BACKGROUND/AIMS: Many recent studies have shown excellent outcomes of surgical resection for ruptured hepatocellular carcinoma (HCC). In addition, there are several reports suggesting that a ruptured HCC did not increase the risk for peritoneal dissemination of a tumor after surgical resection. However, the impact of HCC rupture on recurrence and patient survival has not yet been clarified. METHODS: The medical data of patients who underwent surgical resection for ruptured HCC in our center between January 2011 and December 2015 were retrospectively reviewed. The outcomes of the patients were investigated. RESULTS: Among 128 patients who underwent surgical resection for HCC, 5 patients (3.9%) had a ruptured HCC. All patients underwent elective operation in a stable condition. Transarterial chemoembolization (TACE) was performed for achieving hemostasis in four patients except one who achieved spontaneous hemostasis. Two patients had tumor recurrence and one patient died due to HCC recurrence during the median follow-up duration of 28.3 months (range, 24.3–62.3 months). One patient who developed late intrahepatic recurrence at 40.0 months after resection was managed well by means of radiofrequency ablation and TACE and is now alive for 5 years without any evidence of viable tumor. However, the other patient who showed early peritoneal seeding at 1.9 months after resection finally died despite aggressive treatments. CONCLUSIONS: Rupture of HCC might result in peritoneal seeding of the tumor in the early postoperative stage, which could lead to a poor result. Nonetheless, surgical resection may be the best treatment option yielding good survival, even for a ruptured HCC.
Carcinoma, Hepatocellular* ; Catheter Ablation ; Follow-Up Studies ; Hemostasis ; Humans ; Recurrence ; Retrospective Studies ; Rupture

BACKGROUND: Patients with a prior myocardial infarction who undergo noncardiac surgery have a higher risk of perioperative morbidity and mortality. Therefore, this study was designed to assess the outcomes after non-cardiac surgery in patients who had a previous myocardial infarction. METHODS: Ninety three patients who had a prior myocardial infarction and underwent noncardiac surgery were included in this study. The patients were divided as follows: the Complication group versus the Non-Complication group. A retrospective analysis was performed to determine if age, gender, ejection fraction, prior coronary revascularization, ASA physical status, operation time and type, perioperative vital signs, cardiac risk factor, preoperative medications and coronary multivessel disease influence the perioperative morbidity and mortality. RESULTS: Fourteen of the 93 patients (15.1%) had perioperative complications, of which 3 (3.2%) were fatal. All fatal patients had undergone noncardiac surgery within 3 months after the previous coronary revascularization. The incidence of intraoperative tachycardia and oliguria, operation time and the ASA physical status were longer and greater in the Complication group (P<0.05). Otherwise there were no significant differences between the two groups. CONCLUSIONS: The incidence of intraoperative tachycardia and oliguria, the operation time and ASA physical status influence the outcomes after noncardiac surgery of patients with a prior myocardial infarction. In addition, the interval between the coronary revascularization procedure and the noncardiac surgery has a major impact on postoperative mortality. However, prospective multi-center studies will be needed to determine the effects of several variables.
Humans ; Incidence ; Mortality* ; Myocardial Infarction* ; Oliguria ; Retrospective Studies ; Risk Factors ; Tachycardia ; Vital Signs

Hydranencehaly is an abnormality consisting of complete or almost absence of the cerebral hemispheres, which are replaced by a large fluid-filled cavity. The midbrain and brain stem are relatively intact, and rudiments of frontal, temporal and occipital cortex may be present. We diagnosed it through the evaluation of clinical features, prenatal US (intrauterine pregnancy, 37 wks) and brain CT. Authors have experienced a case of hydranencephaly combined with twin pregnancy and reported with a brief literature review.
Brain ; Brain Stem ; Cerebrum ; Humans ; Hydranencephaly* ; Mesencephalon ; Pregnancy ; Pregnancy, Twin* ; Twins*

Mediastinal masses may cause life-threatening complications such as major airways obstruction, superior vena caval obstruction, and cardiac compression during general anesthesia. We present a case in which superior vena caval and airway obstruction developed at induction of anesthesia in a patient with an anterior mediastinal mass. Shortly after induction of anesthesia in the supine position, the patient became difficult to ventilate and blood began to flow upward into the IV line. The patient was immediately turned to the right lateral position and allowed to breathe spontaneously. The ventilation of patient was improved significantly and cyanosis of the face and upper extremities disappeared. We think that general anesthesia should be avoided if at all possible in patients with mediastinal mass and alternative methods of diagnosis and management are discussed.
Airway Obstruction* ; Anesthesia* ; Anesthesia, General ; Cyanosis ; Diagnosis ; Humans ; Supine Position ; Upper Extremity ; Ventilation

