Takayasu's arteritis is a chronic inflammatory disease of unknown etiology involving the aorta, major branches of aorta, and pulmonary arteries and leads either stenosis and occlusion of the involved artery or aneurysm formation or both. The clinical course and prognosis are variable according to two major prognostic factors, ie, complications and the pattern of the past clinical course, as well as by ESR. Though the aggressive medical and surgical treatment are required for patients with a major complication and a progressive course, surgical reconstruction entails a high incidence of suture line complications including stenosis or dilatation. Moreover all the vascular lesions are amenable for vascular surgery. Initial reports revealed excellent results of percutaneous transluminal angioplasty (PTA) in patients with Takayasu's arteritis. However the suboptimal results and restenosis have been the main limitations of the PTA. Stenting has some benefits for early elastic recoil of the fibrotic vessels and restenosis as in other large vessels in Takayasu's arteritis or atherosclerosis. We report early and long-term results of two cases of carotid stenting in patients with symptomatic carotid stenosis and Takayasu's arteritis, which revealed variable angiographic results according to clinical courses and recommend that stenting in Takayasu's arteritis may be another treatment modality in inactive Takayasu's arteritis.
Aneurysm ; Angioplasty ; Aorta ; Arteries ; Atherosclerosis ; Carotid Arteries* ; Carotid Stenosis ; Constriction, Pathologic ; Dilatation ; Follow-Up Studies* ; Humans ; Incidence ; Prognosis ; Pulmonary Artery ; Stents* ; Sutures ; Takayasu Arteritis

The Kidd system of blood group is clinically significant since the anti-Kidd antibody can cause immediate or delayed hemolytic transfusion reactions as well as hemolytic disease of newborn (HDN). In contrast to the hemolytic activity of Kidd antibodies in incompatible transfusion, the severity of HDN varies but usually tends to be a benign clinical course with favorable outcomes. And severe HDN due to anti-JKa incompatibility is a rare, which is still not reported in Korea. We experienced a newborn with severe jaundice to be detected within 24 hours from birth due to anti-JKa incompatibility. The laboratory data on admission indicated hemoglobin 13.2 g/dL, reticulocyte 4.08%, total bilirubin 18.7 mg/dL, and direct and indirect antiglobulin tests were positive (2+/2+). But, there are no ABO and Rh (D) incompatibilities between the mother and newborn. Maternal serum was found to contain an antibody that recognized JKa , and also seen in neonate. This patient completely recovered with intensive phototherapy without exchange transfusion. We report this case with a brief review of relevant literature.
Antibodies ; Bilirubin ; Blood Group Incompatibility ; Coombs Test ; Erythroblastosis, Fetal ; Hemoglobins ; Humans ; Infant, Newborn ; Jaundice ; Korea ; Mothers ; Parturition ; Phototherapy ; Reticulocytes

The Kidd system of blood group is clinically significant since the anti-Kidd antibody can cause immediate or delayed hemolytic transfusion reactions as well as hemolytic disease of newborn (HDN). In contrast to the hemolytic activity of Kidd antibodies in incompatible transfusion, the severity of HDN varies but usually tends to be a benign clinical course with favorable outcomes. And severe HDN due to anti-JKa incompatibility is a rare, which is still not reported in Korea. We experienced a newborn with severe jaundice to be detected within 24 hours from birth due to anti-JKa incompatibility. The laboratory data on admission indicated hemoglobin 13.2 g/dL, reticulocyte 4.08%, total bilirubin 18.7 mg/dL, and direct and indirect antiglobulin tests were positive (2+/2+). But, there are no ABO and Rh (D) incompatibilities between the mother and newborn. Maternal serum was found to contain an antibody that recognized JKa , and also seen in neonate. This patient completely recovered with intensive phototherapy without exchange transfusion. We report this case with a brief review of relevant literature.
Antibodies ; Bilirubin ; Blood Group Incompatibility ; Coombs Test ; Erythroblastosis, Fetal ; Hemoglobins ; Humans ; Infant, Newborn ; Jaundice ; Korea ; Mothers ; Parturition ; Phototherapy ; Reticulocytes

