In the Dept. of Thoracic Surgery, Korea University Hospital, Preoperative diagnosis as Ebstein anomaly was made on the 11-year old female through the preoperative examination including right cardioangiography and the Glenn Operation was performed to this patients as palliative treatment. During closure of the thoracic wall just after the anastomosis of S.V.C. and right pulmonary artery, sudden cardiac arrest developed. One day later after death, autopsy was performed in order to confirm the pathologic anatomy of the cardiac anomaly and to clarify the cause of death. Pathologic anatomy of the heart revealed the huge dilatation of right atrium, Patent Foramin Ovale, and the deformed and descended posterior and the septal leaflets of tricuspid value by which right ventricle was devided into the atrialized and the functional portion. The diagnosis of the autopsy showed (1) Ebstein Anomaly (2) bilateral total atelectasis of the lung, (3) multiple petechial hemorrhage and edema of the myocardium, brain and liver due to acute hypoxia, (4) fibrocaseous tuberculosis of the liver and tuberculous pericholangitis.
Anoxia ; Autopsy ; Brain ; Cause of Death ; Child ; Death, Sudden, Cardiac ; Diagnosis ; Dilatation ; Ebstein Anomaly* ; Edema ; Female ; Heart ; Heart Atria ; Heart Ventricles ; Hemorrhage ; Humans ; Korea ; Liver ; Lung ; Myocardium ; Palliative Care ; Pulmonary Artery ; Pulmonary Atelectasis ; Thoracic Surgery ; Thoracic Wall ; Tuberculosis

We report herein a case of acral lentiginous melanoma in a 65-year-old female. An about 2x3cm sized erythematous to brownish mass with central ulceration was located on the left heel accompanied by enlargement of the left inguinal lymph nodes. Histopathologic findings showed lentiginous proliferation of atypical melanocytes with pseudoepithliomatous hyperplasia and invasion of tumor cells from the epidermis into the dermis. Focal pigmented melanocytes were also noted. Complete surgical excision and chemotherapy with DTIC were done. Marked edematous swelling on the left lower leg was developed after 8 months and 1 month later she was expired.
Aged ; Dacarbazine ; Dermis ; Drug Therapy ; Epidermis ; Female ; Heel ; Humans ; Hyperplasia ; Leg ; Lymph Nodes ; Melanocytes ; Melanoma* ; Ulcer

BACKGROUND: A peripheral extracorporeal membrane oxygenator (p-ECMO) has been developed to support patients who are dying due to a serious cardiopulmonary condition. This analysis was planned to define the clinical situation in which the patient benefits most from a p-ECMO. MATERIAL AND METHODS: Between June 2007 and Aug 2009, a total of 41 adult patients used the p-ECMO. There were 23 males and 18 females (mean age 54.4+/-15.1 years). All patients had very unstable vital signs with hypoxia and complex cardiac problems. We divided the patients into 4 groups. In the first group, a p-ECMO was used as a bridge to cardiac operation. In the second group, patients did not have the opportunity to undergo any cardiac procedures; nevertheless, they were treated with a p-ECMO. In the third group, patients mostly had difficulty in weaning from CPB (cardiopulmonary bypass) after cardiac operation. The fourth group suffered from many complications, such as pneumonia, bleeding, infections, and LV dysfunction with underlying cardiac problems. All cannulations were performed by the Seldinger technique or cutting down the femoral vessel. A long venous cannula of DLP(R) (Medtronic Inc, Minneapolis, MN) or RMI(R) (Edwards Lifesciences LLC, Irvine, CA) was used together with a 17~21 Fr arterial cannula and a 21 Fr venous cannula. As a bypass pump, a Capiox emergency bypass system (EBS(R); Terumo, Tokyo, Japan) was used. We attempted to maintain a flow rate of 2.4~3.0 L/min/m2 and an activated clotting time (ACT) of around 180 seconds. RESULTS: Nine patients survived by the use of the p-ECMO. Ten patients were weaned from a p-ECMO but they did not survive, and the remainder had no chance to be weaned from the p-ECMO. The best clinical situation to apply the p-ECMO was to use it as a bridge to cardiac operation and for weaning from CPB after cardiac operation. CONCLUSION: Various clinical results were derived by p-ECMO according to the clinical situation. For the best results, early adoption of the p-ECMO for anatomical correction appears important.
Adoption ; Adult ; Anoxia ; Catheterization ; Catheters ; Emergencies ; Extracorporeal Membrane Oxygenation ; Female ; Glycosaminoglycans ; Hemorrhage ; Humans ; Male ; Membranes ; Oxygenators, Membrane ; Pneumonia ; Shock, Cardiogenic ; Tokyo ; Vital Signs ; Weaning

Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.
Acromegaly* ; Growth Hormone ; Hematologic Neoplasms ; Humans ; Insulin ; Male ; Middle Aged ; Pituitary Neoplasms ; Prednisone ; Primary Myelofibrosis* ; Thalidomide

Acromegaly is a chronic condition resulting from the excessive secretion of growth hormone and insulin like growth factor 1, generally from pituitary adenoma. Although there have been several reports suggesting the possible association of hematologic malignancies with acromegaly, myelofibrosis with acromegaly is very rare. Here we report 54-year-old male patient with myelofibrosis accompanied with acromegaly. We treated this patient with low dose thalidomide (50 mg/day) and prednisone (30 mg/day). We reported this case with literature review.
Acromegaly* ; Growth Hormone ; Hematologic Neoplasms ; Humans ; Insulin ; Male ; Middle Aged ; Pituitary Neoplasms ; Prednisone ; Primary Myelofibrosis* ; Thalidomide

BACKGROUND: We compared the results of liver biopsy and the levels of serum type IV collagen of the hepatitis B carriers with normal liver function test (LFT) to evaluate the clinical usefulness of serum type IV collagen in predicting the progression of histopathological findings. METHODS : Thirty one chronic hepatitis B carriers with normal LFT and no significant clinical symptoms, who were Korean combat police, were classified into three groups according to their histologic results of the liver biopsies. The classification followed the standard proposed by Korean Society of Pathology. Blood samplings for serum type IVcollagen (reference : less than 5 ng/mL) were done in the morning of the same day of the liver biopsy. RESULTS: Of thirty one patients, thirteen patients showed normal histologic findings (41.9%, Group A), eleven patients revealed histologic abnormalities without fibrosis (35.5%, Group B) and seven patients were with fibrosis on liver biopsy (22.6%, Group C). Serum type IV collagen levels of Group A, B and C were 3.53 +/- .57 ng/mL, 3.56 +/- .17 ng/mL and 3.97 +/- .88 ng/mL, respectively. The average of serum type IV collagen levels of Group C was higher than of Group B and the average of Group B higher than that of Group A without any statistical significance (p > 0.05). The averages of serum type IV collagen of eighteen patients with histologic abnormalities (Group B and C) and twenty four patients without fibrosis (Group A and B) were 3.73 +/- 1.06 ng/mL and 3.55 +/- .88 ng/mL respectively. Upon comparison of these averages with the those of Group A and C, no statistical significance was established (p > 0.05). CONCLUSION : In chronic hepatitis B carriers with normal LFT findings, levels of serum type IV collagen were elevated along with histologic severities without statistical significance, therefore can not represent the changing degree of the histologic findings. Liver biopsy is considered to be one of the most accurate tool to assess the histologic status of the liver.
Biopsy* ; Classification ; Collagen Type IV* ; Collagen* ; Fibrosis ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Liver Function Tests* ; Liver* ; Needles ; Pathology ; Police

