No abstract available.
Endocarditis* ; Humans

Endometriosis is an enigmatic disease of menstruating females affecting the reproductive life. We report herein a case of perineal endometriosis in a 33-year-old woman. The patient presented two rounded, thickened plaques bilaterally on the perineum for about four year. The plaque on the right side was located mainly at the episiotomy scar. Histologic examination showed confirmative feature of glandular structures embedded in the cellular stroma and predecidual changes of late secretory phase of endometrium. Radical operation of total hysterectomy with bilateral oophorectomy and partial excision of perineal lesions were performed. There was complete resolution with no relapse by the 6-month follow-up. This is of a very rare occurrence and three cases have been reported in the Korean literatures up to date.
Adult ; Cicatrix ; Endometriosis* ; Endometrium ; Episiotomy ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Ovariectomy ; Perineum ; Recurrence

PURPOSE: Although the possibility of distal radius fractures is strong in hemodialysis patients, there are many difficult problems such as the bleeding tendency, hypervascularity and injury to arteriovenous fistula. We studied the outcomes of open reduction and volar locking plate fixation of the distal radius fractures in hemodyalisis patients with ipsilateral arteriovenous fistula. METHODS: From 2007 to 2009, a retrospective chart review was performed of eleven hemodialysis patients who underwent volar locking plate fixation for treatment of distal radius fractures. Eight of them were female and three were male and mean age was 68 years (range, 57-81 years). Mean follow-up period was 19 months (range, 12-28 months). All patients had osteoporosis with mean T-score of -2.7. All operations were performed on the next day of hemodialysis. Scheduled hemodialysis was possible on the next day of surgery without splint. We analyzed radiographic results, the wrist range of motion, Mayo wrist score and disabilities of the arm, shoulder and hand (DASH) score at the last follow-up. RESULTS: All fractures achieved anatomical reduction and united at final follow-up. Complications such as hematoma or occlusion of arteriovenous fistula were not observed. Mean Mayo wrist score was 78 and mean DASH score was 22. CONCLUSION: Volar locking plate fixation for distal radius fractures provides immediate support for continuing hemodialysis and exercise. Open reduction of the fractures and the use of tourniquet don't seem to increase the vascular complications like hematoma and fistula occlusion.
Arm ; Arteriovenous Fistula ; Female ; Fistula ; Follow-Up Studies ; Hand ; Hematoma ; Hemorrhage ; Humans ; Male ; Osteoporosis ; Radius Fractures* ; Radius* ; Range of Motion, Articular ; Renal Dialysis* ; Retrospective Studies ; Shoulder ; Splints ; Tourniquets ; Wrist

Formation of cerebral de novo aneurysms (CDNA) is rare, and the pathogenesis remains obscure. In this study, we investigated the factors that contribute to the formation of CDNA and suggest guidelines for following patients treated for cerebral aneurysms. We retrospectively reviewed 2,887 patients treated for intracranial aneurysm at our institute from January of 1976 to December of 2005. Of those patients, 12 were readmitted due to recurrent rupture of CDNA, which was demonstrated by cerebral angiography. We assessed clinical characteristics, such as gender, size and site of rupture, past history, and the time to CDNA rupture. Of the 12 patients, 11 were female and 1 was male, with a mean age at rupture of the first aneurysm of 44.7 years (range: 30-69 years). The mean time between the first episode of subarachnoid hemorrhage (SAH) and the second was 8.9 years (range: 1.0-16.7 years). The most common site of ruptured CDNA was the internal carotid artery (5 patients, 41.7%), followed by basilar artery bifurcation (3 patients, 25.0%). In the remaining 4 patients, rupture occurred in the anterior communicating, middle cerebral, anterior cerebral (A1), or posterior cerebral (P1) arteries. In 5 cases (41.7%), the CDNA occurred contralateral to the initial aneurysm. Eleven patients (91.7%) had a past history of arterial hypertension. There was no history of habitual smoking or alcohol abuse in any of the patients. Eight patients underwent clipping for CDNA and three patients were treated with coiling. One patient who had multiple aneurysms was treated with clipping following intra-aneurysmal coiling. Assessment according to the Glasgow Outcome Scale (GOS) of the patients after the treatment was good in 10 cases (83.3%) and fair in 2 cases (16.7%). Although formation of CDNA after successful treatment of initial aneurysm is rare, several factors may contribute to recurrence. In our study, female patients with a history of arterial hypertension were at higher risk for ruptured CDNA. We recommend follow-up imaging studies every five years after treatment of the initial aneurysm, especially in women and those with a history of arterial hypertension.

