Heterotopic mesenteric ossification is a very uncommon disorder that is characterized by new bone formation in the mesentery, which does not normally undergo ossification. A 52-year-old female experienced a small bowel obstruction 12 days after a segmental resection of the small bowel following a trauma. A laparotomy was performed 16 days after the initial operation, and a 2 cm hard mass was detected in the small bowel mesentery, with severe fibrous adhesions around the mass, involving the jejunum, which required resection. Postoperatively, the patient developed an intraabdominal abscess, followed by intestinal fistulation. The patient gradually recovered by conservative management, and left hospital 70 days after the first operation. Microscopic examination of the mass showed well oriented trabeculae of the osseous tissue, osteoid formation, with fine calcification and osteoblastic activity, but there was no formation of mature lamellar bone or clear evidence of the "zone phenomenon" that is classically described in heterotopic ossification. These findings appeared consistent with an early stage of heterotopic ossification. The etiology and pathogenesis are unknown; the heterotopic mesenteric ossification was thought to be associated with the trauma (intraabdominal surgery). The previous literature on heterotopic mesenteric ossification is reviewed, and a new case reported.
Abscess ; Female ; Humans ; Intestinal Obstruction ; Jejunum ; Laparotomy ; Mesentery ; Middle Aged ; Ossification, Heterotopic ; Osteoblasts ; Osteogenesis

Heterotopic mesenteric ossification is a very uncommon disorder that is characterized by new bone formation in the mesentery, which does not normally undergo ossification. A 52-year-old female experienced a small bowel obstruction 12 days after a segmental resection of the small bowel following a trauma. A laparotomy was performed 16 days after the initial operation, and a 2 cm hard mass was detected in the small bowel mesentery, with severe fibrous adhesions around the mass, involving the jejunum, which required resection. Postoperatively, the patient developed an intraabdominal abscess, followed by intestinal fistulation. The patient gradually recovered by conservative management, and left hospital 70 days after the first operation. Microscopic examination of the mass showed well oriented trabeculae of the osseous tissue, osteoid formation, with fine calcification and osteoblastic activity, but there was no formation of mature lamellar bone or clear evidence of the "zone phenomenon" that is classically described in heterotopic ossification. These findings appeared consistent with an early stage of heterotopic ossification. The etiology and pathogenesis are unknown; the heterotopic mesenteric ossification was thought to be associated with the trauma (intraabdominal surgery). The previous literature on heterotopic mesenteric ossification is reviewed, and a new case reported.
Abscess ; Female ; Humans ; Intestinal Obstruction ; Jejunum ; Laparotomy ; Mesentery ; Middle Aged ; Ossification, Heterotopic ; Osteoblasts ; Osteogenesis

Periprosthetic fracture after total elbow replacement surgery is a difficult complication to manage, especially when it comes together with implant loosening. If stem revision and internal fixation of the periprosthetic fracture are performed simultaneously, this would be a very challenging procedure. Most of total elbow replacement implants are cemented type. Cement usage at periprosthetic fracture site may interfere healing of fractured site. Authors underwent internal fixation with use of locking plate and cerclage wire for periprosthetic fracture, allogenous fibular strut bone inserted into the humerus intramedullary canal allowing the fractured site to be more stable without cement usage. At 10-month follow-up, the complete union and good clinical outcome was achieved. We present a novel technique for treating periprosthetic fracture with implant loosening after total elbow replacement surgery, using intramedullary allogenous fibula strut bone graft.

Transcatheter arterial embolization (TAE) is widely used in the treatment of unresectable hepatocellular carcinoma. Its common complications are right upper quadrant pain, nausea, vomiting, and rare complications include focal pancreatic necrosis, gastric ulcer, renal failure, DIC, biliary tree necrosis and splenic infarction and so on. It has been reported that hepatobronchial fistula could develop as a pleuropulmonary complication of liver abscess. We report a case of hepatobronchial fistula caused by complicating liver abscess in a patient with hepatocellular carcinoma who was treated with TAE.
Biliary Tract ; Carcinoma, Hepatocellular* ; Dacarbazine ; Fistula* ; Humans ; Liver Abscess ; Nausea ; Necrosis ; Renal Insufficiency ; Splenic Infarction ; Stomach Ulcer ; Vomiting