Extraskeletal Ewing's sarcoma (EES) is a type of Ewing's sarcoma that arises in soft tissue and is now regarded as a member of a family of small round cell neoplasms of bone and soft tissue, including primitive neuroectodermal tumors (PNETs). EES occurs predominantly in adolescents and young adults between the ages of 10 and 30 years. The disease follows an aggressive course with a high recurrence rate. The presence of a distant metastasis is also common. EES arises in the soft tissue of either the trunk or extremities. We recently experienced two cases of EES that occurred in the chest wall. The two patients underwent wide resection and combined radiochemotherapy. There was no evidence of disease 30 and 22 months, respectively, after surgery. Although extremely rare, EES should be considered in the differential diagnosis of chest wall tumors. We report two cases of EES with a brief review of the literature.
Adolescent ; Chemoradiotherapy ; Combined Modality Therapy ; Diagnosis, Differential ; Extremities ; Humans ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Recurrence ; Sarcoma, Ewing ; Thoracic Wall ; Thorax ; Young Adult

BACKGROUND: Open heart surgery using cardiopulmonary bypass (CPB) is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) is a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in cardiac surgery (CS). METHODS: Thirty-seven adult patients undergoing CS with CPB were included in this retrospective study. They had normal preoperative renal function, as assessed by the creatinine (Cr) level, NGAL level, and estimated glomerular filtration rate. Serial evaluation of serum NGAL and Cr levels was performed before, immediately after, and 24 hours after the operation. Patients were divided into two groups: those who showed normal immediate postoperative serum NGAL levels (group A, n=30) and those who showed elevated immediate postoperative serum NGAL levels (group B, n=7). Statistical analysis was performed using Statistical Package for the Social Sciences version 18. RESULTS: Of the 37 patients, 6 (6/37, 16.2%) were diagnosed with AKI. One patient belonged to group A (1/30, 3.3%), and 5 patients belonged to group B (5/7, 71.4%). Two patients in group B (2/7, 28.5%) required further renal replacement therapy. Death occurred in only 1 patient (1/37, 2.7%), who belonged to group B. CONCLUSION: The results of this study suggest that postoperative plasma NGAL levels can be used as an early biomarker for the detection of AKI following CS using CPB. Further studies with a larger sample size are needed to confirm our results.
Acute Kidney Injury* ; Adult ; Biomarkers ; Cardiopulmonary Bypass ; Creatinine ; Glomerular Filtration Rate ; Humans ; Lipocalins* ; Neutrophils* ; Plasma* ; Renal Replacement Therapy ; Retrospective Studies ; Sample Size ; Social Sciences ; Thoracic Surgery*

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.
Abstracting and Indexing as Topic ; CA-125 Antigen ; Humans ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Teratoma

OBJECTIVE: To evaluate the value of sonographic morphology indexing (MI) system and serum CA-125 levels in the assessment of the malignancy risk in patients with ovarian tumors. METHODS: From September 2000 to July 2006, 202 patients who underwent surgery for ovarian tumors were reviewed retrospectively. In all patients, the MI score and serum CA-125 level were measured preoperatively. The association of the final pathologic diagnosis with the MI score and serum CA-125 level were examined. RESULTS: There were 26 malignant tumors out of 141 ovarian tumors with a MI > or =5 (18%). With a cut-off value of 5, the sensitivity, specificity, PPV, and NPV of MI scores were 0.743, 0.293, 0.181, and 0.845, respectively. There were 22 malignant tumors out of 54 ovarian tumors with serum CA-125 >30 u/ml (41%). With a cut-off value of 30 u/ml, the sensitivity, specificity, PPV, and NPV of serum CA-125 level were 0.667, 0.808, 0.407, and NPV 0.925, respectively. On ROC curve, the optimal cut-off value of MI score was 6.5-7.5 and that of serum CA-125 level was 25.6-28.5 u/ml. With a cut-off value of 7, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.023-0.203, respectively. After the exclusion of teratoma cases, the sensitivity and 1-specificity of MI score were 0.875-0.917 and 0.046-0.138, respectively. With a cut-off value of 25.6-28.5 u/ml, the sensitivity and 1-specificity of serum CA-125 level were 0.958 and 0.203-0.215, respectively. CONCLUSION: The sonographic MI system is an accurate and simple method to differentiate a malignant tumor from a benign ovarian tumor. The accuracy of the sonographic MI system improved when the serum CA-125 level was considered and ovarian teratomas were excluded.
Abstracting and Indexing as Topic ; CA-125 Antigen ; Humans ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Teratoma