Confirmation of patency of the portal vein by either ultrasound or angiography is important for evaluating patients considered for living-related liver transplant(LRLT) and liver resection(LR). Portal vein thrombosis(PVT) in LRLT necessitates planning for a technically difficult operation because consideration must be given to obtaining an alternative for splanchnic inflow. When performing LR for hepatocellular carcinoma(HCC), portal vein tumor thrombus was usually thought of as a poor prognositic factor for tumor recurrence. Recently, we experienced two cases of pseudo-obstruction of the portal vein, one in LRLT and the other in LR. In the case of LRLT, a 16-month-old female patient was diagnosed as congenital biliary atresia. PVT had been preoperatively suggested, but the vein was actually open. The patient was successfully transplanted using the left lateral segment of the donor with ordinary portal vein anastomosis and the postoperative course was uneventful except for mild acute rejection episodes. In the case of LR, a 60-year-old male patient presented with incidental symptoms. Preoperative ultrasonography, computed tomography, and angiography showed a 9x8cm-sized mass in the right lobe of the liver with obstruction of the right portal vein, which suggested tumor thrombus. However, the operation disclosed the patency of the portal vein and a right lobectomy was subsequently done. Because of the scanty blood flow of the portal vein due to arterio-portal shunt, PVT was preoperatively suggested. Our experience indicates that more sophisticated image studies are needed for evaluating portal vein patency in the patient who needs hepatic transplant as well as liver resection, and that the surgeon should not hesitate to procede to operative procedures even though conventional studies suggest PVT.
Angiography ; Biliary Atresia ; Female ; Humans ; Infant ; Liver Transplantation* ; Liver* ; Male ; Middle Aged ; Portal Vein* ; Recurrence ; Surgical Procedures, Operative ; Thrombosis ; Tissue Donors ; Ultrasonography ; Veins

PURPOSE: Periampullary malignant tumors become symptomatic at an early stage because of their particular location. For this reason, radical resection is possible in the majority of cases. Periampullary tumors can be removed either by a local resection, as performed by Halsted in 1899, or by a radical pancreaticoduodenectomy, as performed by Whipple et al. in 1935. Both techniques have been used, and their respective places in the treatment of benign or malignant periampullary tumors has been the subject of constant debate. Therefore, we reviewed the cases of four patients who had undergone a transduodenal ampullectomy for an ampullary tumor which was confined to the ampulla of Vater. METHODS: The clinical records of 4 patients who undergone a transduodenal ampullectomy were reviewed. All patients were diagnosed as having an ampullary mass based on gastroduodenoscopy, endoscopic retrograde cholangiopancreatography, or both. Clinical presentation, comparison of pathologic findings of preoperative endoscopic biopsy, operative frozen section, final pathologic examination, complications, follow-up period, and recurrence were reviewed. RESULTS: The two men and the two women studied had a median age of 59.3 (range, 49 to 64 years). Among the four patients who underwent a transduodenal ampullectomy, an adenocarcinoma was found at final pathologic examination in two patients with preoperative diagnoses of a villotubular adenoma and a villous adenoma, respectively. The other two cases were diagnosed as tubular adenomas at final pathologic examination as they had been at the preoperative diagnosis. No evidence of disease was observed in any of the four patients on follow-up at 29 months, 30 months36 months, and 4 months. None of these patients had major complications in the immediate postoperative period, transient hyperamylasemia without clinical significance developed in two patients. CONCLUSION: The transduodenal ampullectomy is a valuable tool in the treatment of ampullary lesions. The result of local excision of the Vater for ampullary tumors appears satisfactory, and this procedure may be particularly indicated for benign tumors, as well as for older or high-risk patients whose malignant lesions are confined to the ampulla of Vater. However, the selection of this procedure required judicious decision making and precise technique and should involve an experienced team of pathologists and surgeons. As a result, for patients in whom it is indicated, a transduodenal ampullectomy is an alternative to the pancreaticoduodenectomy and has good long-term results.
Adenocarcinoma ; Adenoma ; Adenoma, Villous ; Ampulla of Vater ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Decision Making ; Diagnosis ; Female ; Follow-Up Studies ; Frozen Sections ; Humans ; Hyperamylasemia ; Male ; Pancreaticoduodenectomy ; Postoperative Period ; Recurrence

