Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that typically follows an infection or vaccination and has a favorable long-term prognosis. We describe the first reported case of ADEM after vaccination against novel influenza A (H1N1). A previously healthy 34-month-old boy who developed ADEM presented with a seizure and left-sided weakness 5 days after vaccination against novel influenza A (H1N1). Cerebrospinal fluid examination revealed elevated cell counts. T2-weighted images and fluid-attenuated inversion recovery images revealed multiple patchy hyperintense lesions in the frontal and parietal subcortical white matter and the left thalamus. After the administration of intravenous corticosteroid, the patient's clinical symptoms improved and he recovered completely without neurologic sequelae.
Cell Count ; Central Nervous System ; Child ; Demyelinating Diseases ; Drug Toxicity ; Encephalomyelitis, Acute Disseminated ; European Continental Ancestry Group ; Humans ; Influenza, Human ; Preschool Child ; Prognosis ; Seizures ; Thalamus ; Vaccination

Primary melanoma of the vagina is rare, accounting for 2.6-2.8% of all primary malignant tumor of the vagina and 0.4-0.8% of all malignant melanomas in the female. Melanocytes are the presumed precursors of malignant melanoma of the vagina; they are embryologically derived from neural crest cells and can be found in the basal portion of the vaginal epidermis in 3% of normal adult females. Though malignant melanoma may occur anywhere in the vagina, it is most commonly found on the anterior wall and in the distal one-third. Vaginal bleeding is the most common symptom. Histochemical and immunohistochemical procedures confirm the initial diagnosis. Vaginal melanoma is a highly malignant disease; due to the extensive lymphatic invasion and melanoma's propensity for hematogeneous spread, so early metastases are very common. The treatment modalities for the primary management of vaginal melanoma are varied according to the location and extend, individually or in combination, wide local incision, radical surgical extirpation, irradiation, or chemotherapy. Although there have been no consensus as to comprehensive treatment, in the case of upper vaginal melanoma, radical abdominal hysterectomy with bilateral salpingo-oophorectomy with pelvic lymph node dissection is generally advocated. Regardless of primary therapy chosen, result of the treatment of vaginal melanoma has been uniformly poor. We experienced a case of malignant melanoma of the vagina confirmed pathohistologically after radical abdominal hysterectomy with bilateral salpingo-oophorectomy and presented with a brief review of literature.
Adult ; Consensus ; Diagnosis ; Drug Therapy ; Epidermis ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Melanocytes ; Melanoma* ; Neoplasm Metastasis ; Neural Crest ; Uterine Hemorrhage ; Vagina*

Cerebellum is a key structure involved in motor learning and coordination. In animal models, motor skill learning increased the volume of molecular layer and the number of synapses on Purkinje cells in the cerebellar cortex. The aim of this study is to investigate whether the analogous change of cerebellar volume occurs in human population who learn specialized motor skills and practice them intensively for a long time. Magnetic resonance image (MRI)-based cerebellar volumetry was performed in basketball players and matched controls with V-works image software. Total brain volume, absolute and relative cerebellar volumes were compared between two groups. There was no significant group difference in the total brain volume, the absolute and the relative cerebellar volume. Thus we could not detect structural change in the cerebellum of this athlete group in the macroscopic level.
Neuronal Plasticity ; Motor Skills/physiology ; Models, Anatomic ; Male ; Magnetic Resonance Imaging ; Humans ; Cerebellum/*anatomy & histology/physiology ; Basketball/*physiology ; Animals ; Adult

PURPOSE: Elderly colorectal cancer patients may have increased surgical morbidity and mortality due to comorbidity and compromised cardiopulmonary reserves. The aim of this study is to compare the safety and the outcomes of laparoscopic surgery for colorectal cancer in patients of 70 years of age and older to those of patients younger than 70 years of age. METHODS: From August 2004 to April 2006, the authors retrospectively analyzed the medical records of patients who underwent laparoscopic surgery for colorectal cancer. RESULTS: The elderly group included 35 cases, and the younger group included 67 cases. The mean age of the elderly group was 74.4+/-4.1, and that of the younger group was 58.2+/-9.5. Sixty-three percent (63%) of the elderly group and 27% of the younger group had co- morbidity. The mean operation time in the elderly group was 299.9+/-121.0 minutes, and that in the younger group was 295.1+/-110.8 minutes. The mean number of harvested lymph nodes was 17.7+/-8.6 in the elderly group and 19.4+/-9.8 in the younger group. The day of diet start was the 4.1+/-0.6 postoperative day in the elderly group and the 4.4+/-1.4 day in the younger group. Hospital stay was 16.0+/-7.6 in the elderly group and 15.5+/-4.6 days in the younger group. There were no statistical differences in terms of operation time, number of harvested lymph nodes, blood loss at operation, day of flatus passing, diet start, hospital stay, and complications. There was no surgical mortality in either groups. CONCLUSIONS: Laparoscopic surgery for colorectal cancer is a safe and effective treatment option in elderly patients.
Aged* ; Colorectal Neoplasms* ; Comorbidity ; Diet ; Flatulence ; Humans ; Laparoscopy* ; Length of Stay ; Lymph Nodes ; Medical Records ; Mortality ; Retrospective Studies

