Moyamoya disease is a rare occlusive cerebrovascular disease characterized by stenosis or occlusion of the main cerebral arteries. It has a tendency for multifactorial inheritance and familial occurrence, although its pathogenesis is not clear. We observed this disease in two girls from the same family:one was eight years old and the other was 45 months. They presented with transient ischemic attacks. We performed cerebral angiography on both patients and magnetic resonance angiography (MRA) on the younger. Both approaches showed the typical features of moyamoya disease, and MRA successfully revealed abnormal findings specific for the disease in the second child. Both children received encephaloduroarteriosynangiosis (EDAS) and this produced good results. MRA is thus a powerful and noninvasive way of detecting individuals at high risk of developing this disease. Considering the reported familial incidence of moyamoya disease in Japan, a careful search for family members using MRA would probably reveal many more such cases in Korea.
Cerebral Angiography ; Cerebral Arteries ; Child ; Constriction, Pathologic ; Female ; Humans ; Incidence ; Ischemic Attack, Transient ; Japan ; Korea ; Magnetic Resonance Angiography ; Moyamoya Disease* ; Multifactorial Inheritance

BACKGROUND: In the majority of cases, sternal instability and wound infection concomitantly present after a cardiac operation following conventional median sternotomy, and these complications have a major influence on the postoperative course. The aim of this study is to compare the results of the different sternal wiring techniques on sternal infection. MATERIAL AND METHOD: Between April 2004 and December 2008, 157 adult patients underwent cardiac operation through a median sternotomy. 86 patients who had undergone standard peristernal wiring were included in group A, whereas 71 patients who had undergone modified Robicsek sternal wiring were included in group B. The incidences of sternal wound complications in the two groups were assessed. RESULT: The mean age of the group B patients was older than that of the group A patients (61+/-10 years vs 57+/-13 years). The incidence of preoperative left ventricular dysfunction (ejection fraction <30%), chronic obstructive pulmonary disease, renal failure requiring dialysis and diabetes mellitus were significantly higher in Group B, whereas the other perioperative risk factors for infection were not significantly different between the two groups. Two patients in group A experienced superficial wound infection, whereas 4 patients in group B displayed superficial wound infection, but the difference was not statistically significant (p=0.255). Yet poststernotomy deep sternal wound infection appeared in 6 patients of group A, whereas none of the patients in group B displayed this malady. CONCLUSION: The modified Robicsek sternal wiring technique showed greater sternal stability even for the patient with a high risk for infection, and the technique caused a lower incidence of deep sternal wound infection.
Adult ; Diabetes Mellitus ; Dialysis ; Humans ; Incidence ; Pulmonary Disease, Chronic Obstructive ; Renal Insufficiency ; Risk Factors ; Sternotomy ; Sternum ; Ventricular Dysfunction, Left ; Wound Infection

PURPOSE: We studied the apoptotic index in prostate cancer tissues and investigated the relationship of apoptosis and clusterin expression. MATERIALS AND METHODS: Forty-two archival prostatectomy specimens of varying grades of prostate cancer and 10 of benign prostatic hyperplasia were subjected to immunohistochemical clusterin staining with anti- clusterin antibody. Staining intensities were classified from 0 to 3. Apoptotic index was calculated with TUNEL positive cells under fluorescence microscope. We performed double staining for clusterin and TUNEL using immunofluorescence technique to determine the relationship between apoptosis and clusterin expression. RESULTS: Immunohistochemistry of clusterin showed a weak intensity in all benign tissues. Clusterin was localized mainly in the epithelial cells. Staining intensity was increased according to Gleason grade of cancer. Apoptotic indices of cancer were 0.86+/-0.8%, 0.76+/-1.0%, 0.39+/-0.4% and 0.14+/-0.09% in grades 2, 3, 4 and 5, respectively. In immunofluorescence localization study, apoptosis was not detected in the cancer cells stained with clusterin. Conversely, clusterin was not expressed in the cells showing apoptosis. CONCLUSIONS: These results more clearly show that clusterin acts as a survival protein protecting from apoptosis in prostate cancer. In addition, our findings revealed that the apoptotic index is lower in high grade prostate cancer. These findings have significant clinical implications for identifying the value of apoptotic index and clusterin expression in prostate cancer. Further study is needed to define the role of clusterin in the development and progression of prostate cancer.
Apoptosis* ; Clusterin* ; Epithelial Cells ; Fluorescence ; Fluorescent Antibody Technique ; Immunohistochemistry ; In Situ Nick-End Labeling ; Prostate* ; Prostatectomy ; Prostatic Hyperplasia ; Prostatic Neoplasms*

