A 67-year-old woman was admitted to our hospital under suspicion of a hepatic tumor, which had been previously diagnosed to be an adenocarcinoma by fine needle aspiration. Computed tomography and magnetic resonance imaging revealed a large tumor measuring 9 cm in diameter in Couinaud's hepatic segments 4, 5, and 8. We diagnosed the patient to have primary liver cancer, and suspected intrahepatic cholangiocarcinoma preoperatively. We performed a central hepatectomy. According to the immunohistochemical findings of the resected specimen, the tumor was diagnosed to be a primary neuroendocrine carcinoma in the liver. The patient is presently alive without recurrence at 3 months after hepatic resection.
Adenocarcinoma ; Biopsy, Fine-Needle ; Carcinoma, Neuroendocrine ; Cholangiocarcinoma ; Chromogranin A ; Female ; Hepatectomy ; Humans ; Liver ; Liver Neoplasms ; Magnetic Resonance Imaging ; Recurrence

Left atrial dissection does occur, though rarely, after mitral valve surgery. A 68-year-old Korean female presented with moderate mitral stenosis, mild mitral regurgitation, moderate tricuspid regurgitation and mild aortic regurgitation. She was scheduled for mitral valve replacement and tricuspid annuloplasty. We experienced a left atrial dissection after weaning from cardiopulmonary bypass and decided not to repair it. The patient recovered uneventfully. We suggest that a specific type of left atrial dissection can be treated conservatively.
Aged ; Aortic Valve Insufficiency ; Cardiopulmonary Bypass ; Female ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Tricuspid Valve Insufficiency

We experienced a case of venous vessel wall entrapment between the introducer needle and the guide wire during an attempt to perform right internal jugular vein (IJV) catheterization. The guide wire was introduced with no resistance but could not be withdrawn. We performed ultrasonography and C-arm fluoroscopy to confirm the entrapment location. We assumed the introducer needle penetrated the posterior vessel wall during the puncture and that only the guide wire entered the vein; an attempt to retract the wire pinched the vein wall between the needle tip and the guide wire. Careful examination with various diagnostic tools to determine the exact cause of entrapment is crucial for reducing catastrophic complications and achieving better outcomes during catheterization procedures.
Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Fluoroscopy ; Jugular Veins ; Needles ; Punctures ; Ultrasonography ; Veins

OBJECTIVE: The importance of central blood pressure evaluation for cardiovascular risk stratification has been emphasized. The aim of this study is to evaluate whether brachial blood pressure obtained by the oscillometric method accurately reflects central blood pressure. METHODS: The subjects consisted of 84 consecutive patients with suspected coronary artery disease who underwent cardiac catheterization. Central blood pressure was invasively measured in the origin of the left subclavian artery by using the fluid-filled system, and at the same time, brachial blood pressure in the left upper arm was measured by the oscillometric method. RESULTS: No significant difference was found between central systolic pressure and brachial systolic pressure (144.49+/-18.84 mmHg vs. 142.44+/-14.96 mmHg, P=0.063). Bland-Altman analysis accounted for only a small bias of +2.25 mmHg, and the limits of agreement were 24.15 mmHg and -19.65 mmHg. Central diastolic pressure was significantly lower than brachial diastolic pressure (75.80+/-8.74 mmHg vs. 86.70+/-10.48 mmHg, P<0.001). Bland-Altman analysis showed a significant bias of -5.45 mmHg, and the limits of agreement were 2.83 mmHg and -13.73 mmHg. CONCLUSION: These results indicate that central systolic pressure can be directly estimated from brachial systolic pressure using the noninvasive oscillometric method and observed biases seem to remain within the practical range. However, use of the brachial diastolic pressure and pulse pressure measured by the noninvasive oscillometric method is doubtful in clinical practice because of their large biases.
Arm ; Bias (Epidemiology) ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Artery Disease ; Humans ; Oscillometry ; Subclavian Artery

