The co-occurrence of multiple sclerosis and peripheral demyelinating neuropathy is rare. It has been disputed whether these are pathologically related or coincidental findings. We report a 36-year-old woman who presented with diplopia, right facial palsy and left-sided weakness. Brain magnetic resonance imaging showed a lesion indicative of central demyelinating disease. Nerve conduction studies revealed peripheral multifocal demyelinating neuropathies. We suggest that the central and the peripheral lesions may be continua of a demyelinating process.
Adult ; Brain ; Demyelinating Diseases ; Diplopia ; Facial Paralysis ; Female ; Humans ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Neural Conduction

Infection of both native and prosthetic vessels are most frequently seen in the groin. The successful treatment of prosthetic graft infection requires excision of the affected graft, adequate debridement, and restoration of circulation. Restoration of arterial circulation can be accomplished by using in situ reconstruction with femoral vein, cryopreserved allografts, or antibiotic-impregnated synthetic grafts. The obturator and lateral femoral bypasses are the most frequently used extra-anatomic bypasses. We experienced one case of bilateral obturator bypasses for the femoral graft infection.
Allografts ; Debridement ; Femoral Vein ; Groin ; Transplants*

Infection of both native and prosthetic vessels are most frequently seen in the groin. The successful treatment of prosthetic graft infection requires excision of the affected graft, adequate debridement, and restoration of circulation. Restoration of arterial circulation can be accomplished by using in situ reconstruction with femoral vein, cryopreserved allografts, or antibiotic-impregnated synthetic grafts. The obturator and lateral femoral bypasses are the most frequently used extra-anatomic bypasses. We experienced one case of bilateral obturator bypasses for the femoral graft infection.
Allografts ; Debridement ; Femoral Vein ; Groin ; Transplants*

Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.
Adult ; Aortic Aneurysm, Abdominal/diagnosis/pathology/*surgery ; Blood Vessel Prosthesis Implantation/methods ; Graft Survival ; Humans ; Kidney/blood supply ; *Kidney Transplantation ; Male ; Reperfusion Injury/prevention & control ; Tomography, X-Ray Computed ; Transplantation, Homologous

PURPOSE: To evaluate the effectiveness of percutaneous mechanical declotting in thrombosed dialysis graft. MATERIALS AND METHODS: Thirty-two patients with thrombosed dialysis graft in 260 cases involving insufficient hemodialytic access underwent mechanical declotting. Using a 7-F Desilets-Hoffman sheath and the crossed-catheter technique, we aspirated the intragraft clot and pushed the residual clot into the central circulation with balloon catheters. The success rate, procedure time, complications and patency rates were evaluated. RESULTS: Technical success was achieved in 24 of 32 cases, with a procedure time of 30 -240 (average, 111) minutes. In five of eight cases in which technical failure occurred, the guide wire failed to reach the stenotic site and in the other three, there was insufficient luminal dilatation. Complications included vein ruptures (n=2), arterial emboli (n=1) and arterial dissection (1), but there was no evidence of clinical symptoms of pulmonary embolism. The six-month patency rate was 67.8%. CONCLUSION: Mechanical declotting of thrombosed dialysis graft using a balloon catheter is relatively inexpensive, safe and fast, and is well tolerated.
Catheters ; Dialysis* ; Dilatation ; Humans ; Phenobarbital ; Pulmonary Embolism ; Rupture ; Thrombectomy ; Transplants* ; Veins

