Iridocorneal endothelial syndrome is a disease characterized by corneal endothelial degeneration, corneal edema, peripheral anterior synechia, iris stromal change, and secondary glaucoma. This syndrome is considered to have three major variations: Chandler's syndrome, progressive (essential) iris atrophy, and Cogan-Reese syndrome. We experienced three cases of iridocorneal endothelial syndrome with transient intraocular pressure elevation.

A 5-year-old male patient was admitted due to fever, and right upper abdominal pain for 2 weeks. He showed severe right upper quadrant tenderness on palpation, hepatomegaly 5 cm below the right costal margin, no mass, and no splenomegaly. On biochemical studies, ALT was 380IU/ml, AST 462IU/ml, alkaline phosphatase 1,069IU/ml, GTP 239IU/ml, and total bilirubin 2.1mg/dl. Endoscopic retrograde cholangiopancreatography (ERCP) showed cylindrical dilatations of CBD and cystic dilatations with strictures of extrahepatic and both bilateral intrahepatic bile ducts (choledochal cyst type IVa) with multiple stones in the CBD and extra- and intrahepatic bile ducts. Endoscopic sphincterotomy (EST) and stone extraction with basket and balloon were performed successfully. The bile was severely purulent and the stones were pigment stones. Klebsiella pneumoniae were dominantly grown on bile culture. An endoscopic nasobiliary drainage (ENBD) tube was inserted to treat biliary sepsis. The bile ducts were irrigated with tobramycin-mixed normal saline twice a day for 2 week, when ALT, AST, total bilirubin and liver size were normalized and no more bacteria was grown on bile culture. The clinical symptoms were improved just after the therapeutic ERCP. There was no side effect by ERCP, EST and ENBD.
Abdominal Pain ; Alkaline Phosphatase ; Bacteria ; Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Bilirubin ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis* ; Choledochal Cyst* ; Choledocholithiasis* ; Constriction, Pathologic ; Dilatation ; Drainage* ; Fever ; Guanosine Triphosphate ; Hepatomegaly ; Humans ; Klebsiella pneumoniae ; Liver ; Male ; Palpation ; Sepsis ; Sphincterotomy, Endoscopic ; Splenomegaly

OBJECTIVE: Although middle cerebral artery (MCA) aneurysms are less amenable to coil embolization, an increasing number of studies support favorable endovascular treatment for them. The purpose of this study is to compare the outcomes of two different treatments (surgery versus coiling) and evaluate the benefits of surgical clipping for MCA aneurysms. METHODS: Here we retrospectively analyzed the outcomes of 178 ruptured and unruptured MCA aneurysms treated in patients between September 2008 and April 2012. Parameters assessing treatment outcomes include degree of aneurysm occlusion, presence of regrowth, clinical status, and complications. RESULTS: Among 178 MCA aneurysms, 153 were treated surgically. After a mean follow-up of 12 months, the surgery group showed a clinically significant complete occlusion rate (98%) compared with the coiling group (56%) (p<0.001). Follow-up radiologic evaluation showed a higher regrowth rate (four of 16 cases) in the coiling group than in the surgery group (one of 49 cases) (p=0.003). There was no statistically significant difference in favorable clinical outcome rate between the two groups. The procedure-related permanent morbidity and mortality rates were 2% (three of 153 cases) in the surgery group and 0% (0 of 25 cases) in the coiling group. CONCLUSION: Compared to endovascular treatment, surgical neck clipping for both ruptured and unruptured MCA aneurysms results in a significantly higher complete obliteration rate and less regrowth. Therefore, even in this endovascular era, we still recommend surgical clipping as the primary treatment option for MCA aneurysms rather than coil embolization.
Aneurysm* ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Mortality ; Neck* ; Retrospective Studies ; Surgical Instruments

