Duplicated inferior vena cava (IVC) is a congenital anomaly seen rarely in the general population. Patients with IVC variants usually do not present any symptoms and are found incidentally in many cases. However, physicians are urged to recognize the presence of such anomalies during diagnostic or invasive procedures as these variants of blood vessel systems can impose substantial implications in certain clinical situations. Subsequently, information about IVC variants may become critical if surgical injuries or predisposing conditions act as life-threatening risks to patients during medical procedures. We present a case of duplicated IVC in a 68-year-old female patient with rectal cancer where an IVC anomaly was found during surgical resection of her tumor. From our experience, we emphasize the importance of having the knowledge of IVC variations in patients undergoing invasive surgical procedures which may involve large vessels.
Aged ; Blood Vessels ; Female ; Glycosaminoglycans ; Humans ; Intraoperative Complications ; Laparotomy ; Rectal Neoplasms ; Vena Cava, Inferior

PURPOSE: Laparoscopic colectomy has clinical benefits such as short hospital stay, less postoperative pain, and early return of bowel function. However, objective evidence of its immunologic and oncologic benefits is scarce. We compared functional recovery after open versus laparoscopic sigmoidectomy and investigated the effect of open versus laparoscopic surgery on acute inflammation as well as tumor stimulation. MATERIALS AND METHODS: A total of 57 patients who were diagnosed with sigmoid colon cancer were randomized for elective conventional or laparoscopically assisted sigmoidectomy. Serum samples were obtained preoperatively and on postoperative day 1. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured as inflammation markers, and vascular endothelial growth factor (VEGF) and insulin-like growth factor binding protein-3 (IGFBP-3) were used as tumor stimulation factors. Clinical parameters and serum markers were compared. RESULTS: Postoperative hospital stay (p=0.031), the first day of gas out (p=0.016), and the first day of soft diet (p<0.001) were significantly shorter for the laparoscopic surgery group than the open surgery group. The levels of CRP, IL-6, and VEGF rose significantly, and the concentration of IGFBP-3 fell significantly after both open and laparoscopic surgery. However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups. CONCLUSION: Our data suggest that both open and laparoscopic surgeries are accompanied by significant changes in IL-6, CRP, IGFBP-3, and VEGF levels. Acute inflammation markers and tumor stimulating factors may not reflect clinical benefits of laparoscopic surgery.
Aged ; Biological Markers/blood ; C-Reactive Protein/metabolism ; Colectomy/*adverse effects/methods ; Female ; Humans ; Inflammation/etiology/metabolism ; Insulin-Like Growth Factor Binding Protein 3/blood ; Interleukin-6/blood ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Postoperative Period ; Sigmoid Neoplasms/*surgery ; Treatment Outcome ; Vascular Endothelial Growth Factor A/blood

OBJECTS: We developed the Korean version of Hasegawa Dementia Scale(HDS-K) by translating the revised Hasegawa Dementia Scale(HDS-R) which is known to be a useful brief screening instrument for dementia. MATERIALS AND METHODS: The translation was carried out keeping the basic structure of Revised Hasegawa Dementia Scale(HDS-R). HDS-K, along with MMSE-KC, SBT-K and CDR, were administered to 174 dementia patients and 160 elderly control subjects. Cronbach alpha coefficient, inter-rator reliability, and test-retest reliability of HDS-K were examined. The correlations of MMSE-KC, SBT-K and CDR with HDS-K were also examined to confirm the validity of HDS-K. Cut-off scores for dementia were estimated by Receiver Operator Characteristic(ROC) curve anslyses. By comparing Area Under Curve(AUC), the diagnostic efficiency of HDS-K was compared with those of MMSE-KC and SBT-K. RESULTS: 1) HDS-K was found to have significantly high internal consistency(Cronbach alpha coefficient=0.948, <0.01), inter-rater reliability(Pearson correlation coefficient=0.999, <0.01) and test-retest reliability(Pearson correlation coefficient=0.848, <0.01). 2) All the correlations of HDS-K with MMSE-KC, SBT-K and CDR were significant indicating that HDS-K has good concurrent validity. Its optimal cut-off point for dementia was estimated as 15/16, where the sensitivity and specificity were 0.950 and 0.902, respectively. 3) The ROC curve analysis indicated that the diagnostic efficiency of HDS-K(AUC=0.972) was comparable with MMSE-KC(AUC=0.951) and SBT-K(AUC=0.963). CONCLUSION: We conclude that HDS-K is a reliable, valid, and useful screening instrument for dementia.
Aged ; Dementia* ; Humans ; Mass Screening* ; Reproducibility of Results* ; ROC Curve ; Sensitivity and Specificity ; Translating

