PURPOSE: Since the introduction of short vein bypass (SVB), many have reported its feasibility when long vein bypass (LVB) cannot be performed due to limited vein conduit. However, the presence of inflow-vessel disease may affect graft patency and thus require endovascular treatment prior to surgery. Our study aims to analyze the results between SVB and LVB. MATERIALS AND METHODS: From 2009 to 2013, 27 bypass procedures were reviewed retrospectively. Outcomes such as patency rate, postoperative ankle brachial index (ABI) and limb salvage rate between SVB and LVB were compared. Wound healing time and primary patency rate were analyzed and the former was also analyzed according to the respective angiosome and revascularization type. RESULTS: There were 11 males and 16 females and the mean age was 66.6+/-12.3 years. Twenty four patients had TransAtlantic Inter-Society Consensus (TASC) D and 3 patients had TASC C lesions below knee. The 1-year cumulative patency rate between SVB and LVB were 63% and 66%, P=0.627. The limb salvage rate (100% vs. 73%; P=0.280) and postoperative ABI (0.592 vs. 0.508; P=0.620) were higher in the SVB group than in the LVB group, although the differences were not significant. There was no difference in wound healing time by angiosomal revascularization type. In situ vein graft showed higher patency rate than reversed greater saphenous vein (75% vs. 61%; P=0.00) CONCLUSION: The results of SVB were similar to those of LVB. SVB is feasible in the setting of limited conduit availability, in combination with endovascular treatment in the presence of proximal lesions.
Ankle Brachial Index ; Consensus ; Extremities* ; Female ; Humans ; Ischemia* ; Knee ; Limb Salvage ; Male ; Retrospective Studies ; Saphenous Vein ; Transplants* ; Veins* ; Wound Healing

Prolapse of bladder through vesico-vaginal fistula is quite a rare urological problem. A 38-year-old woman was admitted to the Woo Sok University Hospital with a baby head sized round mass attached to the vagina. Patient had a prolapse of uterus after having her second child birth about 10 years ago and cauterization with corrosives for the treatment of prolapse of uterus was undergone for two times. About one year prior to the admission, the prolapse of uterus recurred and cauterization with corrosives was tried again, resulting vesico-vaginal fistula through which the bladder was everted and prolapsed. Under the general anesthesia, the everted and prolapsed bladder was reduced manually in normal position and vesico-vaginal fistulectomy was performed with good result.
Adult ; Anesthesia, General ; Caustics ; Cautery ; Child ; Female ; Fistula* ; Head ; Humans ; Parturition ; Prolapse* ; Urinary Bladder* ; Uterus ; Vagina ; Vesicovaginal Fistula

Plesiomonas shigelloides is known to cause diarrhea in human. It is a facultatively anaerobic gram-negative rod belonging to the family Vibrionaceae. We isolated P. shigelloides from two patients with diarrhea, a 62-year-old woman with steroid therapy and a 4-year-old boy with no predisposing factor. The organisms were isolated on enteric agars as a nonlactose fermenter and were identified by oxidase, indole, and other biochemical characteristics. The isolates were susceptible to commonly used antimicrobial agents with the exception of ampicillin. P. shigelloides infection is rarely reported in our country, but appears to be a significant cause of diarrhea that responds to antimicrobial therapy. Therefore we suggest the need for correctly identifying P. shigelloides.
Agar ; Ampicillin ; Anti-Infective Agents ; Causality ; Child, Preschool ; Diarrhea ; Female ; Humans ; Male ; Middle Aged ; Oxidoreductases ; Plesiomonas* ; Vibrionaceae

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Several recent findings that there are activating mutations in the KIT and PDGFRA (platelet-derived growth factor receptor-alpha) genes of GISTs provide the rationale for using targeted therapies such as imatinib or sunitinib. Sunitinib, an oral multitargeted receptor tyrosine kinase inhibitor that inhibits kinases such as KIT, PDGFR (platelet-derived growth factor recepter), and VEGFR (vascular endothelial growth factor receptor), was recently approved for the treatment of imatinib-refractory GIST. Sunitinib is generally well tolerated and has an acceptable toxicity profile; an adverse event such as bowel perforation is rare. We present a patient with imatinib-refractory GIST who was successfully treated using sunitinib, but developed bowel perforation. The mechanism involved in bowel perforation associated with sunitinib is unknown. However, we presume that in our patient, the dramatic reduction in disseminated peritoneal metastases and bowel invasion of recurrent GIST during sunitinib treatment might have resulted in the bowel perforation.
Endothelial Growth Factors ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Intestinal Perforation ; Neoplasm Metastasis ; Phosphotransferases ; Protein-Tyrosine Kinases ; Imatinib Mesylate

