PURPOSE: Couinaud described segment IV as being equivalent to segments II and III, as the umbilical portion of the portal vein (PV), and its equal branch of segment II, originated from the transverse portion of the PV. On the contrary, Healey suggested the presence of left lateral and medial segments, on the basis of umbilical fissure. Recently, some author have claimed the branch of segment II originated from the distal portion of the ligamentum venosum (LV), and that this branch was not equal to, only a branch of, the umbilical portion. Our goal was to evaluate the surgical anatomy of the left lobe of the liver through dissecting Korean cadavers. METHODS: The number of cadavers dissected totaled 10. PV, its branches, and the LV were dissected and the length of the transverse portion measured. The distance between the origin of the transverse portion and that of the segment II branch were also measured. RESULTS: The branch of segment II originated from the distal portion of the LV in all 10 cases. The length of the transverse portion was 18.8+/-5.8 mm, and the distance between the origins of the LV and segment II branch was 7.0+/-3.1 mm. CONCLUSION: Considering the embryology of the liver, as well as the above result, the umbilical portion and segment II branch were not equal anatomic structures. The umbilical portion and LV are equal anatomic structures. The branch of segment II is only one of the branches of the umbilical portion. We think Healey's classification is more accurate for the left lobe of the liver.
Cadaver* ; Classification ; Embryology ; Hepatectomy ; Liver* ; Portal Vein

OBJECTIVE: To evaluate the efficacy of intravenous cyclophosphamide pulse therapy (IVC) in proliferative lupus nephritis (PLN) with normal serum creatinine. METHODS: We retrospectively reviewed 53 PLN patients treated with IVC more than 6 times from 1992 to 1997. The patients were classified into the alternative and the initial. In the former, IVC was started after failed remission with steroid or steroid and oral immunosuppressive drug; in the latter, IVC was started as initial treatment. Remmission was endpoint of study and defined as all of the followings should be maintained for more than 6 months, 1) 24-hour urine protein less than 1g, 2) normal serum creatinine, 3) less than 5 RBC in high power field microscopy and no granular and RBC cast in urine. We compared remission rate and frequency of complications associated with IVC between the initial and alternative by chi-square test and analyzed the variables of remission including methodological; initial or alternative, clinical; age, onset age of systemic lupus erythematous (SLE) and lupus nephritis (LN), duration of SLE and LN, laboratory; serum concentration of creatinine, C3, C4, albumin, anti ds-DNA Ab. titers and 24 hour urine proteins and pathological; activity and chronicity index, multivariatly. RESULTS: All 53 patients (22 initial, 31 alternative) had normal serum creatinine at start of IVC, treated with 9.7 +/-2.3 times of IVC and followed up during 37.2 +/-15.4 months. Thirty-four patients (64%) had remission (18 of the initial and 16 of the alternative). The remission rate of the initial was higher (82% vs 52%, p=0.04 by chi-square test) than the alternative, but frequency of complications was not different. In multivariate analysis, any other variables; including methodological, clinical, laboratory and pathological, did not influenced on remmission significantly. CONCLUSIONS: IVC is effective in PLN with normal serum creatinine as initial treatments and our results suggest that IVC may be chosen as an alternative therapy in PLN patients who failed remission with steroid or steroid and oral immunosuppressive drug.
Age of Onset ; Creatinine* ; Cyclophosphamide ; DNA ; Humans ; Lupus Nephritis* ; Microscopy ; Multivariate Analysis ; Retrospective Studies

Extramedullary plasmacytoma is a rare presentation of plasma cell dyscrasia. Most such tumors arise on the upper aerodigestive tract and renal plasmacytoma is very rare. The patient was 44 years old female presented with a 3 month-history of palpable mass in the right flank. There was a past history of complete remission after a chemotherapy for multiple myeloma (6 cycles of VAD chemotherapy) for the two years following the first diagnosis. After surgical resection, histologic and immunofluorescence studies of resected specimens revealed that the renal parenchyma was destroyed by sheets of mature plasma cells producing monoclonal protein (IgG-lambda) and by deposits of amorphous eosinophilic substance stained with anti-lambda antisera. Treatment with chemotherapy of Hyper-CVAD and local irradiation was done. The patient has been disease-free for 3 months after treatment. We report a case of relapsed renal plasmacytoma after complete remission of multiple myeloma.
Adult ; Diagnosis ; Drug Therapy ; Eosinophils ; Female ; Fluorescent Antibody Technique ; Humans ; Immune Sera ; Multiple Myeloma* ; Paraproteinemias ; Plasma Cells ; Plasmacytoma*

