Mucocuaneous Lymph Node Syndrome(Kawasaki disease) is a new diseae entity that was first described by Kawasakiin 1967. It occures predominantly in children less than 5yrs old and acute febrile illness, which is mucocutaneousinvolvment associated with swelling of cervical lymph nodes. The coronary artery aneurysms have been revealed 20–30% of patients with Kawsaki disease. The authors report a case of multiple coronary artery aneurysms inKawasaki disease which was diagnosed by a coronary arteriography.
Aneurysm ; Angiography ; Child ; Coronary Vessels ; Humans ; Lymph Nodes ; Mucocutaneous Lymph Node Syndrome

PURPOSE: Longitudinal pancreaticojejunostomy is a treatment option for selected patients with chronic obstructive pancreatitis that is rarely performed laparoscopically. METHODS: A 54-year-old man presented with chronic postprandial abdominal pain. A computed tomography scan revealed multiple calcified stones at the pancreatic head and tail with marked dilation of the pancreatic duct (0.8 cm in diameter). The patient underwent laparoscopic longitudinal pancreticojejunostomy. Impacted stones were removed and Roux-en-Y pancreaticojejunostomy was performed using an intracorporeal suture technique in a longitudinal side-to-side manner. RESULTS: The total operation time and estimated blood loss were 150 min and 50 ml, respectively. The patient tolerated a regular diet without postprandial abdominal pain. Postoperative recovery was uneventful and the patient was discharged on postoperative day 5 in good condition. He returned to work on postoperative day 9. CONCLUSION: Longitudinal pancreaticojejunostomy might be an effective option for relief of chronic pain in treating chronic obstructive pancreatitis.
Abdominal Pain ; Chronic Pain ; Diet ; Head ; Humans ; Middle Aged ; Minimally Invasive Surgical Procedures ; Pancreatic Ducts ; Pancreaticojejunostomy* ; Pancreatitis* ; Pancreatitis, Chronic ; Suture Techniques ; Tail

Adult ; Hand ; Humans ; Parietal Bone ; Rabeprazole ; Skull ; Sutures ; Tissue Donors ; Transplants

The recent advances in human pluripotent stem cells (hPSCs) enable to precisely edit the desired bases in hPSCs to be used for the establishment of isogenic disease models and autologous ex vivo cell therapy. The knock-in approach based on the homologous directed repair with Cas9 endonuclease, causing DNA double-strand breaks (DSBs), produces not only insertion and deletion (indel) mutations but also deleterious large deletions. On the contrary, due to the lack of Cas9 endonuclease activity, base editors (BEs) such as adenine base editor (ABE) and cytosine base editor (CBE) allow precise base substitution by conjugated deaminase activity, free from DSB formation. Despite the limitation of BEs in transition substitution, precise base editing by BEs with no massive off-targets is suggested to be a prospective alternative in hPSCs for clinical applications. Considering the unique cellular characteristics of hPSCs, a few points should be considered. Herein, we describe an updated and optimized protocol for base editing in hPSCs. We also describe an improved methodology for CBE-based C to T substitutions, which are generally lower than A to G substitutions in hPSCs.

We experienced a case of giant arachnoid granulation misdiagnosed as dural sinus thrombosis. A 66-year-old woman presented with a one month history of progressive occipital headache. Computed tomography angiography and cerebral angiography showed a round filling defect at the transverse sinus which was speculated as a transverse sinus thrombosis. Anticoagulation therapy was performed to prevent worsening of thrombosis for 2 weeks and then a Gadolinium-enhanced magnetic resonance imaging scan was performed. The filling defect lesion at the transverse sinus revealed a non-enhancing granule with central linear enhancement, which was compatible with giant arachnoid granulation. We checked the intrasinus pressure difference across the lesion the through the dural sinus in order to exclude the lesion as the cause of headache. Normal venous pressure with no significant differential pressure across the lesion was noted. Headache was treated with medical therapy.
Aged ; Angiography ; Arachnoid ; Cerebral Angiography ; Female ; Headache ; Humans ; Lateral Sinus Thrombosis ; Magnetic Resonance Imaging ; Sinus Thrombosis, Intracranial ; Thrombosis ; Venous Pressure

