Renal infiltration is common in chronic lymphocytic leukemia (CLL), but renal impairment caused by leukemic infiltration is rare. This report describes the case of a 38-year-old man with CLL who required no medical treatment for 1 year and was admitted with nonoliguric renal insufficiency (proteinuria > 2,000 mg/day). A renal biopsy subsequently revealed leukemic infiltration by CLL. Treatment with fludarabine plus cyclophosphamide resulted in the improvement of renal function. Leukemic infiltration should be considered in the differential diagnosis of a patient with CLL and impaired renal function because renal impairment often responds well to chemotherapy.
Adult ; Biopsy ; Cyclophosphamide ; Diagnosis, Differential ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell ; Leukemic Infiltration ; Proteinuria ; Renal Insufficiency ; Vidarabine

No abstract available.
Eating* ; Furosemide* ; Nephrocalcinosis*

PURPOSE: Standard treatment of asymptomatic spinal cord hemangioblastoma in von Hippel-Lindau (VHL) disease has yet to be established. The purpose of this study was to propose guidelines for the treatment of asymptomatic spinal cord hemangioblastomas in VHL disease. MATERIALS AND METHODS: VHL disease patients treated for spinal cord hemangioblastomas between 1999 and 2009 were included. All spinal cord hemangioblastomas were divided into three groups: Group 1, asymptomatic tumors at initial diagnosis followed with serial imaging studies; Group 2, asymptomatic tumors at initial diagnosis that were subsequently resected; and Group 3, symptomatic tumors at initial diagnosis, all of which were resected. RESULTS: We identified 24 spinal cord hemangioblastomas in 12 patients. Groups 1, 2 and 3 comprised 13, 4 and 7 tumors, respectively. Group 1 exhibited a smaller tumor volume (257.1 mm3) and syrinx size (0.8 vertebral columns) than those of Group 2 (1304.5 mm3, 3.3 vertebral columns) and Group 3 (1787.4 mm3, 6.1 vertebral columns). No difference in tumor volume or syrinx size was observed between Groups 2 and 3. Five tumors in Group 1 were resected during follow-up because symptoms had developed or the tumor had significantly grown. Finally, among 17 asymptomatic tumors at the initial diagnosis, nine tumors were resected. Only one tumor of these nine tumors resulted in neurological deficits, while five of seven symptomatic tumors caused neurological deficits. CONCLUSION: Selective resection of asymptomatic tumors before they cause neurological deficits might bring about better outcomes.
Adult ; Aged ; Aged, 80 and over ; Female ; Hemangioblastoma/etiology/*pathology/*surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; von Hippel-Lindau Disease/*complications

OBJECTIVE: Mesenchymal stem cells (MSCs) have shown promise in potentially repairing injured spinal cord. These and similar cell types are being tested clinically, but the understanding about delivering method and subsequent results is lacking. This study was designed to compare the MSCs engraftment results after intralesional, intracisternal, or intravenous injection in a rat with spinal cord injury (SCI). METHODS: A total of 48 male Sprague-Dawley rats (300-350 g in size) were used with 12 in each group. Allogenic MSCs were cultured from human bone marrow aspirates. The SCI was induced using an NYU (New York University) impactor and MSCs were transplanted 1 week after the SCI. Behavioral testing was performed weekly for 6 weeks. The recipients were analyzed histologically to evaluate the extent of cell delivery and survival at the injury site. RESULTS: All three experimental groups showed better behavioral recovery compared with the control group since 6 weeks after stem cell injection (p<0.05). The intracisternal injection group showed the best functional improvement (p<0.05). The intralesional injection group showed the best engraftment until 4 weeks after stem cell injection (p<0.05). A number of the injected MSCs were trapped in the spleen in the intravenous injection group. CONCLUSION: Transplantation of stem cells by a variety of routes can deliver cells with the potential to repair injured spinal cord. Intracisternal injection can easily be translated to patients after some modifications, thus accelerating clinical application of cell therapies.
Animals ; Bone Marrow ; Humans ; Injections, Intralesional ; Injections, Intravenous ; Male ; Mesenchymal Stromal Cells ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; Spinal Cord Injuries ; Spleen ; Stem Cells ; Transplants

We performed combined spondylectomy for 2 patients of malignant tumors invading spinal column and chest wall. For one patient with Pancoast tumor, anterolateral thoracotomy, apical lobectomy, chest wall resection, and hemispondylectomy were performed. For another patient with solitary metastatic tumor from nasopharyngeal cancer, posterolateral thoracotomy, chest wall resection, and total en bloc spondylectomy were performed with anterior and posterior instrumentation. The tumor including invaded chest wall and spinal column werewas removed completely in both patients. No local recurrence was found at 18 months follow-up evaluation in both patients.
Follow-Up Studies ; Humans ; Nasopharyngeal Neoplasms ; Pancoast Syndrome ; Recurrence ; Spine ; Thoracic Wall ; Thoracotomy ; Thorax

