Two American Cocker Spaniels and one Bichon Frise were presented to our veterinary teaching hospital with an enlarged clitoris. Diagnostic imaging showed that the structure was composed of bony material. Exploratory laparotomy revealed uterine-like structures and testes which had an epididymis unilaterally. Surgical removal of internal genitalia, gonads and protruded clitoris were performed well. Histological evaluation revealed; inactive testes, female internal genital tracts with ambisexual ductal remnants, and prominent ossification in the clitoris. All 3 cases were diagnosed with male pseudohermaphroditism. In author's knowledge, this is the first report in Bichon Frise dog with os clitoris and also, it describes not common cases in small dog breeds with os clitoris.
46, XY Disorders of Sex Development ; Animals ; Clitoris ; Diagnostic Imaging ; Dogs ; Epididymis ; Female ; Genitalia ; Gonads ; Hospitals, Teaching ; Humans ; Laparotomy ; Male ; Testis

BACKGROUND: The shortage of human hearts for allotransplantation makes xenotransplantation a possible option for controllable organ providers. To detect acute xenograft rejection, invasive biopsy seems inevitable; however, this occasionally results in poor incision wound healing or infection. To date, no method of noninvasive imaging for early detection of xenograft rejection has been established. We hypothesized that ultrasound speckle tracking would better detect xenograft failure than routine left ventricular ejection fractions (EF). METHODS: From August 2013 to July 2015, a total of six cardiac heterotopic xenotransplants (α 1, 3-galactosyltransferase gene-knockout porcine heart) into cynomolgus monkeys were monitored with echocardiography every 3 to 7 days. M-mode and two-dimensional (2D)-EF measurements and myocardial strain analyses were performed. Cardiac xenograft pathology was reviewed from the immediate postoperative biopsy, as well as the necropsy. RESULTS: Myocardial speckle tracking analysis was feasible in all six cases. The longest survival was 43 days. Only one pathology-proven immunologic rejection occurred. Cardiac xenograft failure appeared as two types: a dilated pattern with decreased EF or a myocardial-thickening pattern with preserved EF. Both antibody-mediated rejection (n=1) and sepsis-induced myocardial dysfunction (n=2) revealed decreased radial or circumferential strains, but normal-range EF. Xenograft functional decline was significant with respect to radial or circumferential strain (P=0.028), but not to conventional M-mode or 2D-EFs (P=0.600, P=0.340, respectively). CONCLUSIONS: Radial and circumferential strains were significantly decreased in both types of xenograft failure, regardless of EF. Further studies are warranted to correlate the strain analysis and immunopathological details.
Biopsy ; Echocardiography ; Heart ; Heart Transplantation ; Heterografts ; Humans ; Macaca fascicularis ; Methods ; Pathology ; Stroke Volume ; Transplantation, Heterologous* ; Transplants* ; Ultrasonography ; Wound Healing

This study was performed to investigate the expression of two porcine endogenous retrovirus (PERV) elements, PERV gag and full-length conserved PERV, in blood cells collected periodically from organ-recipient monkeys that underwent pig to non-human primate xenotransplantation. The heart and kidney-respectively acquired from alpha-1,3-galactosyltransferase knockout (GT-KO) pigs that survived for24 and 25 days-were xenografted into cynomolgus monkeys. The two PERV elements expressed in the xenografted GT-KO pig organs were not present in the blood cells of the recipient monkeys. In the present study, we deduced that PERVs are not transmitted during GT-KO pig to monkey xenotransplantation.
Blood Cells ; Endogenous Retroviruses* ; Haplorhini* ; Heart ; Heterografts ; Macaca fascicularis ; Primates ; Swine ; Transplantation, Heterologous*

BACKGROUNDS/AIMS: For patients with acute cholecystitis, conversion from laparoscopic cholecystectomy to open surgery is not uncommon due to possibilities of serious hemorrhage at the liver bed and bile duct injury. Recent studies reported successful laparoscopic subtotal cholecystectomy for acute cholecystitis. The purpose of this study was to determine the efficacy and feasibility of such an operation based on the experience of surgeons at our facility. METHODS: In this study, we enrolled 144 patients who had received either laparoscopic subtotal cholecystectomy (LSC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC) for acute cholecystitis from January 2004 to December 2009 at the Department of Surgery of our hospital. Their symptoms, signs, operative findings, pathologic results and postoperative results were compared and analyzed. RESULTS: There were 26 patients in the LSC group 80 in the LC group and 38 in the OC group. There were no differences in mean age, sex, and symptoms of acute cholecystitis. The LSC group showed higher CRP levels (p<0.001) and a higher grade according to the Tokyo criteria (p=0.001). The mean operative time was 115.6 minutes and mean blood loss was 158.9 ml without intra-operative or postoperative transfusion. There weren't any bile duct injuries during the operation. No group suffered bile leakage. Drains were removed 3.3 days after the operation in the LC group, the shortest time compared to the other groups (p<0.001). LC and LSC groups demonstrated shorter postoperative hospital days and time to diet resumption than the OC group (p<0.001). CONCLUSIONS: LSC appears to be a safe and effective treatment in cases of severe acute cholecystitis that require consideration of conversion to open surgery.
Bile ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis, Acute ; Conversion to Open Surgery ; Diet ; Hemorrhage ; Humans ; Liver ; Operative Time ; Tokyo

