PURPOSE: One of the most common cause of upper extremity lymphedema is breast cancer surgery. We experienced the nerve entrapment syndrome which was associated with postmastectomy lymphedema. To the best of our knowledge, this is the first case report of lymphedema induced nerve entrapment syndrome on upper extremity in Korea. METHODS: A 54-year-old woman presented with a tingling sensation on her right hand, which had been present for 1 year. On her history, she had a postmastectomy lymphedema on her right upper extremity for 20 years. Initial electromyography (EMG) showed that the ampulitude of the median, ulnar, and dorsal ulnar cutaneous nerve were decreased, and conduction block was also seen in median nerve across the wrist. In needle EMG, incomplete interference patterns were observed in the muscles innervated by median and ulnar nerves. In conclusion, electrophysiologic study and clinical findings suggested right median and ulnar neuropathy below the elbow. Therefore, we performed surgical procedures, which were release of carpal tunnel, Guyon's canal, and cubital tunnel. RESULTS: The postoperative course was uneventful until the first two years. The tingling sensation and claw hand deformity were improved, however, the motor function decreased progressively. In 7 years after the operation, patient could not flex her wrist and thumb sufficiently. EMG which was performed recently showed that ulnar motor response was of low ampulitude. Moreover, median, ulnar, dorsal ulnar cutaneous, lateral antecubital cutaneous and median antebrachial cutaneous sensory response were unobtainable. Abnormal spontaneous activities were observed in upper arm muscles. In conclusion, multiple neuropathies were eventually developed at above elbow level. CONCLUSION: On treating nerve entrapments associated with lymphedema, medical professionals should be fully aware of the possibility of unpredictable results after the surgery, because of the pathophysiologic traits of chronic lymphedema.
Animals ; Arm ; Breast Neoplasms ; Elbow ; Electromyography ; Female ; Hand ; Hand Deformities ; Hoof and Claw ; Humans ; Lymphedema ; Median Nerve ; Middle Aged ; Muscles ; Needles ; Nerve Compression Syndromes ; Sensation ; Thumb ; Ulnar Nerve ; Ulnar Neuropathies ; Upper Extremity ; Wrist

BACKGROUND: There are very few studies on change in body composition after smoking cessation. The purpose of our study was to assess the change in body composition as well as body weight after smoking cessation in men. METHODS: The subjects were 203 men who had received health examination from May in 2000 to April in 2001 on their first visit, and then from May in 2001 to May in 2002 on their second visit, at the department of family medicine of a university hospital. They were divided into groups of non-smokers, current smokers, and former smokers by smoking status. Their past medical history, obesity indexes, smoking status, physical activity, and nutrition intake were reviewed. Body composition of the study subjects was assessed by bioelectrical impedance analysis. RESULTS: After adjustment for age, nutrition intake, and physical activity as confounding factors, former smokers' body weight was significantly increased by 1.8+/-0.4 kg on second visit compared to non-smokers and current smokers. There was a significant difference in body muscle change between first and second visit, but not in body fat change among former smokers. Former smokers' body fat and muscle were significantly increased by 0.9+/-0.3 kg and 0.8+/-0.4 kg, respectively, compared to non-smokers. Former smokers' waist circumference was significantly increased by 2.5+/-0.7 cm on second visit compared with non-smokers and current smokers. CONCLUSION: In former smokers, body weight was increased by 1.8 kg after smoking cessation, which was attributed to increase of body muscle as well as body fat. Compared with non-smokers, former smokers' body muscle and fat were significantly increased on second visit.
Adipose Tissue ; Body Composition* ; Body Weight* ; Electric Impedance ; Humans ; Male* ; Motor Activity ; Obesity ; Smoke* ; Smoking Cessation* ; Smoking* ; Waist Circumference

