Background/Aims: Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is one of the most fatal complications of hematopoietic cell transplantation (HCT), and defibrotide is the only curative drug. We conducted this study to confirm the survival rate of VOD/SOS patients diagnosed in Korea and assess the efficacy of defibrotide. Methods: Patients diagnosed with VOD/SOS after allogenic HCT between 2003 and 2020 were enrolled. We investigated day +100 survival rates and associated risk factors in patients who satisfied the modified Seattle criteria within 50 days of HCT. Results: A total of 110 patients satisfied the modified Seattle criteria, of which 65.5% satisfied the Baltimore criteria. Thirty-seven patients were treated with defibrotide. The day +100 survival rate of the 110 patients was 65.3%. The survival rates in patients who did not meet the Baltimore criteria and in those who did were 86.8% and 53.7%, respectively (p = 0.001). The day +100 survival rate of patients treated with defibrotide was 50.5%. Among the patients receiving defibrotide, those whose creatinine levels were more than 1.2 times the baseline had a significantly lower survival rate at 26.7% (p = 0.014). On multivariate regression analysis, the hazard ratio of satisfaction of the Baltimore criteria was 4.54 (95% confidence interval [CI], 1.69 to 12.21; p = 0.003). In patients treated with defibrotide, the hazard ratio was 8.70 (95% CI, 2.26 to 33.45; p = 0.002), when creatinine was more than 1.2 times the baseline on administration. Conclusions The day +100 survival rate was significantly lower when the Baltimore criteria were satisfied, and when there was an increase in creatinine at the time of defibrotide administration.

PURPOSE: To evaluate the safety and efficacy of a laparoscopic nephroureterectomy in patients with a transitional cell carcinoma of the renal pelvis and ureter. MATERIALS AND METHODS: All patients underwent a nephroureterectomy for an upper tract transitional cell carcinoma. Of these, 23 and 22 underwent a laparoscopic nephroureterectomy (LNU) and open nephroureterectomy (ONU), respectively, between January 2002 and June 2006. After the nephrectomy had been performed, a 5-6cm modified Gibson incision was created to allow dissection of the lower ureter and bladder cuff, and extraction of the intact specimen. A retrospective analysis was performed on the operating time, blood loss, analgesic requirement, ambulation time, interval to resume oral intake, hospital stay, complications and follow-up results for both groups. RESULTS: The LNU was superior to the ONU with regard to the mean operation time; 275 (190-390) versus 258 (180-400) (p=0.259), blood loss; 188 (130-250) versus 488ml (350-750) (p<0.05), ambulation time; 2.5 versus 3.3 days (p<0.05), interval to resume oral intake 2.1 versus 2.8 days (p<0.05), and hospital stay; 8.3 versus 11.1 days (p<0.05). Complications developed in 4 and 5 of the LNU and ONU patients, respectively, but all were resolved with conservative management. The mean follow-up duration of the LNU and ONU groups were 29 versus 14 months, respectively. CONCLUSIONS: Based on our experience, a laparoscopic nephroureterectomy is better tolerated with respect to pain, has less blood loss, shorter hospital stays, ambulation time and time to oral intake. LNU is safe for an upper tract transitional cell carcinoma, and is also an efficacious alternative to open surgery. However, a long-term follow-up will be warranted to ascertain accurate oncologic data.
Carcinoma, Transitional Cell* ; Follow-Up Studies ; Humans ; Kidney Pelvis ; Length of Stay ; Nephrectomy ; Retrospective Studies ; Ureter ; Urinary Bladder ; Urinary Tract* ; Walking

PURPOSE: In 2004, a joint effort was undertaken between Dong-a University Hospital, Busan, Korea and Singapore General Hospital, Singapore, to promote laparoscopic radical prostatectomy (LRP) to yet another level by enhancing the human performance using a master-slave manipulator, the da VinciTM System. Herein, we report our initial experience of employing robotic telepresent technology to perform a LRP. MATERIALS AND METHODS: A 6-port modified transperitoneal approach was used. The da VinciTM System (Intuitive Surgical, Inc., California) consists of three components: a surgeon console, a robotic manipulator and a vision cart. Cable-driven mechanical "Endowrist" instruments are capable of delivering a complete range of motion at the instrument tips, allowing a total of 6 degrees of freedom. RESULTS: Five robotic-assisted LRP were performed. The mean patient age PSA and Gleason score were 65 years, 7.8ng/ml and 6.2, respectively. Overall, the system functioned well, without significant intraoperative errors. The mean operative time was 185 minutes in 2 patients with preservation of the neurovascular bundle, and 154 minutes in 2 patients with non-nerve sparing. In one patient, a bilateral pelvic lymphadenectomy was performed, with an operative time of 195 minutes. The mean blood loss and hospital stay were 245cc and 2.5 days, respectively. All patients maintained continence at 3 month follow-up. CONCLUSIONS: Intuitive hand-eye coordination, superb depth of perception and "Endowrist" instruments allowed tissue handling and suturing quite feasible during the LRP. Continuous effort is underway to further the surgical experience and advances in robotic technology. We believe robotic surgical systems will greatly facilitate and improve the LRP procedure.
Busan ; Follow-Up Studies ; Freedom ; Hospitals, General ; Humans ; Joints ; Korea ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Neoplasm Grading ; Operative Time ; Prostatectomy* ; Range of Motion, Articular ; Robotics ; Singapore