OBJECTIVE: This study is to define the clinical characteristics and formulate the management strategies of the patients with ruptured cerebral aneurysms associated with polycystic kidney diseases (PKD). METHODS: During the past 30 years, among of 3,013 patients who were treated with intracranial aneurysms, 7 patients had ruptured cerebral aneurysms associated with PKD. The authors retrospectively reviewed the database and imaging studies of such patients as sources for identification and analysis. RESULTS: All 7 patients presented with subarachnoid hemorrhage (SAH). One patient showed Hunt and Hess grade I, 4 of grade II, and 2 of grade III. Six patients showed Fisher group II and 1 patient of group III. Four aneurysms were located at anterior cerebral artery, 2 at middle cerebral artery, and 1 at internal carotid artery. Five patients had small aneurysms and the remaining 2 had large (diameter > or = 10 mm) aneurysms. All aneurysms were in saccular shape. Two of the 7 patients (28.6%) had multiple aneurysms. One patient suffered delayed ischemic neurological deficit. All patients were treated by microsurgery and showed favorable outcome (good: 7). CONCLUSIONS: The patients harboring PKD had high probability of hypertension. So, intact aneurysms in those patients were exposed to higher rate of being ruptured. Surgery was necessary for ruptured lesions, as well as unruptured lesions which size was increased at follow up imaging study. Multimodality management approach with nephrologist and neuroradiologist are very necessary. The ultimate management outcome was satisfactory.
Aneurysm ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Follow-Up Studies ; Humans ; Hypertension ; Intracranial Aneurysm* ; Microsurgery ; Middle Cerebral Artery ; Polycystic Kidney Diseases* ; Retrospective Studies ; Subarachnoid Hemorrhage

To evaluate the cerebral blood flow in feline hydrocephalic brain, this study was designed to measure the regional cerebral blood flow(rCBF;frontal and periventricular area) by the hydrogen clearance method in different stages of the kaolin-induced hydrocephalus and the postshunt status. The results were as follows: 1) A reduction of rCBF was detected in the left periventricular area at two weeks after kaolin injection. A significant reduction of rCBF was revealed in the left periventricular area at two and four weeks after kaolin injection. However, the rCBF of the left frontal cortex was significantly decreased at four weks after kaolin injection. 2) At one week after shunt operation, the significant restroration of rCBF was found in the left frontal cortex and the left periventricular area.
Brain ; Hydrocephalus* ; Hydrogen ; Kaolin

No abstract available.
Adrenocortical Carcinoma*

BACKGROUND: The kidney recovery rate associated with deceased donors has increased after the establishment of the Korean Network for Organ Sharing (KONOS). And the KONOS organ allocation system gives priority to candidates affiliated with a Hospital based Organ Procurement Organization (HOPO) and/or donor recovery hospital. Regardless of whether or not this organ allocation system is fair, it can make an important impact on the waiting time for an organ transplant. METHODS: A total of 157 deceased donor kidney transplantations were performed at Severance Hospital between January 2006 and April 2011. The recipients of these transplantations were retrospectively divided into five groups according to their allocation types; general allocation group (GA, n=54), HOPO priority group (HP, n=65), zero antigen mismatching group (ZM, n=23), marginal donor allocation group (MD, n=7), and the combined organ transplant allocation group (CT, n=8). The five groups were assessed in terms of their waiting time for organ allocation, cold ischemia time, and post-transplant graft outcome. RESULTS: Mean waiting time for organ allocation of the HP group (69.5+/-27.4 months) was significantly shorter than for the GA group (90.0+/-34.0 months)(P<0.05). However, the degree of HLA mismatching was not different between each group. The cold ischemia time for the HP group (301.5+/-133.9 min) was significantly shorter than all other groups, except for the ZM group. There were no differences between groups in terms of acute rejection episodes, delayed graft function events or graft survival rates. CONCLUSIONS: Our retrospective analysis of the kidney allocation pattern showed that there were disparities in distribution by priority of allocation. We should make a consensus within the Korean transplant society in order to further develop the allocation system to decease donor kidney transplantation time.
Cold Ischemia ; Consensus ; Delayed Graft Function ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Retrospective Studies ; Tissue and Organ Procurement ; Tissue Donors ; Transplants