BACKGROUND: Tumor markers have been used in diagnosis, predicting the extent of disease, monitering recurrence after therapy and prediction of prognosis. But the utility of markers in lung cancer has been limited by low sensitivity and specificity. TPA-M is recently developed marker using combined monoclonal antibody of Cytokeratin 8, 18, and 19. This study was conducted to evaluate the efficacy of new tumor marker, TPA-M by comparing the estabilished markers 8CC, CEA, Cyfra2 I - I in hmg cancer. METHODS: An immunoradiometric assay of serum CEA, SCC, Cyfra2l-I, and TPA-M was performed in 49 pathologically confirmed lung cancer patients who visited Keimyung University Hospital from April 1996 to August 1996, and 29 benign lung diseases. Commercially available kits, Ab bead CM (Eiken) to CEA, SCC RIA BEAD (DAINABOT) to SCC, CA21-1 (TEE) to Cyfra21-1, arid TPA-M (DAIICHI) to TPA-M were used for this study. RESULTS: The mean serum values of lung cancer group and control group were 10.05 +/- 38.39 micro/L, l.59+/-0.94 micro/L in CEA, 3.04+/-5.79 micro/L, 1.58+/-2.85 micro/L in SCC, 8.27+/-11.96 micro/L, 1.77+/-2.72 micro/L in Cyfra21-1, and 132.02+/-209.35 U/L, 45.86+/-75.86 U/t in TPA-M respectively. Serum values of Cyfra21-1 and TPA-M in lung cancer group were higher than control group (p<0.05). Using cutoff value recommended by the manufactures, that is 2.5 micro/L, in CEA, 3.0 micro/L in Cyfra21-1, 70.0 U/L in TPA-M, arid 2.0 micro/L in SCC, sensitivity and specificity of lung cancer were 33.3%, 786% in CEA, 50.0%, 89.7% in Cyfra2l-l, 52.3%, 89.7% in TPA-M, 23.8%, 89.3% in SCC. Sensitivity and specificity of nonsmall cell lung cancer were 36.1%, 78.1% in CIA, 50.1%, 89.7% in Cyfra2l-1, 53.1%, 89.7% in TPA-M, 33.8%, 89.3% in SCC. Sensitivity and specificity of small cell king cancer were 25.0%, 78.5% in CEA, 50.0%, 89.6% in Cyfra2l-1, 50.0%, 89.6% in TPA-M, 0%, 89.2% in SCC. Cutoff value according to ROC(Receiver operating characteristics) curve was l.25 micro/L in CEA, 1.5 micro/L in Cyfra2l-1, 35 U/L in TPA-M, 0.6 micro/L in SCC. With this cutoff value, sensitivity, specificity, accuracy and kappa index of Cyfra21-1 and TPA-M were Letter than CEA and SCC. SCC only was related with statistic significance to TNM stages, dividing to operable stages(TNM stage I to IIIA) and inoperable stages (IIIB and IV) (p<0.05). But no tumor markers showed any correlation with significance with tumor size(p>0.05). CONCLUSION: Serum TPA-M and Cyfra21-1 shows higher sensitivity and specificity than CEA and SCC in overall lung cancer and nonsmall cell lung cancer those were confirmed pathologically. SCC has higher specificity in nonsmall cell lung cancer. And the level of serum SCC are significantly related with TNM staging.
Carcinoma, Non-Small-Cell Lung ; Diagnosis ; Humans ; Immunoradiometric Assay ; Keratin-8 ; Lung Diseases ; Lung Neoplasms* ; Lung* ; Neoplasm Staging ; Prognosis ; Recurrence ; Biomarkers, Tumor

PURPOSE: Hepatic veno-occlusive disease (VOD) is a life-threatening complication occurring early after stem cell transplantation (SCT). Early diagnosis and effective treatment has not been established in severe VOD. Because there are few reports on VOD in Korean children, we evaluated the clinical characteristics of VOD following SCT in children. METHODS: We retrospectively reviewed the chart of all patients (n=116) receiving SCTs in CNUH Pediatric BMT center between May, 1991 and June, 2004. RESULTS: VOD developed in 11 patients (9.5%) (median age, 9.8 years; range, 2 to 13.9). Underlying diagnoses were ALL (n=3), severe aplastic anemia (n=3), AML (n=2), acute biphenotypic leukemia (n=1), neuroblastoma (n=1), and myelodysplastic syndrome (n=1). The median day of onset of VOD was D+9 (range, D-3 to D+19). VOD was classified as moderate in 5 and severe in 6 cases. Maximum level of serum total bilirubin was 2.9 mg/dL (range, 2.1 to 9.2) in moderate VOD and 7.3 mg/dL in severe VOD (range, 2.0 to 24.2) at D+18 (range, D-5 to D+59). We successfully treated VOD with various combinations including tPA and heparin (2/5, 40%), ursodeoxycholic acid (2/5, 40%), N-acetylcysteine (3/5, 60%), and defibrotide (1/2, 50%). All of 5 patients with moderate VOD survived at D+100 (range, 5.5+ to 66.6+ months). Five of 6 (83%) patients with severe VOD died within first 19 day from complications of VOD. CONCLUSION: This retrospective study showed that the incidence of VOD was 9.5%, and the mortality of severe VOD was still high which would necessitate early diagnosis, effective prevention and treatment.
Acetylcysteine ; Anemia, Aplastic ; Bilirubin ; Child ; Diagnosis ; Early Diagnosis ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Heparin ; Hepatic Veno-Occlusive Disease* ; Humans ; Incidence ; Leukemia, Biphenotypic, Acute ; Mortality ; Myelodysplastic Syndromes ; Neuroblastoma ; Retrospective Studies* ; Stem Cell Transplantation ; Ursodeoxycholic Acid

