No abstract available.
Snake Bites* ; Snakes*

Transarterial chemoembolization is often the first-line treatment for multiple hepatocellular carcinomas. However, hepatic arterial infusion chemotherapy is a treatment option for hepatocellular carcinoma refractory to multiple sessions of transarterial chemoembolization. Hepatic arterial infusion chemotherapy requires implantation of an appropriate port into the hepatic artery. However, it may be impossible to implant a port due to hepatic artery variation. We report a case of hepatocellular carcinoma refractory to transarterial chemoembolization and hepatic artery variation treated successfully with hepatic arterial infusion chemotherapy and radiofrequency ablation with complete response after implantation of ports in both liver lobes.

No abstract available.
Bone Morphogenetic Proteins*

Currently, various tyrosine kinase inhibitors and immune checkpoint inhibitors have been suggested in the treatment guidelines for advanced hepatocellular carcinoma (HCC). However, sorafenib was the only systemic drug approved 10 years ago. In 2010, a woman diagnosed with HCC rupture and multiple lung metastases visited our hospital. At the time of visiting our hospital, she had undergone transarterial chemoembolization at another hospital to control bleeding due to HCC rupture. We treated her with hepatic arterial infusion chemotherapy and sorafenib combination therapy to increase the control of intrahepatic tumors in consideration of the modest efficacy of sorafenib. The intrahepatic tumor was almost controlled. Metastasectomy was performed to control lung oligometastasis. Subsequently, additional muscle metastasis was confirmed, and metastasectomy was performed. Although this is a very rare case, it shows that a multidisciplinary approach can improve the prognosis of patients with HCC.

BACKGROUND: Modern intensive chemotherapy has dramatically improved the prognosis of acute lymphoblastic leukemia in children. However, quality of life and even survival may be threatened by infection. Immunosuppression is experted due to disease itself or therapy, and sometimes, immunosuppression itself may lead to reactivation of latent viral infections in these patients. Often the viruses involved in the most severe infections suggest that patients suffer from defect in the cellular immunity. The principal defects that predispose leukemia patients to infection are defects of T cell, B cell, stem cell, complement, and macrophage. These contributing factors interact in a complex manner resulting in spectrum of problems. But these may result from a T cell defect and, in this study, 7 cell responsiveness of patients at diagnosis, remission induction, maintenance chemotherapy and after chemotherapy for leukemia has been investigated. Studies of the immune competence of patients undergoing chemotherapy for leukemia is in progress, but results are different from each other. METHOD: Between July 1994 and May 1996, seventy patients with childhood ALL were enrolled in this study. In order to expect frequency and depth of infection and prognosis, we investigated concentrations of immunoglobulins G, A, M, peripheral total lymphocyte count, 7 cell subsets, phytohemmaglutinin responsiveness, interleukln-2(IL-2), gamma-interferon(gamma-INF), and natural killer cell activity. RESULTS: 1) IgA concentrations were often markedly raised at diagnosis, and IgG, IgM concentrations both were within normal limits. During and after chemotherapy, IgA had fallen significantly but IgG, IgM are within normal limits. 2) Total lymphocyte count had fallen during chemotherapy, and returned to normal levels after chemotherapy. CD4+ T cell were markedly decresed at diagnosis, during chemotherapy and returned to normal levels after chemotherapy. 3) In vitro proliferative response of peripheral blood lymphocytes to the T cell mitogen phytohenagglutinin were impaired at diagnosis, during chemotherapy but did not returned to normal levels. 4) Interlekin-2, gamma interferon were normal levels at diagnosis, and had fallen in the induction of remission and quickly returned to normal levels with the swish to maintenance chemotherapy. But Interleukin-2 had fallen during and after chemotherapy. Natural killer cell activity had fallen at diagnosis, during chemotherapy and returned to normal levels after chemotherapy. CONCLUSION: It is assumed that evidence of impaired T cell responses is somewhat definite. These observations suggest that proliferative responses to phytohemagglutinin, CD4+ T cell, natural killer cell activity defects are due to leukemia itself but others more likely are generalizable defects caused by chemotherapy. Further investigations, however, have suggested a persisting defect in IgA, proliferative reponses to phytohemagglutinin, and interleukln-2. Our observations also show that despite normal immunoglobulin levels, most of these children have nonprotective levels for common childhood bacterial or viral disease. These results support to the praxis to withdraw prophylactic antibiotics after discontinuation of intensive chemotherapy and to start the immunization. It is expect to try to use cytokine on treatment and to improve mortality and morbidity for children of acute leukemia also.
Anti-Bacterial Agents ; Child* ; Complement System Proteins ; Diagnosis ; Drug Therapy* ; Humans ; Immunity, Cellular ; Immunization ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Immunosuppression ; Interferons ; Interleukin-2 ; Killer Cells, Natural ; Leukemia ; Lymphocyte Count ; Lymphocytes ; Macrophages ; Maintenance Chemotherapy ; Mental Competency ; Mortality ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis ; Quality of Life ; Remission Induction ; Stem Cells ; Virus Diseases