Sagittal split ramus osteotomy (SSRO) is one of the surgical techniques used to correct mandibular deformities. In order to prevent many surgical anatomical problems, we observed the anatomical structures related to SSRO. In dry mandibles of Koreans, lingular tips were located somewhat posteriorly and superiorly on the mandibular ramus. On the coronal sections of mandible, the mean cortical width of facial cortex was increased toward the ramus region while the lingual cortex was thinnest in the ramus region. On the same sections, all the fusion points of the buccal and lingual cortical plate were located above the mandibular lingula and beneath the mandibular notch. So, performing the SSRO on Koreans, medial horizontal osteotomy should be done through the superior aspect of the mandibular lingula. The cut line is extended 5-8 mm posterior to the mandibular lingula to preserve sufficient cortical width to strengthen the involved osseous segments and reduce possible surgical complications.
Anatomy, Artistic ; Human ; Human ; Mandible/surgery* ; Mandible/anatomy & histology* ; Medical Illustration ; Osteotomy/methods*

The vascularized fibula flap, first described in 1975, was originally developed as a vascularized bone flap for extremity reconstruction. In 1989, the first experience with fibula free flap for mandibular reconstruction was published by Hidalgo. Vascularized fibula flaps have many advantages in the restoration of the contour and function of mandible. But a potential disvantages is unreliable skin paddle and the limited volume of fibula. So, we were dissected 63 Korean cadaver limbs. The aim of this study was 1) to define more clearly the anatomy of peroneal artery to fibula and lateral leg skin, specially with regard to the fibular osteocutaneous flap 2) to measure the dimensions of fibula available for dental implant placement. The results were as follows: 1. The peroneal artery arised from the posterior tibial artery in 60 cases(95.2%). But in 3 cases(4.8%), it took place of the posterior tibial artery. The peroneal artery branched off the posterior tibial artery 6.3+/-1.3cm(range 2 - 6.5cm) distal to the fibular head. 2. The musculoperiosteal and septocutaneous branches of the peroneal artery were distributed from 4/10 to 8/10 in most cases. 3. The number of nutrient foramen was one in 60 cases(95.2%). The foramen was positioned on the posterior surface in 50 cases(75.8%) The average foraminal index was 42.4+/-0.8% and its range was 30.2 to 73.3%. 4. The total length of fibula was 35.4+/-1.8 cm (range 31.0 - 39.5cm) in males and 31.3+/-1.5cm(range 28.0 - 35.0cm) in females. 5. The bone height from the base(anatomic posterior surface) to the spot at which was reduced to 6.0mm in midpoint of fibula was 12.3+/-1.8mm in males and 8.8+/-1.9mm in females.
Arteries* ; Cadaver ; Dental Implants ; Extremities ; Female ; Fibula* ; Free Tissue Flaps ; Head ; Humans ; Leg ; Male ; Mandible ; Mandibular Reconstruction ; Skin ; Tibial Arteries

OBJECTIVE: Minimally invasive transforaminal lumbar interbody fusion(mini-TLIF) is an increasingly popular method because of several advantages, including rapid patient recovery, less postoperative pain, and minimized iatrogenic injury of soft tissue and muscle. The purpose of this study is to evaluate the clinical and imaging outcomes after mini-TLIF procedures. Results are compared with open posterior lumbar interbody fusion(oPLIF, Group B) and mini-TLIF(Group A) approach. METHODS: Between March 2007 and May 2008, mini-TLIF and oPLIF were performed in 23 and 36 consecutive patients with single or multilevel lumbar degenerative disease. Clinical outcomes were assessed by postoperative visual analogue scale(VAS) score, operation time, volume of blood loss, number of days to ambulation and duration of hospital stay. To assess fusion rate, all patients underwent postoperative radiography. And postoperative access were compared with an institutional reference series of 36 oPLIF procedures. RESULTS: Fusion success outcomes were obtained in 23(100%) out of 23 patients with mini-TLIF procedure. Mean VAS scores decreased from 8.2 to 1.9 in group A and from 8.1 to 2.4 in group B. The operation time, volume of blood loss, number of days to ambulation and duration of hospital stay were reduced in group A compared with group B. There was no complication associated to mini-TLIF procedure. CONCLUSION: Mini-TLIF yielded good clinical and radiological outcomes with safe and low complication. Further long- term investigating study is required to assess the definitive advantage of mini-TLIF.
Humans ; Imidazoles ; Length of Stay ; Muscles ; Nitro Compounds ; Pain, Postoperative ; Walking

