PURPOSE: To assess the role and efficacy of radiologic intervention in the adult patients with esophagobronchial fistula. MATERIALS AND METHODS: Radiologic intervertion was performed in 4 patients with esophagobronchial fistula. We tried direct occlusion of fistula tract by glue(histoacylate 0.4cc + lipiodol 0.3cc) and coil in 2 patients and performed presurgical wire insertion by using 8F curved catheter via esophageal opening of fistula tract. The latter procedure was carled out to detect the fistula tract easily at operation. RESULTS: Direct occlusions of fistula tract by glue and coil were performed only to fail in 2 patients. Pre-surgical wire incertion by using 8F curred catheter under guidance of fluroscopy in 3 patients were helpful in detecting fistula tract at operation. CONCLUSION: Direct occlusion of the fistulous tract in esophagobronchial fistulas was ineffective. However, presur- gical wire insertion by using cured catheter under fluroscopy guidance is helpful to detect the fistula tract easily at operation.
Adhesives ; Adult* ; Catheters ; Ethiodized Oil ; Fistula* ; Humans

The spontaneous rupture of splenic artery aneurysm during pregnancy is a rare but catastrophic event. Two thirds of all ruptures happen during the third trimester. Clinical presentation is often non-specific, with good hemodynamic compensation, followed by a rapid deterioration. Active management and operation are the most important procedures for diagnosis and therapy of the bleeding. Abdominal delivery will help to establish diagnosis and should be performed immediately. We report a case of a patient at 38 weeks of gestation suffering epigastric pain and fetal distress. At emergency cesarean delivery, an aneurysmal rupture of the splenic artery was found to be the reason for the hemoperitoneum. Spleen, aneurysm and the tail of the pancreas were removed. In spite of fatal hemorrhage, the patient survived but her fetus was dead. With a review of the literature on this topic, diagnostic aspects and treatment options are discussed.
Aneurysm* ; Cesarean Section ; Compensation and Redress ; Diagnosis ; Emergencies ; Female ; Fetal Distress ; Fetus ; Hemodynamics ; Hemoperitoneum ; Hemorrhage ; Humans ; Pancreas ; Pregnancy ; Pregnancy Trimester, Third* ; Rupture ; Rupture, Spontaneous* ; Spleen ; Splenic Artery*

PURPOSE: This descriptive study assessed the current trends in the incidence of urological cancers and patient survival in Korea. MATERIALS AND METHODS: In this nationwide retrospective observational study based on the data from the Korea National Cancer Incidence Database (KNCIDB), this study analyzed the age-standardized incidence rates (ASRs) and annual percentage changes (APCs) of kidney, bladder, prostate, testicular, and penile cancers as well as cancer of the renal pelvis and ureter between 1999 and 2012. The relative survival rates (RSRs) were calculated for urological cancer patients diagnosed between 1993 and 2012 from the KNCIDB data. RESULTS: Prostate cancer was diagnosed in 66,812 individuals followed by bladder (41,549) and kidney (36,836) cancers. The overall ASR (18.26 per 100,000) increased with age because of the higher ASRs of bladder and prostate cancers in the elderly. The ASR for kidney cancer was highest in the 40-59-year-old group, whereas testicular cancer occurred most frequently before the age of 40. The incidence of most urological cancers increased (overall APC, 6.39%; p < 0.001), except for penile (APC, –2.01%; p=0.05) and bladder (APC, –0.40%; p=0.25) cancers. The overall survival increased steadily (5-year RSR, 66.4% in 1993-1995 vs. 84.2% in 2008-2012; p < 0.001), particularly for prostate (by 34.10%) and kidney (by 16.30%) cancers, but not for renal pelvis and ureter cancers (–7.20%). CONCLUSION: The most common urological cancer in Korea was prostate cancer followed by bladder and kidney cancers. The incidence of most urological cancers, except for penile and bladder cancers, increased. Survival also increased, particularly for prostate and kidney cancers.
Aged ; Humans ; Incidence* ; Kidney ; Kidney Neoplasms ; Kidney Pelvis ; Korea* ; Male ; Observational Study ; Penile Neoplasms ; Prostate ; Prostatic Neoplasms ; Retrospective Studies ; Survival Rate* ; Testicular Neoplasms ; Ureter ; Ureteral Neoplasms ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urologic Neoplasms*

