While simultaneous bilateral partial nephrectomy with a conventional multiport robot has been consistently reported since the 2010s, the introduction of the DaVinci SP system (Intuitive Surgical, Sunnyvale, CA, USA) could provide a novel way to perform surgery on bilateral kidneys while innovatively reducing the number of incisions. In our first report worldwide, the patient with bilateral small renal mass (2.0 cm for the left and 1.5 cm for the right side) and preoperative normal renal function was placed in the lateral decubitus position on an inverted bed. After tilting the bed to be as horizontal as possible, a 4-cm incision was made in the lower part of the umbilicus for the floating trocar technique. The partial nephrectomy was performed reliably as with the conventional transperitoneal approach, and then the patient could be repositioned to the contralateral side for the same procedure, maintaining all trocars. Total operation time (skin to skin), total console time, and the left- and right-side warm ischemic times were 260, 164, 27, and 23 minutes, respectively, without applying the early declamping technique. The estimated blood loss was 200 mL. The serum creatinine right after the operation, on the first day, 3 days, and 90 days after surgery were 0.92, 0.77, 0.79, and 0.81 mg/dL, respectively. For 90 days after the procedure, no complications or radiologic recurrence were observed. Further clinical studies will reveal the advantages of using the DaVinci SP device for this procedure over traditional multiport surgery, maximizing the benefit of a single port-based approach.

OBJECTIVE: Human embryonic stem cell derived from blastocyst randomly differentiates into multiple cell types during embryoid body development. Bone morphogenetic proteins (BMPs) are members of the transforming growth factor type beta superfamily. We have a question whether BMP2 and/or BMP4 can induce trophoblast specific genes in human ES cells using SNU hES3 cell line. METHODS: Human embryonic stem cell line (SNU hES3) was supplied by Miz Medi Hospital Seoul National University. Cultured hES cells were divided into small clumps and then allow for EB formation in differentiation medium. After EB formation, EBs were transferred onto gelatin coated dishes and given hES conditioned medium alone (control) or supplemented as following treatment for 6 days; rhBMP4 100 ng/mL; rhBMP2 100 ng/mL; BMP4 100 ng/mL +BMP2 100 ng/mL. RT PCR was performed for trophoblast specific genes. During culture, supernatant was collected and measured for estradiol (E2), progesterone, and hCG beta by enzymeimmuno assay (EIA) kit. RESULTS: BMP4 and BMP2 increase chorionic gonadotropin beta (hCG beta), glical cell missing 1 (GMC1), and CD9 as trophoblast specific gene markers confirmed by RT PCR. However, the non classical HLA class I molecule HLAG1, was not expressed in our studies. And we cannot find significant differences of the level of estradiol, hCG nd progesterone in this study. CONCLUSION: The results suggest that BMP 4 and 2 have an additive effect on induction of trophoblast related genes in SNU hES3 cell line. Although we failed to induce the differentiation of human ES cells to trophoblast, this study could provide the possibility for the differentiation of early human trophoblast cells and thus need further studies.
Blastocyst ; Bone Morphogenetic Proteins ; Cell Line* ; Chorionic Gonadotropin ; Chorionic Gonadotropin, beta Subunit, Human ; Culture Media, Conditioned ; Embryoid Bodies ; Embryonic Stem Cells* ; Estradiol ; Gelatin ; Humans* ; Polymerase Chain Reaction ; Progesterone ; Seoul ; Transforming Growth Factors ; Trophoblasts

Metastasis to small bowel from non-small cell lung cancer is known to be very rare. Here we report a case of intussusception induced by jejunal metastasis of non-small cell lung cancer. A 47-year old man was admitted to hospital complaining cough and sputum for 3 months. He was diagnosed as squamous cell lung cancer by percutaneous needle biopsy of lung mass detected by chest X-ray and CT. Multiple brain metastatic lesions were detected by brain CT on admission. Systemic chemotherapy with whole brain irradiation was performed. After three cycles of chemotherapy, he was admitted with sudden-onset abdominal pain, nausea and vomiting. Jejunal intussusception was the diagnosis by abdominal CT and histologic examination of resected jejunum showed it was induced by metastatic mass from the primary lung cancer.(Korean J Med 64:235-239, 2003)
Abdominal Pain ; Biopsy, Needle ; Brain ; Carcinoma, Non-Small-Cell Lung* ; Cough ; Diagnosis ; Drug Therapy ; Humans ; Intussusception* ; Jejunum ; Lung ; Lung Neoplasms ; Middle Aged ; Nausea ; Neoplasm Metastasis* ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Vomiting