Papillary thyroid carcinoma is the most prevalent type of thyroid cancer. Metastasis of this carcinoma commonly occurs in the lung and has been reported to present 5 to 30 years after the initial diagnosis of thyroid cancer. Pleural effusion can mask this metastatic spread. In patients with pleural effusion, laboratory measurement of the adenosine deaminase (ADA) level in the pleural fluid can be effective in identifying and ranking pulmonary metastasis in the differential diagnosis. A 70-year-old female patient visited our hospital with dyspnea. She presented with a considerable amount of pleural effusion. A pleural biopsy was performed and the Ziehl-Neelsen stains revealed a few acid-fast bacilli, but the ADA level in the pleural fluid was 2.4 IU/L. After drainage of the pleural effusions, we discovered pulmonary nodules by computed tomography (CT), which were later diagnosed through histologic examination as pulmonary metastasis from papillary thyroid carcinoma. We report this case.
Adenosine Deaminase ; Aged ; Biopsy ; Carcinoma ; Carcinoma, Papillary ; Coloring Agents ; Drainage ; Dyspnea ; Female ; Humans ; Lung ; Masks ; Neoplasm Metastasis ; Pleural Effusion ; Pleurisy ; Thyroid Gland ; Thyroid Neoplasms ; Tuberculosis, Pleural

PURPOSE: The detection of occult micrometastasis in breast cancer patients may allow the establishment of prognosis and development of new therapeutic approaches. This study was performed in order to improve on existing methods of detection by evaluating the potential of specific mRNA markers in reverse-transcriptase polymerase chain reaction (RT-PCR) of peripheral blood and bone marrow taken from patients with breast cancer. METHODS: Peripheral blood and bone marrow samples were obtained from thirty-four breast cancer patients who undergone surgery in the Department of Surgery, Uijongbu St. Mary's Hospital between January 2000 and May 2001. In RT-PCR, we tried multiple primers on breast cancer cell lines and patient samples. Using MUC-1 and CK19 mRNA primers, we detected micrometastasis in breast cancer patients. Subsequently, we analysed the correlation with RT- PCR results and other prognostic factors. RESULTS: MUC-1 and CK19 were detected in all breast cancer cell lines. However, CEA was not detected in some cell lines. CK19 showed greater sensitivity than MUC-1 in RT-PCR. Using MUC-1 as primers, the detection rate was 47.1% and 35.3% in bone marrow and peripheral blood, respectively. Seven patients (20.5%) were positive in both sources. In the case of CK19, the detection rate was 50% and 41.2% in bone marrow and peripheral blood, respectively. Twelve patients (35.2%), were noted as being positive for both primers. The concordance rate of both primers mers was 38.2% and 23.5% in bone marrow and peripheral blood, respectively. CK19 positivity in the peripheral blood was correlated with bone marrow positivity and MUC-1 positivity in both sources and inversely correlated with ER. CK19 positivity of bone marrow was correlated with MUC-1 positivity of bone marrow. CONCLUSION: CK19 and MUC-1 may be good candidates for use in RT-PCR for the detection of micrometastasis of breast cancer. CK19 showed greater sensitivity. However, using both primers in RT-PCR, we may detect micrometastasis more sensitively and specifically and more wisely choose a treatment modality.
Bone Marrow* ; Breast Neoplasms* ; Breast* ; Cell Line ; Humans ; Keratin-19 ; Neoplasm Micrometastasis* ; Polymerase Chain Reaction ; Prognosis ; RNA, Messenger

Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present in the absence of specific underlying pathology or trauma and is typically associated with anticoagulation therapy. We report a case of a 74-year-old female patient with a cerebral infarction related to atrial fibrillation who developed a spontaneous lumbar arterial hemorrhage complicating heparin therapy. The diagnosis was suggested by a computed tomography scan and confirmed by angiography. She was treated successfully with transcatheter embolization.
Aged ; Anticoagulants/*adverse effects ; *Embolization, Therapeutic ; Female ; Hemorrhage/etiology/radiography/*therapy ; Heparin/*adverse effects ; Humans ; Lumbar Vertebrae/*blood supply ; Retroperitoneal Space ; Therapeutics ; Tomography, X-Ray Computed