No abstract available.
Humans

Neonatal Gaves disease is a relatively rare condition due to transplacental passage of Thyroid-stimulating antibody(TSAb) from a mother with active or inactive Graveses disease or autoimmune thyroiditis. A 11-day-old female newborn was referred to our department of pediatrics from a local clinic because of low level T4(3.55microg/dl) concurrent with high level TSH (501.74uIU/ml) on the 5th day neonatal metabolic screening. But, our repeated laboratory data showed very high serum T4(59.6microg/dl), T3(1,600ng/dl), suppressed TSH(0.43uIU/ml), and the presence of TSH receptor antibody. Her mother was treated with propylthiouracil(PTU) for Graves disease during pregnancy. Therefore, we thought it was a delayed-onset neonatal hyperthyroidism, because the fetal thyroid gland was initially suppressed by antithyroid drug taken during pregnancy. After initiating antithyroid drug therapy for the hyperthyroid nature, TSH levels became elevated again, while thyroid hormone levels decreased. Maternal and infant blood samples at the 23th day after birth were examined for serum autoantibodies directed towards the TSH receptor(Thyrotropin-binding inhibitory immunoglobulin:TBII, Thyroid-stimulating antibody:TSAb, Thyroid-stimulating blocking antibody:TSBAb) and high levels of TBII and TSAb were detected. About 2 months after birth, TBII and TSAb decreased within normal limit, and then we could stop antithyroid medication in safety. We report here a case of neonatal Graveses disease with very high level of T4 and T3, but firstly presented as hypothyroid nature on neonatal screening because of the maternally transferred antithyroid drug, PTU.
Autoantibodies ; Drug Therapy ; Female ; Graves Disease ; Humans ; Hyperthyroidism ; Infant ; Infant, Newborn ; Mass Screening ; Mothers ; Neonatal Screening ; Parturition ; Pediatrics ; Pregnancy ; Receptors, Thyrotropin ; Thyroid Gland ; Thyroiditis, Autoimmune

It is easy to view the laryngeal aperature with a flexible fiberscope through a laryngeal mask airway (LMA). This is a case report that the LMA could facilitate a fiberscope-aided tracheal intubation easily. Patient was a 59 year old female who had some limitation of mouth opening due to ankylosis of bilateral temporomandibular joints. After thiopental (200 mg) and succinylcholine chloride (50 mg) were given intravenously, a number 3 sized LMA was inserted and the lungs were ventilated via the LMA. The anesthesia cirele system is then disconnected from the LMA and a fiberscope, with the proximal end jacketed with a well-lubricated, cuffless, 6-mm-ID endotracheal tube (ETT); was inserted into the trachea through the lumen of the LMA. The 6-mm-ID ETT was threaded over the fiberscope into the trachea before fiberscope was withdrawn, and a traeheal tube exchanger was inserted through the ETT after enough ventilation for a while, followed withdrawal of the LMA and ETT. Finally, we can make the 7 mm-ID ETT with cuff insert into the trachea over a tracheal tube exchanger very easily without any difficulties.
Anesthesia ; Ankylosis ; Bronchoscopes* ; Female ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngeal Masks* ; Lung ; Middle Aged ; Mouth ; Succinylcholine ; Temporomandibular Joint ; Thiopental ; Trachea ; Ventilation

