PURPOSE: To assess the role of the preoperative portal vein embolization (PVE) in patients in need of major hepatectomy. MATERIALS AND METHODS: Total of 11 cases consisted of Klatskin tumor (n:6), gallbladder cancer (n=2), and hepatocellular carcinoma (n=3). After percutaneous transhepatic puncture of portal vein (right:7, left:4), the embolization of 1st order branch of right portal vein was done with Gentamicin soaked Gelfoam cubes. Radiologically, the angle between the middle hepatic vein and the inferior vena cava was measured on pre- and post-PVE CT (F/U :10 days) to evaluate the hypertrophy of the left lobe. Clinically, amount and nature of the drained bile through the PTBD tube of both lobes were analyzed in 5 patients with Klatskin tumor. The interval between PVE & operation was 10-24 days. Operative findings & the changes of postop. total bilirubin were analyzed and the complication after procedure was checked. RESULTS: There was decrease in mean angle between the middle hepatic vein and the inferior vena cava from 35.9 degree to 23.9 degree, but it was insignificant statistically (p=0.09). The embolization of right portal vein was done and there was increase in amount of drained bile from the nonembolized left lobe by 2-3 folds 8-14 days after PVE. The color and consistency between both lobes were significantly different; right lobe was darker in color and softer in consistency. Postoperative total bilirubin increased by 2-3 folds 1 to 4 days after PVE and normalized 10 to 14 days after PVE. Most of the patients had mild abdominal pain and fever after PVE and 1 patient had localized hematoma at puncture site which was subsided spontaneously. CONCLUSION: The preoperative portal vein embolization is a useful method for minimizing postoperative liver failure in patients in need of major hepatectomy.
Abdominal Pain ; Bile ; Bilirubin ; Carcinoma, Hepatocellular ; Fever ; Gallbladder Neoplasms ; Gelatin Sponge, Absorbable ; Gentamicins ; Hematoma ; Hepatectomy* ; Hepatic Veins ; Humans ; Hypertrophy ; Klatskin's Tumor ; Liver Failure ; Portal Vein* ; Punctures ; Vena Cava, Inferior

No abstract available.
Pyelonephritis*

Extraosseous extradural tuberculosis of the spine is rare entity. A 21-year-old man with low back pain, left-sided sciatica & motor weakness was admitted. Simple X-ray were normal. At operation, extradural, extraosseous granuation tissue were removed, which proved upon histologic examination to be tuberculous granulomas. The authors report a rare case of extraosseous tuberculoma in the posterior extradural space of whole lumbar region with review of literatures.
Granuloma ; Humans ; Low Back Pain ; Lumbosacral Region ; Sciatica ; Spine ; Tuberculoma* ; Tuberculosis ; Young Adult

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method of sampling mediastinal lymph nodes to aid in diagnosing lymphadenopathy and in staging metastatic cancers. This paper describes a case of renal cell carcinoma with mediastinal and hilar lymph nodes metastasis that was diagnosed using EBUS-TBNA. A 17-year-old woman who had mediastinal lymphadenopathy and a right renal mass underwent imaging studies. The results of a first EBUS-TBNA suggested malignancy, but the type of tumor and exact site of the primary tumor were uncertain. Therefore, we repeated EBUS-TBNA with a lower pressure on the vacuum syringe. We successfully diagnosed the mediastinal lymph node metastasis from renal cell carcinoma.
Adolescent ; Biopsy, Needle ; Carcinoma, Renal Cell ; Female ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Needles ; Neoplasm Metastasis ; Syringes ; Vacuum

