Extrahepatic portal vein obstruction (EHPVO) is the most common cause of pediatric portal hypertension and can cause life-threatening variceal bleeding. MesoRex shunt (MRS) is a surgical procedure that restores physiological portal venous blood flow to the liver by using a graft to connect the superior mesenteric vein and the left portal vein within the Rex recess, and can relieve variceal bleeding and other complications associated with EHPVO. Although the MRS is regarded as an optimal and potentially curative treatment with good long-term patency, graft thrombosis or failure due to unknown causes is not rare, prompting the need for further research on the risk factors of graft failure or poor patency. Herein, we report two cases of EHPVO in patients with recurrent or uncontrolled variceal bleeding, one treated with the classic Rex shunt and the other with the modified Rex shunt, which resulted in a failure and success, respectively.

We present two very interesting cases of acute graft-versus-host disease (GVHD), whose skin rashes initially appeared on the localized area of total nodal irradiation (TNI) performed previously to prevent graft rejection and/or GVHD. The histopathologic findings showed some dyskeratotic cells in the epidermis and perivascular mononuclear cell infiltration in the upper dermis. The immunohistochemical studies revealed that HLA-DR was diffusely strongly positive in a number of keratinocytes, whereas both CD4 and CD8 were focally weakly positive in the perivascular lymphocytes in the upper dermis. Later on, liver dysfunction and diarrhea developed and skin rashes began to spread over the other parts of the body in those two patients.
Dermis ; Diarrhea ; Epidermis ; Exanthema ; Graft Rejection ; Graft vs Host Disease* ; HLA-DR Antigens ; Humans ; Keratinocytes ; Liver Diseases ; Lymphocytes ; Skin*

A 71-year-old woman presented with an enlarging mass in the right buttock, with pain and tingling sensation in sitting position. Five years ago, she was diagnosed with acute limb ischemia due to acute thrombosis of right persistent sciatic artery (PSA), and she underwent successful thromboembolectomy and femoro-tibioperoneal trunk bypass. Computed tomography angiography revealed a huge PSA aneurysm (PSAA). During the previous bypass, the distal popliteal artery was ligated just above the distal anastomosis to exclude the PSAA, whose proximal end was already thrombosed. However, PSAA has grown to cause compression symptoms, and the mechanism of aneurysm growth can be ascribed to type 1a or type 2 endoleak. In order to relieve the compression symptoms, aneurysm excision was performed without any injury to the sciatic nerve. A postoperative tingling sensation due to sciatic-nerve stimulation in the supine position resolved spontaneously one month after surgery.
Aged ; Aneurysm* ; Angiography ; Arteries* ; Buttocks ; Congenital Abnormalities ; Endoleak ; Extremities ; Female ; Humans ; Ischemia ; Popliteal Artery ; Sciatic Nerve ; Sciatica ; Sensation ; Supine Position ; Thrombosis

PURPOSE: Acute Ischemia Of The Arm Is Uncommon Compared With Events In The Leg And Much Less Attention Has Been Paid To The Management Of Acute Arterial Thromboembolism Of The Upper Extremities. The Aim Of This Study Was To Evaluate The Clinical Aspects And Treatment Outcomes Of Acute Upper Extremity Thromboembolism. METHODS: From January 2007 to March 2010, seven patients underwent the management of upper extremity thromboembolism in three Seoul National University (SNU)-affiliated hospitals. We retrospectively reviewed the medical records. RESULTS: The mean age was 64.6 years (range 48~93 years) and 4 patients (57.1%) were female. Distribution of the thromboembolism were 4 in brachial, 1 in axillary plus brachial, 1 in ulnar and radial, and 1 in axillary artery, respectively. Time from symptom onset to presentation was 3.5 days (range 1~10 days). Primary treatment modality were Fogarty catheter embolectomy in 3 cases, bypass surgery in 1 case, and urokinase thrombolysis in 2 cases. A patient without symptoms was treated conservatively. Patients receiving primary thrombolytic therapy underwent surgical approach due to recurred thromboembolism during admission. In our 11.2 months of mean follow-up, there was recurrence but 1 patient died from cerebral infarction after 1.5 year of discharge. CONCLUSION: In this study, functional outcome of acute upper extremity ischemia following appropriate treatments was excellent. Key features of treatment are shortening the time interval of diagnosis to primary treatment, proper anticoagulation, and treatment of underlying conditions. Larger-volume, long-term results and meta-analysis of upper extremity thromboembolism are required to establish standardized treatment in Korea.
Arm ; Axillary Artery ; Catheters ; Cerebral Infarction ; Embolectomy ; Embolism ; Female ; Follow-Up Studies ; Humans ; Ischemia ; Korea ; Leg ; Recurrence ; Retrospective Studies ; Thromboembolism ; Thrombolytic Therapy ; Upper Extremity ; Urokinase-Type Plasminogen Activator

