No abstract available.
Poroma*

Topical photodynamic therapy (PDT) via topical 5-aminolevulinic acid (ALA) is potentially useful for the treatment of basal cell carcinoma. However, as a photosensitizer used in PDT, methyl aminolevulinate (MAL) can replace ALA, because MAL has more advantages than ALA. We treated two patients with basal cell carcinoma using MAL-PDT. Topical MAL-PDT may be a safe and effective treatment modality for basal cell carcinoma.
Carcinoma, Basal Cell ; Humans ; Photochemotherapy ; Triazenes

BACKGROUND AND OBJECTIVES: Corrected transposition of the great arteries (C-TGA) is a rare congenital heart disease, of which prognosis depends on the associated cardiac defects, systemic ventricular function, competency of atrioventricular valves, and the presence of conduction disturbances. This study was aimed to assess the midterm follow-up status of C-TGA. PATIENTS AND METHODS: Retrospective review was performed on 89 cases with C-TGA and two ventricles of adequate size, which were diagnosed between January 1980 and June 1997. RESULTS: Study subjects consisted of 56 males and 33 females (average age at diagnosis, 9 months). Mean follow-up duration was 98 months (range, 2 months - 23 years 8 months). Based on the associated cardiac anomalies, there were 6 simple C-TGA and 83 complex C-TGA patients. Surgery including 19 palliative and 47 corrective operations was attempted on 61 cases at mean age of 69 months. Tricuspid regurgitation (TR) was noted at the time of first examination in 52 (mild in 39; moderate in 8; severe in 5) and progressed in 18 patients. TVR was done on 5 patients and double switch on 7 patients. Arrhythmia was noted preoperatively (complete AV block in 3) in 11 and postoperatively (postoperative complete AV block in 3) in 22 patients. A total of 13 cases died including 10 perioperative deaths during follow-up. Actuarial survival rate at 10 year was 84.5%. CONCLUSION: In this study, the midterm outcome of corrected TGA is acceptable. However, long-term follow-up is required in respect to the function of atrioventricular valve and the systemic ventricle.
Arrhythmias, Cardiac ; Arteries* ; Atrioventricular Block ; Child* ; Diagnosis ; Female ; Follow-Up Studies* ; Heart Defects, Congenital ; Humans ; Male ; Prognosis ; Retrospective Studies ; Survival Rate ; Tricuspid Valve Insufficiency ; Ventricular Function

OBJECTIVE: Massive intracerebral hemorrhage (ICH) and major infarction (MI) are devastating cerebral vascular diseases. Decompression craniectomy (DC) is a common treatment approach for these diseases and acceptable clinical results have been reported. Author experienced the postoperative intracranaial pressure (ICP) trend is somewhat different between the ICH and MI patients. In this study, we compare the ICP trend following DC and evaluate the clinical significance.METHODS: One hundred forty-three patients who underwent DC following massive ICH (81 cases) or MI (62 cases) were analyzed retrospectively. The mean age was 56.3±14.3 (median=57, male : female=89 : 54). DC was applied using consistent criteria in both diseases patients; Glasgow coma scale (GCS) score less than 8 and a midline shift more than 6 mm on brain computed tomography. In all patients, ventricular puncture was done before the DC and ICP trends were monitored during and after the surgery. Outcome comparisons included the ictus to operation time (OP-time), postoperative ICP trend, favorable outcomes and mortality.RESULTS: Initial GCS (p=0.364) and initial ventricular ICP (p=0.783) were similar among the ICH and MI patients. The postoperative ICP of ICH patients were drop rapidly and maintained within physiological range if greater than 80% of the hematoma was removed. While in MI patients, the postoperative ICP were not drop rapidly and maintained above the physiologic range (MI=18.8 vs. ICH=13.6 mmHg, p=0.000). The OP-times were faster in ICH patients (ICH=7.3 vs. MI=40.9 hours, p=0.000) and the mortality rate was higher in MI patients (MI=37.1% vs. ICH=17.3%, p=0.007).CONCLUSION: The results of this study suggest that if greater than 80% of the hematoma was removed in ICH patients, the postoperative ICP rarely over the physiologic range. But in MI patients, the postoperative ICP was above the physiologic range for several days after the DC. Authors propose that DC is no need for the massive ICH patient if a significant portion of their hematoma is removed. But DC might be essential to improve the MI patients’ outcome and timely treatment decision.
Brain ; Cerebral Hemorrhage ; Cerebral Infarction ; Decompression ; Decompressive Craniectomy ; Glasgow Coma Scale ; Hematoma ; Humans ; Infarction ; Intracranial Hemorrhages ; Intracranial Pressure ; Male ; Mortality ; Punctures ; Retrospective Studies ; Stroke ; Vascular Diseases

