinical aspects of twin pregnancy and its outcome. METHODS: From January 1993 to December 2002, we reviewed the medical records of 249 cases of twin birth at least weighed 500 g or more and over 20 weeks of gestation among 14,273 deliveries at Hanyang University Hospital. Paired sample t test and linear regression test were used for statistical analysis. p<0.05 was defined significantly. RESULTS: The incidence of twin births was one in 59.6 birth, and the annual rate of twin births has increased since last 10 years (p<0.05). The predominant age group was 25-29 (47.0%) and mean age was 29.8 +/- 3.9 years old. According to parity, primipara (63.9%) was the most frequent. The predominant gestational age of twin births was 37-38 weeks (42.2%) and mean gestational weeks of twin births was 36.3 +/- 2.9 weeks. The ratio of spontaneous and iatrogenic twinning were 73.1% vs 26.9%. The cephalic-cephalic combination (49.8%) was the predominant presentation. The most common mode of twin delivery was cesarean section (76.5%) and its main indication was "elective" (33.5%). The mean interval between 1st and 2nd baby deliveries among normal spontaneous vaginal delivery was 6 minute 28 seconds. Both male group (43.0%) was predominant. The mean birth weights of 1st and 2nd baby were 2341 +/- 592 grams and 2200 +/- 594 grams respectively. No significant differences were seen in one minute and five minute Apgar scores between 1st and 2nd baby. The most common type of placental membrane was single placenta, two chorion, two amnion (40.6%). The most frequent maternal complication during pregnancy was anemia (41.8%), followed by preterm labor (39.0%) and preeclampsia (20.9%). The perinatal mortality rate was 50 per 1000 newborns and 2 cases (0.8%) of maternal death were encountered. The risk of intrauterine fetal death and abortion was 2.4% and 0.8% respectively. CONCLUSION: Recently, although the incidence of twin pregnancy has been increased, it has greater risks of obstetrical complications and higher perinatal mortality than singleton pregnancy. Therefore, further prospective studies of twin pregnancy are needed for counselling and effective management about perinatal prognosis.
Amnion ; Anemia ; Birth Weight ; Cesarean Section ; Chorion ; Female ; Fetal Death ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Linear Models ; Male ; Maternal Death ; Medical Records ; Membranes ; Obstetric Labor, Premature ; Parity ; Parturition ; Perinatal Mortality ; Placenta ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin* ; Prognosis