PURPOSE: To evaluate two different heel lancet device in terms of pain response and success of the procedure in the preterm infants undergoing heel puncture. METHODS: 100 preterm infants undergoing capillary blood gas analysis or capillary bilirubin monitoring underwent heel puncture, were randomly allocated to blood sampling from the heel with either a conventional manual lancet or an automatic incision device. Primary outcome measures included the Premature Infants Pain Profile (PIPP) score, total duration of procedure, number of heel puncture and number of bruise. The pain response was evaluated using PIPP score and the effectiveness was evaluated using three criteria: total duration of blood sampling, number of puncture, bruising of the heel or ankle. Statistical analysis was performed using the SPSS ver. 13.0 program. Difference between the groups were analysed with t test (continuous variables) and the Chi square test or Fisher test (categorical variables). RESULTS: The mean PIPP score was 4.91 for the automatic lancet group compared with 5.84 for the conventional manual lancet group (P=0.0255).The number of pain scores above 7 during blood collection did not differ between two groups (P=0.2167). The procedure took less time to perform in the automatic lancet group (mean, 30.69 seconds) than in the conventional lancet group (mean, 48.92 seconds) (P<0.0001). CONCLUSION: This study demonstrated that the automatic lancet device causes less pain and a shorter procedure time than the conventional manual lancet in preterm infants undergoing heel puncture. On the basis of these results the automatic lancet device is very useful method for blood collection in preterm infants by heel puncture.
Animals ; Ankle ; Bilirubin ; Blood Gas Analysis ; Capillaries ; Contusions ; Heel ; Humans ; Infant, Newborn ; Infant, Premature ; Outcome Assessment (Health Care) ; Punctures

PURPOSE: To evaluate two different heel lancet device in terms of pain response and success of the procedure in the preterm infants undergoing heel puncture. METHODS: 100 preterm infants undergoing capillary blood gas analysis or capillary bilirubin monitoring underwent heel puncture, were randomly allocated to blood sampling from the heel with either a conventional manual lancet or an automatic incision device. Primary outcome measures included the Premature Infants Pain Profile (PIPP) score, total duration of procedure, number of heel puncture and number of bruise. The pain response was evaluated using PIPP score and the effectiveness was evaluated using three criteria: total duration of blood sampling, number of puncture, bruising of the heel or ankle. Statistical analysis was performed using the SPSS ver. 13.0 program. Difference between the groups were analysed with t test (continuous variables) and the Chi square test or Fisher test (categorical variables). RESULTS: The mean PIPP score was 4.91 for the automatic lancet group compared with 5.84 for the conventional manual lancet group (P=0.0255).The number of pain scores above 7 during blood collection did not differ between two groups (P=0.2167). The procedure took less time to perform in the automatic lancet group (mean, 30.69 seconds) than in the conventional lancet group (mean, 48.92 seconds) (P<0.0001). CONCLUSION: This study demonstrated that the automatic lancet device causes less pain and a shorter procedure time than the conventional manual lancet in preterm infants undergoing heel puncture. On the basis of these results the automatic lancet device is very useful method for blood collection in preterm infants by heel puncture.
Animals ; Ankle ; Bilirubin ; Blood Gas Analysis ; Capillaries ; Contusions ; Heel ; Humans ; Infant, Newborn ; Infant, Premature ; Outcome Assessment (Health Care) ; Punctures

Postoperative hypertension occurs often in hypertensive patients due to pain, hypercapnia, hypoxemia, or excessive intravascular fluid volume. In addition, tracheal extubation exacerbates hypertension and tachycardia, which leads to left ventricular failure, myocardial infarction, or cerebral hemorrhage. We experienced a case of recurrent intracerebral hemorrhage after extubation in the postanesthetic care unit. The patient was 50-year old female who underwent total abdominal hysterectomy. Three months ago, she suffered a hypertensive cerebral hemorrhage with conservative treatment. Anesthesia induction and intraoperative course were relatively uneventful. In the postanesthetic care unit, she had voluntary movement of all limbs to command and fully awake consciousness. Immediately after tracheal extubation, the blood pressure was increased sharply to 200/110 mmHg. After then, the patient's mental status was deteriorated and the motor weakness of left extremities was developed. Brain CT showed a hypertensive hemorrhage at the right putamen and emergency stereotaxic aspiration was performed. After rehabilitative treatment, the patient was discharged with alert mental status and moderate improvement of motor weakness.
Airway Extubation ; Anesthesia ; Anoxia ; Blood Pressure ; Brain ; Cerebral Hemorrhage* ; Consciousness ; Emergencies ; Extremities ; Female ; Hemorrhage ; Humans ; Hypercapnia ; Hypertension ; Hysterectomy ; Intracranial Hemorrhage, Hypertensive ; Middle Aged ; Myocardial Infarction ; Putamen ; Tachycardia