BACKGROUND: Most immune reactions related to transfusion and transplantation are caused by IgM ABO antibodies. However, IgG also plays an important role in these reactions. Therefore, a method to measure antibodies, including IgG, is necessary. We investigated ABO antibody titers of healthy individuals using a column agglutination technique (CAT) with or without dithiothreitol (DTT) and compared them with titers obtained using a conventional tube method. METHODS: Among healthy adults who underwent a medical examination, 180 individuals (60 with blood group A, 60 with group B, and 60 with group O) were selected. Antibody titrations were performed using the immediate spin (IS) tube, anti-human globulin (AHG) tube, and CAT with or without DTT methods. RESULTS: Higher median values of anti-B and anti-A titers in groups A and B individuals, respectively, were obtained using the IS method than using the AHG method. Higher values for group O individuals were obtained using the AHG method. Higher median titers of anti-B and anti-A in group O individuals were obtained using CAT without DTT than using the AHG method. Median titers of anti-B and anti-A in all blood groups were higher in CAT without DTT than in CAT with DTT, especially for group O individuals. CONCLUSIONS: We recommend CAT with and without DTT for titration of anti-A and anti-B, especially in group O individuals, to provide more sensitive results that include IgG data. Adjustment of insurance coverage of fees associated with antibody titration might be necessary, considering the actual cost of reagents and personnel.
ABO Blood-Group System/*immunology ; Adult ; *Agglutination Tests/instrumentation ; Antibodies/*analysis/immunology ; Female ; Humans ; Immunoglobulin G/immunology ; Male ; Middle Aged

Autoimmune hepatitis is a generally progressive chronic hepatitis of unknown etiology. Systemic lupus erythematosus (SLE) and Sjogren's syndrome are chronic, multifaceted inflammatory diseases that can affect every organ system, although hepatic involvement is rare. Here, we report two rare cases: autoimmune hepatitis associated with SLE and with primary Sjogren's syndrome. A 52-year-old woman and a 60-year-old woman were admitted our hospital with jaundice and pruritus. They had no history of viral hepatitis, alcohol consumption, or drug use. The pathological findings, clinical manifestations, and laboratory findings satisfied each of the diagnostic criteria for autoimmune hepatitis as well as for SLE and Sjogren's syndrome in the first and second cases, respectively. These patients were treated with prednisolone, and then followed regularly.
Alcohol Drinking ; Connective Tissue ; Connective Tissue Diseases ; Female ; Hepatitis ; Hepatitis, Autoimmune ; Hepatitis, Chronic ; Humans ; Jaundice ; Lupus Erythematosus, Systemic ; Middle Aged ; Prednisolone ; Pruritus ; Sjogren's Syndrome

BACKGROUND: The aim of this study is to evaluate the feasibility of living donor liver transplantation (LDLT) using an right posterior sector (RPS) graft selected by liver volumetry of living donors. METHODS: From April 2008 to August 2014, 132 LDLTs were performed in our hospital. Of these, 20 recipients (15.1%) received an RPS graft. Perioperative data of LDLTs using an RPS graft were analyzed retrospectively. RESULTS: Mean of the Model for End-stage Liver Disease score of the 20 recipients was 12.1+/-6.2. The mean right liver volume was 72.4%+/-3.1% of total liver volume (TLV) and the mean volume of RPS was 38.2%+/-5.3% of TLV. Anatomical anomalies were found in the portal vein (PV) of 14 donors (70%), in the hepatic artery of one donor (5%), and bile duct of seven donors (35%). All donors were discharged with normal liver function. Two donors (10%) developed bile leakage after RPS donation. None of the recipients experienced complication associated with hepatic artery and PV anastomosis. One recipient had in-hospital mortality due to pneumonia. The remaining 19 recipients were discharged with good graft function. Four recipients (20%) developed biliary stricture and one (5%) had a liver abscess during follow-up. CONCLUSIONS: The RPS donor had a high incidence of abnormal anatomy of PV. LDLT using an RPS graft might have high incidence of biliary complications. We think that selection of an RPS graft from a donor with an inappropriately large right lobe volume could expand the donor pool and be a feasible option in LDLT.
Adult* ; Bile ; Bile Ducts ; Constriction, Pathologic ; Follow-Up Studies ; Hepatic Artery ; Hospital Mortality ; Humans ; Incidence ; Liver Abscess ; Liver Diseases ; Liver Transplantation* ; Liver* ; Living Donors* ; Pneumonia ; Portal Vein ; Retrospective Studies ; Tissue Donors ; Transplants*

