We report a case of alpha-fetoprotein (AFP)-producing acinar cell carcinoma (ACC) of the pancreas. The tumor was diagnosed in a 72 yearold female after radical subtotal gastrectomy (Billroth I) due to early gastric cancer six months before. The initial serum AFP levels were increased to 2,254.1 IU/ml and preoperative imaging studies showed a mass with approximately 2.5 cm in diameter near the neck of the pancreas. A pancreaticoduodenectomy was performed. The pathologic examination revealed an ill-defined lobulating tumor confined to the pancreas (T1 stage). Immunohistochemical study showed that the tumor cells expressed AFP. The Adenosine triphosphate-based chemotherapy response assay (ATP-CRA) suggested that cisplatin would be more desirable than gemcitabine in AFP-producing ACC of the pancreas as an adjuvant chemotherapy. However, the adjuvant chemotherapy was not performed due to the early pathological stage. The patient died from carcinomatosis and pneumonia. Even if the tumor was on a relatively early stage, an adjuvant treatment should be considered ACC.
Acinar Cells* ; Adenosine ; alpha-Fetoproteins ; Carcinoma ; Carcinoma, Acinar Cell* ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy ; Female ; Gastrectomy* ; Humans ; Neck ; Pancreas ; Pancreatectomy ; Pancreaticoduodenectomy* ; Pneumonia ; Stomach Neoplasms*

The low rate repetitive nerve stimulation test(RST) using the electric stimulation has been known the best procedure among the electroliagnostic evaluations for the neuromuscular transmission. However, the electric stimulation often causes a considerable discomfort and pain during the procedure. On the contrary, the magnetic stimulation is much easier and less painful in activating to activate the deep seated nerves. The purpose of this study was to compare the effect of repetitive magnetic and electric stimulation for the induction of compound muscle action potentials(CMAP) of abductor digiti quinti and deltoid muscles in 25 healthy subjects. The results were showed there were no significant differences in the amplitudes of CMAP of axillary and ulnar nerves between the magnetic and electric stimulations. And there were no significant differences in the decremental ratio of CMAP between the magnetic and electric stimulations. The magnetic stimulations were less painful for the subjects than electric stimulations in both proximal and distal muscles. In conclusion, the magnetic stimulation proved to be a useful method for repetitive nerve stimulations in the diagnosis of neuromuscular disease.
Deltoid Muscle ; Diagnosis ; Electric Stimulation ; Muscles ; Neuromuscular Diseases ; Ulnar Nerve

OBJECTIVE: Maturation of the acoustic and visual pathways in brainstem can be reflected by the brainstem auditory evoked potential(BAEP) and visual evoked potential(VEP) response studies. The purpose of this study was to evaluate the high-risk infants by the BAEP and VEP studies as a screening test for Their brainstem maturities. METHOD: The BAEP and VEP studies were used as a screening test in 142 high-risk infants with 31 to 42 weeks of conceptional age. Further follow-up data were obtained within 1 year in the same infants who showed the abnormal findings in BAEP and VEP at an initial screening test. RESULTS: On an initial BAEP and VEP study, the proportion of the abnormal findings was significantly higher among infants with below 36weeks(53.8%, 28.2%) of conceptional age than above 36 weeks(27.2%, 3.9%). At the follow-up study, 3 of 21 infants with no responses in BAEP and 1 of 6 infants with no responses in VEP on an initial test showed the persistent abnormal findings. However, normal configurations of BAEP and VEP were observed in infants with prolonged latencies or with distorted waveforms of BAEP and VEP at the first examination. CONCLUSIONS: These results suggest that the BAEP and VEP studies on the useful screening tests in infants above 36weeks of conceptional age. Because of the risk of persistent abnormal results, infants with no responses on an initial screening test need a follow-up study.
Acoustics ; Brain Stem* ; Evoked Potentials, Auditory, Brain Stem* ; Evoked Potentials, Visual* ; Follow-Up Studies ; Humans ; Infant* ; Mass Screening ; Visual Pathways

