Transcatheter hepatic arterial embolization (THAE) is one of the treatment modalities that can be applied to hepatocellular carcinomas (HCC) and metastatic tumors of the liver. Complications such as cholecystitis and gallbladder necrosis, are common with THAE, but liver and peripheral bile duct necrosis are rare, and intrahepatic stones with main bile duct necrosis have never been reported. To prevent intrahepatic spread during operative manupulation and to decrease the vascularity and size of the tumor, we performed a THAE on a huge-sized HCC five times before performing the hepatectomy. We succesfully undertook a right lobectomy after the THAE with lipiodol, gelform, and adriamycin. However, severe bile duct stricture and intrahepatic stones were confirmed during the operation.
Bile Ducts* ; Bile* ; Carcinoma, Hepatocellular ; Cholecystitis ; Constriction, Pathologic* ; Doxorubicin ; Ethiodized Oil ; Gallbladder ; Hepatectomy ; Liver ; Necrosis

PURPOSE: To find if the alpha adrenergic blocker, terazosin, changes the PSA in BPH patients. MATERIALS AND METHODS: Patients with a PSA level over 2.5ng/ml, who visited our hospital with lower urinary tract symptoms, were reviewed, and excluded from having prostate cancer (n=101). After a routine check up for BPH, included history taking, a physical examination, laboratory examinations and a transrectal ultrasound, on their first visit, the PSA level and IPSS were checked again after 4 weeks of alpha adrenergic blocker (terazosin) management. RESULTS: The average size of the prostates and age of the patients were 40.6ml and 67.7 years, respectively. Overall, the PSA levels before the treatment was 4.12+/-2.03ng/ml, which decreased significantly, to 3.57+/-1.99ng/ml, after the terazosin treatment (p=0.002). The subgroups, divided by age, prostate size and IPSS score, all showed meaningful declines in the PSA levels, but with no statistical differences. CONCLUSIONS: The results from this research shows that terazosin treatment reduces the PSA levels in BPH patients complaining of lower urinary tract symptoms, and the changes in the pattern of the level may help to differentiate prostatic cancer, and reduce the incidence of a prostatic biopsy.
Adrenergic Antagonists* ; Biopsy ; Humans ; Incidence ; Lower Urinary Tract Symptoms ; Physical Examination ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Ultrasonography

Farber disease (FD) is a rare lysosomal storage disorder that shows autosomal recessive inheritance. We report the case of a 58-month-old girl with FD, who was misdiagnosed with epithelioid hemangioendothelioma. The patient had undergone five surgeries for sacrococcygeal masses and three surgeries for scalp masses owing to misdiagnosis. Here, we describe this rare case of FD.
Diagnostic Errors ; Farber Lipogranulomatosis* ; Female ; Hemangioendothelioma* ; Hemangioendothelioma, Epithelioid ; Humans ; Scalp ; Wills

BACKGROUND: Tumor necrosis factor(TNF) has been considered as an important candidate for cancer gene therapy based on it9 potent anti-tumor activity. However, since the efficiency of current techniques of gene transfer is not satisfactory, the majorities of current protocols is aiming the in vitro gene transfer to cancer cells and re-introducing genetically modified cancer cells to host In previous study, it was shown that TNF-sensitive cancer cells transfected with TNF-α CDNA would become highly resistant to TNF. Understanding the mechanisms of TNF-resistance in TNF-α gene transfected cancer cells would be an important step for improving the efficacy of cancer gene therapy as we]1 as for better understandings of tumor biology. This study was designed to evaluate the role of new protective protein synthesis in the acquired resistance to TNF of TNF-α gene transfected cancer cells. METHOD: We transfected TNF-α c-DNA to WEHI l64, a murine fibrosarcoma cell line, using retroviral vector (pLT12SN(TNF)) and confirm the expression of TNF with PCRf ELISA, MTT assay. Then we determined the TNF resistance of TNF gene transfected cells(WEHI 164-TNF) and the changes of TNF sensitivities after treatments with actinomycin D(transcription inhibitor) and cycloheximide(translation inhibitor). RESULTS: WEHI 164 which was sensitive to TNF became resistant to TNF after being trsnsfected with TNF-α gene and the resistance to TNF was partially reversed after treatment with actinomycin D, but not with cycloheximide. CONCLUSION: The acquired resistance to TNF after TNF-α gene transfection may be associated with synthesis of some protective proteins.
Biology ; Cell Line ; Cycloheximide ; Dactinomycin ; DNA, Complementary ; Enzyme-Linked Immunosorbent Assay ; Fibrosarcoma ; Genes, Neoplasm ; Necrosis ; Transfection ; Tumor Necrosis Factor-alpha* ; Zidovudine*