Anastomotic complications occur after 5% to 20% of operations for rectosigmoid colon cancer. The intestinal perfusion status at the anastomotic site is an important modifiable risk factor, and surgeons should carefully evaluate and optimize the perfusion at the intended site of anastomosis. Indocyanine green (ICG) angiography is a simple noninvasive perfusion assessment modality. The use of ICG angiography is rapidly spreading in the field of colorectal surgery. However, there is debate on its contribution to reducing anastomotic complications. In this review, we discuss the clinical utility and the standardization of ICG angiography. ICG angiography can unequivocally reveal unfavorable perfusion zones and provide quantitative parameters to predict the risk of hypoperfusion-related anastomotic complications. Many studies have demonstrated the clinical utility of ICG angiography for reducing anastomotic complications. Recently, two multicenter randomized clinical trials reported that ICG angiography did not significantly reduce the incidence of anastomotic leakage. Most previous studies have been small-scale single-center studies, and there is no standardized ICG angiography protocol to date.Additionally, ICG angiography evaluations have mostly relied on surgeons’ subjective judgment. For these reasons, it is necessary to establish a standardized ICG angiography protocol and develop a quantitative analysis protocol for the objective assessment. In conclusion, ICG angiography could be useful for detecting poorly perfused colorectal segments to prevent anastomotic leakage after colorectal surgery. An optimized and standardized ICG angiography protocol should be established to improve the reliability of perfusion assessments. In the future, artificial intelligence-based quantitative analyses could be used to easily assess colonic perfusion status.

Anastomotic complications occur after 5% to 20% of operations for rectosigmoid colon cancer. The intestinal perfusion status at the anastomotic site is an important modifiable risk factor, and surgeons should carefully evaluate and optimize the perfusion at the intended site of anastomosis. Indocyanine green (ICG) angiography is a simple noninvasive perfusion assessment modality. The use of ICG angiography is rapidly spreading in the field of colorectal surgery. However, there is debate on its contribution to reducing anastomotic complications. In this review, we discuss the clinical utility and the standardization of ICG angiography. ICG angiography can unequivocally reveal unfavorable perfusion zones and provide quantitative parameters to predict the risk of hypoperfusion-related anastomotic complications. Many studies have demonstrated the clinical utility of ICG angiography for reducing anastomotic complications. Recently, two multicenter randomized clinical trials reported that ICG angiography did not significantly reduce the incidence of anastomotic leakage. Most previous studies have been small-scale single-center studies, and there is no standardized ICG angiography protocol to date.Additionally, ICG angiography evaluations have mostly relied on surgeons’ subjective judgment. For these reasons, it is necessary to establish a standardized ICG angiography protocol and develop a quantitative analysis protocol for the objective assessment. In conclusion, ICG angiography could be useful for detecting poorly perfused colorectal segments to prevent anastomotic leakage after colorectal surgery. An optimized and standardized ICG angiography protocol should be established to improve the reliability of perfusion assessments. In the future, artificial intelligence-based quantitative analyses could be used to easily assess colonic perfusion status.

The most common recurrent cytogenetic abnormalities in T-lymphoblastic leukemia (T-acute lymphoblastic leukemia [T-ALL]) involve T-cell receptor (TCR) loci and a variety of partner genes, including HOX11, HOX11L2, MYC, and TAL1. In this report, we present a rare case involving simultaneous translocation of the TCR alpha/delta loci with different partner loci (Xq22 and 12p13); this resulted in a poor prognosis. Chromosomal analysis showed 46,Y,t(X;14)(q22;q11.2),t(12;14)(p13;q11.2) and FISH analysis by using a T-cell receptor alpha delta DNA probe, Split Signal (DakoCytomation, Denmark), showed translocations at the same TCR alpha/delta locus on both chromosomes. FISH with 2 bacterial artificial chromosome clones showed break apart signal, which suggests involvement of the IRS4 gene. To our knowledge, this is the first report of T-ALL in which both TCR alpha/delta loci were translocated with different partner loci, and 1 of the partner loci, Xq22, was a rare translocation partner locus that included IRS4 gene.
Adult ; Chromosomes, Human, Pair 12 ; Chromosomes, Human, Pair 14 ; Chromosomes, Human, X ; Genetic Loci ; Humans ; Insulin Receptor Substrate Proteins/genetics ; Karyotyping ; Male ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/*genetics/pathology ; Receptors, Antigen, T-Cell/*genetics ; *Translocation, Genetic