The editorial department of Journal of Korean Neurosurgical Society(JKNS) polled more than 1,210 members of the Korean Neurosurgical Society(KNS) to evaluate the present status of JKNS from a viewpoint of readers or authors. The survey form includes questions about the impressions and opinions of JKNS regarding to its contents, style, and service. The responses were collected by means of e-mail and a total of 107 replies could be gathered during 2 months. Analysis of the responses revealed that majority of members of the KNS recognized the efforts to improve the quality of JKNS during recent years. However, there was also apprehensions and discontent about the quality of articles and review process in some KNS members.
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The authority and reputation of a medical journal is based on the number of received citations. Korean Medical Citation Index (KoMCI) provides information about citations of Korean medical journals since 2002. All six issues of KoMCI (from 2000 to 2005) were used for analysis. Citations, impact factor, and their changes were evaluated. We compared the data of Journal of Korean Neurosurgical Society(JKNS) with other Korean medical journals. The impact factor(IF) of 2005 maintained increased value since 2004, although the impact factor excluding self citation(ZIF) returned previous low value. Improvement in proportion of Korean citations and in proportions of non-self received citations were encouraging changes. Although there were some improvements, the status of JKNS with respect to ZIF is still behind other Korean medical journals selected for comparison. Improvement of the status of JKNS by aid of KoMCI and enhanced reputation of KoMCI by its positive influence on JKNS or other Korean medical journals will be beneficial to members and medical societies of Korea.
Korea ; Societies, Medical

BACKGROUND: With progressive improvement in the fraction of long-term surviviors, chronic GVHD has emerged as a increasingly frequent complication of allogenic bone marrow transplantation. Except for a few case reports, there has been no clinical study of chronic cutaneous GVHD in Korea so far. OBJECTIVE: In the present study we planned to investigate the clinical characteristics of chronic cutaneous GVHD and to compare the clinical manifestation and incidence of chronic cutaneous GVHD in Korea with previous reports in U.S.A. and Europe. METHODS: On the basis of the patients' charts and the records of bone marrow transplantation, we investigated the incidence of chronic cutaneous GVHD in Korean leukemia patients and studied the clinical manifestations of chronic cutaneous GVHD ocurring in 16 patients whose diagnosis was confirmed by histopathologic findings of skin biopsy. We also analysed whether total body irrdiation before bone marrow transplantation, GVHD prophylaxis and presence of preceding acute GVHD affected chronic cutaneous GVHD. RESULTS: 1. The incidence in chronic cutaneous GVHD in Korea was lower than that in Caucasian countries. 2. The onset was milder than that in Caucasians. 3. The clinical manifestation was earlier than that in Caucasians. 4. The relationship between the GVHD prophylaxis and incidence chronic cutaneous GVHD was not significant. 5. The incidence of chronic cutaneous GVHD in the presence of preceding acute GVHD was higher than in cases with no preceding acute GVHD. CONCLUSION: We speculate that the low incidence of chronic cutaneous GVHD and clinical characteristics differing from the reports in the U.S.A. and Europe might be unassociated with irradiation, GVHD prophylaxis or the presence of preceding acute GVHD but maybe related to differences in genetic background.
Biopsy ; Bone Marrow Transplantation ; Diagnosis ; Europe ; Humans ; Incidence ; Korea ; Leukemia ; Skin