PURPOSE: The COST study trial has demonstrated oncological safety by using laparoscopy for colon cancer. However, in a prior trial, the transverse colon was excluded. Therefore, it has not been determined whether laparoscopy can be used in the setting of transverse colon cancer. Moreover, a transverse colectomy for transverse colon cancer is controversial. This study evaluated the peri-operative and short-term oncological outcomes of a laparoscopic transverse colectomy. METHODS: A retrospective review of patients with colorectal cancer treated using laparoscopy from August 2004 to August 2007 was conducted. Peri-operative and short-term oncological outcomes were compared between an extended right or left colectomy and a transverse colectomy. RESULTS: Of 234 patients, 26 patients underwent laparoscopic surgery for transverse colon cancer. Extended right & left colectom were performed in 20 cases, and a transverse colectomy was performed in 6 cases. There were no significant differences between the two groups in terms of age, gender, BMI, blood loss, time to pass flatus, start of diet, hospital stay, tumor size, number of lymph nodes, and radial margin. The distal and the proximal resection margins of an extended Rt. or Lt. colectomy were longer than those of a transverse colectomy. One transverse colectomy was converted to open surgery because of a T4 lesion of transverse colon cancer. There were no differences between the two groups in terms of morbidity and mortality. CONCLUSIONS: The results of this study show that a laparoscopic transverse colectomy has acceptable peri-operative and short-term oncological outcomes compared to an extended right and left colectomy. However, further investigations are needed to establish the long-term oncological safety of laparoscopic surgery, including transverse colectomy, for transverse colon cancer.
Colectomy ; Colon, Transverse ; Colonic Neoplasms ; Colorectal Neoplasms ; Diet ; Flatulence ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Retrospective Studies

PURPOSE: Hepatolithiasis causes many complications as well as an intrahepatic cholangiocarcinoma, which means that it should definitely be treated. However, it is difficult to make an accurate diagnosis for a concurrent cholangiocarcinoma prior to surgery. This study examined the surgical treatment for a hepatoithiasis with a hidden intrahepatic cholangiocarcinoma. METHODS: A retrospective analysis for patients who had undergone a hepatic resection for hepatolithiasis between September 1994 and July 2004 was made by comparing them in two groups. One group comprised of patients with hepatolithiasis only (group H) and the other group comprised of patients with hepatolithiasis and a hidden cholangiocarcinoma of which the preoperative diagnosis had failed (group HC). The prognostic factors, such as age, gender ratio (M: F), symptoms and the duration of their onset, tumor markers and total bilirubin, preoperative radiological findings, intraoperative findings, and operation type were analyzed. RESULTS: Group H consisted of 261 patients and the group HC consisted of 5. In group HC, 2 cases of tumor necrosis were misdiagnosed as a liver abscess, 1 case of hilar cholangiocarcinoma was misdiagnosed as severe cholangitis, and another case of intrahepatic cholangiocarcinoma was misdiagnosed as duct dilatation with periductal inflammatory proliferation. On the other hand, the presence of a history of a undergoing hepatobiliary surgery, the preoperative radiological findings of a liver abscess and lymphadenopathy, the type of surgery, and the site of the intrahepatic stones were statistically different in the two groups. CONCLUSION: A hidden cholangiocarcinoma should be suspected preoperatively in cases in whom there is a history of undergoing hepatobiliary surgery, the preoperative radiological findings of a liver abscess or lymphadenopathy. In addition, a meticulous exploration for a possible incidental tumor mass with an additional consultation of a frozen biopsy should be carried out intraoperatively to determine if the preoperative finding of a liver abscess is a tumor necrosis.
Bilirubin ; Biopsy ; Biomarkers, Tumor ; Cholangiocarcinoma* ; Cholangitis ; Diagnosis ; Dilatation ; Hand ; Humans ; Liver Abscess ; Lymphatic Diseases ; Necrosis ; Retrospective Studies

