For the modern practice of cancer surgery, the concept of oncovascular surgery (OVS), defined as cancer resection with concurrent ligation or reconstruction of a major vascular structure, can be very important. OVS for advanced cancers requires specialized procedures performed by a specialized multidisciplinary team. Roles of oncovascular surgeons are summarized as: a primary surgeon in vessel-origin tumors, a rescue surgeon treating complications during cancer surgery, and a consultant surgeon as a multidisciplinary team for cancer surgery. Vascular surgeons must show leadership in cancer surgery in cases of complex advanced diseases, such as angiosarcoma, leiomyosarcoma, intravenous leiomyomatosis, retroperitoneal soft tissue sarcoma, iatrogenic injury of the major vessels during cancer surgery, pancreatic cancer with vascular invasion, extremity soft tissue sarcoma, melanoma and others.
Consultants ; Extremities ; Hemangiosarcoma ; Humans ; Leadership ; Leiomyomatosis ; Leiomyosarcoma ; Ligation ; Melanoma ; Pancreatic Neoplasms ; Sarcoma ; Surgeons

Seborrheic keratosis is one of the most common benign growths of the skin, arising from keratinocytes within the epidermis. Unlike actinic keratosis, which frequently progresses to squamous cell carcinoma, seborrheic keratosis generally has a low risk of malignancy. The reasons for this low risk are not fully understood, but some studies suggest it may be due to the lack of mutations in tumor suppressor genes. This case report describes a rare instance of squamous cell carcinoma arising from a long-standing seborrheic keratosis located in a sun-protected area. We performed immunohistochemical staining for tumor suppressor proteins p53 and p16, as well as the proliferation marker Ki-67. Based on this case, we speculate that cumulative mutations in tumor suppressor genes might play a role in the progression of seborrheic keratosis to squamous cell carcinoma. Further studies involving a larger sample size and combining immunohistochemical staining with genomic analysis are necessary to elucidate the mechanisms underlying malignant transformation in seborrheic keratosis.

Seborrheic keratosis is one of the most common benign growths of the skin, arising from keratinocytes within the epidermis. Unlike actinic keratosis, which frequently progresses to squamous cell carcinoma, seborrheic keratosis generally has a low risk of malignancy. The reasons for this low risk are not fully understood, but some studies suggest it may be due to the lack of mutations in tumor suppressor genes. This case report describes a rare instance of squamous cell carcinoma arising from a long-standing seborrheic keratosis located in a sun-protected area. We performed immunohistochemical staining for tumor suppressor proteins p53 and p16, as well as the proliferation marker Ki-67. Based on this case, we speculate that cumulative mutations in tumor suppressor genes might play a role in the progression of seborrheic keratosis to squamous cell carcinoma. Further studies involving a larger sample size and combining immunohistochemical staining with genomic analysis are necessary to elucidate the mechanisms underlying malignant transformation in seborrheic keratosis.

Seborrheic keratosis is one of the most common benign growths of the skin, arising from keratinocytes within the epidermis. Unlike actinic keratosis, which frequently progresses to squamous cell carcinoma, seborrheic keratosis generally has a low risk of malignancy. The reasons for this low risk are not fully understood, but some studies suggest it may be due to the lack of mutations in tumor suppressor genes. This case report describes a rare instance of squamous cell carcinoma arising from a long-standing seborrheic keratosis located in a sun-protected area. We performed immunohistochemical staining for tumor suppressor proteins p53 and p16, as well as the proliferation marker Ki-67. Based on this case, we speculate that cumulative mutations in tumor suppressor genes might play a role in the progression of seborrheic keratosis to squamous cell carcinoma. Further studies involving a larger sample size and combining immunohistochemical staining with genomic analysis are necessary to elucidate the mechanisms underlying malignant transformation in seborrheic keratosis.