BACKGROUND: The purpose of this study as to assess the impact of obesity on prostate volume by estimating prostate volume using transrectal ultrasonography in men without obesity related metabolic diseases. METHODS: The study sample consisted of 135 men (age 51.8+/-8.0 y) in whom trans-rectal ultrasonography was performed to estimate the prostate volume at an university hospital in Pusan from March 2001 to April 2002. The subjects with obesity-related diseases, such as diabetes, impaired fasting glucose, hypertension, and dyslipidemia were excluded. Subjects were divided into three groups -normal, overweight, and obese- according to body mass index (BMI) and also classified into two groups -normal, central obese- according to abdominal circumference. Differences in means of prostate volume in three groups divided by BMI and two groups by abdominal circumference, respectively, were tested using ANOVA with Sheffe posthoc test and two-sample t test. The correlation between prostate volume and age, obesity index, male hormone and lifestyle factors were assessed using Pearson and Spearman correlation coefficients. Multiple logistic analysis were used to evaluate the independent factor associated with prostatic hyperplasia defined as volume more than 20 cc. RESULTS: The mean prostate volume was significantly larger in obese group than normal group (P<0.05) and in central obese group than normal group (P<0.05). The prostate volume correlated with BMI, abdominal circumference after adjusting for age. Central obesity was an independent factor affecting prostatic hyperplasia (OR=4.3, P<0.05). CONCLUSION: There was significantly larger prostate volume in both obese and central obese group than normal group after excluding for obesity related metabolic diseases. Although both BMI and abdominal circumference were positively correlated with the prostate volume, central obesity was the only independent factor affecting prostate hyperplasia. We suggest central obesity to be a risk factor of prostatic hyperplasia.
Body Mass Index ; Busan ; Dyslipidemias ; Fasting ; Glucose ; Humans ; Hyperplasia ; Hypertension ; Life Style ; Male ; Metabolic Diseases ; Obesity* ; Obesity, Abdominal ; Overweight ; Prostate* ; Prostatic Hyperplasia ; Risk Factors ; Ultrasonography

Methylbromide has been widely used of recent years in fire extinguishers for ships and aircraft and in refrigeration plants. because it exists as a gas at ordinary temperatures, most exposures occur by inhalation and absorption through the skin. The principal manifestations in acute poisoning depend on amount ingested or the concentration inhaled or absorbed. If the amount is large or concentration high, nausea, vomiting, vertigo, weakness, drowsiness, hypotention, coma, convulsion and pulmonary edema may occur after a latent period of up to 12 hour. After exposure to lower concentrations, symtoms are less severe and may be delayed twelve to twenty-four hours. We experienced 3 cases of acute methylbromide intoxication after inhalation. Of them, 2 patients with coma and convulsion were managed by mechanical ventilatior, anticonvulsant, hemodialysis and BAL, but they expired on 4th, 5th hospital day. We report them with review of literature.
Absorption ; Aircraft ; Coma ; Fires ; Humans ; Inhalation ; Nausea ; Poisoning ; Pulmonary Edema ; Refrigeration ; Renal Dialysis ; Seizures ; Ships ; Skin ; Sleep Stages ; Vertigo ; Vomiting

BACKGROUND: We tested the effect of indomethacine and total spinal anesthesia on the improvement of placental flow during cardiopulmonary bypass on fetal lamb. MATERIAL AND METHOD: Twenty fetuses at 120 to 150 days of gestation were subjected to bypass via trans-sternal approach with a 12 G pulmonary arterial cannula and 14 to 18 F venous cannula for 30 minutes. All ewes received general anesthesia with ketamine. In all the fetuses, no anesthetic agents were used except muscle relaxant. Ten served as a control group in which placenta was worked as an oxygenator during bypass (Control group). The remainder worked as an experimental group in which pretreatment with indomethacine and total spinal anesthesia was performed before bypass with the same extracorporeal circulation technique as control group (Experimental group). Observations were made every 10 minutes during a 30-minute bypass and 30-minute post bypass period. RESULT: Weights of the fetuses ranged from 2.2 to 5.2 kg. In Control group, means of arterial pressure decreased from 44.7 to 14.4 mmHg and means of PaCO2 increased from 61.9 to 129.6 mmHg at each time points during bypass. Flow rate was suboptimal (74.3 to 97.0 ml/kg/min) during bypass. All hearts fibrillated immediately after the discontinuation of bypass. On the contrary, in Experimental group, means of arterial pressure reamined higher (45.8 to 30 mmHg) during bypass (p<0.05). Means of PaCO2 were less ranging from 59.8 to 79.4 mmHg during bypass (p<0.05). Flow rates were higher (78.8 to 120.2 ml/ kg/min) during bypass (p<0.05). There were slower deterioration of cardiac function after cessation of bypass. CONCLUSION: In this study, we demonstrated that the placental flow was increased during fetal cardiopulmonary bypass in the group pretreated with indomethacine and total spinal anesthesia. However, further studies with modifications of the bypass including a creation of more concise bypass circuit, and a use of axial pump are mandatory for the clinical application.
Anesthesia, General ; Anesthesia, Spinal ; Anesthetics ; Arterial Pressure ; Cardiopulmonary Bypass* ; Catheters ; Extracorporeal Circulation ; Fetus ; Heart* ; Indomethacin ; Ketamine ; Oxygen ; Oxygenators ; Placenta ; Pregnancy ; Thoracic Surgery* ; Weights and Measures

