No abstract available.
Endometriosis* ; Female

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder that affects synovium, tendon sheath and bursa. Although the condition can present in any joint, knee joint is the most commonly affected site and only 2.5% of cases occur in foot and ankle joint. PVNS occurs in two types: localized and diffuse. Localized type is characterized by focal involvement of the synovium with either nodular or pedunculated masses, Diffuse type affects virtually the entire synovium. Diffuse type has reported more recurrence rate. We have experienced a patient who has diffuse type PVNS of ankle joint and report an optimal method of surgical treatment.
Animals ; Ankle ; Ankle Joint ; Foot ; Humans ; Joints ; Knee Joint ; Recurrence ; Synovial Membrane ; Synovitis, Pigmented Villonodular ; Tendons

BACKGROUND: The major problem in transplants between widely disparate species is hyperacute rejection, a rapid and violent rejection that damages the graft within minutes or hours. Hyperacute rejection is mediated by the components of natural immunity, most notably natural antibodies and complements. The absorption of natural antibodies on endothelial cells by passing the recipient's blood through a donor kidney or liver is very effective in removing xenoreactive natural antibodies from a recipient's blood. To modify hyperacute rejection in a pig-to-dog renal transplant, we transplanted a porcine kidney, which had been perfused after organ perfusion of canine blood through a pig's liver and kidney, was transplanted en-bloc with the kidney. METHODS: The en-bloc organ procurement from male pigs weighing 15-20 kg, including the liver and two kidneys, was performed after perfusion with a cold Euro-Collins solution through the aorta and portal vein. The harvested organs were vascularized to male dogs weighing 25-30 kg by anastomosis of the graft aorta to the recipient's infrarenal aorta, the graft inferior vena cava to the recipient's infrarenal inferior vena cava, and the graft portal vein to the recipient's portal vein with a end-to-side fashion. The recipient's blood was perfused into the liver and one kidney, and then into the other kidney 60 minutes later. During the procedure, the recipient's blood was sampled and assayed for natural xenoreactive antibodies. Natural anti-porcine endothelial antibodies were measured by ELISA with porcine aortic endothelial cells in the culture as targets. Each grafted organ was biopsied serially at 2, 4, 6, 8, 10, 20, 40, and 60 minutes after reperfusion for light microscopic and immunofluorescent examinations. RESULTS: Natural anti-porcine endothelial antibody levels(both IgM and IgG) of canine serum decreased at 60 minutes after organ perfusion of canine blood through a porcine liver and one kidney. Hyperacute rejection (capillary congestion, interstitial hemorrhage, thrombosis, etc.) of the kidneys appeared within20 minutes after blood perfusion regardless of organ absorption of natural antibodies through the porcine liver and one kidney. The appearance of interstitial hemorrhage and thrombosis of the kidney was delayed about 4-10 minutes by organ absorption of natural antibodies. However, acute tubular necrosis appeared early and more obviously in the second kidneys. Immunofluorescence showed granular deposits of canine IgM and IgG in the glomerular mesangium and on the microvessels. Canine IgM, but not IgG, deposition on the second kidney decreased after organ absorption of natural antibodies. Complement deposition was not altered by organ absoption. CONCLUSIONS: The organ perfusion of canine blood through a porcine liver and kidney was effective for only a short time in decreasing the natural anti-porcine endothelial IgM and IgG antibodies of canine serum, and histologic changes appeared in the second kidney of a slightly later time than in the kidney used in antibody absorption. Further efforts should be made toward modifying the technique for removal of specific natural antibodies and complements.
Absorption ; Animals ; Antibodies ; Aorta ; Complement System Proteins ; Dogs ; Endothelial Cells ; Enzyme-Linked Immunosorbent Assay ; Estrogens, Conjugated (USP) ; Fluorescent Antibody Technique ; Glomerular Mesangium ; Hemorrhage ; Heterografts* ; Humans ; Immunity, Innate ; Immunoglobulin G ; Immunoglobulin M ; Kidney* ; Liver* ; Male ; Microvessels ; Necrosis ; Perfusion* ; Portal Vein ; Reperfusion ; Swine ; Thrombosis ; Tissue and Organ Procurement ; Tissue Donors ; Transplantation, Heterologous ; Transplants ; Vena Cava, Inferior

No abstract available.

