Soft-tissue sarcomas account for 1% of all solid tumors. Of these, less than 15% will occur in the retroperitoneum. Late diagnosis and large tumor size make retroperitoneal sarcomas difficult to resect. Resection with wide margins in all directions is rarely possible owing to proximity to vital structures. Radiation therapy is limited in dosage and, as with chemotherapy, has only been successful in a limited number of cases. These problems result in a poor prognosis. A series of patients with retroperitoneal sarcoma was reviewed with a focus on issues of surgical management and prognostic factors. A retrospective analysis of 12 patients with retroperitoneal sarcomas who had undergone operations at the Department of Surgery, Inje University Paik Hospital, Seoul, from 1980 through 1996 was performed. The mean age of the 10 adult patients was 51 years; the male-to-female ratio was 2:1. Eighty-three percent of the patients presented with an abdominal mass. The mean diameter of the tumors was 18.3 cm. Leimyosarcomas(33%) and liposarcomas(25%) comprised the majority of the histologic types. The tumor grades were I, II, and III in 3 cases each. Resection of the tumor was possible in 75%(9/12) of the cases, although 17% of the resections were incomplete. Resection of adjacent organs was required in 66% of the cases. The resectability rose from 60% in 80s to 86% in 90s, with no statistical significance, possibly due to the small number of cases in this series. There was no postoperative morbidity or mortality. Actuarial 1-, 3-, and 5-year survival rates after resection were 75%, 60%, and 30%, respectively. Four of the 7(57%) patients who underwent complete resections had recurrence 3 to 33 months after surgery; this was notable for grade II or III tumors only. Two patients with grade I tumors are alive 65 and 102 months respectively after complete resection and show no evidence of the disease. One patient who underwent an incomplete resection of the tumor died 50 months after the operation. Only the tumor grade was a significant prognostic factor(p=0.0207). In conclusion, a wide en-bloc resection of a retroperitoneal sarcoma with a clear margin in all directions is a prerequisite for long-term survival. Aggressive follow-up for the first 3 years after a complete resection of a high-grade tumor is justified.
Adult ; Delayed Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Mortality ; Prognosis ; Recurrence ; Retrospective Studies ; Sarcoma* ; Seoul ; Survival Rate

BACKGROUND: Although a history of febrile convulsion (FC) is common in epilepsy patients, the preferential associa-tion of febrile convulsion with temporal lobe epilepsy (TLE) is not clear. METHODS:We obtained the FC data from "Paik and Bongsang hospital" epilepsy clinic. We classified epilepsy syndromes into generalized epilepsy (GE), temporal lobe epilepsy (TLE), extratemporal epilepsy (ETLE), unclassified partial and undetermined epilepsy by standardized criteria. The incidence of antecedent FC was evaluated in relation to the epilepsy classifications. We calculated kappa values for inter and intra observer reliability for the classifications of epilepsy syndromes. RESULTS: The agreement of epilepsy classifications were reliable (intra-observer kappa value=0.78, inter-observer kappa value=0.77). Thirteen percent of the studied patients (72/537) had a history of FC and 38% of FC (27/72) were complex types of FC. TLE was more likely to be preceded by FC 25% (42/166) than ETLE 6% (12/189), p<0.05 or GE 13% (12/93), p<0.05 and 85% of complex FC (23/27) preceded TLE. GE however, was more likely to have non-complex FC 100% (12/12) than partial epilepsy 55% (32/58), p<0.05. CONCLUSIONS We therefore conclude and agree that FC should be preferentially associated with TLE.
Classification ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Epilepsy, Temporal Lobe* ; Humans ; Incidence ; Seizures, Febrile* ; Temporal Lobe*

Branchio-oto-renal (BOR) syndrome is a clinically heterogeneous autosomal dominant form of syndromic hearing loss characterized by variable hearing impairment, malformations of the pinnae, the presence of branchial arch remnants, and various renal abnormalities. BOR syndrome is caused by mutations in EYA1 and SIX1, which are critical to organogenesis and are expressed together in developing otic, branchial, and renal tissue. Branchio-otic (BO) syndrome comprises branchial fistulas and preauricular pits, but lacks renal anomalies. We present a case of BO syndrome in 30year-old man with a review of the literature.
Branchial Region ; Branchio-Oto-Renal Syndrome ; Branchioma ; Fistula ; Hearing Loss ; Organogenesis