PURPOSE: A 70-gene prognostic signature has prognostic value in patients with node-negative breast cancer in Europe. This diagnostic test known as "MammaPrint(TM) (70-gene prognostic signature)" was recently validated and implementation was feasible. Therefore, we assessed the 70-gene prognostic signature in Korean patients with breast cancer. We compared the risk predicted by the 70-gene prognostic signature with commonly used clinicopathological guidelines among Korean patients with breast cancer. We also analyzed the 70-gene prognostic signature and clinicopathological feature of the patients in comparison with a previous validation study. METHODS: Forty-eight eligible patients with breast cancer (clinical T1-2N0M0) were selected from four hospitals in Korea. Fresh tumor samples were analyzed with a customized microarray for the 70-gene prognostic signature. Concordance between the risk predicted by the 70-gene prognostic signature and risk predicted by commonly used clinicopathological guidelines (St. Gallen guidelines, National Institutes of Health [NIH] guideline, and Adjuvant! Online) was evaluated. RESULTS: Prognosis signatures were assessed in 36 patients. No significant differences were observed in the clinicopathological features of patients compared with previous studies. The 70-gene prognosis signature identified five (13.9%) patients with a low-risk prognosis signature and 31 (86.1%) patients with a high-risk prognosis signature. Clinical risk was concordant with the prognosis signature for 29 patients (80.6%) according to the St. Gallen guidelines; 30 patients (83.4%) according to the NIH guidelines; and 23 patients (63.8%) according to the Adjuvant! Online. Our results were different from previous validation studies in Europe with about a 40% low-risk prognosis and about a 60% high-risk prognosis. The high incidence in the high-risk group was consistent with data in Japan. CONCLUSION: The results of 70-gene prognostic signature of Korean patients with breast cancer were somewhat different from those identified in Europe. This difference should be studied as whether there is a gene disparity between Asians and Europeans. Further large-scale studies with a follow-up evaluation are required to assess whether the use of the 70-gene prognostic signature can predict the prognosis of Korean patients with breast cancer.
Asian Continental Ancestry Group ; Breast ; Breast Neoplasms ; Diagnostic Tests, Routine ; Europe ; Follow-Up Studies ; Gene Expression Profiling ; Genes, vif ; Humans ; Incidence ; Korea ; National Institutes of Health (U.S.) ; Prognosis

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure, and multiple organ failure. Recently, the number of gastric-cancer patients patient who has liver cirrhosis has been increasing, especially for early gastric-cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically in our degartment. RESULTS: Of the 410, 9 cases with liver cirrhosis underwent a gastric resection: 5 standard subtotal gastrectomies and 4 curative subtotal gastrectomies. Three major postoperative complications occurred in 2 patient: anastomosis leakage in one and bleeding in both. CONCLUSIONS: The purpose of this study was to report our complicated cases, to assess the causes of the complications, and to decide the appropriate operation type for improving the prognosis of these patients. Serosal flap can be the solving techniques in B-I anastomosis and complicated perforation in cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Fibrosis ; Gastrectomy ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*

PURPOSE: To qualitatively analyse barium coating status in the intestinal mucosa, we used scanning electronmicroscopy to observe barium particles coated in the small intestinal mucosa of rabbit, and we attempted to assessthe relationship between electron microscopic findings and radiographic densities. MATERIALS AND METHODS: Sixdifferent combinations of barium and methylcellulose suspensions were infused into the resected small intestinesof 15 rabbits. Barium powders were mixed with water to make 40% and 70% w/v barium solutions, and also mixed with0.5% methylcellulose solution to make 40% and 70% w/v barium-methylcellulose mixtures. 0.5% methylcellulosesolutions were used as a double contrast agent. After the infusion of barium suspensions, a mammography unit wasused to obtain radiographs of the small intestine, and their optical densities were measured by a densitometer.Thereafter, photographs of barium-coated small intestinal mucosa were obtained using a scanning electronmicroscope (x8,000), and the number of barium particles in the unit area were measured. To compare therelationship between the electron microscopic findings and optical densities, statistical analysis using Spearmancorrelation was performed. RESULTS: With a Spearman coefficient of-0.544, correlation between the number of smallbarium particles of less than 1 micrometer and optical densities was statistically significant(p<0.05). CONCLUSION: Thisstudy shows that by using scanning electron microscopy, barium particles coated on the small intestinal mucosa canbe qualitatively analysed. It also shows that the number of small barium particles measured by scanning electronmicroscopy is related to optical densities.
Animals ; Barium* ; Intestinal Mucosa* ; Intestine, Small ; Mammography ; Methylcellulose ; Microscopy, Electron, Scanning ; Powders ; Rabbits ; Suspensions ; Water