Diabetic nephropathy is a common and serious complication in diabetic patients. Renal diseases other than diabetic nephropathy (non-diabetic nephropathy) can occur in diabetic patients with nephrosis. The presence of non-diabetic nephropathy is noted in type 2 diabetes patients, but no data exists for type 1 diabetes. In this report we describe the case of a 15-year-old girl with type 1 diabetes mellitus, who presented with an acute elevation of urinary microalbumin excretion, general edema, and liver enzyme elevation. She had shown microalbuminuria about 3 years earlier, as well as an uncontrolled hemoglobin A1c level, but she had no diabetic retinopathy and neuropathy. A renal biopsy was conducted, and she was diagnosed with primary focal segmental glomerulosclerosis. She was treated with corticosteroids and an angiotensin converting enzyme inhibitor.
Adolescent ; Adrenal Cortex Hormones ; Biopsy ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies ; Diabetic Retinopathy ; Edema ; Glomerulosclerosis, Focal Segmental ; Hemoglobins ; Humans ; Liver ; Nephrosis ; Peptidyl-Dipeptidase A

In the pediatric ICU and operating room, a central venous catheter (CVC) provides accurate hemodynamic information and serves as a reliable route for the administration of vasoactive drugs, fluids and allogeneic blood products. The placement of CVC is associated with a complication rate of 0.4% to 20%, including hemothorax, pneumothorax, thrombosis, infection and cardiac tamponade. We describe a case of CVC being misplaced in the innominate vein after penetrating the subclavian vein during anesthesia induction for arterial switch operation. Our report discusses the mechanisms by which this mishap took place, and reviews the proper positions of the head, arm, thorax and safe depth of venipuncture for the placement of a CVC in neonates.
Anesthesia ; Arm ; Brachiocephalic Veins ; Cardiac Tamponade ; Central Venous Catheters ; Head ; Hemodynamics ; Hemothorax ; Humans ; Hypogonadism ; Infant, Newborn ; Mitochondrial Diseases ; Operating Rooms ; Ophthalmoplegia ; Phlebotomy ; Pneumothorax ; Subclavian Vein ; Thorax ; Thrombosis

PURPOSE: For the treatment of arterial lesions occurring after catheterization, ultrasound-guided compressionrepair (UGCR) has recently been introduced. Using this technique, we repeatedly attempted treatment of theselesions and assessed their characteristics, as seen on US. MATERIALS AND METHODS: We prospectively studied 21patients who had suffered arterial injury (16 pseudoaneurysms and five arteriovenous fistulae) during arterialcatheterization. Occlusion of one pseudoaneurysm (PA) occurred spontaneously. UGCR was attempted in 20 casesinvolving arterial injury, including two which had occurred five months earlier. In six lesions, multiple attemptswere necessary. RESULTS: UGCR was successful in 18 (90%) of 20 arterial injuries, and all 15 PAs weresuccessfully treated;eight were completely closed at the first attempt, five were seen on follow-up US to havebeen closed after the first attempt, and two were completely closed at the second attempt. Three of fiveateriovenous fistulae (AVF) were successfully closed, one was completely closed at the first attempt, and two atthe second attempt. Mean compression time was 37(range:3-75)min in AVFs. Mean diameter of the cavity of PAs was3.8(range:1.5-10)cm;mean width of the track was 2.6(range:1-5)mm in PAs and 3.8(range:1.6-8)mm in AVFs. CONCLUSION: USGC can be successful after multiple attempts, even in patients with large cavity lesions and in chronic cases.AVFs with wide necks need a longer compression time and the results of the procedure are poorer.
Aneurysm, False* ; Catheterization ; Catheters ; Fistula ; Follow-Up Studies ; Humans ; Neck ; Prospective Studies

