BACKGROUND/AIMS: To compare treatment outcome of hepatocellular carcinoma(HCC) under the size of 5 cm in relation to underlying liver function and treatment modalities, analysis of data from 145 patients was performed. METHODS: In this study, the records of 145 patients with small HCC (< 5 cm in diameter determined by hepatic angiography) were reviewed. Clinical parameters were analyzed and survival rate, recurrence rate were calculated. RESULTS: There were 107(73.8%) men and 38 women. Mean age at diagnosis was 55.1(range .' 25 83 year-old). HBsAg was detected in 97(66.9%) patients. Seventy two(50.0%) patients showed markedly elevated(>40 ng/mL) serum alpha-fetoprotein(AFP) level. Liver cirrhosis was associated in 109(75.2%) patients. Sixty five(44.8%) patients underwent surge, 63(43.5%) underwent transarterial therapy(TAT), 8(5.5%) underwent other modalities of therapy and the remaining 9(6.2% ) patients did not receive any specific treatment for HCC. In relation to the underlying liver function, 119(82.1% ) patients belonged to the non-cirrhotic or Child-Pugh class A, 20(13.8%) to class B and 6(4.1%) to class C. The median follow-up duration was 21 months. When analyzed with respect to treatment modalities alone, median survival was 43 months for all patients, 60 months for surgery, 29 months for TAT, 20 months for other treatment and 18 months for patients who received no specific treatment. Without considering liver function, cumulative 3 year survival rate was 68.6% for surgery, 43.9% for TAT, 29.2% for other treatment and 0% for no treatment. The survival rate for the patients who underwent surgery was significantly higher than for any other treatment modalities without considering the underlying liver function or in the non-cirrhotic/Child-Pugh class A(p<0.001). In patients whose tumor size was equal to or less than 3 cm, there was no difference in survival rate in relation to the treatment modalities when not considering the underlying liver function of each patient(p>0.05). But in patients classified as the non-cirrhotic/Child-Pugh class A, better survival was observed in the surgep group than the TAT group(p<0.05). The only factor influencing survival was the pre-treatment serum AFP level(p<0.05). The overall recurrence rate was 30.3%. For the entire patients, the factor significantly influencing the recurrence rate was the presence of underlying cirrhosis. When considering only the patients in the surgery group, the different types of surgical procedures significantly influenced the recurrence rate. CONCLUSION: Surgery is the treatment of choice for patients with HCC equal to or smaller than 5 cm. But for those patients whose tumor size is less than 3 cm, TAT may be a reasonable alternative to surgep when the liver function is not adequate for hepatic resection. Because overall recurrence rate exceeded 30% and median time of recurrence was only 9.5 months after definitive treatment, careful follow-up is required for all patients who undergo treatment for small HCC.
Carcinoma, Hepatocellular* ; Diagnosis ; Female ; Fibrosis ; Follow-Up Studies ; Hepatitis B Surface Antigens ; Humans ; Liver Cirrhosis ; Liver* ; Male ; Recurrence ; Survival Rate ; Treatment Outcome*

A 50-year-old woman reported to the emergency department with thunderclap headache and vomiting. Non-enhanced brain computed tomography (CT) showed a subarachnoid hemorrhage of Hunt-Hess Grade II and Fisher Grade III. Brain angiography CT and transfemoral cerebral angiography (TFCA) revealed an aneurysm of the anterior communicating artery. A direct neck clipping was performed using the pterional approach. The post-operation CT was uneventful. Six days postoperatively, the patient became lethargic. The mean velocity (cm/s) of the middle cerebral artery peaked at 173 cm/s on the right side and 167 cm/s on the left. A TFCA revealed decreased perfusion in both recurrent arteries of Heubner (RAH), but no occlusion in either. Intra-arterial nimodipine injection was administered. On the 7th postoperative day, CT demonstrated a newly developed low-density lesion in the RAH territory bilaterally. The cause of the infarction was attributed to decreased perfusion caused by cerebral vasospasm. The patient was discharged with no definite neurologic deficit except for mild cognitive disorder.
Aneurysm ; Angiography ; Arteries* ; Brain ; Cerebral Angiography ; Emergency Service, Hospital ; Female ; Headache Disorders, Primary ; Humans ; Infarction* ; Infarction, Anterior Cerebral Artery ; Intracranial Aneurysm* ; Middle Aged ; Middle Cerebral Artery ; Neck ; Neurologic Manifestations ; Nimodipine ; Perfusion ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial ; Vomiting