BACKGROUND: Surgical closure of the PDA in premature infants with complications or contraindications to indomethacin use, or recurrence of symptomatic PDA is a safe and effective procedure with low operative risk and minimal complications. MATERIAL AND METHOD: From April 1996 to August 1998, 11 premature infants with body weight under 1.5 kg at operation underwent operation for a symptomatic PDA (male:5, female: 6). Associated dise ases were congenital heart disease(7), hyaline membrane disease(6), intraventricular hemor rhage(4), pneumonia(4), pneumothorax(3), hyperbilirubinemia(2), necrotizing enterocolitis(2), renal failure(1), epilepsy(1), and hydrocephalus(1). Surgical techniques are hemoclipping(8) and ligation(3). The size of PDA was 3~6 mm (5.0+/-1.2). RESULT: Systolic and diastolic blood pressure rised and heart rates decreased after PDA closure. ABGA improved postoperatively. There were no surgical complications. Six infants with improved ABGA data were weaned from mechanical ventilatory support. The follow-up durations after discharge were 3 month to 12 month. Five deaths were not related to operation. The causes of death were hyaline membrane disease(2), bronchopulmonary dysplasia with pneumonia(1), sepsis(1), and con gestive heart failure with respiratory distress syndrome(1). CONCLUSION: Early operative closure is the treatment of choice in most premature infants with a hemodynamically significant shunt(PDA), recurrence of symptomatic PDA, complications of Indomethacin, or contraindi cations to Indomethacin.
Blood Pressure ; Body Weight ; Bronchopulmonary Dysplasia ; Cations ; Cause of Death ; Ductus Arteriosus, Patent ; Female ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Rate ; Humans ; Hyalin ; Indomethacin ; Infant ; Infant, Newborn ; Infant, Premature* ; Membranes ; Recurrence

PURPOSE: We used MRI to retrospectively analyze the brain of patients suffering from cerebral palsy. Our aim is to determine MRI's role in the assessment of brain damage, the relationship of gestational age. METHODS: A total of 66 patients(29 preform group and 37 term group), who visited Kang-Dong Sacred Heart Hospital from January, 1994 to July, 1998, were enrolled in this study. RESULTS: Among the 29 in the preform group, 13 patients showed MR images of hypoxic ischemic injury in which periventricular leukomalacid(PVL) and multifocal ischemic necrosis in 12(41.3%) and 1(3.4%) respectively. Neuronal migration disorders were 6(20.8%), other congenital malformations 5(17%) and normal MR images 5(17%) in this preform group. Among the 37 in the term group, 22 patients showed MR images of hypoxic ischemic injury in which selective neuronal necrosis were 11(29.7%), PVL 4(10.8%), focal and multifocal ischemic necrosis 4(10.8%) and status marmoratus 3(8.1%). Neuronal migration disorders were 4(10.8%), other congenital malformations 5(13.5%) and normal MR images 6(16.2%) in the term group. CONCLUSION: MRI provided useful information in a majority of children with cerebral palsy. Hypoxic ischemic injury was significantly different in preform and term groups. PVL was frequent in the preterm group and selective neuronal necrosis was statistically common in the term group.
Brain* ; Cerebral Palsy ; Child* ; Gestational Age ; Heart ; Humans ; Magnetic Resonance Imaging* ; Movement Disorders ; Necrosis ; Neuronal Migration Disorders ; Neurons ; Paralysis* ; Retrospective Studies