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Several recent findings that there are activating mutations in the KIT and PDGFRA (platelet-derived growth factor receptor-alpha) genes of GISTs provide the rationale for using targeted therapies such as imatinib or sunitinib. Sunitinib, an oral multitargeted receptor tyrosine kinase inhibitor that inhibits kinases such as KIT, PDGFR (platelet-derived growth factor recepter), and VEGFR (vascular endothelial growth factor receptor), was recently approved for the treatment of imatinib-refractory GIST. Sunitinib is generally well tolerated and has an acceptable toxicity profile; an adverse event such as bowel perforation is rare. We present a patient with imatinib-refractory GIST who was successfully treated using sunitinib, but developed bowel perforation. The mechanism involved in bowel perforation associated with sunitinib is unknown. However, we presume that in our patient, the dramatic reduction in disseminated peritoneal metastases and bowel invasion of recurrent GIST during sunitinib treatment might have resulted in the bowel perforation.
Endothelial Growth Factors ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Intestinal Perforation ; Neoplasm Metastasis ; Phosphotransferases ; Protein-Tyrosine Kinases ; Imatinib Mesylate

Anti-E and anti-c is one of the clinical significant irregular antibodies developing a delayed hemolytic transfusion reaction and hemolytic disease of the newborn. Since anti-c occurs frequently with anti-E in immunized people whosoe cells are E-and c-, it has been recommended to select blood of the patient's own R1 phenotype for transfusion, even when the presence of anti-c cannot be demonstrated in his/her serum. To determine the utility of this approach, we reviewed the blood bank laboratory records of patients identified anti-E and anti-c in his/her serum in Severance hospital over a 12 year period (1985-1996). During the 12-year period of study, 53 patients were identified with anti-E and/or anti-c; 30(56.6%) patients had anti-E alone, 6(11.3%) had anti-c, and 17(32.1%) had both. Thirty eight of forty two patients whose Rh-hr phenotypes were tested were R1R1. Of these 38 R1R1 patients, 16 patients (42.1%) presented with anti-c concomitant with anti-E. Ouru study showed that the incidence of antni-c in R1R1 patients with anti-E is similar to that of studies reported in Caucasian groups. We highly suggest the transfusion protocol of prophylactic use of c negative blood for R1R1 patients with anti-E. Furthermore, because anti-c may be present in concentrations too low to be detected, the enzyme technique is recommended in parallel with standard serologic methods for the identification of irregular antibodies.
Antibodies ; Blood Banks ; Blood Group Incompatibility ; Humans ; Incidence ; Infant, Newborn ; Phenotype

No abstract available.

No abstract available.
Intestinal Atresia*

No abstract available.
Tetanus*

Steroid withdrawal followed by interferon therapy is an alternative approach for treating chronic hepatitis B virus infection when there has been no therapeutic response to interferon alone. The effectiveness of steroid withdrawal followed by interferon therapy and factors predictive of the response were evaluated in 35 children with biopsy-proven chronic hepatitis B. Patients had received a 1-month course of prednisolone, 1 mg/kg per day orally, followed by a 2-week rest, and then were treated with interferon alpha 3 MU three times per week for 4-6 months. The serum aminotransferase values normalized in 80%, and negative seroconversion rates of HBeAg and HBV-DNA were 69% and 66%. The good response rate was associated with a pretreatment HBV-DNA level lower than 100 pg/ml and a posttreatment ALT level more than 200 IU/L. Normalization of ALT values usually took 5 months, and the clearance of HBV-DNA and HBeAg took 7.8 and 6.7 months, respectively. These results suggest that steroid withdrawal followed by interferon therapy is useful in the treatment of chronic hepatitis B in children, and that a good response rate can be expected in children with lower pretreatment HBV-DNA levels (< 100 pg/ml).
Adolescence ; Alanine Transaminase/blood ; Child ; Child, Preschool ; DNA, Viral/analysis ; Female ; Hepatitis B, Chronic/virology ; Hepatitis B, Chronic/therapy* ; Hepatitis B, Chronic/pathology ; Human ; Infant ; Interferon Alfa-2a/therapeutic use* ; Male ; Prednisolone/therapeutic use*