BACKGROUND/AIMS: Fecal microbiota transplantation (FMT) is a highly effective therapy for refractory and recurrent Clostridium difficile infection (CDI). Despite its excellent efficacy and recent widespread use, FMT has not been widely used in South Korea thus far. We describe our experience with FMT to treat refractory/recurrent CDI. METHODS: We conducted a chart review of patients who underwent FMT for refractory/recurrent CDI at Inha University Hospital, between March 2014 and June 2016. The demographic information, treatment data, and adverse events were reviewed. FMT was administered via colonoscopy and/or duodenoscopy. All stool donors were rigorously screened to prevent infectious disease transmission. RESULTS: FMT was performed in nine patients with refractory/recurrent CDI. All patients were dramatically cured. Bowel movement was normalized within one week after FMT. There were no procedure-related adverse events, except aspiration pneumonia in one patient. During the follow-up period (mean 11.4 months), recurrence of CDI was observed in one patient at one month after FMT due to antibiotics. CONCLUSIONS: FMT is a safe, well-tolerated and highly effective treatment for refractory/recurrent CDI. Although there are many barriers to using FMT, we expect that FMT will be widely used to treat refractory/recurrent CDI in South Korea.
Anti-Bacterial Agents ; Clostridium difficile* ; Clostridium* ; Colonoscopy ; Disease Transmission, Infectious ; Duodenoscopy ; Fecal Microbiota Transplantation* ; Follow-Up Studies ; Gastrointestinal Microbiome ; Humans ; Korea ; Pneumonia, Aspiration ; Recurrence ; Tissue Donors

Cowden's disease, a rare autosomal dominant disorder characterized by benign hamartomatous overgrowth of various tissues, increases the risk of cancer of the thyroid, breast, endometrium, prostate, and possibly other organs. Generally, germline mutations in the coding sequence for PTEN are found in 80% of patients with Cowden's disease. Here we report a rare case of incidentally discovered gastric polyposis during esophagogastroscopy for medical screening in a patient with a history of surgery for breast and thyroid cancer. Identifyng the mutation in the PTEN gene to a diagnosis of Cowden's disease.
Breast ; Clinical Coding ; Endometrium ; Endoscopy ; Female ; Germ-Line Mutation ; Hamartoma Syndrome, Multiple ; Humans ; Mass Screening ; Prostate ; Thyroid Neoplasms

PURPOSE: Intraductal papillary mucinous neoplasm (IPMN) has variable malignant potential ranging from premalignant intraductal lesions to malignant neoplasms with invasive carcinoma. To help physicians managing patients with IPMN, International consensus guidelines was made in 2006 and revised in 2012. This study was designed to evaluate the clinical usefulness of guidelines and to validate. METHODS: From October 1996 to December 2011, we retrospectively reviewed the data of 230 patients who underwent pancreatic resection for IPMN. Univariate and multivariable analyses were used to identify significant predictors of malignancy in IPMN. RESULTS: Of the 230 patients, 62 patients (27%) were diagnosed with invasive carcinoma. Jaundice (P < 0.001; 95% confidence interval [CI], 3.086-40.010) main pancreatic duct diameter equal to or greater than 10 mm (P < 0.001; 95% CI, 1.723-6.673) and also abdominal pain (P < 0.001; 95% CI, 4.363-22.600) show statistical significance in univariate and multivariate analysis. "High-risk stigmata" was statistical powerful predictors of malignancy than "worrisome features". International consensus guidelines 2012 had improvement on specificity but deterioration of sensitivity. CONCLUSION: Revised guidelines seemed to bring about an improvement of weak side of Sendai criteria. Abdominal pain, jaundice, main pancreas duct greater than 10 mm can be clinical variables to predict malignancy.
Abdominal Pain ; Consensus* ; Humans ; Jaundice ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatic Ducts ; Retrospective Studies ; Sensitivity and Specificity