No abstract available.
Acanthoma*

PURPOSE: The purpose of the study is to investigate the correlation between the symptoms and the incidence of anatomical variant without mucosal abnormality. MATERIALS AND METHODS: Out of 892 patients with CT performed for the evaluation of sinus disease symptoms between March 1991 and March 1993, we observed the anatomic variations in 82 symptomatic patients without mucosal abnormality(male:female=43:39, mean age 36. 4 years). The control group included 88 patients with facial bone CT performed for the evaluation of trauma during the same period while patients with recent paranasal sinusitis were excluded. (male:female=76:12, mean age 22. 4 years). The scouis were performed with 5-ram section thickness from posterior margin of sphenoid sinus to anterior margin of posterior ethmoid and then with 3 mm thickness from anterior margin of posterior ethmoid to anterior margin of frontal sinus. The artatomic variations included nasoseptal deviation, concha bullosa, Hailer cells, Agger nasi cells, etc. RESULTS: The anatomic variations were demonstrated in 71 our of 82 symptomatic patients(86. 5%), whereas they were seen 26 of 88 patients(29. 5%) in control group. CONCLUSION: Our data suggest that there is a possible causal relationship between anatomic variations and symptomas. Even though without accompaning mucosal abnormalities, anatomic variations could contribute simply to its symptomas. ^natomic variants may obstruct or narrow the airway, leading to turbulating air flow or interrupting ucociliary movement, and finally may produce a series os symptoms.
Facial Bones ; Frontal Sinus ; Humans ; Incidence ; Sinusitis ; Sphenoid Sinus

BACKGROUND: The dipyridamole and dobutamine stress echocardiography have been studied as a non-invasive diagnostic test in coronary artery disease. Recently, some authors have extended the usefulness of these tests to predicting the prognosis of myocardial infarction patients. But as far as we know, there was no literature which tried boh tests to the same infarcted patients group. So, we performed both tests in the 23 infarcted patients to compare and evaluate both tests as predicting the prognosis in myocardial infarction. METHODS: Patients underwent (1) two-dimensional echocardiography under basal condition and after dipyridamole infusion for 4 minites at the dose of 0.14mg/kg/min, (2) another two dimensional echocardiography under basal and during dobutamine infusion at each dose of 5 to a maximum of 20microg/kg/min at 1 or 2 days after dipyridamole stress echocardiography, and (3) coronary and left ventricular angiography. Preinfusion and peak infusion images were analyzed independently by two different observers using Nova Micro Sonic soft were(DataVueII and ColorVue II analysis system). The segmental wall motions were scored as follows ; hyperkinetic : 1, normal : 2, hypokinetic : 3, akinetic : 4. THe test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during drug infusion at the vascular distributions except the akinetic infarcted segment identified during basal condition. The coronary angiography was analyzed by measuring the maximal luminal diameter stenosis with caliper and 50% or greater diameter narrowing was considered significant. The sensitivity and specificity were calculated by comparing echocardiographic prediction and angiographic findings. RESULTS: 1) Among 22 patients with sufficient image in dipyridamole stress echocardiography, 13 patients have myltivessel coronary disease without resting akinesia of non-infarcted segments. Only 5 patients showed positive findings in dipyridamole stress echocardiography(sensitivity, 38.4%). Among 9 patients who has single or minimal disease, 9 patients were negative finding(specificity, 100%). 2) Among 21 patients with sufficient image in dobutamine stress echocardiography, 12 patients have multivessel coronary disease without resting akinesia of non-infarcted segments. 7 patients showed positive finding in dobutamine stress echocardiography(sensitivity, 58.3%). Among 9 patients who has single or minimal disease, 8 patients showed negative finding(specificity, 88.8%). 3) In hemodynamic changes, dipyridamole stress echocardiography showed significant changes in heart rates and double products and dobutamine stress echocardiography showed significant changes in heart rates, systolic blood pressure and double products. 4) There was no significant side effect during both stress tests inacute and old myocardial infarction patients. CONCLUSION: 1) The dobutamine and dipyridamole stress echocardiography are safe and easy test for myocardial infarction patients. 2) The dobutamine stress echocardiography has higher sensitivity than dipyrdamole stress echocardiography for identifying multivessel coronary disease in myocardial infarction patients but the dose of both drugs were relatively small to get the adequate results. So the high dose of drugs must be tried in feature study.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Diagnostic Tests, Routine ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Exercise Test ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction* ; Phenobarbital ; Prognosis ; Sensitivity and Specificity