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

PURPOSE: To design and test the CT simulator phantom for geometrical test. MATERIAL AND METHODS: The PMMA phantom was designed as a cylinder which is 20 cm in diameter and 24 cm in length, along with a 25x25x31 cm3 rectangular parallelepiped. Radio-opaque wires of which diameter is 0.8 mm are attached on the other surface of the phantom as a spiral. The rectangular phantom was made of four 24x24x0.5 cm3 square plates and each plate had a 24x24 cm2, 12x12 cm2, 6x6 cm2 square line. The squares were placed to face the cylinder at angles 0degrees, 15degrees, 30degrees, respectively. The rectangular phantom made it possible to measure the field size, couch angle, the collimator angle, the isocenter shift and the SSD, the measurements of the gantry angle from the cylindrical part. A virtual simulation software, AcQSimTM, offered various conditions to perform virtual simulations and these results were used to perform the geometrical quality assurance of CT simulator. RESULTS: A 0.3~0.5 mm difference was found on the 24 cm field size which was created with the DRR measurements obtained by scanning of the rectangular phantom. The isocenter shift, the collimator rotation, the couch rotation, and the gantry rotation test showed 0.5~1 mm, 0.5~1degrees0.5~1degrees, and 0.5~ 1degreesdifferences, respectively. We could not find any significant differences between the results from the two scanning methods. CONCLUSION: The geometrical test phantom developed in the study showed less than 1 mm (or 1degrees) differences. The phantom could be used as a routine geometrical QC/QA tools, since the differences are within clinically acceptable ranges.
Polymethyl Methacrylate ; Silver Sulfadiazine

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

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*

No abstract available.

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

BACKGROUND: A decrease in core body temperature caused by heat distribution depends on the anesthetic agent used. The purpose of this study is to investigate the effects of sevoflurane and propofol on core temperature during laparoscopic major abdominal surgery requiring pneumoperitoneum of more than 90 min. METHODS: Fifty adult patients undergoing laparoscopic major abdominal surgery were randomly assigned to either a sevoflurane group (n = 25) or a propofol group (n = 25). In the sevoflurane group, anesthesia was induced with propofol 2 mg/kg, remifentanil 1.0 microg/kg, and maintained with 0.8-2.0 vol% sevoflurane and 0.1-0.2 microg/kg/min remifentanil. In the propofol group, anesthesia was induced with the effect-site concentration of propofol of 5.0 microg/ml and remifentanil 4 ng/ml, and maintained with the effect-site concentration of propofol of 2-3.5 microg/ml and remifentanil 3-5 ng/ml. Core body temperature was measured with an esophageal stethoscope with a temperature sensor after the start of the pneumoperitoneum (baseline) and at 15-min intervals until completion of surgery. RESULTS: During the study period, core temperature was comparable between the two groups. When compared with baseline values, core temperatures in both groups were significantly decreased 45 min after pneumoperitoneum. CONCLUSIONS: This study demonstrated that in patients undergoing prolonged laparoscopic surgery, a decrease in core body temperature during sevoflurane-remifentanil anesthesia was not different than propofol-remifentanil anesthesia, and the incidence of hypothermia of the two groups did not differ.
Adult ; Anesthesia ; Body Temperature ; Hot Temperature ; Humans ; Hypothermia ; Incidence ; Laparoscopy ; Methyl Ethers ; Piperidines ; Pneumoperitoneum ; Propofol ; Stethoscopes