Hepatic glycogenosis is an under-recognized cause of hepatomegaly and elevated serum aminotransferase levels in patients with type 1 diabetes; further, most cases of hepatic glycogenosis are reported to be associated with poor glycemic control. In this report, we describe the case of a 12-year-old girl with hepatic glycogenosis, who presented with elevated liver enzymes. She was diagnosed with type 1 diabetes at the age of 6 years, and her diabetes was very "brittle" with recurrent episodes of hypoglycemic attacks. Her recent hemoglobin A1C (HbA1c) level was 8.4%, and the average HbA1c level during the last 2 years was 8.7%. Her aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were persistently elevated during the last year, up to 700 and 258 U/L, respectively. Her growth rate and pubertal development were normal. Her serum was negative for hepatitis viral markers, and the plasma levels of ceruloplasmin and ferritin were also normal. Ultrasound examination revealed hepatomegaly with increased hepatic echogenicity. Liver biopsy demonstrated irregular glycogen deposition in hepatocytes. Recurrent hypoglycemia was resolved with continuous subcutaneous insulin infusion, and after 3 weeks, her AST and ALT levels decreased to 47 and 33 U/L, respectively. We conclude that hepatic glycogenosis should be suspected as a cause of abnormal liver function tests in patients with poorly controlled or brittle type 1 diabetes. After excluding other causes of hepatic dysfunction, a 1-month trial for achieving improved glycemic control, while avoiding hypoglycemia, is recommended before proceeding with invasive investigation of the patient.
Alanine Transaminase ; Aspartate Aminotransferases ; Biomarkers ; Biopsy ; Ceruloplasmin ; Child ; Diabetes Mellitus ; Ferritins ; Glycogen ; Glycogen Storage Disease ; Hemoglobins ; Hepatitis ; Hepatocytes ; Hepatomegaly ; Humans ; Hypoglycemia ; Insulin ; Liver ; Liver Diseases ; Liver Function Tests ; Liver Glycogen ; Plasma

PURPOSE: To compare the effect of using fibrin glue or 10-0 nylon sutures on the clinical outcome of patients undergoing pterygium excision and conjunctival autografting. METHODS: We retrospectively reviewed the medical records of 52 eyes from 46 patients who underwent pterygium excision and conjunctival autografting and were followed up for more than 3 months. The operation duration, postoperative inflammation, complications, and recurrence rates were compared between groups of 20 patients (22 eyes) for whom fibrin glue was used (fibrin glue group) and 26 patients (30 eyes) for whom suturing was performed with 10-0 nylon (suture group) in pterygium excision and conjunctival autografting. RESULTS: The operation duration was 27.71 (5.22) minutes in the fibrin glue group and 43.30 (8.18) minutes in the suture group (p = 0.000). Seven days after the operation, the fibrin glue group showed milder conjunctival inflammation than the suture group (p = 0.000). Postoperative complications and corneal recurrence rates were not statistically different between the two groups. CONCLUSIONS: The use of fibrin glue in pterygium excision with conjunctival autografting is likely to be a more effective, safer procedure than suturing.
Adult ; Aged ; Aged, 80 and over ; Conjunctiva/*transplantation ; Female ; Fibrin Tissue Adhesive/*pharmacology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Pterygium/*surgery ; Retrospective Studies ; Suture Techniques/*instrumentation ; *Sutures ; Time Factors ; Tissue Adhesives/pharmacology ; Transplantation, Autologous