Pleomorphic xanthoastrocytoma(PXA) is a rare neoplasm with favorable prognosis despite of its aggressive histological features. The authors report three cases of pleomorphic xanthoastrocytomas. The masses were in the temporal or parietal lobe of children or adolscence and presented as complex partial seizures. Total removal of mass was performed in all three cases and the seizure was abscent postoperatively. It is important to differentiate of pleomorphic xanthoastrocytoma from other malignant brain tumors and identify this type of glioma as a distinct entity.
Brain Neoplasms ; Child ; Glioma ; Humans ; Parietal Lobe ; Prognosis ; Seizures

Methotrexate (MTX) has been widely used in the treatment of psoriasis and rheumatoid arthritis. But prolonged use of MTX can induce hepatic fibrosis and even cirrhosis. To date, in Korea, there have been very few reports on hepatotoxicity due to MTX, and no report on biopsy-proven chronic active hapatitis. We report one patient who developed chronic acitve hepatitis while taking long-term daily dose of MTX(10mg per day) for psoriasis for a prolonged period.
Arthritis, Rheumatoid ; Fibrosis ; Hepatitis ; Hepatitis, Chronic* ; Humans ; Korea ; Methotrexate* ; Psoriasis*

PURPOSE: Diamond-Blackfan anemia (DBA) is a rare heterogeneous genetic disorder of infancy and early childhood. It is characterized by red cell aplasia, congenital anomalies, and a predisposition to cancer. Corticosteroids and red cell transfusions are the mainstays of therapy. We describe our experience of 6 cases of DBA that were encountered over a period of 16 years. METHODS: Medical records of 6 patients diagnosed to have DBA and admitted to the Chonnam National University Hospital between 1992 and 2008 were retrospectively reviewed. RESULTS: Three patients were males. The age at diagnosis ranged from 3 to 18 months (median, 5.5 months). Heart defects were observed in 4, polydactyly in 2, and strabismus in 1 patient. The median number of transfusions was 3 (range, 2 -8). All patients responded to initial treatment with steroids and had a hemoglobin level > or =9 g/dL with a median of 12.5 days (range, 7-22 days). Three patients are currently not receiving steroid therapy. A minimum dose of oral prednisolone (<5 mg per day) was required to maintain hemoglobin > or =9 mg/dL in 3 cases. Red cell transfusion was infrequently required in 1 patient. In the median follow-up of 14 years, there was no development of malignancy. No significant side effects of steroids were found, except for short stature in 2. CONCLUSION: The majority of DBA patients achieved complete response and under maintenance therapy with low dose of steroids. Close observation is needed to monitor steroid side effects, cardiac function, and development of malignancy. A nation-wide survey is necessary to further characterize this rare disease in Korean children.
Adrenal Cortex Hormones ; Anemia, Diamond-Blackfan ; Child ; Follow-Up Studies ; Heart ; Hemoglobins ; Humans ; Male ; Medical Records ; Organothiophosphorus Compounds ; Polydactyly ; Prednisolone ; Rare Diseases ; Retrospective Studies ; Steroids ; Strabismus

The halogenated anesthetics, halothane, enflurane and isoflurane undergo biotransformation in man. They produce inorganic fluoride ion as a metabolite, which is well known as the cause of methoxyflurane induced nephrotoxicity. This study was done to investigate the rapidity and extent of biotransformation of volatile anesthetics for 2 hours of operation. Thirty patients were randomly divided into halothane, enflurane and isoflurane group according to anesthetics. Blood and urine sampling was done before operation, post-induction 10 min, 20 min, 30 min, 1 hour, 1 hour 30 min and 2 hours for the measurement of inorganic fluoride ion. Aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen and creatinine levels were measured before and 24 hours after operation. The results were as follows ; 1) The values of blood fluoride ion in halothane and isoflurane group were decreased with time during operation and there was no change in enflurane group. 2) The values of urine fluoride ion in three groups were increased with time during operation. The rate of increase was the greatest in enflurane group. 3) There were no changes in the value of AST, ALT, BUN and creatinine. The above results suggest that the biotransformation of volatile anesthetics to inorganic fluoride ion was the greatest in enflurane, but the level was insufficent to cause renal dysfunction during 3.18 hour operation.
Alanine Transaminase ; Anesthetics* ; Aspartate Aminotransferases ; Biotransformation* ; Blood Urea Nitrogen ; Creatinine ; Enflurane ; Fluorides ; Halothane ; Humans ; Isoflurane ; Metabolism ; Methoxyflurane