BACKGROUND: Non-small cell lung cancer is one of the most frequent cause of death due to cancer in men, and its incidence among women is rapidly increasing. Although there has been a recent surge of interest in combined modality therapy for stage III non-small cell lung cancer(NSCLC), the optimal treatment is still not well established. Thoracic irradiation has long been the gold standard for locally advanced unresectable NSCLC. However, although conventional radiotherapy(XRT) can palliate symptom and improve local control of disease, it huts at most only a modest effect on survival. Recently, cisplatin(cia-diamminedichloroplatinum ) has been reported to enhance the cell-killing effect of radiation For patients with unresectable NSCLC, cisplatin-based concurrent chemoradiotherapy(CCRT) had the advantage of therapeutic response over XRT alone and therapeutic side effect more commonly occurred in CCRT group in EORTC(European Organization for Research and Treatment of Cancer) and other trials. Objectives : We compared therapeutic response, compliance, and side effects between CCRT and XRT in patients with advanced NSCLC. Patients and METHOD: Thirty patients with biopsy-proven inoperable NSCLC were randomized to one of two treatment arms. Arm A consisted of XRT, radiotherapy for 4~6 weeks(1.8 Gy given 20~33 times, in five fractions a week), and arm B consisted of CCRT, radiotherapy for 2 weeks(3 Gy given 10 times, in five fractions a week), followed by 3 week rest period and then radiotherapy 2 more weeks(2.5 Gy given 10 timed in five fractions a week), combined with 6mg cisplatin per square meter, given daily before radiotherapy. We evaluate therapeutic response, compliance, change of performance status, side effects, and radiation pneumonitis by using the author's made scoring system. RESULTS: There was no significant difference in therapeutic response and compliance. But there was a significantly lower laboratory complication and radiation pneumonitis in CCRT group (p<0.05). There's significant negative correlation between stage and therapeutic response score in both groups(R=0.353, p<0.05). In both groups, patients with squamous cell carcinoma had a tendency to higher therapeutic response score than those with adenocarcinoma. CONCLUSION: There was. no difference between CCRT and XRT in respect to therapeutic response and compliance. But CCRT had a advantage of decreased side effects.
Adenocarcinoma ; Arm ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Cause of Death ; Chemoradiotherapy* ; Cisplatin ; Combined Modality Therapy ; Compliance ; Female ; Humans ; Incidence ; Lung Neoplasms* ; Lung* ; Male ; Radiation Pneumonitis ; Radiotherapy*

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) is one of the surgical methods used to cure obstructive sleep apnea (OSA). It is designed to relieve of oropharyngeal obstruction and to enlarge the potential air space in the oropharynx by removing the excessive soft tissues involved in the free margin of the soft palate, uvula, tonsils and the pharyngeal wall. Although laser-assisted uvulopalatoplasty (LAUP) has been recently popular for the treatment of snoring and some OSA, UPPP remains the best choice of treatment for moderate to severe OSA. The criteria for selecting patients for this procedure, however, are obscure and factors that can predict successful responses are not well established. The purpose of this study was to evaluate the success rate of UPPP and to determine the factors that can predict the response to UPPP. MATERIALS AND METHODS: We report our experience on 27 OSA patients who underwent UPPP. We evaluated their preoperative cephalometric radiograph readings as well as body mass index (BMI). Each patient also underwent polysomnography before and after UPPP. RESULTS: Defining surgery to be successful when the postoperative apnea index (AI) was reduced by more than 50%, the success rate of the surgery was 74%. The mean AI decreased from 32 to 4, and the mean lowest oxygen saturation increased from 79% to 89% in good responders. Snoring was reduced in 67% of the patients. However, no single parameter could be used to predict good responses to UPPP. CONCLUSION: We found that UPPP is an effective treatment for OSA, but we could not identify a single parameter which can invariably predict the success of the operation.
Apnea ; Body Mass Index ; Humans ; Oropharynx ; Oxygen ; Palate, Soft ; Palatine Tonsil ; Polysomnography ; Reading ; Sleep Apnea, Obstructive* ; Snoring ; Uvula

Tumor lysis syndrome (TLS) is a metabolic derangement that may be seen after the initial treatment of cancer and usually occurs in patients with bulky, rapidly proliferating, or treatment-responsive tumors such as acute leukemia or Burkitt lymphoma. However, it is rare in the treatment of the solid tumor, especially osteosarcoma. An 11-year-old girl was admitted with a 3-months history of severe right leg pain. She was diagnosed as osteosarcoma and was treated with cisplatin and adriamycin. Three days after treatment, the values of potassium, phosphorus, uric acid were 6.4 mEq/L, 5.6 mg/dL and 8.9 mg/dL, respectively. At the same time, the value of calcium was 6.2 mg/dL. Although she was treated with proper conservative treatment including dialysis, she had significant complications such as renal failure, heart failure, hypoxic brain damage. We report a case of TLS in a girl with huge osteosarcoma.
Burkitt Lymphoma ; Calcium ; Child ; Cisplatin ; Dialysis ; Doxorubicin ; Heart Failure ; Humans ; Hypoxia, Brain ; Leg ; Leukemia ; Osteosarcoma ; Phosphorus ; Potassium ; Renal Insufficiency ; Tumor Lysis Syndrome ; Uric Acid

Hepatocellular carcinoma (HCC) can be diagnosed noninvasively on multiphasic CT and MRI based on its distinctive imaging findings. These features include arterial phase hyperenhancement and washout on portal or delayed phase images. However, radiologists face significant diagnostic challenges because some HCCs exhibit atypical imaging characteristics. In addition to many HCC-mimicking lesions, such as arterioportal shunts, combined HCC-cholangiocarcinoma, intrahepatic cholangiocarcinoma, and hemangioma present a challenge for radiologists in actual clinical practice. The ability to distinguish HCCs from mimickers on initial imaging examinations is crucial for appropriate management and treatment decisions. Therefore, this pictorial review presents the imaging findings of atypical HCCs and HCCs mimicking malignant and benign lesions and discusses important clues that may help narrow down the differential diagnosis.