Seborrheic keratosis is one of the most common benign growths of the skin, arising from keratinocytes within the epidermis. Unlike actinic keratosis, which frequently progresses to squamous cell carcinoma, seborrheic keratosis generally has a low risk of malignancy. The reasons for this low risk are not fully understood, but some studies suggest it may be due to the lack of mutations in tumor suppressor genes. This case report describes a rare instance of squamous cell carcinoma arising from a long-standing seborrheic keratosis located in a sun-protected area. We performed immunohistochemical staining for tumor suppressor proteins p53 and p16, as well as the proliferation marker Ki-67. Based on this case, we speculate that cumulative mutations in tumor suppressor genes might play a role in the progression of seborrheic keratosis to squamous cell carcinoma. Further studies involving a larger sample size and combining immunohistochemical staining with genomic analysis are necessary to elucidate the mechanisms underlying malignant transformation in seborrheic keratosis.

Objective: This study was conducted to estimate the incidence of cardiovascular disease (CVD) independently from low-density lipoprotein (LDL) cholesterol according to triglyceride (TG) levels in young adults. Methods: Subjects aged 30–49 years with data from routine health check-ups provided by the National Health Insurance Service during 2009 were selected. The primary outcome was incident CVD, defined as a composite of ischemic heart disease and ischemic stroke during the follow-up period from 2009 to 2018. Results: The mean age of study subjects (n=1,823,537) was 40.1±5.7 years, and the median follow-up period was 8.3 years. The quartiles of serum TG levels at the baseline were calculated: Q1, <74 mg/dL; Q2, 74–108 mg/dL; Q3, 109–166 mg/dL; and Q4: >166 mg/dL.The highest quartile of TG levels (Q4) had a significantly higher risk of the primary outcome than Q1 (hazard ratio [HR], 2.40 [95% confidence interval; CI, 2.33–2.47]). Q2 and Q3 also experienced the primary outcome more frequently than Q1 (HR, 1.37 [95% CI, 1.33–1.42] and HR, 1.80 [95% CI, 1.75–1.86], respectively). Even after adjustment for age, sex, obesity, alcohol drinking amount, smoking, LDL cholesterol, diabetes mellitus, hypertension, lipidlowering medication use, and family history of CVD, there was a significant dose-response relationship between TG quartiles and the risk of the primary outcome (HR per quartile, 1.13 [95% CI, 1.12–1.14]). Conclusion In conclusion, in the Korean population aged 30–49 years, high TG levels independently increased future CVD risk in both men and women.

BACKGROUND: Henoch-Schӧnlein purpura (HSP) is a common vasculitis of childhood. Though HSP is usually self-limiting, severe complications can occur. The management for this condition has not been established yet. Thus, this nationwide study aimed at investigating epidemiological characteristics of children with HSP in Korea. The patterns of clinical practice with regard to the complications of the condition were also investigated. METHODS: This is a national population-based study that used the National Health Insurance Database. Children below 18 years who were diagnosed with HSP in Korea between 2006 and 2015 were enrolled. Data, such as age, sex, yearly and monthly distribution of HSP, hospitalization, re-hospitalization, comorbidities, and interventions were obtained. The use of steroids was also analyzed. RESULTS: A total of 56,841 children were enrolled. The annual incidence of HSP was 55.9 per 100,000 children. The peak age was 5 years. Spring was the most prevalent season. Sex (male) and young age (< 9 years) were risk factors of hospitalization. Younger children were more likely to be re-hospitalized and suspected with intussusception, arthritis, and nephritis. Only 4 children received laparotomy. In total, 57% were managed with steroids, and mean durations of medication were 4–5 days. Children who were hospitalized and those with comorbidities used steroids more frequently (P < 0.001). CONCLUSION: The annual incidence of HSP is 55.9 per 100,000 children which is higher in Korea than that in other countries. Younger children can have a more severe clinical course. This nationwide survey provides valuable information to understand HSP in children and to inspire further research on HSP.
Arthritis ; Child* ; Comorbidity ; Epidemiology ; Hospitalization ; Humans ; Incidence ; Intussusception ; Korea* ; Laparotomy ; National Health Programs ; Nephritis ; Purpura* ; Risk Factors ; Seasons ; Steroids ; Vasculitis