The recent introduction of an intraoperative near infrared fluorescence (INIF) imaging system installed on the da Vinci Si(R) robotic system has enabled surgeons to identify intravascular NIF signals in real time. This technology is useful in identifying hidden vessels and assessing blood supply to bowel segments. In this study, we report 3 cases of patients with rectal cancer who underwent robotic low anterior resection (LAR) with INIF imaging for the first time in Asia. In September 2012, robotic-assisted rectal resection with INIF imaging was performed on three consecutive rectal cancer patients. LAR was performed in 2 cases, and abdominoperineal resection was performed in the third case. INIF imaging was used to identify the left colic branch of the inferior mesenteric artery and to assess blood supply to the distal rectum. We evaluated the utility of INIF imaging in performing robotic-assisted colorectal procedures. Our preliminary results suggest that this technique is safe and effective, and that INIF imaging may be a useful tool to colorectal surgeons.
Aged ; Digestive System Surgical Procedures/*methods ; Female ; Fluorescence ; Humans ; Image Processing, Computer-Assisted/instrumentation/*methods ; *Intraoperative Care ; Male ; Middle Aged ; Rectal Neoplasms/*surgery ; Rectum/*surgery ; Robotics/*methods ; Spectroscopy, Near-Infrared/*methods ; Treatment Outcome

No abstract available.
Drug Therapy, Combination ; Female ; Human ; Infant ; Male ; Serologic Tests ; Toxoplasma/immunology ; Toxoplasmosis, Congenital/complications ; Toxoplasmosis, Congenital/diagnosis ; Toxoplasmosis, Congenital/pathology*

The familial occurrence of intracranial aneurysms, defined as the presence of one or more aneurysms in two or more blood relatives, is well established and is relatively rare. The pattern of inheritance in these families is not usually known. The authors report one case of familial intracranial aneurysm, without specific genetic disorder, occurring during a recent six-month period in three of five siblings. Two of these were females, aged 36 and 39, and the other was a 40-year-old male. Two of these patients had ruptured aneurysms, but in the other, the aneurysm was unruptured. All were treated successfully by clipping of the aneurysmal neck, without any neurological deficits. The authors describe their experience of a rare familial intracranial aneurysm, occurring in the absence of a specific genetic disorder, and review the literature concerning this type of aneurysm.
Adult ; Aneurysm ; Aneurysm, Ruptured ; Female ; Humans ; Intracranial Aneurysm* ; Male ; Neck ; Siblings ; Subarachnoid Hemorrhage ; Wills

OBJECTIVES: Thalamic structural changes were implicated in the pathophysiology of schizophrenia by some studies. So, we investigated the differences in thalamic volumes between previously untreated patients with first-episode schizophrenia and controls. METHODS: Thalamic volumes of 24 subjects with schizophrenia and 24 controls were measured from their T1-weighted coronal magnetic resonance images using manual tracing. The thalamus was further segmented into regions that roughly reflected individual thalamic nuclei. RESULTS: Comparing to the controls, significantly smaller volumes were found in the left posterior subdivision of thalamus in patient group. Tendency of volume differences were also seen in right posterior subdivision of thalamus in patient group. These regions primarily comprised the pulvinar, a thalamic nucleus thought to be an important component of aberrant circuitry in schizophrenia. CONCLUSION: Our findings suggest the possibility of a volumetric alteration of the thalamus in patients with first-episode schizophrenia.
Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Pulvinar ; Schizophrenia ; Thalamus