Retrocaval ureter is a rare congenital anomaly that causes symptomatic hydronephrosis. Despite difficulties in the intracorporeal suturing, a retrocaval ureter is thought to be a good candidate for laparoscopic surgery, especially from the cosmesis. Laparoscopic ureteroureterostomy has advantages compared to conventional open surgery in terms of less pain, decreased blood loss, smaller operative wound and shorter hospital stay. Herein, we report our initial experience of laparoscopic ureteroureterostomy in a patient with a retrocaval ureter.
Humans ; Hydronephrosis ; Laparoscopy ; Length of Stay ; Retrocaval Ureter* ; Sutures ; Ureter ; Wounds and Injuries

A human Echinostoma hortense infection was diagnosed by gastroduodenoscopy. An 81-year-old Korean male, living in Yeongcheon-shi, Gyeongsangbuk-do and with epigastric discomfort of several days duration, was subjected to upper gastrointestinal endoscopy. He was in the habit of eating fresh water fish. Two live worms were found in the duodenal bulb area and were removed using an endoscopic forcep. Based on their morphological characteristics, the worms were identified as E. hortense. The patient was treated with praziquantel 10 mg/kg as a single dose. The source of the infection in this case remains unclear, but the fresh water fish consumed, including the loach, may have been the source. This is the second case of E. hortense infection diagnosed by endoscopy in Korea.
Aged ; Aged, 80 and over ; Animals ; Duodenal Diseases/*diagnosis/drug therapy/parasitology ; Echinostoma/*growth & development ; Echinostomiasis/*diagnosis/drug therapy/parasitology ; Endoscopy, Gastrointestinal ; Female ; Fishes/parasitology ; Food Parasitology ; Human ; Korea ; Male ; Praziquantel/therapeutic use

BACKGROUND: This study was undertaken to analyze the outcome of composite valve graft replacement(CVGR) for the treatment of aneurysms of the ascending aorta involving the aortic root. MATERIAL AND METHOD: Between April 1995 and June 2001, 56 patients had replacement of the ascending aorta and aortic root with a composite graft valve and were reviewed retrospectively. Aortic regurgitation was present in 50 patients(89%), Marfan's syndrome in 18 patients(32%), and bicuspid aortic valve in 7(12.5%). The indications for operation were annuloaortic ectasia(AAE) in 30 patients(53.6%), aortic dissection in 13(23.2%), aneurysms of the ascending aorta involving aortic root in 11(19.6%), and aortitis in 2(3.6%). Cardiogenic shock due to the aortic rupture was present in 2 patients. Nine patients(16%) had previous operations on the ascending aorta or open heart surgery. The operative techniques used for CVGR were the aortic button technique in 51 patients(91%), the modified Cabrol technique in 4, and the classic Bentall technique in 1. The concomitant procedures were aortic arch replacement in 24 patients(43%), coronary artery bypass graft in 8(14.3%), mitral valve repair in 2, redo mitral valve replacement in 1, and the others in 7. The mean time of circulatory arrest, total bypass, and aortic crossclamp were 21+/-14 minutes, 186+/-68 minutes, and 132+/-42 minutes, respectively. RESULT: Early mortality was 1.8%(1/56). The postoperative complications were left ventricular dysfunction in 16 patients(28.6%), reoperation for bleeding in 7(12.5%), pericardial effusion in 2, and the others in 7. Fifty-three patients out of 55 hospital survivors were followed up for a mean of 23.2+/-18.7 months(1-75 months). There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage, and CVGR-related late mortality was 1.9%. The 1- and 6-year actuarial survival was 98.1+/-1.9% and 93.2+/-5.1%, respectively. Two patients required reoperation for complication of CVGR(3.8%) and two other patients required subsequent operations for dissection of the remaining thoracoabdominal aorta. The 1- and 6-year actuarial freedom from reoperation was 97.8+/-2.0% and 65.3+/-26.7%, respectively. CONCLUSION: This study suggests that aortic root replacement with a composite valve graft for a variety of aneurysms of the ascending aorta involving the aortic root is a safe and effective therapy, with good early and intermediate results. Careful follow-up of all patients following composite graft root replacement is important to long-term survival.
Aneurysm ; Aorta ; Aorta, Thoracic ; Aortic Rupture ; Aortic Valve ; Aortic Valve Insufficiency ; Aortitis ; Bicuspid ; Cerebral Hemorrhage, Traumatic ; Coronary Artery Bypass ; Follow-Up Studies ; Freedom ; Hemorrhage ; Humans ; Marfan Syndrome ; Mitral Valve ; Mortality ; Pericardial Effusion ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Shock, Cardiogenic ; Survivors ; Thoracic Surgery ; Transplants* ; Ventricular Dysfunction, Left