Bone graft and guided tissue regeneration have been used for the regeneration of periodontal tissue which is the ultimate goal of periodontal treatment. Recently, it was reported that some kind of growth factors were used for regeneration. Platelet rich plasma was researched that it could increase the density of bone and the rate of bone regeneration. For that, 25 patients which have pocket depth more than 5mm at any of 6 surfaces, of healthy patient without any systemic disease were treated. Biogran? were grafted into 14 infrabony pockets as controls, and Biogran(R) with PRP were inserted into 31 infrabony pockets. And then, follwing evaluations were made at the end of 1, 3 and 6 months. 1.There was no statistical difference between control and experimental group in pocket depth, gingival recession, minimum probing attachment level and maximum probing attachment level at preoperation(p>0.05). 2.Decrease in probing pocket depth were reduced to 3.32mm for experimental group and 2.71mm for control group. The decrease was evident at the end of 1 month, they were 2.97mm and 2.29mm, and it was statistically difference(p<0.05). 3.Gingival recession was increased by 0.55mm in experimental group and 0.50mm in control group, it was evident at the end of 1 month. And it was statistically difference(p<0.05). 4.Minimum probing attachment level was increased by 0.35mm in experimental group and 0.36mm in control group, it was statistically difference(p<0.05). 5.Maximum probing attachment level was decreased by 3.19mm in experimental group and 2.93mm in control group, it was statistically difference(p<0.05). 6.There was no statistical difference between control and experimental group in pocket depth, gingival recession, minimum probing attachment level and maximum probing attachment level(p>0.05). There was statistical difference in decrease of pocket depth between pre-operation and 1 month after post-operation(p<0.05). In conclusion, bone graft using Biogran? and bone graft using Biogran? with platelet rich plasma were both effective in treatment of infrabony pocket, bone graft using Biogran? with platelet rich plasma was more effective in early soft tissue healing.
Blood Platelets* ; Bone Regeneration ; Gingival Recession ; Guided Tissue Regeneration ; Humans ; Intercellular Signaling Peptides and Proteins ; Platelet-Rich Plasma* ; Regeneration ; Transplants*

PURPOSE: To analyze the correlation between microperimetric parameters and optical coherent tomographic findings in the eyes of patients with macular diseases. METHODS: A total of 64 eyes were included in this retrospective cross-sectional study. Differences in the macular integrity index and microperimetric parameters were analyzed according to types of outer retinal band defects. Correlations between average threshold values and retinal thickness in the corresponding areas were analyzed. Finally, microperimetric parameters were compared between inner and outer retinal lesions. RESULTS: Measures of best-corrected visual acuity, macular integrity index, and average threshold values were significantly worse in eyes with defects in the ellipsoid portion of the photoreceptor inner segment (ISe), the cone outer segment tip (COST), and the external limiting membrane (ELM) than in eyes without ISe, COST, and ELM defects. Also, visual functionality is more significantly impacted by ELM defects than by other hyper-reflective band defects. There was a significant negative correlation between retinal thickness and the average threshold of the corresponding area in the Early Treatment Diabetic Retinopathy Study grid. Microperimetric parameters in the eyes of patients with inner retinal lesions were better than in the eyes of patients with outer retinal lesions. CONCLUSIONS: The macular integrity index may be a useful factor for reflecting the functional aspects of macular diseases. Specifically, ELM, ISe, and COST defects are significantly associated with poor retinal sensitivity and macular integrity index values that suggest abnormalities. Among eyes with these particular defects, the visual functionality of patients is most sensitively impacted by ELM defects. This finding suggests that microperimetric parameters are sensitive and useful for evaluating functional abnormalities in the eyes of patients with macular disease, particularly in patients with outer retinal pathology.
Cross-Sectional Studies ; Female ; Fluorescein Angiography ; Fundus Oculi ; Humans ; Macula Lutea/*pathology ; Macular Edema/*diagnosis ; Male ; Middle Aged ; Retrospective Studies ; Tomography, Optical Coherence/*methods ; Visual Field Tests/*methods