Anorectal malignant melanoma (AMM) is a very rare and aggressive disease. The purpose of this article is to review the clinical features of AMM, to understand treatment options, and optimal therapy by reviewing pertinent literature. Traditionally an abdominoperineal resection (APR) sacrificing the anal sphincter has been performed for radical resection of cancer, but recently, wide excision of AMM is attempted since quality of life after surgery is an important issue. Some authors reported that there was no difference in five-year survival between the patient who underwent an APR and wide excision. The goal of both APR and wide excision was to improve survival with R0 resection. Adjuvant chemoradiation therapy can be performed to achieve an R0 resection. AMM shows very poor prognosis. At this time, research on AMM is insufficient to suggest a treatment guideline. Thus, treatment options, and a therapeutic method should be selected carefully.
Anal Canal ; Anus Neoplasms ; Humans ; Melanoma* ; Prognosis ; Quality of Life ; Skin Neoplasms

PURPOSE: A colorectal carcinoma is the fourth most common malignancy in the world. Unfortunately, only approximately 20% of the liver metastases are resectable at the initial presentation. Neoadjuvant chemotherapy has been used for downsizing in unresectable disease. In addition, the use of newer biologic agents, such as cetuximab and bevacizumab, has much improved responses in patients with unresectable colorectal liver metastases. The aim of this study was to report on patients who had received a curative resection following neoadjuvant chemotherapy including a molecularly targeted agent for unresectable colorectal liver metastases. METHODS: Following the neoadjuvant chemotherapy using cetuximab plus FOLFIRI (irinotecan and infused fluorouracil plus leucovorin) or bevacizumab plus FOLFOX (oxaliplatin and infused fluorouracil plus leucovorin), 10 patients with initially unresectable colorectal liver metastases underwent a curative surgical resection between September 2005 and June 2007. RESULTS: One patient underwent a right lobectomy, three patients a segmentectomy and five a wedge resection with or without radiofrequency ablation. With a median postoperative follow-up of 14 months (range, 1 to 22 months), five recurrences (50%) occurred. The common toxic effects were grade 2/3 skin toxicity (60%), grade 4 hematologic toxicity (20%), grade 3 gastrointestinal toxicity (10%), and grade 3 neurologic toxicity (10%). CONCLUSIONS: Our preliminary data suggests that neoadjuvant chemotherapy including a molecularly targeted agent may improve resectability in patients with initially unresectable colorectal liver metastases although a high recurrence rate exists. Randomized prospective studies comparing neoadjuvant chemotherapy including a targeted agent in cases of unresectable colorectal liver metastases are warranted.
Antibodies, Monoclonal, Humanized ; Bevacizumab ; Cetuximab ; Colorectal Neoplasms ; Fluorouracil ; Follow-Up Studies ; Humans ; Liver ; Mastectomy, Segmental ; Neoplasm Metastasis ; Recurrence ; Skin

The efflux pump system has been suggested as an important mechanism in the drug resistance of Mycobacterium tuberculosis (MTB). In this study, molecular analysis of five genes in the efflux pump system of MTB isolates from Korean patients was performed in order to identify appropriate molecular targets. In this study, 35 culture-positive specimens were included. PCR was performed for five efflux genes, mmpL7, efpA, mmr, p55 and tap-like gene. In the 35 clinical isolates, molecular analysis of five kinds of efflux pump genes was performed. Only one clinical isolate showed negative PCR results for all five efflux pump genes. All the rest 34 isolates presented concurrent positive results for the five efflux pump genes. In the near future, gene expression study with quantitative PCR should be performed using these genes.
Drug Resistance ; Gene Expression ; Genes, MDR ; Humans ; Mycobacterium tuberculosis* ; Polymerase Chain Reaction