Anisakiasis is a parasitic disease following eating raw fishes infected with Anisakis larvae. The endoscopic features of the gastric mucosa are edema, erosion, ulceration and hemorrhage. Gastric anisakiasis forming submucosal tumor is rare. Twenty six-year-old man who complained of severe epigastric pain was admitted. The pain began approximately three hours after eating slices of raw Astroconger myriaster. Gastric endoscopy revealed a submucosal tumor with central erosion on the gastric fundus. Endoscopic ultrasonography detected a thickening of the gastric wall made of mainly thickened submucosal layer. Abdominal CT scan showed a gastric mass lesion with hypodensity in the gastric fundus and subsequently wedge resection was performed. The pathologic finding of the resected mass was eosinophilic abscess in the submucosal layer. We report a case of gastric submucosal tumor which seems to be caused by Anisakis, with a review of relevant literature.
Abscess ; Anisakiasis ; Anisakis* ; Eating ; Edema ; Endoscopy ; Endosonography ; Eosinophils ; Fishes ; Gastric Fundus ; Gastric Mucosa ; Hemorrhage ; Larva ; Parasitic Diseases ; Tomography, X-Ray Computed ; Ulcer

Multiple lymphomatous polyposis (MLP) is an uncommon type of primary non-Hodgkin's gastrointestinal B cell-lymphoma characterized by the presence of multiple lymphomatous polyps along the gastrointestinal tract. Unlike MALT-lymphoma, MLP has a strong tendency for histologically monomorphic character, extra-digestive localization, rare lymphoepithelial lesion and poor prognosis. The malignant cells of MLP share morphological, immunohistologic and cytogenetic similarities with cells of node-based mantle cell lymphoma. We report a case of mantle cell lymphoma presenting with MLP involving various segments of the gastrointestinal tract, skeletal muscles of the right thigh and bone marrow observed in a 71-year-old woman who complained of lower abdominal pain and a palpable right thigh mass.
Abdominal Pain ; Aged ; Bone Marrow ; Cytogenetics ; Female ; Gastrointestinal Tract ; Humans ; Lymphoma, Mantle-Cell* ; Muscle, Skeletal* ; Polyps ; Prognosis ; Thigh

The objective of this study was to compare changes in the simplified disease activity index (SDAI) between biologic (b) and conventional (c) disease-modifying antirheumatic drugs (DMARD) users with seropositive rheumatoid arthritis (RA) in daily clinical practice. Methods: This was a nationwide multicenter observational study. Patients who had three or more active joint counts and abnormal inf lammatory marker in blood test were enrolled. The selection of DMARDs was determined by the attending rheumatologist. Clinical parameters, laboratory findings, and Health Assessment Questionnaire (HAQ) scores were obtained at baseline and at 6 and 12 months. Serial SDAI changes and clinical remission rate at 6 and 12 months were assessed. Results: A total of 850 patients participated in this study. The mean baseline SDAI score in bDMARD group was higher than that in cDMARD group (32.08 ± 12.98 vs 25.69 ± 10.97, p < 0.0001). Mean change of SDAI at 12 months was –19.0 in the bDMARD group and –12.6 in the cDMARD group (p < 0.0001). Clinical remission rates at 12 months in bDMARD and cDMARD groups were 15.4% and 14.6%, respectively. Patient global assessment and HAQ at 12 months were also significantly improved in both groups. Multivariate logistic regression showed that baseline HAQ score was the most notable factor associated with remission. Conclusions: There was a significant reduction in SDAI within 12 months after receiving DMARDs in Korean seropositive RA patients irrespective of bDMARD or cDMARD use in real-world practice. Clinical remission was achieved in those with lower baseline HAQ scores.