PURPOSE: Breast conserving surgery using mesh can effectively fill the defective space, but there is the risk of infection. METHODS: From June 2007 to August 2010, 243 patients who underwent breast conserving surgery with polyglactin 910 mesh insert for breast cancer at our institution were retrospectively studied. RESULTS: Infection occurred in 25 (10.3%) of 243 patients. When comparing the infection and non-infection groups in multivariate analysis, there was no significant difference in age, underlying disease, preoperative biopsy methods, mass location, axillary lymph node dissection, operative methods, neoadjuvant or adjuvant chemotherapy use, mass size and removed breast volume. The infection appeared more common only in patients with body mass index (BMI) greater than 25. Infection symptoms occurred, on average, 119.5 days after surgery, and the average duration of the required treatment was 34.4 days. Out of 25 patients with postoperative infection complications, 16 (64%) patients underwent incision and drainage with mesh removal, whereas the remaining 9 (36%) only required conservative treatment. CONCLUSION: During breast conserving surgery, the risk of infection is increased in patients with high BMI, and should be taken into account when considering insertion of a polyglactin 910 mesh. Patient's age, underlying disease and perioperative treatment methods were not significant risk factors for developing mesh infection. Given that most infections seem to develop symptoms one month after surgery, a long enough observation period should be initiated. Early detection and appropriate conservative treatments may effectively address infections, thus reducing the need for more invasive therapies.
Biopsy ; Body Mass Index ; Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Drainage ; Humans ; Lymph Node Excision ; Mastectomy, Segmental ; Multivariate Analysis ; Polyglactin 910 ; Retrospective Studies ; Risk Factors

No abstract available.

BACKGROUND AND OBJECTIVES: The repolarization abnormalities, after radiofrequency catheter ablation (RFCA) of accessory pathway (AP) in patients with Wolff-Parkinson-White (WPW) syndrome, is commonly appeared in standard 12 lead electrocardiogram (ECG) as inverted T waves. We analyzed the serial ECGs after RFCA of AP in patients with WPW syndrome, in order to understand the repolarization abnormalities after RFCA. MATERIALS AND METHOD: The study patients were consisted of ninety two patients (mean age: 35 years old, male: 56 patients) out of 157 patients whose ECGs were taken at before, immediately after, one day, one, four, eight, twelve week (s) after RFCA from December 1992 to July 1997. RESULTS: The seventy three patients (79%) out of ninety two patients showed the repolarization abnormalities and the thirteen patients (14%) showed normalization of secondary T wave changes immediately after RFCA. In contrast, six patients (7%) did not show any T wave changes after RFCA and they had left lateral AP. The lead that most frequently showed inverted T wave changes after RFCA was lateral lead (lead I, aVL) in case of left lateral AP and inferior lead (II, III, aVF) in case of other APs. The incidence of repolarization abnormalities after RFCA was significantly higher in patients whose preRFCA QRS duration is longer (> or =0.12 sec). The concordance rate of repolarization abnormalities after RFCA was 86% (63 patients of 73 patients showing repolarization abnormalities after RFCA). The normalization of repolarization abnormalities after RFCA was acquired in sixty four patients (94%) out of sixty eight patients who showed repolarization abnormalities and followed up to twelve weeks after RFCA. The mean time interval to the normalization of repolarization abnormalities after RFCA was 4.3+/-3.2 weeks. The time interval to the normalization of repolarization abnormality after RFCA was not related with age, AP or preRFCA QRS duration. CONCLUSION: The ECG lead, in which the repolarization abnormalities occurs after RFCA , is related with the location of the AP. The repolarization abnormalities after RFCA were more common in patients with longer preRFCA QRS duration. The repolarization abnormalities after RFCA could not be understood only by cardiac memory.
Adult ; Catheter Ablation* ; Electrocardiography ; Humans ; Incidence ; Male ; Memory ; Wolff-Parkinson-White Syndrome

BACKGROUND AND OBJECTIVES: The change in QT dispersion (QTd) immediately after balloon angioplasty reflects the immediate impact of ischemia. We intended to analyze the immediate impact of ischemia on myocardial repolarization. MATERIALS AND METHODS: Forty-six patients who underwent percutaneous coronary intervention were enrolled. The standard 12-lead electrocardiogram (ECG) was recorded just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning. QTd was determined by the difference between the maximum and minimum QT interval (QTi). We then calculated the corrected QTi (QTc) using Bazett's formula. QTd and QTi were compared according to the site of the ballooned vessel, number of ballooned vessels and history of acute myocardial infarction. RESULTS: QTd just before, during, and 1 minute, 5 minutes and 10 minutes after ballooning were 35.21+/-10.36 msec, 54.56+/-16.89 msec, 50.91+/-14.20 msec, 45.52+/-9.6 msec and 38.56+/-10.89 msec, respectively. QTd increased markedly during ballooning, but after myocardial ischemia was relieved, decreased rapidly. Ten minutes after ballooning, QTd was reduced to a similar level as that of baseline. There were no significant differences between the AMI and non-myocardial infarction groups, single-vessel and multi-vessel groups, and the location of the stenosed artery. There was no significant difference in QTi according to different stenosed vessel. CONCLUSION: QT (QTc) dispersion increased rapidly with myocardial ischemia and reduced rapidly after the myocardial ischemia was resolved. Therefore, increased QTd can be used as an early clue of myocardial ischemia.
Angioplasty* ; Angioplasty, Balloon ; Arteries ; Electrocardiography ; Humans ; Infarction ; Ischemia ; Myocardial Infarction ; Myocardial Ischemia ; Percutaneous Coronary Intervention

We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.
Treatment Outcome ; Spinal Diseases/*surgery ; Risk Factors ; Retrospective Studies ; Postoperative Complications/diagnosis/*epidemiology ; Middle Aged ; Male ; Humans ; Hematoma, Epidural, Spinal/diagnosis/*epidemiology/*etiology ; Female ; Aged ; Adult