PURPOSE: To determine the incidence of and the systemic risk factors for postoperative vitreous hemor-rhage(PVH). METHOD: The records of 503 consecutive diabetic vitrectomy cases were reviewed. RESULT: Eighty-seven eyes(17.3%) had at least one episode of PVH. Sixty-five eyes(12.9%) had PVH within 3 months after vitrectomy, and the mean onset time of the first episode of PVH was about 13 weeks after vitrectomy. The mean follow-up period was 17.2 months in non-hemorrhage group, and 21.9 months in hemorrhage group. While 34 eyes(29.6%) had spontaneous absorption of blood, 42 eyes(36.5%) required air(or gas)-fluid exchange and 39 eyes(33.9%) vitreous cavity lavage. Using univariate analysis, the factors associated with increased incidence of PVH include type 1 diabetes mellitus(p=0.01), method of glycemia control(p=0.02), anemia(p=0.04), and hypercholesterolemia(p=0.005). Multivariate analysis revealed diabetic nephropathy(p=0.02) and hypercholesterolemia(p=0.01) were the risk factors. Five eyes(1.0%) lost light perception, 7 eyes(1.4%) had rhegmatogenous retinal detachment, and 11 eyes(2.2%) had neovascular glaucoma. CONCLUSION: Vitreous hemorrhage after diabetic vitrectomy occurred in the 17.3%, three quarters of them within 3 months. About one third had spontaneous clearing, and two-thirds required reoperation. Diabetic nephropathy and hypercholesterolemia were the systemic risk factors of vitreous hemorrhage after diabetic vitrectomy.
Absorption ; Diabetic Nephropathies ; Follow-Up Studies ; Glaucoma, Neovascular ; Hemorrhage ; Hypercholesterolemia ; Incidence ; Multivariate Analysis ; Reoperation ; Retinal Detachment ; Risk Factors* ; Therapeutic Irrigation ; Vitrectomy* ; Vitreous Hemorrhage*

OBJECTIVE: The purpose of this study was to evaluate the mobility and ratio of the bone-implant contact (BIC) of a sandblasted, large grit and acid-etched (SLA) orthodontic micro-implant. METHODS: Ninety-six micro-implants (48 SLA and 48 machined) were implanted in the upper and lower buccal alveolar bone, and palatal bone of four beagle dogs. Two weeks after surgery, orthodontic force (150 - 200 g) was applied. Two beagles were sacrificed at 4-weeks and the other two at 12-weeks. Histomorphometric comparisons were made between the SLA experimental group and the machined micro-implant as a control group to determine the ratio of contact between the bone and implant. Micro-implant mobility was also evaluated using Periotest(R). RESULTS: Periotest values showed no statistically significant difference in the upper alveolar and palatal bone between groups except for the lower buccal area. BIC in the upper buccal area showed no significant difference between groups both at 4-weeks and 12-weeks. However, both the groups showed a significant difference in BIC ratio in the rest of the experimental areas between 4 weeks and 12 weeks. The experimental group showed active bone remodeling around the bone-implant interface compared to the control group. CONCLUSIONS: There were significant differences in the BIC and the Periotest values between the surface-treated and machined micro-implants according to bone quality in the early stage.
Animals ; Bone Remodeling ; Dogs ; Nitrogen Mustard Compounds ; Osseointegration

PURPOSE: This study is to evaluate the Brain CT manifestations of late hemorrhagic disease of the newborn. METHODS: We evaluated 13 cases with late hemorrhagic disease of the newborn, for whom brain CT scans were performed. Clinical indications for brain CT scan were mental changes(n=5), vomiting(n=2), irritability(n=2), seizure(n=3), and lethargy(n=1). We analyzed the result of the brain CT findings with attention to anatomic locations of hemorrhage and characteristics of hemorrhagic manifestations. RESULTS: Only one patient in 13 patients was normal on brain CT scan, and 12 patients showed hemorrhagic lesions. Among 12 patients, 5 cases had single hemorrhagic lesion(3 subdural hemorrhages and 2 intracerebral hemorrhages, and 7 cases had multiple lesions, in which subdural hemorrhage and subarachnoid hemorrhage were common respectively. The other common brain CT findings except hemorrhagic lesion were the mass effects with ventricle compression(n=11), midline shifting(n=6), ventricular dilatation(n=7), and fluid-fluid levels in hemorrhagic lesion(n=9). CONCLUSION: The common intracranial hemorrhages of late hemorrhagic disease of the newborn were subdural and subarachnoid hemorrhages. The associated CT findings were mass effect and fluid-fluid levels. Intracranial hemorrhage in late hemorrhagic disease of newborn could massively occurr. Thus brain CT scan should be done if any symptom for neurologic abnormality was present.
Brain* ; Cerebral Hemorrhage ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infant, Newborn* ; Intracranial Hemorrhages* ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed ; Vitamin K Deficiency Bleeding