PURPOSE: The study was aimed to determine the correlations of tissue-based biomarker expressions between primary and metastatic specimens of renal cell carcinoma and with several well-known prognostic clinicopathological parameters. MATERIALS AND METHODS: The immunohistochemistry (IHC) was used to determine the expression levels of 9 tissue-based markers calculated in H-score expressed by percentage of expression multiplied by the intensity score (0, 1, 2, and 3 points). Using 17 patients' 38 specimens paired with primary renal lesion and its metastatic lesions collected between 2004 and 2015, Tissue microarray with IHC was performed with BAP1, PBRM1, pS6, PTEN, TGase2, PD-L1, CA9, PSMA, and Ki-67 on formalin-fixed paraffin-embedded sections. Pearson correlation and accuracy test were performed to analyze the correlation between primary and metastatic tissues. RESULTS: The 17 patients' mean age was 56.9 years old, mean tumor size was 7.9 cm, and the male to female ratio was 13:4 (76.5%:23.5%), respectively. Three patients had 2, 3, and 3 metastatic tissues, and the rest of 14 patients had only one metastatic tissue. The H-score (PSMA and Ki67) and intensity score (pS6 and PSMA) showed that some differential significant markers were identified which had statistical correlations of expression levels between primary and metastatic lesions among 9 markers. However, no real correlation of PSMA, Ki67, and pS6 markers were found their expressions of between primary and metastatic tissues because of their skewed expressions. CONCLUSIONS: Tissue markers failed to correlate their expression levels in primary lesions with those of metastatic lesions.
Biomarkers* ; Carcinoma, Renal Cell* ; Female ; Humans ; Immunohistochemistry ; Male ; Neoplasm Metastasis

PURPOSE: Secondary primary cancers (SPCs) commonly arise in patients with renal cell carcinoma (RCC). We designed the present study to estimate the SPC incidence in Korean patients with RCC. MATERIALS AND METHODS: The study cohort was population-based and consisted of 40,347 individuals from the Korean Central Cancer Registry who were diagnosed with primary renal cancer between 1993 and 2013. Standardized incidence ratios (SIRs) for SPCs were estimated for different ages at diagnosis, latencies, diagnostic periods, and treatments. RESULTS: For patients with primary RCC, the risk of developing a SPC was higher than the risk of developing cancer in the general population (SIR, 1.13; 95% confidence interval, 1.08 to 1.18). Most cancer types showed higher incidences in patients with RCC than in the general population. However, the relative incidence of gastric cancer as an SPC varied by age. Gastric cancer incidence was elevated in young patients (< 30 years) with RCC, but reduced in older (≥ 30) patients with RCC. Patients with advanced RCC died prematurely, regardless of SPC development. In contrast, those with early-stage RCC survived for longer periods, although SPC development affected their post-RCC survival. After SPC development, women had better survival than men. CONCLUSION: In Korean patients with primary RCC, the incidence of SPC was 13% higher than the incidence of cancer in the general population. These findings may play important roles in the conduct of follow-up evaluations and education for patients with RCC.
Carcinoma, Renal Cell ; Cohort Studies ; Diagnosis ; Education ; Female ; Follow-Up Studies ; Humans ; Incidence ; Kidney Neoplasms ; Kidney ; Korea ; Male ; Neoplasms, Second Primary ; Prognosis ; Stomach Neoplasms

A resorbable barrier membrane is commonly used for the repair of perforated sinus membranes during sinus lifting surgeries. However, repairing largescale perforations poses challenges for clinicians as the protection and isolation of graft material remain uncertain. With this technique, we aimed to prevent graft material loss and subsequent sinus-related complications using intra-sinus rigid fixation of the resorbable barrier membrane in cases with a large perforation of the sinus membrane.

Transplantation of ABO-nmatched solid organs has been associated with the development of immune hemolysis due to donor-erived antibodies produced by passenger lymphocytes in the graft, called "Passenger Lymphocyte Syndrome". In a liver transplantation, about 40% of patients at risk has detectable donor-erived antibodies and hemolytic anemia occurs in 29% of patients. It is characterized by hemoglobinemia, a rapid fall in hemoglobin, hyperbilirubinemia, and an excessive red cell transfusion requirement occurring 1 to 3 weeks after the transplantation. These clinical findings are accompanied by the laboratory findings of a positive direct antiglobulin test and the detection of unexpected antibodies in the patients' red cell eluate and serum. Both the hemolytic anemia and serology resolve over the course of weeks to months. To the best of our knowledge, this is the first case of hemolytic anemia due to passenger lymphocyte syndrome after ABO-nmatched liver transplantation in Korea.
Anemia, Hemolytic ; Antibodies ; Coombs Test ; Hemolysis ; Humans ; Hyperbilirubinemia ; Korea ; Liver Transplantation ; Liver* ; Lymphocytes* ; Transplants