BACKGROUND: Reoperations on the aortic root or the ascending aorta are being performed with increasing frequency and remain a challenging problem.This study was performed to analyze the results of reoperations on the ascending aorta and aortic root. MATERIAL AND METHOD: Between May 1995 and April 2001,30 patients had reoperations on the ascending aorta and aortic root and were reviewed retrospectively.The mean interval between the previous repair and the actual reoperation was 56 months(range 3 to 142 months).Seven patients(23.3%)had two or more previous operations.The indications for reoperations were true aneurysm in 7 patients(23.3%),prosthetic valve endocarditis in 6(20%),false aneurysm in 5(16.7%),paravalvular leak associated with Behcet's disease in 4(13.3%),malfunction of prosthetic aortic valve in 4(13.3%),aortic dissection in 3(10%),and annuloaortic ectasia in 1(3.3%).The principal reoperations performed were aortic root replacement in 17 patients(56.7%),replacement of the ascending aorta in 8(26.7%),aortic and mitral valve replacement with reconstruction of fibrous trigone in 2(6.6%),patch aortoplasty in 2(6.6%), and aortic valve replacement after Bentall operation in 1(3.3%).The cardiopulmonary bypass was started before sternotomy in 7 patients and the hypothermic circulatory arrest was used in 16(53.3%).The mean time of circulatory arrest,total bypass,and aortic crossclamp were 20 +/- 12 minutes,228 +/- 56 minutes,and 143 +/- 62 minutes,respectively. RESULT: There were three early deaths(10%).The postoperative complications were reoperation for bleeding in 7 patients(23.3%),cardiac complications in 5(16.7%),transient acute renal failure in 2(6.6%), transient focal seizure in 2(6.6%),and the others in 5.The mean follow-up was 22.8 +/- 20.5 months.There were two late deaths(7.4%).The actuarial survival was 92.6 +/- 5.0%at 6 years. One patient required reoperation for complication of reoperation on the ascending aorta and aortic root(3.7%).The 1-and 6-year actuarial freedom from reoperation was 100%and 83.3 +/- 15.2%,respectively.One patient with Behcet's disease are waiting for reoperation due to false aneurysm,which developed after aortic root replacement with homograft.There were no thromboembolisms or anticoagulant related complications. CONCLUSIONS: This study suggests that reoperations on the ascending aorta and aortic root can be performed with acceptable early mortality and morbidity,and adequate surgical strategies according to the pathologic conditions are critical to the prevention of the reoperation.
Acute Kidney Injury ; Aneurysm ; Aorta* ; Aortic Valve ; Cardiopulmonary Bypass ; Dilatation, Pathologic ; Endocarditis ; Follow-Up Studies ; Freedom ; Hemorrhage ; Humans ; Mitral Valve ; Mortality ; Postoperative Complications ; Reoperation ; Seizures ; Sternotomy ; Thromboembolism