PURPOSE: Highly sensitized patients with a high level of panel reactive antibody (PRA) experience more episodes of antibody-mediated rejection (AMR) and poorer graft survival than non-sensitized patients. Rituximab is a well-known monoclonal anti-CD20 antibody that causes the depletion of B lymphocytes. The aim of this study was to compare a rituximab-administered and a non-administered group of highly sensitized recipients. METHODS: Forty-three kidney recipients with a PRA level of > or =50% were included. Sixteen (group R) received one dose of rituximab at 2 days prior to transplantation and 27 patients (group NR) did not. RESULTS: Patients' demographics, such as age, sex, dialysis duration, and type of immunosuppressive agent were not different in the two groups. No side effects due to rituximab administration were observed in group R. Class I PRA of group R (75.6 +/- 37.7%) was higher than that of group NR (45.7 +/- 35.8%, P = 0.013). More acute rejection episodes occurred within 1 year after transplantation in group NR but the difference between the groups was not significant (18.8% in group R vs. 29.6% in group NR, P = 0.631). However, two AMR episodes occurred only in group NR. Renal functions were not different in the two groups. In group R, CD19 and CD20 rapidly decreased 2 days after rituximab infusion. Furthermore, the administration of rituximab was not linked to acute rejection. CONCLUSION: To confirm the long-term anti-rejection and beneficial effects of rituximab, further studies should be performed with a larger cohort. In conclusion, rituximab administration 2 days prior to transplantation is both effective and safe.
Antibodies, Monoclonal, Murine-Derived ; B-Lymphocytes ; Cohort Studies ; Demography ; Dialysis ; Graft Survival ; Humans ; Immunization ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Rituximab ; Transplants

OBJECTIVE: Many researchers believe that the hypothermia shows neuroprotective effect on brain injury. To understand the molecular mechanism of the hypothermic treatment, this study investigated its effects on the expression of cell death or survival related proteins such as p53, Bcl-2 and Bax in the rat traumatic brain injury(TBI) model. METHODS: Twenty rats (Spraque Dawley, 200~250g) were subjected to the brain injury of moderate severity (2.4~2.6atm) using the fluid percussion injury device and five rats were received only same surgery as controls. During 30minutes after the brain injury, the hypothermia group was maintained the body temperature around 34 degrees C while the control group were maintained that of 36 degrees C. Five rats in each group were sacrificed 12h or 24h after brain injury and their brain sections was analyzed for physical damages by H-E stains and the extent of apoptosis by TUNEL assay and immunohistochemical stains. The tissue damage after TBI was mainly observed in the ipsilateral cortex and partly in the hippocampus. RESULTS: Apoptosis was observed by TUNEL assay and the Bax protein was detected in both sample which harvested 12h and 24h after TBI. In the hypothermia treatment group, tissue damage and apoptosis were reduced in HE stains and TUNEL assay. In hypothermia treatment group rat shows more expression of the Bcl-2 protein and shows less expression of the Bax protein, at both 12h and 24h after TBI. CONCLUSION: These results show that the hypothermia treatment is an effective treatment after TBI, by reducing the apoptotic process. Therefore, it could be suggested that hypothermia has a high therapeutic value for treating tissue damages after TBI.
Animals ; Apoptosis ; bcl-2-Associated X Protein ; Body Temperature ; Brain ; Brain Injuries* ; Cell Death ; Coloring Agents ; Hippocampus ; Hypothermia* ; In Situ Nick-End Labeling ; Neurons* ; Neuroprotective Agents ; Percussion ; Rats