OBJECTIVE: Bipolar depression has a disabling course and its treatment represents a major challenge. Recently, a randomized, controlled trial of quetiapine monotherapy in patients with bipolar depression showed significant reductions in depressive symptomatology. The purpose of this study was to evaluate the efficacy of quetiapine in bipolar depression in the clinical setting. METHODS: This study was a multi-center, prospective, open-label, observational, 8-week evaluation of the efficacy of quetiapine in patients with bipolar depression. Patients with a DSM-IV-TR diagnosis of bipolar depression (bipolar I disorder, most recent episode depressed and bipolar II disorder, most recent episode depressed) were included and treated with quetiapine. The dose of quetiapine was flexible and concomitant mediations were permitted, by clinical judgment. Clinical improvements were rated with the Clinical Global Impression-Bipolar version (CGI-BP) and Montgomery-Asberg Depression Rating Scale (MADRS) at baseline, week 4, and week 8. RESULTS: A total of 1,193 patients were recruited and 46 (3.9%) patients were dropped from the study. The mean initial dose of quetiapine was 192.3+/-181.9 mg/day and the mean doses at weeks 4 and 8 were 315.2+/-229.7 mg/day and 337.1+/-229.9 mg/day, respectively. CGI-BP and MADRS were significantly improved at weeks 4 and 8, compared with baseline. In addition, improvements at week 8 were greater than at week 4. Subjectively, about 75% of the patients reported therapeutic compliance above 75% at weeks 4 and 8. Seven (0.6%) and four (0.3%) patients showed manic/hypomanic episodes at weeks 4 and 8, respectively. CONCLUSION: This study suggests that quetiapine improves depressive symptoms in bipolar depression, with minimal incidence of manic switching. We suggest that quetiapine could be an effective and safe option in treating bipolar depression.
Bipolar Disorder ; Compliance ; Depression ; Dibenzothiazepines ; Humans ; Incidence ; Judgment ; Prospective Studies ; Quetiapine Fumarate

OBJECTIVE: To evaluate the efficacy and safety of balloon-occluded retrograde transvenous obliteration (BRTO) with sodium tetradecyl sulfate (STS) liquid sclerotherapy of gastric varices. MATERIALS AND METHODS: Between February 2012 and August 2014, STS liquid sclerotherapy was performed in 17 consecutive patients (male:female = 8:9; mean age 58.6 years, range 44-86 years) with gastric varices. Retrograde venography was performed after occlusion of the gastrorenal shunt using a balloon catheter and embolization of collateral draining veins using coils or gelfoam pledgets, to evaluate the anatomy of the gastric varices. We prepared 2% liquid STS by mixing 3% STS and contrast media in a ratio of 2:1. A 2% STS solution was injected into the gastric varices until minimal filling of the afferent portal vein branch was observed (mean 19.9 mL, range 6-33 mL). Patients were followed up using computed tomography (CT) or endoscopy. RESULTS: Technical success was achieved in 16 of 17 patients (94.1%). The procedure failed in one patient because the shunt could not be occluded due to the large diameter of gastrorenal shunt. Complete obliteration of gastric varices was observed in 15 of 16 patients (93.8%) with follow-up CT or endoscopy. There was no rebleeding after the procedure. There was no procedure-related mortality. CONCLUSION: BRTO using STS liquid can be a safe and useful treatment option in patients with gastric varices.
Adult ; Aged ; Aged, 80 and over ; Balloon Occlusion ; Contrast Media/*chemistry ; Demography ; Embolization, Therapeutic ; Endoscopy, Digestive System ; Esophageal and Gastric Varices/*therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Portal Vein/radiography ; Sclerotherapy ; Sodium Tetradecyl Sulfate/*chemistry ; Tomography, X-Ray Computed

Autoimmune cholangitis is a disease with clinicopathologic features of primary biliary cirrhosis without antimitochondrial antibodies and, frequently, with high antinuclear antibody titers. Alternative terms have been suggested, including antimitochondrial antibody-negative primary biliary cirrhosis, immunocholangitis, autoimmune cholangiopathy, and autoimmune hepatobiliary overlap syndrome type 1. The question of whether autoimmune cholangitis is distinct from primary biliary cirrhosis and autoimmune hepatitis or is an antimitochondrial antibody-negative variant of primary biliary cirrhosis and autoimmune hepatitis is controversial. This case report describes the clinical, immunohistochemical, and pathological findings in four patients with autoimmune cholangitis and reviews the literature.
Antibodies ; Antibodies, Antinuclear ; Cholangitis ; Hepatitis, Autoimmune ; Humans ; Liver Cirrhosis, Biliary