Most cases of spinal subdural hematoma are very rare and result from iatrogenic causes, such as coagulopathy or a spinal puncture. Cases of non-traumatic spinal subdural hematoma accompanied by intracranial hemorrhage are even more rare. There are a few reports of spontaneous spinal subdural hematoma with concomitant intracranial subdural or subarachnoid hemorrhage, but not with intracerebral hemorrhage. Especially in our case, the evaluation and diagnosis were delayed because the spontaneous intracerebral hemorrhage accompanying the unilateral spinal subdural and subarachnoid hemorrhages caused hemiplegia. We report a case of spinal subdural and subarachnoid hemorrhage with concomitant intracerebral hemorrhage, for the first time, with a relevant literature review.
Cerebral Hemorrhage ; Diagnosis ; Hematoma ; Hematoma, Subdural, Spinal ; Hemiplegia ; Intracranial Hemorrhages ; Spinal Puncture ; Subarachnoid Hemorrhage

This is a report of a 58-year-old female with Cushing syndrome who underwent posterior lumbar fusion and lost both her vision completely. She was diagnosed with posterior ischemic optic neuropathy. Cushingoid features such as buffalo hump and central obesity might have attributed in triggering posterior ischemic optic neuropathy. When laid prone for surgery, perioperative high abdominal pressure causes venous hypertension leading to increase amount of blood loss. To compensate, infusion of large quantities of intravenous fluids is necessary which leads to hemodilution which decreases ocular perfusion pressure. Hypercoagulability of Cushing syndrome is also potentially a risk factor of this condition which increases the incidence of venous thromboembolism. For there is no known effective treatment for posterior ischemic optic neuropathy, means to prevent this complication must be strategically reviewed. When performing long spine surgery on patient who has Cushing syndrome or cushingoid features, caution must be taken to avoid this devastating complication.
Buffaloes ; Cushing Syndrome ; Female ; Hemodilution ; Humans ; Hypertension ; Incidence ; Intraocular Pressure ; Middle Aged ; Obesity, Abdominal ; Optic Neuropathy, Ischemic ; Perfusion ; Risk Factors ; Spinal Fusion ; Spine ; Thrombophilia ; Venous Thromboembolism

OBJECTIVE: The laboratory biomarkers used to diagnose spinal infection include white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Recently, procalcitonin (PCT) has been used as a biomarker to distinguish between bacterial infection and non-bacterial infection. We aimed to compare the changes of conventional biomarker and PCT in patients with spinal infection before and after antibiotic treatment. METHODS: ESR, CRP, WBC counts, and PCT were measured in 29 patients diagnosed with pyogenic spinal infection at our hospital between May 2016 and December 2018 prior to antibiotic administration. After antibiotic administration, the values were followed up for 4 weeks at 1-week intervals. RESULTS: A total of 29 patients were enrolled, with a mean age of 67.8 years, consisting of 16 men and 13 women. Twenty-five patients had lumbar infections, and 2 each had cervical and thoracic infections. The mean ESR, CRP, PCT, and WBCs decreased at week 4 of antibiotic treatment compared to their baseline values. CRP and WBCs were significantly decreased after 4 weeks of treatment compared to before treatment. The mean ESR and PCT was not statistically significant compared to pretreatment and after antibiotic treatment (p-value>0.05). CONCLUSION: Among several biomarker, CRP and WBCs are biomarkers that can aid early evaluation of the effects of antibiotic treatment in pyogenic spondylitis. Although PCT did not have statistical significance, it can be used as a biomarker that reflects the effect of antibiotic and severity of infection.
Bacterial Infections ; Biomarkers ; C-Reactive Protein ; Calcitonin ; Erythrocyte Count ; Female ; Humans ; Leukocytes ; Male ; Spondylitis