PURPOSE: To evaluate the usefulness of MRI findings in the differentiation of benign from malignant ovarian lesions. MATERIALS AND METHODS: Using MR findings, 29 surgically proven ovarian masses in 22 patients (14 bilateral tumors) were evaluated Twenty-one benign tumors in 16 patients (5 simple cysts, 4 mucinous cystadenomas, 4 serous cystadenomas, 4 endometriomas, 3 cystic teratomas and 1 tuboovarian abscess), and eight malignant tumors in six patients (4 serous papillary cystadenocarcinomas and 4 mucinous cystadenocarcinomas) were included. MRI was performed with SE T1WI, FSE T2WI and Gd-T1WI. MRI findings of lesion size, thickness of wall and of internal septations, number of internal septations, nodularities, and ancillary findings such as adhesion in the pelvic cavity, dissemination, ascites and lymphadenopathy were retrospectively analyzed. RESULTS: Malignant ovarian lesions were larger (18 cm : 11 cm) and had more internal septations, more solid components and nodularities (63 % : 5 %) than benign lesions. On T1WI, cystic lesions, both benign and malignant, showed low signal intensity. Hemorrhage, fat components and mucin containing lesions showed high signals and solid components and nodularities were isointense with muscle on T1WI. Solid components and nodularities were well-enhanced after gadolinium enhancement. Adhesion (50 % : 10 %), dissemination (38 % : 0 %) and ascites (63 % : 24 %) were more frequent in malignant lesions. CONCLUSION: MRI, especially with gadolinium-enhanced T1W1 is useful in the differentiation of benign from malignant ovarian lesions.
Ascites ; Cystadenocarcinoma, Papillary ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Endometriosis ; Female ; Gadolinium ; Hemorrhage ; Humans ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Mucins ; Retrospective Studies ; Teratoma

BACKGROUND: The patency of arteriovenous access is important for stable and effective hemodialysis, and long-term technical survival is best achieved with a native arteriovenous fistula (AVF). However, maintaining AVF patency remains a challenge. This study was designed to determine the independent prognostic factors for AVF patency according to hemodialysis duration. METHODS: The primary study end point was unassisted patency of the AVF, which was defined as the time from the first fistula surgery to the first AVF failure. AVF failure was defined as an event that required percutaneous intervention or surgery to revise or replace the fistula, which occurred at least 2 months after fistula formation. RESULTS: We enrolled 478 patients with a mean age of 55.5+/-14.0 years, and mean duration of dialysis was 2.5+/-2.1 years. There were 109 cases (22.8%) of AVF failure. The factors related to AVF patency differed according to hemodialysis duration. Using a Cox-adjusted model, we observed a significant correlation between the incidence of AVF failure and diabetes within the initial 12 months of hemodialysis. Uncontrolled hyperphosphatemia (mean serum phosphorus>5.5 mg/dL during hemodialysis) was associated with patency loss of AVF after 1 year of hemodialysis. CONCLUSION: Various factors were associated with the development of patency loss of AVF as hemodialysis duration differed, and a preventive role of hyperphosphatemia control in AVF survival needs further clinical study.
Arteriovenous Fistula* ; Dialysis ; Fistula ; Humans ; Hyperphosphatemia* ; Incidence ; Renal Dialysis*

Background: Microcirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to assess whether microvascular reactivity during CPB could predict major adverse events (MAE) after cardiac surgery. Methods: This prospective observational study included 115 patients who underwent elective on-pump cardiac surgeries. A vascular occlusion test (VOT) with near-infrared spectroscopy was performed five times for each patient: before the induction of general anesthesia, 30 min after the induction of general anesthesia, 30 min after applying CPB, 10 min after protamine injection, and post-sternal closure. The postoperative MAE was recorded. The area under the receiver operating characteristic (AUROC) curve analysis was performed for the prediction of MAE using the recovery slope. Results: Of the 109 patients, MAE occurred in 32 (29.4%). The AUROC curve for the recovery slope during CPB was 0.701 (P < 0.001; 95% CI [0.606, 0.785]). If the recovery slope during CPB was < 1.08%/s, MAE were predicted with a sensitivity of 62.5% and specificity of 72.7%. Conclusions Our study demonstrated that the recovery slope of the VOT during CPB could predict MAE after cardiac surgery. These results support the idea that disturbances in microcirculation induced by CPB can predict the development of poor clinical outcomes, thereby demonstrating the potential role of microvascular reactivity as an early predictor of MAE after cardiac surgery.