A 12-year-old female presented with the abnormal findings on the chest PA. The chest CT revealed a retrosternal defect of the diaphragm and a fatty opacity in the pleural cavity, resulting in a diagnosis of Morgagni hernia. It was decided to undergo a laparoscopic surgery. The retrosternal defect of the diaphragm measuring 3.5 cm in diameter was found, through which a portion of the greater omentum and the fatty tissue connected with the falciform ligament were herniated into the pleural cavity. The greater omentum was pushed back into the peritoneal cavity and the fatty tissue connected with falciform ligament was excised. The mediastinal pleura was plicated and the defect of the diaphragm was repaired primarily. Immediately after the operation, the patient developed a right pneumothorax for which a chest tube was inserted. She was discharged at the post-operative third day without any further complications.
Adipose Tissue ; Chest Tubes ; Child ; Diaphragm ; Female ; Hernia ; Hernia, Diaphragmatic ; Humans ; Laparoscopy ; Ligaments ; Omentum ; Peritoneal Cavity ; Pleura ; Pleural Cavity ; Pneumothorax ; Thorax

We are now in the middle of stem cell war. Each country is trying to invest a large amount of funds into stem cell research. This is due to a potentiality of stem cells. Stem cells are capable of proliferating in an undifferentiated manner and are able to differentiate into a desired cell lineage under certain conditions. These abilities make stem cells an appealing source for cell replacement therapies (regenerative medicine), the study of developmental biology and drug/toxin screening. In addition to embryonic and adult stem cells, induced pluripotent stem (iPS) cells has been recently generated through reprogramming from adult tissue cells such as fibroblasts. This technique has opened up new avenues to generate patient- and disease-specific pluripotent stem cells. Human iPS cells may be useful for gaining valuable insight into the pathophysiology of disease, as well as for discovering for new prognostic biomarkers and drug screening. Moreover, the iPS cell technology may play a major role in immune-matched clinical application in the future. In this chapter, we introduce general characteristics of various stem cells, clinical application of stem cells and future perspectives.
Adult ; Adult Stem Cells ; Biomarkers ; Cell Lineage ; Developmental Biology ; Drug Evaluation, Preclinical ; Embryonic Stem Cells ; Fibroblasts ; Financial Management ; Humans ; Induced Pluripotent Stem Cells ; Mass Screening ; Pluripotent Stem Cells ; Regenerative Medicine ; Stem Cell Research ; Stem Cells

Intracranial metastasis of hepatocellular carcinoma have been rarely reported, even in the Orient and Africa where this carcinoma is one of the relatively common malignancies. Hepatocellular carcinomas usually spread to regional lymph nodes around the porta hepatis via lymphatics. But venous metastasis of this cacinoma can occur via intrahepatic vein. The lungs are the most common distant metastatic sites followed by stomach, bones, and adrenals. Recently, we experienced a case of intracranial metastasis of hepatocellular carcinoma associated with epidural hematoma. Although the epidural hematoma and the metastatic tumor mass were totally removed, the patient died of liver complications on the 9th day of postoperative care. The clinical and radiological details of this case are presented here with a brief review of the literature.
Africa ; Carcinoma, Hepatocellular* ; Hematoma* ; Humans ; Liver ; Lung ; Lymph Nodes ; Neoplasm Metastasis* ; Postoperative Care ; Stomach ; Veins