PURPOSE: Diabetes mellitus refers to one of several risk factors for cardiovascular diseases, renal failure and so on. Medical treatments of T2DM cannot suggest a perfect cure. But gastric bypass resulting in the exclusion of the duodenum and proximal jejunum has been shown to improve or resolve T2DM. The goal of this study is to evaluate the effect of duodenojejunal bypass for T2DM patients below BMI 25 kg/m2 in early postoperative period. METHODS: Duodenojejunal bypass was performed on 25 patients at Inha University Hospital from July 2009 to April 2010. We compared 75 g OGTT, insulin, C peptide to those 7 days postoperative. The definitions for improvement are serum glucose level below 200 mg/dl of 75 g OGTT at 120 min or below 200 mg/dl at every other time in spite of over 200 mg/dl at 120 min. RESULTS: A total of 25 patients (15 men and 10 women) were included. Median value BMI was 23.17 kg/m2 and the mean duration of T2DM was 8.3 years. There was a significant decrease of postoperative 75 g OGTT levels from 176, 268, 345, 373, 371 mg/dl to 125, 170, 200, 225 and 241 mg/dl, respectively (P<0.001). Only patients' age was an independent factor resolution of T2DM based on this study. CONCLUSION: Duodenojejunal bypass could be one viable treatment modality for improving or resolving of T2DM although these are early results. This study has preliminary meanings only and the results of longer follow-up and a larger number of patients are necessary, by which we should be able to determine the effect and indications for surgical treatment of T2DM.
C-Peptide ; Cardiovascular Diseases ; Diabetes Mellitus ; Duodenum ; Follow-Up Studies ; Gastric Bypass ; Glucose ; Glucose Tolerance Test ; Humans ; Insulin ; Jejunum ; Male ; Postoperative Period ; Renal Insufficiency ; Risk Factors

PURPOSE: Endovascular treatment for peripheral arterial obstructive disease (PAOD) is replacing traditional arterial bypass in the western world. Yet there are few reports to evaluate the pattern of clinical practice pattern for PAOD in Korea. This study was conducted to evaluate the treatment pattern for PAOD between endovascular treatment and arterial bypass, and to compare their clinical characteristics. METHODS: We conducted a retrospective study on the prospectively maintained database of patients who underwent endovascular treatment and arterial bypass for PAOD from March 2005 to December 2009 in Inha University Hospital. The aortoiliac lesions and femoropopliteal lesions were categorized by the Trans Atlantic Inter-Society Consensus (TASC) II classifications. Their treatments and clinical characteristics were compared between the former period (2005~2007 y) and the latter period (2008~2009 y). RESULTS: Three hundred nine cases (178 patients) were treated for PAOD by either arterial bypass or endovascular treatment. The patients' mean age was 69.1+/-11.3 year old. There was no difference in clinical characteristics between the two periods except for age. Endovascular treatments of both aortoiliac and femoropopliteal arterial lesions were increased in the latter period (P=0.023, P<0.001). Also, the endovascular treatments were increased in the TASC C and D aortoiliac and femoropopliteal lesions in the latter period (P=0.020, P<0.001). CONCLUSION: Endovascular treatment for PAOD is increasing in clinical practice and this shows feasibility in critically ill patient with TASC C and D lesions, although arterial bypass is still important.
Angioplasty ; Arterial Occlusive Diseases ; Atherosclerosis ; Consensus ; Critical Illness ; Humans ; Korea ; Physician's Practice Patterns ; Prospective Studies ; Retrospective Studies ; Western World

BACKGROUND/AIMS: Surgery has been the mainstay of treatment for duodenal perforations after the introduction of endoscopic retrograde cholangiopancreatography (ERCP). Yet there have recently been arguments that conservative management with or without endoscopic intervention may be possible and safe. METHODS: For the patients who received ERCP at Inha University Hospital from Jan. 2001 to Dec. 2007, we retrospectively analyzed the clinical manifestations, the treatment and the clinical outcomes of the cases with duodenal perforation. RESULTS: Among the 1708 ERCP cases, duodenal perforation occurred in eleven (0.6%) patients. There were two cases of duodenal perforations (type I), four cases of peri-Vaterian injury (type II), two cases of bile duct perforations (type III) and three cases of retroperitoneal perforations (type IV). Six patients (55%) were treated surgically while the others were managed conservatively. Except for one death (9.1%), ten patients fully recovered. Either residual diseases or fluid collections, as seen on CT, were present in the surgically managed patients. The median time interval between ERCP and surgery was 19 hours (range: 8~30 hours). CONCLUSIONS: To decide on the management of duodenal perforation after ERCP, the presence of residual disease or the leakage of intraluminal contents should be considered along with the type of the perforation.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenum ; Humans ; Retrospective Studies