PURPOSE: Prognostic factors for patients who underwent colorectal cancer surgery, are such as clinical staging, possibility for curative surgery, and pathologic findings. But the age as a prognostic factor is still controversial. Therefore, we investigated the significance of age factor in colorectal cancer between young and older patients. METHODS: The study subjects included 755 patients who underwent surgery for colorectal adenocarcinoma from January 1, 1990 to March 31, 1999 in Kangnam St. Mary's Hospital, Seoul, Korea. Average follow-up period was 24.8 24.4 months. The patients were divided into younger than 40 and older than 74 year-old groups and compared with control group including the age from 40 to 74. The prognosis of each group was evaluated according to the sex, staging, characteristics of tumor, family history, recurrence rate and patterns, pathologic findings, possibility for curative surgery, and survival rate. RESULTS: Younger than 40 year-old group included 65 patients (8.6%) and older than 74 year-old group included 77 patients (10.2%). Their control groups included 613 patients (81.2%). There were no significant differences in tumor location, sex ratio, stage distribution, recurrence rate and patterns between the study and the control groups. However, there was significant higher incidence of family history in younger than 40 year-old group (7.7% vs 0.3%, P<0.05). Although there was no statistical significance, it is noteworthy that the ratio of undifferentiated or mucinous type were higher in younger than 40 year-old group than control group. Comparing the survival rates for each stage, the advanced stage of older than 74 year-old group had lower survival rate than control group (P<0.05). CONCLUSIONS: Low survival rate in the older group can be explained by poor general condition and the high ratio of palliative surgery. The prognosis of cancer in the young age can not be poor just because it is discovered at the young age itself and it can be improved by careful follow-up in patients with familial history and early diagnosis and radical surgery in patients without familial history. However, it must be noted that younger patients have higher risk for undifferentiated or mucinous type.
Adenocarcinoma ; Adult ; Age Factors* ; Aged ; Colorectal Neoplasms* ; Early Diagnosis ; Fibrinogen ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Mucins ; Palliative Care ; Prognosis* ; Recurrence ; Seoul ; Sex Ratio ; Survival Rate

Neoplastic meningitis occurs in approximately 5% of patients with cancer. Primary diffuse leptomeningeal gliomatosis is a rare condition whereby a glioma arises from heterotopic cell nests in the leptomeninges. We report here a case presenting with clinical features similar to those of chronic infectious meningitis without positive cerebrospinal fluid cytology. Neurological signs in our patient deteriorated progressively without responding to antitubercular, antiviral, or antibiotic therapy. Leptomeningeal biopsy sampling revealed the condition to be primary diffuse leptomeningeal gliomatosis.
Biopsy ; Cerebrospinal Fluid ; Glioma ; Humans ; Meningitis*

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) was not actively performed in elderly acute myeloid leukemia (AML) or myelodysplastic syndrome patients who are at a high-risk based on hematopoietic cell transplantation-specific comorbidity index (HCT-CI). The advent of reduced-intensity conditioning (RIC) regimens has made HSCT applicable in this population. However, the selection of appropriate conditioning is a major concern for the attending physician. The benefits of combination of treosulfan and fludarabine (Treo/Flu) have been confirmed through many clinical studies. Korean data on treosulfan-based conditioning regimen are scarce. Methods: A retrospective study was conducted to compare the clinical outcomes of allogeneic HSCT using RIC between 13 patients receiving Treo/Flu and 39 receiving busulfan/ fludarabine (Bu/Flu). Results: In terms of conditioning-related complications, the frequency of ≥ grade 2 nausea or vomiting was significantly lower and the duration of symptoms was shorter in the Treo/ Flu group than in the Bu/Flu group. The incidence of ≥ grade 2 mucositis tended to be lower in the Treo/Flu group. In the analysis of transplant outcomes, all events of acute graft versus host disease (GVHD) and ≥ grade 2 acute GVHD occurred more frequently in the Treo/ Flu group. The frequency of Epstein-Barr virus reactivation was significantly higher in the Treo/Flu group (53.8% vs. 23.1%, P = 0.037). Non-relapse mortality (NRM) at 12 months was higher in the Treo/Flu group (30.8% vs. 7.7%, P = 0.035). Significant prognostic factors included disease type, especially secondary AML, disease status and high-risk based on HCT-CI, ≥ grade 2 acute GVHD, and cases requiring ≥ 2 immunosuppressive drugs for treating acute GVHD. In the comparison of survival outcomes according to conditioning regimen, the Bu/Flu group seemed to show better results than the Treo/Flu group (60% vs.46.2%, P = 0.092 for overall survival; 56.4% vs. 38.5%, P = 0.193 for relapse-free survival). In additional analysis for only HCT-CI high-risk groups, there was no difference in transplant outcomes except that the Treo/Flu group tended to have a higher NRM within one year after transplantation. Survival outcomes of both groups were similar. Conclusion This study suggests that Treo/Flu conditioning may be an alternative to Bu/Flu regimen in elderly patients with high-risk who are not suitable for standard conditioning.