PURPOSE: Axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) are important for staging of patients with node-positive breast cancer. However, these can be avoided in select micrometastatic diseases, preventing postoperative complications. The present study evaluated the ability of axillary lymph node maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET-CT) to predict axillary metastasis of breast cancer.METHODS: The records of invasive breast cancer patients who underwent pretreatment (surgery and/or chemotherapy) PET-CT between January 2006 and December 2014 were reviewed. ALNs were preoperatively evaluated by PET-CT. Lymph nodes were dissected by SLNB or ALND. SUVmax was measured in both the axillary lymph node and primary tumor. Student t-test and chi-square test were used to analyze sensitivity and specificity. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) analyses were performed.RESULTS: SUV-tumor (SUV-T) and SUV-lymph node (SUV-LN) were significantly higher in the triple-negative breast cancer (TNBC) group than in other groups (SUV-T: 5.99, P < 0.01; SUV-LN: 1.29, P=0.014). The sensitivity (0.881) and accuracy (0.804) for initial ALN staging were higher in fine needle aspiration+PET-CT than in other methods. For PET-CT alone, the subtype with the highest sensitivity (0.870) and negative predictive value (0.917) was TNBC. The AUC for SUV-LN was greatest in TNBC (0.797).CONCLUSION: The characteristics of SUV-T and SUV-LN differed according to immunohistochemistry subtype. Compared to other subtypes, the true positivity of axillary metastasis on PET-CT was highest in TNBC. These findings could help tailor management for therapeutic and diagnostic purposes.
Area Under Curve ; Breast Neoplasms ; Electrons ; Humans ; Immunohistochemistry ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Needles ; Neoplasm Metastasis ; Postoperative Complications ; ROC Curve ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Triple Negative Breast Neoplasms

Purpose: This study examined the one-year mortality after locking plate fixation for distal femur fractures and the risk factors related to death. Materials and Methods: From July 2011 to June 2020, 128 patients who underwent locking plate fixation for distal femur fractures were analyzed retrospectively. Epidemiologic information of the patients, characteristics related to fracture and surgery, and death were investigated. The risk factors related to death were investigated using Cox analysis, and a subgroup analysis was also performed based on the age of 65 years. Results: The one-year mortality rate after locking plate fixation for distal femur fractures was 3.9%, and the mortality rates in patients younger than 65 years and older than 65 years were 0% and 6.7%, respectively. There were no significant risk factors related to death in the total population. On the other hand, in patients aged 65 years or older, however, high-energy fracture and high comorbidity index increased the risk of death after surgery by 6.9-fold and 1.9-fold, respectively. Conclusion The one-year mortality rate for the total patients was 3.9%, but the mortality rate for patients over 65 years of age increased to 6.7%. High-energy fractures and high comorbidity index were risk factors related to death after surgery for distal femur fractures in patients aged 65 years or older.

PURPOSE: To investigate the effect of antifreeze protein (AFP) supplementation on ovarian vitrification and transplantation. MATERIALS AND METHODS: In this experimental study, we researched a total of 182 ovaries from 4-week-old ICR mice. The equilibration solution included 20% ethylene glycol (EG), and the vitrification solution included 40% EG, 18% Ficoll, and 0.3 M sucrose. Intact ovaries were first suspended in 1 mL of equilibration solution for 10 min, and then mixed with 0.5 mL of vitrification solution for 5 min. Ovaries were randomly assigned to 3 groups and 0, 5, or 20 mg/mL of type III AFP was added into the vitrification solution (control, AFP5, and AFP20 groups, respectively). The vitrified ovaries were evaluated after warming and 2 weeks after autotransplantation. The main outcome measurements are follicular morphology and apoptosis assessed by histology and the TUNEL assay. RESULTS: A significantly higher intact follicle ratio was shown in the AFP treated groups (control, 28.9%; AFP5, 42.3%; and AFP20, 44.7%). The rate of apoptotic follicles was significantly lower in the AFP treated groups (control, 26.6%; AFP5, 18.7%; and AFP20, 12.6%). After transplantation of the vitrified-warmed ovaries, a significantly higher intact follicle ratio was shown in the AFP20 group. The rate of apoptotic follicles was similar among the groups. CONCLUSION: The results of the present study suggest that supplementing AFP in the vitrification solution has beneficial effects on the survival of ovarian tissue during cryopreservation and transplantation.
Animals ; Antifreeze Proteins/*pharmacology ; Apoptosis/drug effects ; Cryopreservation/*methods ; Cryoprotective Agents/*pharmacology ; Female ; Fertility Preservation ; Humans ; Mice ; Mice, Inbred ICR ; Ovarian Follicle/drug effects ; Ovary/*drug effects/*transplantation ; *Vitrification