BACKGROUND: The diagnostic criteria of complex regional pain syndrome (CRPS) have mainly focused on dichotomous (yes/no) categorization, which makes it difficult to compare the inter-patient's condition and to evaluate the intra-patient's subtle severity over the course of time. To overcome this limitation, many efforts have been made to create laboratory methods or scoring systems to reflect the severity of CRPS; measurement of the skin temperature asymmetry is one of the former, and the CRPS severity score (CSS) is one of the latter. However, there has been no study on the correlations among the CSS, temperature asymmetry and subjective pain score. The purpose of this study was to evaluate whether there is any correlation between the CSS, skin temperature asymmetry and subjective pain score. METHODS: Patients affected with CRPS in a unilateral limb were included in this study. After making a diagnosis of CRPS according to the Budapest criteria, the CSS and skin temperature difference between the affected and unaffected limb (DeltaT) was measured in each patient. Finally, we conducted a correlation analysis among the CSS, DeltaT and visual analogue scale (VAS) score of the patients. RESULTS: A total of 42 patients were included in this study. There was no significant correlation between the DeltaT and VAS score (Spearman's rho = 0.066, P = 0.677). Also, the CSS and VAS score showed no significant correlation (Spearman's rho = 0.163, P = 0.303). CONCLUSIONS: The DeltaT and CSS do not seem to reflect the degree of subjective pain in CRPS patients.
Diagnosis ; Extremities ; Humans ; Pain Measurement ; Severity of Illness Index ; Skin Temperature*

OBJECTIVE: The purpose of this study was to determine the effects of isokinetic eccentric knee extensor and flexor strengthening training on affected limbs of patients with chronic hemiplegia. METHOD: Twenty-one subjects with chronic stroke were participated in this study. All subjects were indoor ambula tors. The hemiplegic knee flexors and extensors of the experimental group (n=11) were trained eccentrically using Cybex 770 dynamometer 3 times a week for 6 weeks. Conventional rehabilitation treatment was administrated to the control group at the same duration and frequency as the experimental group. Total peak torque, total work and functional parameters were measured before and after training. RESULTS: Significantly higher mean percent changes of peak torque and total work were observed in the experimental group compared to the control group at all eccentric angular velocities tested. Functional parameters also showed significant improvements in the gait speed, a timed stair climb up and down, and sit-to-stand time compared to the control group (p<0.05). CONCLUSION: The isokinetic eccentric strengthening training of knee extensors and flexors in patients with chronic hemi plegia were useful in strengthening the affected leg and functional improvement.
Extremities ; Gait ; Hemiplegia* ; Humans ; Knee* ; Leg ; Paralysis ; Rehabilitation ; Stroke ; Torque

BACKGROUND: In large clinical series, noise induced hearing loss (NIHL) following middle ear surgery has been demonstrated in 1.2% to 4.5% of patients and it is associated with a lower incidence than expected. The aim of the present work was to analyze the effect of halothane anesthesia on NIHL and hair cell morphological change. METHODS: We used 40 BALB/c mice with normal Preyer's reflex to investigate the effect of halothane on the NIHL. Control (n = 20) and halothane group (n = 20, respectively) were exposed to 120 dB SPL (sound pressure level), broad band white noise 3 hours daily for 3 consecutive days. The halothane group was anesthetized with halothane while exposed to noise. Hearing thresholds were determined with the auditory brainstem response (ABR). On day 7 post-noise, mice were sacrificed and the cochlea were collected for the histological study. RESULTS: ABR thresholds in the halothane group were less elevated after noise exposure than in the control group and then gradually recovered. In control group, the damage to the outer hair cell and supporting cell was noticeable, but not in halothane group. The expression of Bcl-2 protein was detected in halothane group, the expression of Bax protein was seen in control group. As a result in TUNEL stain, the result is positive in the control group but negative in the halothane group. CONCLUSIONS: The occurrence of NIHL decreased and the tissue damage was suppressed while anesthetized by halothane. And the noise-induced cell death of hair cell was also suppressed during anesthesia.
Anesthesia ; Animals ; Apoptosis* ; bcl-2-Associated X Protein ; Cell Death ; Cochlea ; Ear, Middle ; Evoked Potentials, Auditory, Brain Stem ; Hair ; Halothane* ; Hearing Loss* ; Hearing* ; Humans ; In Situ Nick-End Labeling ; Incidence ; Mice* ; Noise* ; Reflex