PURPOSE: Computed-tomography (CT) is known as a useful modality to diagnose the occurrence and extent of deep vein thrombosis (DVT) and the existence of pulmonary embolism (PE). This article will focus on the availability of DVT-CT at Kyungpook National University Hospital. METHOD: From 1994 to 2006, 403 DVT patients were documented for the extent of thrombus and the existence of PE. DVT-CTs, according to our protocol, were obtained for 136 patients; there were 112 CT scans taken that were limited to the abdomen and lower extremity, and 47 patients underwent only chest CT to diagnose PE. Other modalities such as duplex scan and venography for DVT and lung scan for PE were also performed for 155 patients. RESULT: The patients in the CT group (248 patients) demonstrated that the extent of the thrombus was in the inferior vena cava (IVC) in 38 (16%), the iliac veins (IVs) in 98 (40%), the femoral veins (FVs) in 73 (29%), the popliteal veins (PVs) in 3 (1%), and the mesenteric veins in 24 (10%). For the group that underwent venography or duplex scanning (155 patients), the extent of thrombus was in the IVC in 4 (3%), the IVs in 47 (30%), the FVs in 73 (47%), and the PVs in 21 (14%). For the 136 patients who underwent DVT-CTs, 38 (28%) cases had PE. The DVT-CT and lung scan were in agreement for all the 12 cases who underwent both two tests. CONCLUSION: In the present study, DVT-CT accurately revealed the extent of DVT and it is a useful tool for making the diagnosis of PE.
Abdomen ; Diagnosis ; Femoral Vein ; Gyeongsangbuk-do ; Humans ; Iliac Vein ; Lower Extremity ; Lung ; Mesenteric Veins ; Phlebography ; Popliteal Vein ; Pulmonary Embolism ; Thrombosis ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; Venous Thrombosis*

PURPOSE: Computed-tomography (CT) is known as a useful modality to diagnose the occurrence and extent of deep vein thrombosis (DVT) and the existence of pulmonary embolism (PE). This article will focus on the availability of DVT-CT at Kyungpook National University Hospital. METHOD: From 1994 to 2006, 403 DVT patients were documented for the extent of thrombus and the existence of PE. DVT-CTs, according to our protocol, were obtained for 136 patients; there were 112 CT scans taken that were limited to the abdomen and lower extremity, and 47 patients underwent only chest CT to diagnose PE. Other modalities such as duplex scan and venography for DVT and lung scan for PE were also performed for 155 patients. RESULT: The patients in the CT group (248 patients) demonstrated that the extent of the thrombus was in the inferior vena cava (IVC) in 38 (16%), the iliac veins (IVs) in 98 (40%), the femoral veins (FVs) in 73 (29%), the popliteal veins (PVs) in 3 (1%), and the mesenteric veins in 24 (10%). For the group that underwent venography or duplex scanning (155 patients), the extent of thrombus was in the IVC in 4 (3%), the IVs in 47 (30%), the FVs in 73 (47%), and the PVs in 21 (14%). For the 136 patients who underwent DVT-CTs, 38 (28%) cases had PE. The DVT-CT and lung scan were in agreement for all the 12 cases who underwent both two tests. CONCLUSION: In the present study, DVT-CT accurately revealed the extent of DVT and it is a useful tool for making the diagnosis of PE.
Abdomen ; Diagnosis ; Femoral Vein ; Gyeongsangbuk-do ; Humans ; Iliac Vein ; Lower Extremity ; Lung ; Mesenteric Veins ; Phlebography ; Popliteal Vein ; Pulmonary Embolism ; Thrombosis ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; Venous Thrombosis*

We report a case of renin-secreting juxtaglomerular cell tumor which developed in a hypertensive 47-yr-old Korean man. Presumptive clinical diagnosis was made before surgery based on the high level of plasma renin and the radiologic evidence of renal mass. Grossly, a round, bulging, well-encapsulated mass of 3x3 cm was located in the mid-portion of the right kidney. On microscopic examination, the tumor was composed of ovoid to polyhedral cells with bland nuclei, indistinct nucleoli and light eosinophilic cytoplasm. The immunostaining for renin showed strong positivity in the cytoplasm of tumor cells. The characteristic rhomboid shaped renin protogranules were observed in ultrastructural analysis.
Human ; Hypertension, Renal/*etiology/pathology ; Juxtaglomerular Apparatus/*pathology ; Kidney Neoplasms/*complications/*pathology/secretion ; Male ; Middle Age ; Renin/blood/secretion

No abstract available.
Humans ; Surgeons* ; Thyroid Gland* ; Thyroid Neoplasms*

Background: Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. Methods: Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). Results: On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. Conclusions Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.