PURPOSE: To evaluate the clinical result of hydroxyapatite implantation using autologous sclera as wrapping material. METHODS: From December 2001 to February 2003, we performed 20 cases of hydroxyapatite implantation with autologous sclera as wrapping material. Eyes were enucleated for severe phthisis because evisceration could not provide adequate space for hydroxyapatite implantation or secondary hydroxyapatite implantation after prior evisceration. Postoperative complications were evaluated at postoperative 1 week, 2 weeks, 3 weeks - 1 month, 2 months, 3 months, and every 2 or 3 months thereafter. RESULTS: The mean follow up period was 12.1 +/- 4.52 months (4~18 months). During the follow up period, conjunctival erosions developed in 2 cases, which were controlled by conservative management only. No such postoperative complications as implant exposure, orbital infection, extrusion, inflammatory reaction occured. CONCLUSIONS: Autologous sclera is the suitable wrapping material of hydroxyapatite implant when enucleation is needed in primary surgery for severe phthisis, or for secondary hydroxyapatite implantation after prior evisceration surgery.
Durapatite* ; Follow-Up Studies ; Orbit* ; Orbital Implants* ; Postoperative Complications ; Sclera*

PURPOSE: To evaluate the effect of photodynamic therapy (PDT) for idiopathic subfoveal choroidal neovascularization with various imaging studies. METHODS: We retrospectively reviewed the medical records and imaging studies of 17 patients (17 eyes) who were diagnosed with idiopathic subfoveal choroidal neovascularization and treated with PDT between December 2000 and May 2003. Slit lamp examination, fluorescein angiography (FAG), indocyanine green angiography (ICGA), and optical coherence tomography (OCT) were conducted before and after PDT. RESULTS: After PDT, the mean visual acuity was improved from 0.23 (20/80) to 0.48 (20/40). On FAG, the mean size of neovascular lesion (the longest length of lesion) was slightly decreased from 2038 +/- 592 micrometer to 1872 +/- 622 micrometer after PDT. However, the change was not significant. Fluorescein dye leakage decreased or disappeared, but staining of the lesion was noted. On OCT, the macular edema disappeared, but the hyperreflective area remained after PDT. CONCLUSIONS: PDT was effective in the treatment of idiopathic choroidal neovascularization. The factors representing the therapeutic effect of PDT were visual improvement, decreased leakage on FAG, and decreased macular edema on OCT, and these three factors were significantly related to each other.
Angiography ; Choroid* ; Choroidal Neovascularization* ; Fluorescein ; Fluorescein Angiography ; Humans ; Indocyanine Green ; Macular Edema ; Medical Records ; Photochemotherapy* ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

No abstract available.
Humans ; Liver Cirrhosis/*therapy ; *Nutrition Assessment ; *Nutritional Support

PURPOSE: The therapeutic effects of amniotic membrane transplantation (AMT) contain anti-fibrosis, anti-inflammation and facilitation of epithelialization. Thus we investigated whether applying of amniotic membrane (AM) ointment could get the same effect as AMT. METHODS: Alkali burn was induced by applying 6 mm round filter paper which was soaked with 1 N NaOH, onto the central cornea for 60 seconds on both eyes of 10 white rabbits. Then we applied AM ointment on one eye and base ointment on the other eye, four times a day for 1 week. The corneas were harvested for histopathologic studies at 1 day and 3 weeks. Corneal opacity and thickness were measured in 3 days and 1, 2, 3 weeks. RESULTS: In the AM ointment applicated group, the number of the infiltrated PMNs (polymorp-honuclear cells) and apoptotic keratocytes were significantly less than that of the control group (P<0.05). The degree of lipid peroxidation and myofibroblast differentiation were less than those of the control group. Corneal opacity and corneal edema were less in AM ointment group than control group. CONCLUSIONS: AM ointment application after alkali burn is beneficial to reduce inflammation, keratocyte apoptosis and lipid peroxidation, and is considered to suppress corneal haze by these effects. Therefore, this report may be a basic study for the AM ointment research to treat recalcitrant keratitis.
Alkalies ; Amnion ; Apoptosis ; Ascorbic Acid* ; Burns ; Cataract ; Cornea ; Corneal Edema ; Corneal Opacity ; Epithelial Cells* ; Fibronectins ; Hydrogen Peroxide* ; Hydrogen* ; Inflammation ; Keratitis ; Lipid Peroxidation ; Myofibroblasts ; Rabbits

PURPOSE: The purpose of this study is to evaluate the clinical and radiological results of the trochanteric flip osteotomy in cases of femoral head fractures. MATERIALS AND METHODS: Between May 2000 and January 2012, we evaluated 14 cases of femoral head fractures treated by trochanteric flip osteotomy in combination with the Kocher-Langenbeck approach after a minimum follow-up of one year. There were 13 men and one woman and the average follow-up period was 36.4 months. The clinical results were evaluated according to Merle d'Aubigne-Postel scores and the Thompson-Epstein scoring scale and the radiological results were evaluated according to time to union of fractures and osteotomy site. We also evaluated the incidence of complications. RESULTS: At the last follow-up, mean Merle d'Aubigne-Postel score was 16.4 and 11 cases out of 14 patients presented with good to excellent, two cases presented with fair, and one case presented with a poor clinical result according to the Thompson-Epstein scoring scale. Radiologically all cases achieved union of fractures and osteotomy site and the mean time to union of the osteotomy site was 7.9 weeks. Complications included one case of heterotopic ossification which did not disturb hip function, two cases of avascular necrosis of the femoral head, and one case of post-traumatic osteoarthritis. CONCLUSION: The trochanteric flip osteotomy in the case of a femoral head fracture showed good clinical and radiological results through good visualization and accurate reduction of the fracture site. However, conduct of further studies including larger number of patients is needed in order to evaluate the incidence of complications such as avascular necrosis of the femoral head.
Female ; Femur ; Femur Head ; Follow-Up Studies ; Head ; Hip ; Humans ; Incidence ; Male ; Necrosis ; Ossification, Heterotopic ; Osteotomy