PURPOSE: Bleeding from esophago-gastric varices needs urgent treatment. Esophageal varix bleeding usually was controlled by intervention, but rebleeding rate was high. Gastric varix bleeding is unable to be controlled by intervention. Recently, newly developed methods for varix bleeding controll have been used, but surgical intervention is still advocated. We report our experience with esophago-gastric devascularization for bleeding control in portal hypertension and its effectiveness. METHODS: This retrospective study was performed on 32 cases who underwent esophago-gastric devascularization in portal hypertension at Kyuung Hee University Hospital from Nov. 1990 to Feb. 2004. Author analyzed characteristics & patients, causes of portal hypertension, liver function reserve, operation methods, perioperative finding, complications and factors determining postoperative mortality. RESULTS: Sex ratios of male to female was 5.4:1. The ages were ranged from 25 to 70 years old with mean age of 50.5. Postoperative complication rate was 40.6% (13/32) and those were recovered by conservative management. There was one case of recurrent bleeding at 9months postperatively (3%). Mortality rate was 4% in Child-Pugh group A and B, and 57% in group C. The overall mortality rate was 15%. Preoperative hepatic reserve (P<0.05) & preoperative blood pressure (P<0.05) was a significant factors. A mean follow up period is 18.7 months. CONCLUSION: In our study, esophago-gastric devascularization in portal hypertension showed good results with 3% rebleeding rate and 85% overall survival rate. Esophago-gastric devascularization was effective method for esophago-gastric varix bleeding.
Aged ; Blood Pressure ; Esophageal and Gastric Varices ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal* ; Liver ; Male ; Mortality ; Postoperative Complications ; Retrospective Studies ; Sex Ratio ; Survival Rate ; Varicose Veins

Artificial intelligence (AI) is used in various fields of medicine, with applications encompassing all areas of medical services, such as the development of medical robots, the diagnosis and personalized treatment of diseases, and personalized healthcare. Medical AI research and development have been largely focused on diagnosis, prediction, treatment, and management as an auxiliary means of patient care. AI is mainly used in the fields of personal healthcare and diagnostic imaging. In urology, substantial investments are being made in the development of urination monitoring systems in the personal healthcare field and diagnostic solutions for ureteral stricture and urolithiasis in the diagnostic imaging field. This paper describes AI applications for urinary diseases and discusses current trends and future perspectives in AI research.

BACKGROUND: In the acute phase of myocardial infarction, the hemostatic mechanism is known to be activated. However, it remains unclear whether increased activity of the hemostatic mechanism is only a marker of the acute thrombotic episode or precedes its appearance. It is also inapparent whether a hypercoagulable state persist for a prolonged period after the apparent resolution of these disorders. METHODS: In a group of 23 patients with acute myocardial infarction who received fibrinolytic therapy with urokinase(group A) or tPA(group B), the plasma level of fibrinogen, antithrombin compared to those of the 10 normal controls. RESULTS: The plasme level of fibrinogen was significantly decreased in both group A and B before and 4 to 24 hours after thrombolytic therapy compared to that of normal controls. But it was increased 7 to 14 days after thrombolytic therapy. In a few of the patients, the plasma level of FDP and D-dimer were positive before thrombolytic therapy and in the most patients they were positive 4 hours after thrombolytic therapy. The plasma level of AT-III was significantly increased in both group A and B before thrombolytic therapy compared with that of normal controls, but, after thrombolytic therapy, there was no significant change in its level. CONCLUSIONS: In the patients with acute myocardial infarction, the thrombolysis occurred before thrombolytic therapy and it lasted for 24 hours after thrombolytic therapy.
Antithrombin III* ; Fibrinogen ; Humans ; Myocardial Infarction* ; Plasma ; Thrombolytic Therapy*

BACKGROUND: Solid and papillary epithelial neoplasm(SPEN) is a rare malignant tumor of the pancreas that typically occurs in young females and has an excellent prognosis. This tumor has a low malignant potential, and is highly curable with surgical treatment. METHODS AND MATERIALS: From January 1986 to July 1999, ten patients of solid and papillary epithelial neoplasm of the pancreas pathologically verified at Kyung Hee University Hospital were retrospectively analyzed. Pre-, intra-, and post-operative data were evaluated in all patients to determine optimal management with specific reference to surgical strategy. RESULTS: Nine patients out of ten were females, with a mean age of 21.8 years (range 12-38). Six patients presented with a palpable abdominal mass and four patients with abdominal pain. Remaining patients presented with fever, low back pain, and no specific symptom. Abdominal ultrasonography and/or CT scan showed an abdominal mass in all patients. The correct preoperative diagnosis of SPEN was made in six patients. Incorrect diagnosis included pseudocysts in two and cystadenoma in two. The tumor size ranged from 5 to 14.5 cm in diameter (average 8.85 cm). Four patients with tumor in the pancreatic head had a pylorus preserving pancreaticoduodenectomy (PPPD). Four patients with tumor in the pancreatc tail underwent distal pancreatectomy and splenectomy(without in one). Two patients were performed mass enucleation only. The histologic diagnosis was confirmed in all patients. There were no nuclear atypia and pleomorphism in microscopic findings. Postoperative complications were intraabdominal abscess in one, lymphatics leakages in one, and wound infection in one. All ten patients are alive without sign of recurrence with a mean follow-up of 5.36 years (range 0.1 to 13 years). CONCLUSIONS: SPEN is an indolent tumor of the pancreas with low malignant potential and excellent long-term prognosis and should be considered in the differential diagnosis of large pancreatic masses, especially in young females. Resection is the treatment of choice that is resectable.
Abdominal Pain ; Abscess ; Cystadenoma ; Diagnosis ; Diagnosis, Differential ; Female ; Fever ; Follow-Up Studies ; Head ; Humans ; Low Back Pain ; Neoplasms, Glandular and Epithelial* ; Pancreas* ; Pancreatectomy ; Pancreaticoduodenectomy ; Postoperative Complications ; Prognosis ; Pylorus ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography ; Wound Infection