The purpose of this study was to evaluate cervical lymph node metastasis of oral squamous cell carcinoma patients by MRI film and neural network system. MATERIALS AND METHODS: The oral squamous cell carcinoma patients(21 patients, 59 lymph nodes) who have visited SNU hospital and been taken by MRI, were included in this study. Neck dissection operations were done and all of the cervical lymph nodes were confirmed with biopsy. In MR images, each lymph node were evaluated by using 6 MR imaging criteria(size, roundness, heterogeneity, rim enhancement, central necrosis, grouping) respectively. Positive predictive value, negative predictive value, and accuracy of each single MR imaging criteria were calculated. At neural network system, the layers of neural network system consisted of 10 input layer units, 10 hidden layer units and 1 output layer unit. 6 MR imaging criteria previously described and 4 MR imaging criteria (site I-node level 2, site II-other node level, shape I-oval, shape II-bean) were included for input layer units. The training files were made of 39 lymph nodes(24 metastatic lymph nodes, 10 non-metastatic lymph nodes) and the testing files were made of other 20 lymph nodes(10 metastatic lymph nodes, 10 non-metastatic lymph nodes). The neural network system was trained with training files and the output level (metastatic index) of testing files were acquired. Diagnosis from neural network was decided according to 4 different standard metastatic index-68, 78, 88, 98 respectively and positive predictive values, negative predictive values and accuracy of each standard metastatic index were calculated. RESULTS: In the diagnosis of using single MR imaging criteria, the rim enhancement criteria had the highest positive predictive value, 0.95 and the size criteria showed the highest at negative predictive value, 0.77. The highest accurate criteria was heterogeneity with the accuracy of 0.81 and the lowest one was central necrosis with accuracy of 0.59. In the diagnosis of using neural network systems, the highest accurate standard metastatic index was 78, and that time, the accuracy was 0.90. Neural network system was more accurate than any other single MR imaging criteria in evaluating cervical lymph node metastasis. CONCLUSION: Neural network system has been shown to be more useful than any other single MR imaging criteria. In future, Neural network system will be powerful aiding tool in evaluating cervical node metastasis.
Biopsy ; Carcinoma, Squamous Cell* ; Diagnosis ; Humans ; Lymph Nodes* ; Magnetic Resonance Imaging ; Neck Dissection ; Necrosis ; Neoplasm Metastasis* ; Population Characteristics

Chlorfenapyr is a widely used, moderately hazardous pesticide. Previous reports have indicated that chlorfenapyr intoxication can be fatal in humans. We reported the first non-fatal case of chlorfenapyr-induced toxic leukoencephalopathy in a 44-year-old female with resolution of extensive and abnormal signal intensities in white matter tracts throughout the brain, brain stem, and spinal cord on serial magnetic resonance imaging.
Adult ; Brain/*radiography ; Brain Stem/radiography ; Female ; Humans ; Insecticides/*toxicity ; Leukoencephalopathies/*etiology/radiography ; *Magnetic Resonance Imaging ; Pyrethrins/*toxicity ; Spinal Cord/*radiography ; White Matter/radiography

Background and objectives: Carvedilol is a cardiovascular drug, beta- and alpha1-adrenoceptor antagonist, currently approved for the treatment of hypertension, angina, congestive heart failure by FDA. Carvedilol has been shown to attenuate oxygen free radical-initiated lipid peroxidation and to inhibit neointimal formation of aorta following vascular injury by balloon angioplasty. We have investigated the effect of carvedilol on DNA synthesis of vascular smooth muscle cells (VSMC) stimulated by platelet-derived growth factor (PDGF)-BB. MATERIALS AND METHOD: Rat aortic smooth muscle cells were obtained by the combined collagenase and elastase methods. Cells between the 4th and 8th passages were used for the experiments. Incorporated radioactivity of [3H]-thymidine was measured by liquid scintillation spectrometry. RESULTS: PDGF-BB (1 nM) increased [3H]-thymidine incorporation about 70-100% over basal value in cultured VSMC. PDGF-stimulated increase in DNA synthesis was significantly suppressed by simultaneous administration of carvedilol. In contrast, propranolol did not significantly affect 3[H]-thymidine uptake in rat aortic VSMC. CONCLUSION: The present study demonstrate that carvedilol significantly inhibits the proliferation of vascular smooth muscle cell in our condition. These results indicate that carvedilol may be effective in the treatment of cardiovascular diseases principally associated with abnormal vascular smooth muscle growth.
Angioplasty, Balloon ; Animals ; Aorta ; Cardiovascular Diseases ; Cell Proliferation ; Collagenases ; DNA ; Heart Failure ; Hypertension ; Lipid Peroxidation ; Muscle, Smooth, Vascular* ; Myocytes, Smooth Muscle ; Oxygen ; Pancreatic Elastase ; Platelet-Derived Growth Factor ; Propranolol ; Radioactivity ; Rats ; Spectrum Analysis ; Vascular System Injuries