BACKGROUND: Contact immune modulating therapy with diphenylcyclopropenone (DPCP) is a topical treatment option for extensive alopecia areata (AA). Because the response to DPCP treatment varies according to the patient, and it takes several months to evaluate the clinical effectiveness of the treatment, it is necessary to identify the factors that can predict the prognosis of the disease while treating with topical DPCP. OBJECTIVE: In this study, cytokine levels in the scales of alopecic patches were investigated to identify whether they could predict response to DPCP during the early treatment period. METHODS: Scale samples were taken from the alopecic patches in eight AA patients at 1 week, 2 months, and 4 months after DPCP sensitization. The patients were divided into responders and non-responders according to the clinical responses of DPCP treatment. Interferon (IFN)-gamma, interleukin (IL)-2, IL-12 and IL-10 levels of the subjects were compared in several perspectives. RESULTS: Cytokine levels after 1 week of DPCP sensitization showed no statistically significant difference between two groups. After 4 months of treatment, IFN-gamma levels were significantly lower in responders than in non-responders. CONCLUSION: The results of this study show IFN-gamma levels in the scales of alopecic patches might possibly reflect the clinical response in AA patients treated with DPCP. However, initial cytokine levels could not predict the treatment response.
Alopecia Areata* ; Alopecia* ; Cytokines ; Humans ; Interferons ; Interleukin-10 ; Interleukin-12 ; Interleukins ; Prognosis ; Treatment Outcome ; Weights and Measures*

BACKGROUND: Dysregulation of apoptosis plays an important role in carcinogenesis, tumor progression, and resistance to chemotherapy. X-linked inhibitor of apoptosis (XIAP) is considered to be the most potent caspase inhibitor of all known IAP (inhibitor of apoptosis) family members. This study was designed to assess the pattern of expression and the prognostic value of XIAP in radically resected non-small cell lung carcinoma (NSCLC) patients. METHOD: The expression of XIAP and its relationship with clinicopathologic parameters (patient age, TNM stage, TNM-pT, TNM-pN, histologic type, VEGF expression, microvessel density, PCNA index) and overall survival were analysed with formalin-fixed, paraffin-embedded blocks from eighty cases of NSCLC. In addition, the apoptotic index (AI) was also assessed. RESULTS: In a regard to histologic type, squamous cell carcinoma (SCC) showed XIAP expression in 91.3%(42/46) and adenocarcinoma (AC) in 61.8%(21/34). The difference was significant(p=0.001). There was no correlation between XIAP expression and other parameters. In the group of AC, XIAP expression showed the signifcant correlation with older age group > or = 58 years and VEGF expression(p=0.028, p=0.014, respectively). The AI in the group with or without XIAP expression were 2.5+/-4.9% and 18.5+/-28.9%, respectively(p=0.001). Both groups just aforementioned showed no significant difference in median survival time (42.5 months, 29.8 months, respectively). CONCLUSION: This study suggests that the XIAP expression in NSCLCs could have relation to inhibition of apoptosis, and show differential expression according to histologic type. However, its prognostic role during the progression of NSCLC needs to be further defined.
Adenocarcinoma ; Apoptosis* ; Carcinogenesis ; Carcinoma, Squamous Cell ; Drug Therapy ; Humans ; Inhibitor of Apoptosis Proteins ; Lung ; Microvessels ; Prognosis* ; Proliferating Cell Nuclear Antigen ; Small Cell Lung Carcinoma* ; Vascular Endothelial Growth Factor A ; X-Linked Inhibitor of Apoptosis Protein*

Nodular fasciitis is rare and benign fibroblastic proliferative disease which tends to be confused microscopically with spindle cell sarcoma. It is a distinctive lesion and a very important one because of its ability to simulate a malignant process. Histopathologically, nodular fasciitis can be grouped into three subtypes based on their relation with the fascia: subcutaneous, fascial, intramuscular. We report a case of nodular fasciitis misdiagnosed as Baker's cyst in a patient with rheumatoid arthritis.
Arthritis, Rheumatoid* ; Fascia ; Fasciitis* ; Fibroblasts ; Humans ; Popliteal Cyst* ; Sarcoma