OBJECTIVE: The beneficial effect of decompressive craniectomy in the treatment of severe traumatic brain injury (TBI) is controversial, but there is no debate that decompression should be performed before irreversible neurological deficit occurs. The aim of our study was to assess the value of ultra-early decompressive craniectomy in patients with severe TBI. METHODS: Total of 127 patients who underwent decompressive craniectomy from January 2007 to December 2013 was included in this study. Among them, 60 patients had underwent ultra-early (within 4 hours from injury) emergent operation for relief of increased intracranial pressure. Initial Glasgow coma scale, brain computed tomography (CT) scan features by Marshall CT classification, and time interval between injury and craniectomy were evaluated retrospectively. Clinical outcome was evaluated, using the modified Rankin score. RESULTS: The outcomes of ultra-early decompressive craniectomy group were not better than those in the comparison group (p=0.809). The overall mortality rate was 68.5% (87 patients). Six of all patients (4.7%) showed good outcomes, and 34 patients (26.8%) remained in a severely disabled or vegetative state. Forty of sixty patients (66.7%) had died, and two patients (3.3%) showed good outcomes at last follow-up. CONCLUSION: Ultra-early decompressive craniectomy for intracranial hypertension did not improve patient outcome when compared with "early or late" decompressive craniectomy for managing severe TBI.
Brain Injuries ; Brain* ; Classification ; Decompression ; Decompressive Craniectomy* ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Intracranial Hypertension ; Intracranial Pressure ; Mortality ; Persistent Vegetative State ; Retrospective Studies ; Treatment Outcome

PURPOSE: To determine the optimal radiation dose in a localized non-Hodgkin's lymphoma of the head and neck in the treatment setting for combined chemoradiotherapy. MATERIALS AND METHODS: Fifty-three patients with stage I and II diffuse large cell non-Hodgkin's lymphoma of the head and neck, who were treated with combined chemoradiotherapy between 1985 and 1998 were retrospectively reviewed. The median age was 49 years, and the male-to-female ratio was approximately 1.6. Twenty-seven patients had stage I disease and 26 had stage II. Twenty-three patients had bulky tumors (> or =5 cm) and 30 had non-bulky tumors (<5 cm). The primary tumors arose mainly from an extranodal organ (70%), most cases involving Waldeyer's ring (90%). All patients except one were initially treated with 3~6 cycles of chemotherapy, which was followed by radiotherapy. Radiation was delivered either to the primary tumor area alone (9%) or to the primary tumor area plus the bilateral neck nodes (91%) with a minimum dose of 30 Gy (range 30~60 Gy). The failure patterns according to the radiation field were analyzed, and the relationship between the dose and the in-field recurrence was evaluated. RESULTS: The 10-year overall survival and the 10-year disease free survival rates were similar at 75% and 76%, respectively. A complete response (CR) after chemotherapy was achieved in 44 patients (83%). Subsequent radiotherapy showed a CR in all patients. Twelve patients (23%) had a relapse of the lymphoma after the initial treatment. Two of these patients had a recurrence inside the radiation field. No clear dose response relationship was observed and no significant prognostic factors for the in-field recurrences were identified because of the small number of in-field recurrences. However, for patients with tumors <5 cm in diameter, there were no in-field recurrences after a radiation dose 30 Gy. The 2 in-field recurrences encountered occurred in patients with a tumor > or =5 cm. CONCLUSION: A dose of 30 Gy is sufficient for local control in patients with a non-bulky (<5 cm), localized, diffuse large cell non-Hodgkin's lymphoma when combined with chemotherapy. An additional boost dose in the primary site is recommended for patients with bulky tumors (> or =5 cm).
Chemoradiotherapy ; Disease-Free Survival ; Drug Therapy ; Head* ; Humans ; Lymphoma ; Lymphoma, Large B-Cell, Diffuse* ; Lymphoma, Non-Hodgkin ; Neck* ; Radiotherapy ; Recurrence ; Retrospective Studies