Giant cell arteritis (GCA) is a systemic vasculitis predominantly found in individuals of Northern European ancestry over 50 years of age. Typically it presents with new-onset persistent headache, claudication of jaws, and existence of an abnormal temporal artery. However, the diagnosis of GCA and the assessment of its activity remain challenging, especially in patients presenting with a variety of non-specific symptoms and laboratory tests. In those cases, 18F-fluorodeoxy-glucose positron emission tomography (18F-FDG-PET) is useful for the diagnosis of GCA. Recently, the number of foreign patients who visit domestic hospitals for medical care is increasing in Korea. Here-in, we report a Russian patient who was admitted to our hospital with fever of unknown origin (FUO). FUO study was performed to search for infection or malignancy and GCA was suspected by 18F-FDG-PET. The patient was eventually diagnosed with GCA by random temporal artery biopsy.
Biopsy ; Fever ; Fever of Unknown Origin ; Giant Cell Arteritis ; Giant Cells ; Headache ; Humans ; Jaw ; Korea ; Positron-Emission Tomography ; Systemic Vasculitis ; Temporal Arteries

Background: Pyruvate dehydrogenase complex (PDHC) deficiency is a rare mitochondrial disorder caused by a genetic mutation affecting the activity of the PDHC enzyme, which plays a major role in the tricarboxylic cycle. Few cases of surgery or anesthesia have been reported. Moreover, there is no recommended anesthetic method.Case: A 24-month-old child with a PDHC deficiency presented to the emergency room with respiratory failure, mental decline, systemic cyanosis, and lactic acidosis. During hospitalization period, the patient presented with pneumothorax, pneumoperitoneum, and multiple air pockets in the heart. Two surgeries were performed under general anesthesia using an inhalational anesthetic agent. The patient was discharged with home ventilation. Conclusions Anesthesiologists should be wary of multiple factors when administering anesthesia to patients with PDHC deficiency, including airway abnormalities, acid-base imbalance, intraoperative fluid management, selection of appropriate anesthetics, and monitoring of lactic acid levels.

Proteus syndrome (PS) is a rare congenital hamartomatous disorder with multisystem involvement. PS shows highly clinical variability due to overgrowth of the affected areas, and several features can make anesthetic management challenging. Little is known about the airway problem associated with anesthesia in PS patients. An 11-year-old girl with PS was scheduled for ear surgery under general anesthesia. She had features complicating intubation including facial asymmetry and disproportion, abnormal teeth, limitation of neck movement due to torticollis, and thoracolumbar scoliosis. This study reports on a case of deformed airway of a PS patient under fiberoptic bronchoscopy.
Anesthesia ; Anesthesia, General ; Bronchoscopy ; Child ; Ear ; Facial Asymmetry ; Female ; Humans ; Intubation ; Neck ; Proteus Syndrome* ; Proteus* ; Scoliosis ; Tooth ; Torticollis

We report here on a case of a neurogenic tumor of the neck with an uncertain origin on the preoperative evaluation. A 67-year-old woman with a palpable mass in the left side of the neck was referred to our hospital. The mass had slowly grown over 7 years and her dyspnea had gradually become more severe over the recent 6 months. Computerized tomography and magnetic resonance imaging showed an 8 cm sized solid mass that abutted the trachea and the esophagus without invasion, but the origin of the mass was not clearly identified. During surgical exploration, we identified that the tumor was located in the esophageal muscle layer. Immunohistochemical staining revealed that the tumor cells were positive for S-100 protein, which confirmed a diagnosis of schwannoma.
Aged ; Diagnosis ; Diagnosis, Differential* ; Dyspnea ; Esophagus ; Female ; Humans ; Magnetic Resonance Imaging ; Neck ; Neurilemmoma ; S100 Proteins ; Thyroid Gland ; Trachea