Kasabach-Merritt phenomenon does not occur with common hemangioma, rather it is associated with the more aggressive Kaposiform hemangioendothelioma and rarely with other vascular neoplasm. We report the case of an adult who was diagnosed as Kaposiform hemangioendothelioma complicated by Kasabach-Memtt phenomenon. This is the first report in Korea of an adult with Kasabach-Merritt phenomenon who has osteolytic changes of femur, pelvic bone, and lumbar spine.
Adult* ; Femur ; Hemangioendothelioma* ; Hemangioma ; Humans ; Kasabach-Merritt Syndrome ; Korea ; Pelvic Bones ; Spine ; Vascular Neoplasms

PURPOSE: The prognosis of a ductal adenocarcinoma of the body and tail of the pancreas is poor because it is usually diagnosed at an advanced stage and is rarely resectable. The aim of this study was to evaluate the clinical outcomes after a surgical resection of an adenocarcinoma of the distal pancreas. METHODS: A total of 311 patients with an adenocarcinoma of the distal pancreas were admitted between 1985 and 2001, and of these, 54 patients were surgically treated; 29 patients underwent a distal pancreatectomy (extended resection in 12 cases), 9 underwent a palliative bypass, and 16 underwent a open biopsy. The clinical outcome of the 29 patients who underwent a surgical resection for the adenocarcinoma of the distal pancreas was retrospectively analyzed. RESULTS: The resectability rate was 9.3% (29/311). In the resected cases, the cumulative 3-year survival rate was 14.9%, whereas it was 0% (p=0.013) in the non-resected cases. Moreover, a significant survival difference was found between the curatively resected cases (n=16, 28.1%) and the palliatively resected cases (n=13, 0%)(p=0.003). After the curative resection, 11 patients (68.8%) developed a recurrence. Three patients survived more than 3 years (46, 74, 56 months), of whom only one had no recurrent disease. The size of the tumor and the residual tumor were identified as independent significant prognostic factors by multivariate analysis. CONCLUSION: Only a curative resection can offer long-term survival as well as a survival benefit in patients with a ductal adenocarcinoma of the body and tail of the pancreas. Therefore, a surgical resection should be preferably performed and efforts for a curative resection should be made. However, adjuvant therapy, local and systemic, needs to be further developed because most patients develop a recurrence after the resection.
Adenocarcinoma* ; Biopsy ; Carcinoma, Pancreatic Ductal ; Humans ; Multivariate Analysis ; Neoplasm, Residual ; Pancreas* ; Pancreatectomy ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

We report a case of free flap deterioration which may have been induced by pressure gradient resulting from cranial defect overlying a ventriculoperitoneal shunt (VP shunt). The patient, male and aged 78, had a VP shunt operation for progressive hydrocephalus. Afterwards, the scalp skin flap surrounding the VP shunt collapsed and showed signs of necrosis, exposing part of the shunt catheter. After covering the defect with a radial forearm free flap, the free flap site showed signs of gradual sinking while the vascularity of the flap remained unimpaired. An agreement was reached to remove the shunt device and observe the patient for any neurological symptoms, and after the shunt was removed and the previous cranial opening filled with fibrin glue by Neurosurgery, we debrided the deteriorated flap and provided coverage with 2 large opposing rotational flaps. During 2 months' outpatient follow-up no neurological symptoms appeared, and the new scalp flap displayed slight depression but remained intact. The patient has declined from any further follow-up since.
Catheters ; Decompressive Craniectomy ; Depression ; Fibrin Tissue Adhesive ; Follow-Up Studies ; Forearm ; Free Tissue Flaps* ; Humans ; Hydrocephalus ; Male ; Necrosis ; Neurosurgery ; Outpatients ; Scalp ; Skin ; Ventriculoperitoneal Shunt*