BACKGROUND AND OBJECTIVES: High dose systemic steroid therapy is currently the mainstay of the treatment for sudden sensorineural hearing loss (SSNHL). However, it makes a glycemic control worse in patients with diabetes. Intratympanic steroid injection (ITSI) can result in reduced systemic steroid toxicity and higher perilymph steroid level selectively. The purpose of this study is to compare the efficacy of ITSI (IT group) with that of systemic steroid (IV group) on SSNHL with diabetes. SUBJECTS AND METHOD: Thirty eight SSNHL patients who were diagnosed with diabetes were divided into the IV group (19 patients) and the IT group (19 patients). In the IV group, prednisolone was administrated intravenously for 7 days followed by tapered doses orally for 7 days. In the IT group, dexamethasone was administrated 4 times within a 2 week-period. Hearing outcome was assessed before and after treatment. RESULTS: In the IV group, 10 patients (58.8%) showed an improvement in the pure tone audiogram (PTA), with a mean improvement of 17.6 dB (p=0.023). In the IT group, 16 patients (84.2%) showed improvement in the PTA, with the mean improvement of 25.1 dB (p=0.000). But there was no significant difference in hearing gain and the recovery rate between the two groups. And it is more difficult to control blood sugar in the IV group rather than in the IT group. CONCLUSION: ITSI treatment is as effective as the systemic steroid treatment for SSNHL patients with diabetes and it can avoid a significant side effect of systemic steroids. So it could be considered as an initial treatment for the SSNHL patient with diabetes.
Blood Glucose ; Dexamethasone ; Hearing ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Perilymph ; Prednisolone ; Steroids

Purpose: This study aimed to evaluate the real-world efficacy of immune checkpoint inhibitors (ICIs), and to identify clinicolaboratory factors to predict treatment outcomes in patients with advanced esophageal squamous cell carcinoma (ESCC) receiving ICIs. Materials and Methods: Sixty patients with metastatic or unresectable ESCC treated with nivolumab (n=48) or pembrolizumab (n=12) as ≥ second-line treatment between 2016 and 2019 at Asan Medical Center were included. Results: The median age of the patients was 68 years (range, 52 to 76 years), and 93.3% were male. Most patients had metastatic disease (81.7%) and had been previously treated with fluoropyrimidines, platinum, and taxane. In 53 patients with measurable disease, the overall response rate and disease control rate were 15.1% and 35.8%, respectively. With a median follow-up duration of 16.0 months, the median progression-free survival (PFS) and overall survival (OS) were 1.9 months (95% confidence interval [CI], 1.54 to 2.19) and 6.4 months (95% CI, 4.77 to 8.11), respectively. After multivariate analysis, recent use of antibiotics, low prognostic nutrition index (< 35.93), high Glasgow Prognosis Score (≥ 1) at baseline, and ≥ 1.4-fold increase in neutrophil-to-lymphocyte ratio after one cycle from baseline were significantly unfavorable factors for both PFS and OS. Younger age (< 65 years) was a significant factor for unfavorable PFS and hyponatremia (< 135 mmol/L) for unfavorable OS. Conclusion The use of ICIs after the failure of chemotherapy showed comparable efficacy in patients with advanced ESCC in real practice; this may be associated with host immune-nutritional status, which could be predicted by clinical and routine laboratory factors.