We report a case of trichilemmal catcinoma in a 79-year-old woman presentde an atrophic scar remaining after excision of a recurrent nodule on the right mandibular area, Her past history revealed that there had been a painful pea-sized brownish nofule on the same site for two years. Eleven months before presentation, it had been excised but recurred 9 months later. Histopathologic findings showed a clear cell neoplasm with trichilemmal keratinization. The tumor cells showed PAS-positive cytoplasm and cytologic atypia with a few mitoitic figures. Immunohistochemical staining for high molecular weight cytokeratin was positive but carcinoembryonic antigens and epithelial membrane antigens were all negative. To our knowledge this is the first report of trichilemmal carcinoma in Korea.
Aged ; Carcinoembryonic Antigen ; Cicatrix ; Cytoplasm ; Female ; Humans ; Keratins ; Korea ; Molecular Weight ; Mucin-1

PURPOSE: Urinary tract infections (UTIs) are the most common source of bacterial infections in infants and young children. Accurate diagnosis and treatment is important because of their association with renal scarring, which can lead to complications. Urine endothelin-1 (ET-1) is the major renal isoform produced and released by renal mesangial cells in response to glomerular injury. This study aimed to investigate whether urinary levels of ET-1 can be used as a biomarker for UTI diagnosis. METHODS: We conducted a prospective study using medical records of 70 patients below the age of 18 years, who visited Chung-Ang University Hospital from July 2012 to July 2013. We classified the patients into the UTI and control groups based on urine culture studies. The UTI group was further divided into upper and lower UTI groups using 99m-Technetium dimercaptosuccinic acid scintigraphy. Urine ET-1 was measured using enzyme linked immunosorbent assay with 0.3 mL urine. RESULTS: The UTI and control groups were comprised of 45 and 25 patients, respectively. Mean urine ET-1 levels were significantly higher in the UTI group than in the control group (1.41+/-0.35 pg/mL vs. 0.33+/-0.07 pg/mL, P=0.04). There was no significance difference in the quantitative value between the upper and lower UTI groups (P=0.552). There was no correlation between urine ET-1 and serum C-reactive protein (Pearson correlation [R]=0.24), urine ET-1 and serum white blood cell count (R=0.19). CONCLUSION: Our study suggests that urine ET-1 can be used for early diagnosis of UTI in children.
Bacterial Infections ; Biomarkers ; C-Reactive Protein ; Child* ; Cicatrix ; Diagnosis ; Early Diagnosis ; Endothelin-1* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant ; Leukocyte Count ; Medical Records ; Mesangial Cells ; Pediatrics ; Prospective Studies ; Radionuclide Imaging ; Succimer ; Urinary Tract Infections*

In children presenting to hospital with gastrointestinal symptoms, diseases such as intussusception and acute appendicitis require particular attention and careful examination. Early diagnosis and proper treatment are important because of possible severe complications such as peritonitis and death. Intussusception and appendicitis share similar clinical manifestations. More importantly, the presence of acute appendicitis together with intussusception in children is very rare. We describe an interesting case of a 38-month-old boy who presented with abdominal pain in the right lower quadrant. His vital signs were stable and laboratory test findings showed no specific alterations. We detected tenderness in the right lower quadrant. A computed tomography scan showed an ileocolic intussusception with no strangulation and diffuse wall thickening of the appendix trapped within the intussusception. The patient underwent an appendectomy and manual reduction.
Abdominal Pain ; Appendectomy ; Appendicitis* ; Appendix ; Child ; Child, Preschool ; Early Diagnosis ; Humans ; Intussusception* ; Male ; Peritonitis ; Vital Signs