PURPOSE: The aim of this study was to compare the short and long-term outcomes following carotid endarterectomy (CEA) with either primary closure (PC) or patch angioplasty (PAT) performed by single center vascular surgeons. METHODS: Between November 1994 and March 2008, a total of 366 patients underwent 401 consecutive primary CEA procedures at our institution. We retrospectively reviewed patients' medical records. Two vascular surgeons prefer routine PC and one vascular surgeon prefer routine patch closure using bovine pericardial patch. Postoperative neurologic complications were determined by clinical neurologists. Restenosis was defined as >50% stenosis on follow-up duplex scan. Data was analyzed to compare the early (< or =30 days) and late results of CEA between PC group and PAT group. RESULTS: The mean follow-up duration was significantly longer in the PC group than that in the PAT group (61.7 months vs. 41.2 months, P<0.001). Coronary artery disease and combined CEA with coronary artery bypass were more common in the PAT group (39% vs. 55%, P<0.002; 4% vs. 12%, P<0.004). Perioperative ipsilateral TIA/stroke rates in the PC and PAT groups were 1.5% and 0.7% (PC=4/270 vs. PAT=1/131, P=0.564). Regarding late outcomes, Kaplan-Meier analysis failed to show any difference between 2 groups on freedom from ipsilateral transient ischemic attack (TIA)/stroke, freedom from restenosis and TIA/stroke-free survival (P=0.851, P=0.232, P=0.103, log-rank test). CONCLUSION: Our results suggest that PC following CEA is not necessarily inferior to PAT for experienced surgeons.
Angioplasty ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Endarterectomy, Carotid ; Follow-Up Studies ; Freedom ; Humans ; Ischemic Attack, Transient ; Kaplan-Meier Estimate ; Medical Records ; Retrospective Studies

PURPOSE: As Korea is an aging society (WHO classification) and projected to be an aged society in 10 years, peripheral vascular diseases (PVD) in the elderly population has emerged as an important social and medical issue. But their prevalence was rarely reported in Korea. The purpose of this study is to define the prevalence of carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), and peripheral arterial occlusive disease (PAOD) of lower limb in the Incheon area. METHODS: Elderly men (> or =65 years) were referred randomly from the Incheon Federation of Korean Senior Citizens' Association (from Nov 2008 to Sep 2009) to Inha Univeristy Hospital, Incheon, Korea for a PVD screening program. The subjects were screened for CAS and AAA by duplex. CAS was defined as > or =50% internal CAS and AAA as > or =3 cm aortic diameter in minor axis. PAOD of lower limb was screened by measurement of ankle brachial index (ABI); ABI of < or =0.9 was considered abnormal. RESULTS: 1150 subjects were screened including 103 octogenarians (9.0%). Mean age was 72.3+/-0.2 years. Combined conditions were hypertension (54.3%), diabetes mellitus (25.2%), coronary artery disease (15.6%), dyslipidemia (18.9%), obesity (31.1%) and smoking history (71.7%). CAS was detected in 7.7% (89/1,150) subjects. Thirty-three (2.9%) were diagnosed with AAA. PAOD was detected in 50 subjects (4.4%). CONCLUSION: Prevalence of PVD in Korea is not lower compared to that of western countries, especially the USA and the UK. A nationwide program for timely detection and treatment for PVD should be developed.
Aged ; Aged, 80 and over ; Aging ; Ankle Brachial Index ; Aortic Aneurysm, Abdominal ; Arterial Occlusive Diseases ; Axis, Cervical Vertebra ; Carotid Stenosis ; Coronary Artery Disease ; Diabetes Mellitus ; Dyslipidemias ; Humans ; Hypertension ; Korea ; Lower Extremity ; Male ; Mass Screening ; Obesity ; Peripheral Vascular Diseases ; Prevalence ; Smoke ; Smoking ; Vascular Diseases

PURPOSE: Endoleak is a common complication following endovascular aortic aneurysm repairs (EVAR). The aim of this study was to discover the frequency and characteristics after EVAR with on-label use. METHODS: A retrospective review was performed on 25 patients who underwent EVAR in Inha University Hospital between December 2005 and February 2009. The data included in this study accounted for patient characteristics, anatomic features, operative technical details, and types of devices used. The results of EVAR were analyzed for clinical success, technical success and endoleak. RESULTS: Endoleaks were observed during 11 (47.8%) procedures. Type I endoleaks were observed in 2 (18.2%) cases. A total of 6 type II intraoperative endoleaks (54.5%) were observed. 3 type III endoleaks (27.3%) occurred. But all endoleaks were resolved without additional intervention CT scan after 6 months. CONCLUSION: Although the endovascular management of AAAs is less invasive than open surgery, many complications including endoleak were still the most common adverse event during the first postoperative month. However, observation may be a good treatment for minor endoleak after EVAR.
Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Endoleak ; Humans ; Retrospective Studies