The sinking skin flap syndrome (SSFS) is a rare complication after a large craniectomy. Hemorrhage infarction after a cranioplasty is a very rare complication with only 4 cases to date. We report a case of the patient who underwent an autologous cranioplasty to treat SSFS that developed intracerebral hemorrhage infarction. A 20-year-old male was admitted to our emergency department with stuporous mentality. Emergent decompressive craniectomy (DC) have done. He had suffered from SSFS and fever of unknown origin (FUO) since DC. After 7 months of craniectomy, cranioplasty was done. After 1 day of surgery, acute infarction with hemorrhagic transformation involved left cerebral hemisphere. We controlled increased intracranial pressure by using osmotic diuretics, steroid and antiepileptic drugs. After 14 day of surgery, he improved neurological symptoms and he had not any more hyperthermia. Among several complication of large cranioplasty only 4 cases of intracerebral hemorrhagic infarction due to reperfusion injury has been reported. In this case, unstable autoregulation system made brain hypoxic damage and then reperfusion and recanalization of cerebral vessels resulted in intracerebral hemorrhagic infarction. 7 month long FUO was resolved by cranioplasty.
Anticonvulsants ; Brain ; Cerebral Hemorrhage ; Cerebrum ; Decompressive Craniectomy ; Diuretics, Osmotic ; Emergency Service, Hospital ; Fever ; Fever of Unknown Origin ; Hemorrhage ; Homeostasis ; Humans ; Infarction* ; Intracranial Pressure ; Male ; Reperfusion ; Reperfusion Injury ; Skin* ; Stupor ; Young Adult

BACKGROUND: Women with end-stage renal disease have low fertility. Following renal transplantation, the reproductive function returns to normal, and pregnancy becomes possible. METHOD: At our medical center, between June 1990 and February 1998, 263 female patients underwent renal transplantations, and 14 of them later became pregnant. The outcomes from 23 pregnancies in these 14 kidney transplant recipients were analyzed. RESULT: Forty-three percent (43%) of the pregnancies ended in artificial (9 cases) or spontaneous abortion (1 case), and 11 of 13 deliveries were successful. A vaginal delivery was performed in 9 cases (69%) and a cesarian section was done in 4 cases (31%). All of the 11 pregnancies that continued over 30 weeks ended successfully. The mean age of the recipients at the first pregnancy was 29.4 +/- 4.6 years (23-37). The mean time to first pregnancy since renal transplantation was 22.6 +/- 12.3 months (1-50). Thirteen (13) recipients were maintained on cyclosporin-based immunosuppressive regimens before and during pregnancy. One recipient, who was considered to have developed immune tolerance later, stopped the immunosuppressive drug at 3 months prior to the first pregnancy. The renal function remained stable and unchanged in all the recipients, and no rejection episodes occurred during and after pregnancy in any of the recipients. Preeclamsia occurred in 8 cases (35%) and a previous rupture of membrane in 1 case (4%). Of the 11 live births, 4 (36%) were premature (<37 weeks), 1 (9%) had a lowbirth-weight (<2500 gm), 1 (9%) had transient apnea, and 3 (27%) had transient neutropenia. The mean Apgar score at 1 minute was 7.8 (7-9), with only 2 children having a score below 7. No congenital anomalies were documented. The later development and health of all of the children were good during a mean follow-up of 16.6 +/- 10 (1-38) months. Two (2) recipients who had a successful first pregnancy had a second baby. CONCLUSION: From these results, we can conclude that pregnancy does not adversely affect graft function and fetal development, provided that the graft function was stable at the time of conception and prudent fetal monitoring could be done.
Abortion, Spontaneous ; Apgar Score ; Apnea ; Child ; Female ; Fertility ; Fertilization ; Fetal Development ; Fetal Monitoring ; Follow-Up Studies ; Humans ; Immune Tolerance ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Live Birth ; Membranes ; Neutropenia ; Pregnancy* ; Rupture ; Transplantation ; Transplants