Pelvic actinomycosis is a chronic, progressive, granulomatous and suppurative disease caused by an anaerobic or microaerobic Gram-positive organism, not fungi. Actinomyces species exhibit branching, filamentous growth and appear in the human skin, oral cavity, gastrointestinal tract. Actinomyces infection in human is relatively rare, however, prolonged use of an intrauterine contraceptive device (IUD) is a well known risk factor of pelvic actinomycosis. Pelvic actinomycosis can mimick pelvic malignancy leading to mutilating surgical excision, and diagnostic problems necessitated a laparotomy in many patients. The pathohistological diagnosis is based on the characteristic microscopic image and specific staining of sulfur granule. Adequate surgical excision and administration of antibiotics show good prognosis. We experienced 2 cases of pelvic actinomycosis with the intestinal obstruction, confirmed patho- histologically after laparotomy.
Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Diagnosis ; Fungi ; Gastrointestinal Tract ; Humans ; Intestinal Obstruction* ; Intrauterine Devices ; Laparotomy ; Mouth ; Prognosis ; Risk Factors ; Skin ; Sulfur

Pelvic actinomycosis is a chronic, progressive, granulomatous and suppurative disease caused by an anaerobic or microaerobic Gram-positive organism, not fungi. Actinomyces species exhibit branching, filamentous growth and appear in the human skin, oral cavity, gastrointestinal tract. Actinomyces infection in human is relatively rare, however, prolonged use of an intrauterine contraceptive device (IUD) is a well known risk factor of pelvic actinomycosis. Pelvic actinomycosis can mimick pelvic malignancy leading to mutilating surgical excision, and diagnostic problems necessitated a laparotomy in many patients. The pathohistological diagnosis is based on the characteristic microscopic image and specific staining of sulfur granule. Adequate surgical excision and administration of antibiotics show good prognosis. We experienced 2 cases of pelvic actinomycosis with the intestinal obstruction, confirmed patho- histologically after laparotomy.
Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Diagnosis ; Fungi ; Gastrointestinal Tract ; Humans ; Intestinal Obstruction* ; Intrauterine Devices ; Laparotomy ; Mouth ; Prognosis ; Risk Factors ; Skin ; Sulfur

Purpose: While a carcinoma of the splenic flexure is uncommon, is associated with a high risk of obstruction, and has a dual lymphatic drainage system, A COST study excluded transverse colon cancer, including splenic flexure colon cancer. This study reviews our experience with splenic flexure colon cancer treated laparoscopically and discusses a appropriate, safe laparoscopic surgical procedure. Methods: The authors reviewed the medical records of patients who underwent laparoscopic surgery for splenic flexure colon cancer from January 1995 to June 2006. The splenic flexure colon was defined as 5 cm from the splenic flexure proximally and distally by using radiologic studies. Curative surgery for splenic flexure colon cancer was defined as: primary cancer removal, a safe resected margin, no metastasis, and a complete lymphadenectomy including high ligation of left colic artery and of the left branch of the middle colic artery. Results: A total of 407 patients underwent laparoscopic surgery for colon cancer; among them, 15 patients underwent a laparoscopic left colectomy for splenic flexure colon cancer. The mean age of the patients was 63.8 years, and the male-to-female ratio was 9:6. The mean operation time was 325.3+/-95.1 minutes, and the average hospital stay was 15.8+/-4.9 days. The average number of harvested lymph nodes was 12.3+/-9.7, the average distal resection margin was 15.3+/-7.6 cm, and the average proximal margin was 10.7+/-3.2 cm. One case of chyle discharge and one case of ileus developed, but were treated conservatively. There was no surgical mortality. Conclusions: A laparoscopic left colectomy for splenic flexure colon cancer is a technically feasible and safe procedure with acceptable short-term outcomes in experienced hands.
Female ; Male ; Humans ; Mortality

A retrospective study was conducted to determine the incidence of major complications after liver transplantations which had been performed at Asan Medical Center from August 1992 to October 1996. Among the 43 orthotopic liver transplantations(OLTs), 27 were cadaveric donor liver transplantation(CDLT) including one retransplantation, 16 were living donor liver transplantation(LDLT). The over-all incidence of major complication was 52.4%, and there were no statistical difference between CDLT and LDLT. But the one-year cumulative survival was better in LDLT than CDLT(86.2% vs 63.3% : p < 0.1). To reduce the incidence of major complications after OLT, proper management of donors, early transplantation of recipients and shortening of cold ischemic time are mandatory especially in CDLT.
Cadaver ; Chungcheongnam-do ; Cold Ischemia ; Humans ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors ; Retrospective Studies ; Tissue Donors