PURPOSE: Hepatolithiasis has been regarded as having a potential of to invoke cholangiocarcinogenesis. The aim of this study was to examine the expression of survivin in hepatolithiasis and cholangiocarcinoma, and to try to predict whether hepatolithiasis plays a role in the carcinogenesis of cholangiocarcinoma. We also investigated the expression of survivin according to subcellular sites (cytoplasmic and nuclear) in the cholangiocarcinoma specimens and to correlation this with the clinical outcome. METHODS: Thirty-four surgically resected hepatolithiasis specimens and ten stone-containing cholangiocarcinoma specimens were the focus of this study. Immunohistochemical staining was done to check the expression of survivin in the hepatolithiasis and cholangiocarcinoma specimens. We classified the survivin positive group according to the subcellular sites in the cholangiocarcinoma specimens. RESULTS: The expression rate of survivin was 5.9% in the hyperplasia specimens, 47.1% in the dysplasia specimens and 90% in the adenocarcinoma specimens (p < 0.01), respectively. The over expression of nuclear and cytoplasmic survivin was seen in 3 specimens and 6 specimens, respectively, among the survivin positive specimens (9 total specimens) of the cholangiocarcinoma specimens. The median survival time of the nuclear and cytoplasmic expression groups of patients was 1.5 months and 10 months, respectively. CONCLUSION: We conclude that the overexpression of survivin in hepatolithiasis could be associated with cholangiocarcinoma based on the sequentially increased survivin expression. We purpose that the nuclear survivin expression predicts aggressive clinical behavior of cholangiocarcninoma.
Adenocarcinoma ; Carcinogenesis ; Cholangiocarcinoma* ; Cytoplasm ; Humans ; Hyperplasia

BACKGROUND/AIMS: The purpose of this study is to evaluate the efficacy of CT colonography (CTC) in comparison with colonoscopy for the detection of colorectal adenomatous polyp in asymptomatic adults. METHODS: A total 208 asymptomatic adults underwent successive CTC and colonoscopy, on the same day. RESULTS: On the analysis of adenomatous polyps per subject, the sensitivity of CTC was 90% (9/10) in case of polyps > or =10 mm in size, and 67.7% (21/31) in case of polyps > or =6 mm in size. Those values of colonoscopy were 100% and 93.5%, respectively. The per-patient specificity of CTC was 98.0% (194/198) in case of polyps > or =10 mm in size and 88.1% (156/177) in case of polyps > or =6 mm in size. CTC missed 4 (3 flat adenomas and, 1 sessile adenoma) out of 17 adenomatous polyps > or =10 mm in size in 2 subjects. CONCLUSIONS: In asymptomatic adults, the sensitivity of CTC for detecting adenomatous polyps was lower than that of colonoscopy, particularly for the small lesions below 10 mm in size, and also for the flat adenomas > or = 10 mm in size. However, CTC showed a high sensitivity and specificity for detecting the subjects with clinically important colorectal adenomatous polyps > or = 10 mm in size. These results suggest that CTC has potential as a screening method for colorectal neoplasm.
Adenoma ; Adenomatous Polyps* ; Adult* ; Colonography, Computed Tomographic* ; Colonoscopy* ; Colorectal Neoplasms ; Humans ; Mass Screening ; Polyps ; Prospective Studies* ; Sensitivity and Specificity

Gemella morbillorum, an anaerobic-to-aerotolerant Gram-positive coccus, is a normal flora of the oral cavity, respiratory tract, urogenital organ and gastrointestinal tract, and infections caused by this organism are unusual. It has been associated mainly with endocarditis and bacteremia, and rarely with arthritis, spondylodiscitis, meningitis, brain abscess and septic shock. Liver abscess caused by G. morbillorum is very rare, and only a few cases were reported. We experienced a case of liver abscess by G. morbillorum in a 56-year-old woman presented with fever. We report this case with a review of literatures.
Female ; Gram-Positive Bacterial Infections/*diagnosis ; Humans ; Liver Abscess/diagnosis/*microbiology ; Middle Aged ; *Staphylococcaceae ; Tomography, X-Ray Computed