PURPOSE: The purpose of this study is to determine the maximum tolerated dose (MTD), safety, pharmacokinetics, and recommended phase II dose of an oral drug composed of paclitaxel and HM30181A, which is an inhibitor of P-glycoprotein, in patients with advanced cancers. MATERIALS AND METHODS: Patients with advanced solid tumors received standard therapy were given the study drug at escalating doses, using a 3+3 design. The study drug was orally administered on days 1, 8, and 15, with a 28-day cycle of administration. The dose of paclitaxel was escalated from 60 to 420 mg/m2, and the dose of HM30181A was escalated from 30-210 mg/m2. RESULTS: A total of twenty-four patients were enrolled. Only one patient experienced a dose-limiting toxicity-a grade 3 neutropenia that persisted for more than 2 weeks, at 240 mg/m2 of paclitaxel. MTD was not reached. The maximum plasma concentration was obtained at a dose level of 300 mg/m2 and the area under the curve of plasma concentration-time from 0 to the most recent plasma concentration measurement of paclitaxel was reached at a dose level of 420 mg/m2. The absorption of paclitaxel tends to be limited at doses that exceed 300 mg/m2. The effective plasma concentration of paclitaxel was achieved at a dose of 120 mg/m2. Responses of 23 patients were evaluated; 8 (34.8%) had stable disease and 15 (65.2%) had progressive disease. CONCLUSION: The study drug appears to be well tolerated, and the effective plasma concentration of paclitaxel was achieved. The recommended phase II dose for oral paclitaxel is 300 mg/m2.
Absorption ; Humans ; Maximum Tolerated Dose ; Neutropenia ; P-Glycoprotein* ; Paclitaxel* ; Pharmacokinetics ; Plasma

PURPOSE: Platinum-based chemotherapy has conferred a modest but significant survival benefit and the introduction of newer drugs has led to achieve higher response rate in patients with advanced non-small cell lung cancer (NSCLC). We performed a phase II trial in order to evaluate the efficacy and toxicity of combination chemotherapy with vinorelbine (Navelbine) and cisplatin in advanced NSCLC. MATERIALS AND METHODS: Patients with previously untreated, unresectable stage IIIB or IV NSCLC with measurable lesion (s) were eligible for entry into the study. NP chemotherapy consisted of intravenous vinorelbine 25 mg/m2, on day 1 and 8, and intravenous cisplatin 80 mg/m2 on day 1; this cycle was repeated every three weeks. RESULTS: A total of 33 patients were enrolled in the study between July 1999 and Feb 2000. Of the 30 patients deemed eligible for analysis, thirteen patients achieved a partial response and thirteen showed a stable disease. The overall response rate was 43.3%. The median duration of response was 5.7 months (95% CI: 2.8~8.5 months). The median time to progression was 7.6 months (95% CI: 5.5~9.7 months) and the overall median survival time was 15.1 months (95% CI: 9.8~20.4 months) in the intent-to-treat analysis. Chemotherapy-related grade 3 or 4 toxicities were anemia in 1.5%, leukopenia in 4.5%, nausea/vomiting in 2.3%, alopecia in 13.3%, and neurotoxicity in 3.3%. CONCLUSION: The combination of vinorelbine and cisplatin chemotherapy seems to be active and fairly tolerable in patients with advanced NSCLC.
Alopecia ; Anemia ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy* ; Drug Therapy, Combination ; Humans ; Leukopenia

Since beginning with the first organ transplantation from brain-dead donor in 1979, organ transplantation has been developing continuously in Korea. However, organ shortage still is a serious problem in the field of solid organ transplantation. For this reason, it is necessary to promote deceased donor organ transplantation and achieve self sufficiency. There are two system requirements managing deceased donor organ transplantation; operational and regulatory systems. In operational system, mutual and balanced cooperation between transplantation centers, organ procurement organism (OPO), registration/allocation system and NGOs is one of most important determinants to maximize brain dead donor. Especially, transplantation center and OPO need to improve in their organ donation process through evaluating donation practices and developing critical pathway for each step. In addition, public education program focusing on the hospital staff, the family of deceased donors and students should be enhanced to increase public awareness for organ donation. In regulatory system, national transplantation authority for the transplant coordination among various structures and policy-making on the issue of organ donation is necessary. For this purpose, Korean Network for Organ Sharing (KONOS) has to be improved into professional and authoritative body and establish more expanded national database network system. Further improvement in operational and regulatory systems to activate organ donation could enable to achieve the Asian leadership in the field of transplantation as well as self sufficiency for organ transplantation.
Asian Continental Ancestry Group ; Brain Death ; Critical Pathways ; Humans ; Korea ; Organ Transplantation ; Tissue and Organ Procurement ; Tissue Donors ; Transplants