The angiomyoma or vascular leiomyoma is an uncommon type of leiomyoma composed of smooth muscle cells and vascular endothelium. The tumor occurs mostly in the lower extremities as a slowly growing, firm and mobile mass, occasionally accompanied by pain. There are few cases of auricular angiomyoma reported in the literature; however, recently, we experienced a case of a 18-year-old man with protruding auricular mass. We performed a surgical excision and the final pathological result confirmed to angiomyoma. We report this case with a review of the related literatures.
Adolescent ; Angiomyoma* ; Ear Auricle ; Endothelium, Vascular ; Humans ; Leiomyoma ; Lower Extremity ; Muscle, Smooth ; Myocytes, Smooth Muscle

Congenital anomalies of ossicle in the middle ear are rare and could appear in various forms. The most common congenital isolated ossicular anomalies are stapes fixation and incudostapedial discontinuity, with isolated congenital stapes fixation representing about one third of ossicular malformations. We present a rare case of monocrural anomaly of unilateral stapes in a 36-year-old woman with nonprogressive conductive hearing loss. During explotympanotomy, the lateral half of the suprastructure of anomalous stapes was removed and sculptured total ossicular replacement prosthesis was fitted between the long process of incus and remained stapes. Postoperative pure tone audiogram showed a significant decrease in air-bone gap. We report this case with a review of literature.
Congenital Abnormalities ; Ear, Middle ; Female ; Hearing Loss, Conductive ; Humans ; Incus ; Ossicular Prosthesis ; Stapes

Objective: Venom-induced coagulopathy (VIC) is a common snakebite complication that can cause life-threatening hemorrhage. Previous studies have shown that snake venom can cause a decrease in the erythrocyte sedimentation rate (ESR), but this has not been investigated in actual clinical practice. This study evaluated the clinical utility of erythrocyte sedimentation rate as a predictive factor for VIC in patients with a poisonous snakebite. Methods: From January 2012 to December 2021, this study performed a retrospective study of patients with venomous snakebites presenting to a tertiary emergency department. The demographic and laboratory data were collected through a chart review. The patients were divided into two groups, VIC and NoVIC groups. Logistic regression analysis was performed to identify the factors that predicted the presence of VIC, and the receiver operating characteristic (ROC) curve was drawn. Results: One hundred and fifty-three patients were enrolled, and 31 patients (20.3%) developed VIC. The VIC group had significantly lower ESR than the NoVIC group (5.1±5.6 vs. 14.8±13.8; P<0.001). Logistic regression analysis showed that the decreased ESR was associated with the occurrence of coagulopathy (odds ratio, 0.957; 95% confidence interval, 0.917-0.999; P=0.045). The area under the curve was 0.701 in the ROC curve, and the cutoff value was set to 4.5 mm/hr. Conclusion ESR measured upon arrival at the emergency department was available to predict venom-induced coagulopathy in snakebite patients.

Acute ischemic stroke due to embolic occlusion of the middle cerebral artery (MCA) in patients with chronic ipsilateral internal carotid artery (ICA) occlusion is quite rare. Several previous reports demonstrated that intra-arterial (IA) thrombolytic therapy or aspiration thrombectomy using the cross-circulation technique via an alternative collateral pathway is feasible in acute stroke patients with an unfavorable direct route to the occluded sites. However, stent-retriever embolectomy via the cross-circulation approach has not been reported in the literature. The present paper reports the first case of successful stent-retriever embolectomy for acute MCA occlusion via the patent posterior communicating artery (PComA) by using Trevo XP ProVue stent-retriever in a patient with acute MCA stroke and chronic occlusion at the origin site of the ipsilateral ICA.
Arteries* ; Carotid Artery, Internal ; Embolectomy* ; Humans ; Middle Cerebral Artery ; Stroke ; Thrombectomy ; Thrombolytic Therapy