In 1957 Sament and Schwartz reported patient with profound coma and hyperglycemia but without ketonemia or acidosis. This syndrome in usually termed hyperosmolar hyperglycemic nonketotic coma(HHNC). Six critically ill patients while on the neurosurgical service were studied to establish the diagnosis of HHNC. Criteria for the diagnosis of HHNC included. 1) Serum glucose over than 220 mg/dl wigh glucosuria. 2) absence of significant acetonuria. 3) serum Na over than 150 mEq/l. 4) serum osmolarity over than 310 mOsM/kg. 5) neurological dysfunction. The production of the characteristic stupor and diminution of mental acuity appears to result from a decrease in intracellular water content within the brain due to the osmotic effects of those predominately extracellular substances. Factors documented to be significant in it's development include nonspecific stress to primary illness, hyperosmolar tube feeding. Dehydration, and mannitol, dilantin and steroid administration. The treatment of HHNC recommended the division of replacement into two stages: 1) rapid repair of water deficits which was calculated by described formula and correct the Na abnormality. 2) insulin replacement according to the degree of glucosuria. During the replacement therapy of water deficit and insulin, it should be necessary to repeat plasma electrolytes and blood glucose at 4 hour intervals until normal levels are approached. One among the 6 cases of HHNC became good recovery and 5 cases were expired on treatment, Fatal complications of this syndrome, such as acute renal failure, terminal arrhythmias and cardiopulmonary dysfunction, both cerebral and systemic, were common in these cases.
Acidosis ; Acute Kidney Injury ; Arrhythmias, Cardiac ; Blood Glucose ; Brain ; Coma ; Critical Illness ; Dehydration ; Diagnosis ; Electrolytes ; Enteral Nutrition ; Humans ; Hyperglycemia ; Hyperglycemic Hyperosmolar Nonketotic Coma* ; Insulin ; Ketosis ; Mannitol ; Osmolar Concentration ; Phenytoin ; Plasma ; Stupor ; Water

Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studifford criteria. The clinical characteristics of abdominal pregnancy is extremely variable, so early diagnosis is very difficult. Because of it's high maternal morbidity and mortality, the prompt surgical intervention is required. We experienced a primary abdominal pregnancy with intraperitoneal hemorrhage. So we present our case with a brief review of literature.
Early Diagnosis ; Female ; Hemorrhage* ; Mortality ; Pregnancy ; Pregnancy, Abdominal*

Various commercial assays have recently been developed for detecting glutamate dehydrogenase (GDH) and/or toxin A/B to diagnose Clostridioides difficile infection (CDI). We compared the performance of two assays for the simultaneous detection of C. difficile GDH and toxin A/B, using 150 stool samples: C. DIFF QUIK CHEK COMPLETE (QCC; TechLab, Blacksburg, VA, USA) and RIDASCREEN Clostridium difficile GDH (RC-GDH) and Toxin A/B (RC-Toxin A/B; R-Biopharm, Darmstadt, Germany). For GDH detection, QCC and RC-GDH showed satisfactory sensitivity (95.7% and 94.3%, respectively) and specificity (92.5% and 93.8%, respectively) compared with C. difficile culture. For toxin A/B detection, QCC showed higher sensitivity than RC-Toxin A/B (60.0% vs 33.3%, P < 0.001) compared with toxigenic C. difficile culture. When the results of QCC or RC-GDH+RC-Toxin A/B were used as the first step of a two-step algorithm for diagnosing CDI, QCC permitted more accurate discrimination than RC of positive or negative results for CDI (77.3% and 65.3%, respectively). QCC is useful for the simultaneous detection of C. difficile GDH and toxin A/B as a part of the two-step algorithm for diagnosing CDI.
Clostridium difficile ; Discrimination (Psychology) ; Glutamate Dehydrogenase ; Glutamic Acid ; Sensitivity and Specificity