BACKGROUND: Cystic neoplasms of the pancreas are rare tumor with malignant potential. Preoperative differentiation of a benign versus malignant tumor is unreliable and routine testing for this purpose is questionable. Therefore an aggressive resectional approach for cystic tumor of the pancreas was a recent trend and anticipate good prognosis. METHODS: This is a retrospective analysis of 23 patients with cystic neoplasm of the pancreas between Jun.1990 and Dec.1999. Data include patient demographics, presenting symptom, operative procedure, pathologic diagnosis, perioperative morbidity and mortality, survival follow-up data. RESULTS: The mean age of patients was 33.48 years and twenty one patients were women. There were 3 serous cystadenoma, 4 mucinous cystadenoma, 2 mucinous cystadenocarcinoma, 13 SPEN, 1 ductal ectasia. Major symptoms were abdominal pain(39.1%), palpable mass(30.4%), incidental(21.7%), melena( 4.3%), hematemesis(4.3%). Tumor site were 6 head(26.1%), 3 body(13.4%), 14 tail(60.9%). Main investigations were ultrasonography and CT. Other investigation were ERCP, MRCP, cytology. Operative procedure were 12 distal pancreatectomy and splenectomy, 4 PPPD, 2 mass enucleation, 2 distal pancreatectomy, 1 PD, 1 subtotal pancreatectomy, 1 cystojejunostomy. An accurate preoperative diagnosis of tumor type was proposed 65% pancreatic cystic tumor. Mean follow-up was 27 months(range 0.8 months to 90 months). Of these 23 patients, 20 patients were alive without recurrence during mean follow-up. One patient was died due to postoperative sepsis. Two patients was dead of unrelated cause. CONCLUSION: An aggressive resectional approach for cystic tumor of the pancreas is recommend in cystic tumor of the pancreas, if medically fit to tolerate surgery.
Cholangiopancreatography, Endoscopic Retrograde ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Mucinous ; Cystadenoma, Serous ; Demography ; Diagnosis ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Humans ; Mortality ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Prognosis ; Recurrence ; Retrospective Studies ; Sepsis ; Splenectomy ; Surgical Procedures, Operative ; Ultrasonography

OBJECTIVES: Since Mountain proposed the new staging system of non-small cell lung cancer in 1986, the indications for operation of NSCLC have been extended. However, operative mortality is from 3 to 6%. Therefore it is important to reduce unnecessary operation and to evaluate unresectability of tumor correctly, preoperatively The purpose of this study is to find out the causes of unresectability in patients who were initially thought to be resectable preoperatively. METHODS: By retrospective analysis, 64 patients out of 291 NSCLC patients who were undergone operation for curative resection in Seoul National University Hospital from Jan. of 1987 to Dec. of 1991, ware found to be unresectable at operating roost were selected for this study. Out of 64 patients,42 were evaluable. The analysis was focused on the change of pre- & post-operative staging and the causes of unresectability of tumors. RESULTS: Among B2 patients with unresectable tumor who could be evaluated, preoperative CT finding showed resectable tumors in 55% (23 patients) and suspicious for unresectable tumors in 45% (19 patients). The causes of unresectability were technically unresectable T3 lesions in 7% (3 patients), T4 lesions in 62% (26 patients), N2 lesions in 17% (7 patients) and N3 lesions in 14% (6 patients). CONCLUSION: The major causes of unresectability of NSCLC were pulmonary artery invasions. It is suggested that careful evaluation of mediastinal structure, especially great vessels by additional imaging technique other than CT (like MRI) is indicated in selected NSCLC cases.
Carcinoma, Non-Small-Cell Lung* ; Humans ; Mortality ; Pulmonary Artery ; Retrospective Studies ; Seoul