BACKGROUND: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). MATERIAL AND METHOD: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). RESULT: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was 97+/-44 minutes in group A and 77+/-18 minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was 156+/-87 cc in group A and 147+/-87 cc in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was 31.7+/-25.3 months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. CONCLUSION: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.
Blister ; Chest Tubes ; Drainage ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Length of Stay ; Operative Time ; Pleurodesis ; Pneumothorax ; Recurrence ; Reoperation ; Retrospective Studies ; Thoracic Surgery, Video-Assisted

Lymphorrhea is a common complication after inguinal dissection for exposure of the femoral artery. Injury of the lymphatics occurs frequently because they are anatomically close to blood vessels. Uncontrolled lymph drainage increases postoperative morbidity, and wound infection may follow. Despite current treatment options, lymphorrhea after inguinal dissection is still difficult to manage and results in a prolonged hospital stay. A vacuum-assisted closure device was used in a 72-year-old woman who had lymphorrhea after vascular surgery by groin incision. Vacuum-assisted control for lymphorrhea resulted in earlier closure of the wound and reduced the length of hospital stay.
Aged ; Blood Vessels ; Drainage ; Female ; Femoral Artery ; Groin ; Humans ; Length of Stay ; Lymphatic System ; Negative-Pressure Wound Therapy ; Wound Infection

PURPOSE: The purpose was to analyze the relationship between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL) in patients with total knee arthroplasty. MATERIALS AND METHODS: Four hundred and twenty-four patients (24 males and 400 females; 636 knees) who received total knee arthroplasty for osteoarthritis were included. Their mean age was 68.9 years (range, 48 to 88 years). The patients were classified into three groups according to the status of ACL; normal ACL group (group I), mucoid degeneration of ACL group (group II) and ruptured or absent ACL group (group III). Plain lateral radiographs were used to measure the PTS and the values were compared among groups. RESULTS: There were no significant differences with regard to gender, age and left-to-right side ratio among groups (p>0.05). The mean PTS was 9.9degrees (range, 0.6degrees to 20.1degrees) in group I (161 knees), 10.8degrees (range, 0.2degrees to 21.8degrees) in group II (342 knees) and 12.3degrees (range, 2degrees to 22.2degrees) in group III (133 knees), which showed significant differences (p<0.001). CONCLUSIONS: The patients with mucoid degeneration of the ACL and those with ruptured or absent ACL had greater PTS than those with normal ACL. These findings suggest that an increased PTS may be one of the causative factors for mucoid degeneration of the ACL.
Anterior Cruciate Ligament ; Arthroplasty ; Female ; Humans ; Knee ; Male ; Osteoarthritis

Signet ring cell adenocarcinoma of the cervix is most commonly considered to be metastatic in origin. We describe one case of primary signet ring cell adenocarcinoma of the cervix occuring in 49-year-old patient. The lesion was located at the posterior lip of the cervix and about 3 cm in size. This case was parametrium thickening in pelvic examination and positive for HPV type 18. CCRT (concurrent chemoradiotherapy) was done for clinical FIGO stage II B adenocarcinoma of the cervix. The patient is alive for 6month since diagnosis and disappear lesion of the cervix. A upper gastroenteroscopy, colonoscopy, cystoscopy, intravenous pyelogram, abdominal pelvic CT, PET CT, mammogram were reported negative. Therefore we concluded this case for a primary cervical origin of signet ring cell adenocarcinoma of the uterine cervix.
Adenocarcinoma* ; Cervix Uteri* ; Colonoscopy ; Cystoscopy ; Diagnosis ; Female ; Gynecological Examination ; Humans ; Lip ; Middle Aged