BACKGROUND/AIMS: The human leukocyte antigen (HLA) system is an integral component of immune response. Highly polymorphic HLA genes may play a pivotal role in the response of antiviral therapy. We investigated the effects of HLA gene polymorphism on the clinical outcome of chronic hepatitis B patients who received lamivudine treatment. METHODS: Depending on their clinical response to lamivudine therapy, a total of sixty one patients were divided into following groups; non-responders, viral breakthroughers, relapsers, and seroconverters. HLA-A, -B, -Cw, -DRB and HLA-DRB1 alleles typing was performed on each group through the polymerase chain reaction and the sequence-specific oligonucleotide hybridization method. The distribution patterns of HLA-A, HLA-B, HLA-Cw, HLA-DRB, and HLA-DRB1 were then analysed. RESULTS: When non-responders were compared to the other groups, high frequencies in HLA-Cw*1, HLA-DRB1*4 and HLA-DRB*4 (p=0.015, 0.033 and 0.004 respectively) were evident. When seroconverters were compared to viral breakthroughers, high frequencies in HLA-A*2 and HLA-DRB*4 (p=0.048, 0.025 respectively) were evident. CONCLUSIONS: Our data suggests that HLA-A*2, HLA-Cw*1, HLA-DRB1*4 genes are related to the clinical outcomes of lamivudine treatment in chronic hepatitis B patients. These genes may be used in the prediction of the clinical outcome of lamivudine therapy in chronic hepatitis B patients.

PURPOSE: The prediction of breast cancer recurrence is a crucial factor for successful treatment and follow-up planning. The principal objective of this study was to construct a novel prognostic model based on support vector machine (SVM) for the prediction of breast cancer recurrence within 5 years after breast cancer surgery in the Korean population, and to compare the predictive performance of the model with the previously established models. METHODS: Data on 679 patients, who underwent breast cancer surgery between 1994 and 2002, were collected retrospectively from a Korean tertiary teaching hospital. The following variables were selected as independent variables for the prognostic model, by using the established medical knowledge and univariate analysis: histological grade, tumor size, number of metastatic lymph node, estrogen receptor, lymphovascular invasion, local invasion of tumor, and number of tumors. Three prediction algorithms, with each using SVM, artificial neural network and Cox-proportional hazard regression model, were constructed and compared with one another. The resultant and most effective model based on SVM was compared with previously established prognostic models, which included Adjuvant! Online, Nottingham prognostic index (NPI), and St. Gallen guidelines. RESULTS: The SVM-based prediction model, named 'breast cancer recurrence prediction based on SVM (BCRSVM),' proposed herein outperformed other prognostic models (area under the curve=0.85, 0.71, 0.70, respectively for the BCRSVM, Adjuvant! Online, and NPI). The BCRSVM evidenced substantially high sensitivity (0.89), specificity (0.73), positive predictive values (0.75), and negative predictive values (0.89). CONCLUSION: As the selected prognostic factors can be easily obtained in clinical practice, the proposed model might prove useful in the prediction of breast cancer recurrence. The prediction model is freely available in the website (http://ami.ajou.ac.kr/bcr/).
Artificial Intelligence ; Breast ; Breast Neoplasms ; Estrogens ; Follow-Up Studies ; Hospitals, Teaching ; Humans ; Lymph Nodes ; Recurrence ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Support Vector Machine