PURPOSE: The aim of this study was to evaluate the usefulness of sentinel lymph node (SLN) biopsy in the treatment of primary melanoma. METHODS: Fifty-one cases that were diagnosed as malignant melanoma of the skin without clinical evidence of regional lymph node metastasis and underwent SLN biopsy at Samsung Medical Center were analyzed retrospectively. A lymphoscintigraphy with peritumoral injection of radionuclide was performed preoperatively. SLNs were identified using a hand-held gamma probe and by methylene blue dye injection intraoperatively. RESULTS: Twenty patients (39%) had metastasis in the SLN and they underwent immediate complete radical dissection of the nodal basin. Among the 20 patients who had SLN metastasis, additional metastatic lymph nodes were detected in 5 patients after the complete lymph node dissection. When several clinico-pathologic parameters such as gender, age, primary tumor location, draining nodal basin, tumor depth and size of tumor were compared between SLN positive group and negative group, there was a significant difference in the mean thickness of melanoma between SLN (+) group (5+/-2.9 mm) and SLN (-) group (4.5+/-5.0 mm) (P<0.05). In the same way, as the thickness of melanoma increased, positive SLN were detected more frequently (P<0.05). Recurrences occurred in 18 patients (35.3%) during the follow-up period, but only one case in 31 patients with negative SLN recurred at the SLN basin without evidence of distant or loco-regional recurrence (false negative rate 4.8%). Lymphedema of extremity developed in 9 patients who underwent complete radical lymph node dissection and 2 patients who underwent only SLN biopsy had a very mild-form lymphedema. CONCLUSION: SLN biopsy in the treatment of cutaneous melanoma is a safe, useful and feasible method to identify status of regional lymph node with low false negative rates and low complications.
Biopsy ; Extremities ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphedema ; Lymphoscintigraphy ; Melanoma ; Methylene Blue ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Recurrence ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Skin

Purpose: Cancer antigen 15-3 (CA15-3) is a serum tumor marker for breast cancer (BC) extensively used in clinical practice. CA15-3 is non-invasive, easily available, and a costeffective tumor marker for immediate diagnosis, monitoring and prediction of BC recurrence. We hypothesized that an elevation of CA15-3 may have prognostic impact in patients with early BC with normal serum CA15-3 level. Methods: This was a retrospective cohort study, which included patients with BC who received curative surgery at a comprehensive single institution between 2000 and 2016.CA15-3 levels from 0 to 30 U/mL were considered normal, and patients who had CA15-3 > 30 U/mL, were excluded from the study. Results: The mean age of study participants (n = 11,452) was 49.3 years. The proportion of participants with elevated CA15-3 ≥ 1 standard deviation (SD) compared with the previous examination during follow-up was 23.3% (n = 2,666). During the follow-up (median followup 5.8 years), 790 patients experienced recurrence. The fully-adjusted hazard ratio (HR) for recurrence comparing participants with stable CA15-3 level to subjects with elevated CA15-3 level was 1.76 (95% confidence interval [CI], 1.52–2.03). In addition, if the CA15-3was elevated ≥ 1 SD, the risk was much higher (HR, 6.87; 95% CI, 5.81–8.11) than in patients without elevated CA15-3 ≥ 1 SD. In sensitivity analysis, the recurrence risk was consistently higher in participants with elevated CA15-3 levels than in participants without elevated CA15-3 levels. The association between elevated CA15-3 levels and incidence of recurrence was observed in all subtypes and the association was stronger in patients with N+ than in patients with N0 stage (p-value for interaction < 0.01). Conclusion The results of the present study demonstrated that elevation of CA15-3 in patients with early BC and initial normal serum CA15-3 levels has a prognostic impact.

Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.
*Hepatectomy/statistics & numerical data ; Humans ; *Laparoscopy/statistics & numerical data ; Liver/*surgery ; Liver Diseases/pathology/surgery ; Liver Neoplasms/pathology/surgery ; Postoperative Complications/epidemiology ; Questionnaires ; Republic of Korea