Laparoscopic liver resection has been widely accepted nowadays for selective cases of liver diseases. Laparoscopic left lateral sectionectomy and minor LLR are considered standard practice worldwide and cautious introduction of major laparoscopic liver resections like hemihepatectomies, central sectionectomy etc.. in institutions having experienced liver surgeons. Because of increasing young liver donor, laparoscopic donor hepatectomy is becoming popular, which gives better cosmetic outcomes. Many clinical trials compared laparoscopic liver resection safety, long term outcomes with open procedures. More recently, advances in laparoscopic instruments and techniques encouraged Korean surgeons to choose a laparoscopic procedure as one of the treatment options for benign or malignant diseases of liver.
Hepatectomy ; Humans ; Liver Diseases ; Liver* ; Mastectomy, Segmental ; Surgeons ; Tissue Donors

Language disorganization, an objective component of formal thought process abnormality, has been regarded as a core symptom of schizophrenia from an evolutionary psychopathology perspective. However, to the best of our knowledge, the network structure of language disorganization has rarely been examined in patients with schizophrenia. Thus, our preliminary study aimed to evaluate the network structure using the Clinical Language Disorder Rating Scale (CLANG) in 167 inpatients with schizophrenia. All 17 of the CLANG items were considered to be ordered categorical variables ranging from 0 to 3. Our results indicated that disclosure failure, excess syntactic constraints, abnormal prosody, and aprosodic speech rank among the top five central domains within the network structure. We deemed that disclosure failure and prosody problems are the most important symptoms of language disorder in schizophrenia. Thus, reduced top-down processing of linguistic information may be a core neurobiological underpinning of language disorganization in schizophrenia. Further studies controlling for the potential effects of confounding factors (i.e., duration of illness) on network analyses of language disorder and formal thought disorder are warranted in patients with schizophrenia.

PURPOSE: This study was done to review our clinical experience of fluorodeoxyglucose (FDG)-positron emission tomography (PET) in biliary-pancreatic malignancies, and evaluated its diagnostic accuracy and usefulness. METHODS: FDG-PET was performed in 15 patients with biliary-pancreatic malignancies, to determine the extent of the disease (n=9) and to detect the recurrence (n=6). RESULTS: Of the 9 patients with a suspected loco-regional spread, 6 patients were disclosed by FDG-PET as having multiple metastasis to the regional lymph nodes and extraperitoneal organs, but the other 3 showed no evidence of regional or distant metastasis. Thus, FDG-PET performed preoperatively to estimate the extent of the disease, showed sensitivity and specificity of 100%, respectively. However, for the detection of a recurrent disease only 3 out of 5 with recurrent diseases were detected by FDG-PET (sensitivity: 60%). FDG-PET revealed one suspected recurrent lesion, but a computed tomography (CT) scan showed no evidence of a recurrence. Due to the 2 false-negative results, the overall sensitivity and specificity of this study were 81.8 (9/11) and 100% (4/4), respectively. CONCLUSION: Unnecessary surgical procedures were avoided in 6 cases, and 3 curative surgeries aborted through the use of FDG-PET. Despite the lack of cases, FDG-PET was useful in estimating the extent of a disease, but was unsatisfactory in detecting a recurrent disease compared to CT. Coupled with conventional imaging, FDG-PET may also provide more helpful information for biliary-pancreatic malignancies as well.
Humans ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Sensitivity and Specificity

Cytomegalovirus (CMV) infection commonly affects patients who are in an immunocompromised state, such as acquired immune deficiency syndrome (AIDS) and during organ transplantation. Although cytomegalovirus infection does not occur frequently, it is a major cause of morbidity and mortality in patients suffering with connective tissue diseases, including dermatomyositis. Cytomegalovirus pneumonitis and retinitis has been rarely reported in patients with dermatomyositis. We report here on an usual case involving the simultaneous occurrence of cytomegalovirus pneumonitis and retinitis in a 39-year-old female with dermatomyositis, and this woman had been treated with steroids and immunosuppressive agents for the previous 5 months.
Acquired Immunodeficiency Syndrome ; Adult ; Connective Tissue Diseases ; Cytomegalovirus ; Cytomegalovirus Infections ; Cytomegalovirus Retinitis ; Dermatomyositis ; Female ; Humans ; Immunosuppressive Agents ; Organ Transplantation ; Pneumonia ; Retinitis ; Steroids ; Stress, Psychological ; Transplants