BACKGROUND: This study was undertaken to investigate the outcome of composite graft aortic root replacement using coronary button reimplantation technique for the treatment of aneurysms of the ascending aorta involving the aortic root. MATERIAL AND METHOD: Between April 1995 and September 2001, 54 patients having aortic root replacement with a composite valve graft using direct coronary button reimplantation were reviewed retrospectively. Left ventricular dysfunction was present in 14 patients(25.9%), aortic regurgitation in 48(89%), and Marfan's syndrome in 17(31.5%). The indications for operation were annuloaortic ectasia in 29 patients(53.7%), aortic dissection in 11(20.4%), aneurysms of the ascending aorta involving aortic root in 12(22.2%), and aortitis in 2(3.7%). Six patients(11.1%) had previous cardiac or ascending aortic operations. Concomitant procedures were arch replacement in 21 patients(38.9%), coronary artery bypass graft in 7(13%), mitral valve repair or replacement in 4(7.4%), and others in 6. The mean time of circulatory arrest, total bypass, and aortic crossclamp were 18+/-9 minutes, 177+/-42 minutes, and 127+/-31 minutes, respectively. RESULT: There was 1 early death(1.9%). Mean follow-up was 24.6+/-19.5 months. There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage. The Kaplan-Meier survival rate was 98.0+/-2.0% and 93.1+/-5.1% at 1 and 6 years, respectively. Two patients required reoperation owing to a false aneurysm at the root anastomosis site anda malfunction of prosthetic aortic valve(3.8%). Staged operation for dissection of the remaining thoracoabdominal aorta was performed in 1 patient. The freedom rate from reoperation was 97.8+/-2.0% and 65.3+/-26.7% at 1 and 6 years, respectively. CONCLUSION: This study suggests that composite graft aortic root replacement using open button technique is a safe and effective therapy for a variety of aneurysms of the aortic root, resulting in good early and mid-term results. Careful follow-up of all patients following composite graft root replacement is important for the good long-term results.
Aneurysm ; Aneurysm, False ; Aorta ; Aortic Valve Insufficiency ; Aortitis ; Cerebral Hemorrhage, Traumatic ; Coronary Artery Bypass ; Dilatation, Pathologic ; Follow-Up Studies ; Freedom ; Humans ; Marfan Syndrome ; Mitral Valve ; Reoperation ; Replantation* ; Retrospective Studies ; Survival Rate ; Transplants* ; Ventricular Dysfunction, Left

Patients who have complex endocarditis with involvement of both the aortic and mitral valves and intervalvular fibrous skeleton are among the most difficult to treat and still have the highest surgical mortality and morbidity rates. We report one case of aortic and mitral valve replacement with reconstruction of the fibrous skeleton performed in a 55-year-old female patient who had an aortic annular abscess and both the aortic and mitral prosthetic valve endocarditis with destruction of the fibrous skeleton. Previously, she had undergone redo double valve replacement. Transesophageal echocardiogram showed the paravalvular defect at the noncoronary aortic sinus and abnormal sinus tract along the fibrous skeleton. Emergent operation was performed due to positive blood cultures of staphylococcus epidermidis and persistent sepsis despite appropriate antibiotic therapy. After aortotomy extended to the roof of left atrium, both prosthetic valves and destroyed fibrous skeleton were completely resected and the aortic annular abscess was debrided and closed with a bovine pericardial patch. Reconstructions of both aortic and mitral annuli and the fibrous skeleton were done by using two separate bovine pericardial patches in triangular shape and mechanical valves were implanted. Postoperatively, adequate antibiotic therapies were continued and the patient was discharged at the postoperative 72 days without evidence of recurrence of endocarditis. Transthoracic echocardiogram of the postoperative 8 months shows no paravalvular leakage or recurrence of endocarditis and the patient has been followed up with no symptom.
Abscess ; Endocarditis* ; Female ; Heart Atria ; Humans ; Middle Aged ; Mitral Valve* ; Mortality ; Recurrence ; Sepsis ; Sinus of Valsalva ; Skeleton* ; Staphylococcus epidermidis

The effects of deep hypothermia and circulatory arrest during aortic arch reconstruction are associated with potential neurologic and myocardial injury. We describe a surgical technique that two patients underwent a modified Norwood procedure without circulatory arrest and myocardial ischemia. One was 13-day-old female patient, weighing 3.1kg, having a variant of hypoplastic left heart syndrome and another was 38-day-old male patient, weighing 3.4 kg, diagnosed Taussig-Bing anomaly with severe aortic arch hypoplasia, coarctation of the aorta, and subaortic stenosis. The arterial cannula was inserted in innominate artery directly. During Norwood reconstruction, regional high-flow perfusion into the inominate artery and coronary perfusion were maintained and there were no neurologic, cardiac, and renal complications in two patients. This technique may help protect the brain and myocardium from ischemic injury in patients with hypoplastic left heart syndrome or other arch anomalies including coarctation or interruption.
Aorta, Thoracic ; Aortic Coarctation ; Arteries ; Brachiocephalic Trunk ; Brain ; Catheterization, Peripheral ; Catheters ; Constriction, Pathologic ; Double Outlet Right Ventricle ; Female ; Humans ; Hypoplastic Left Heart Syndrome ; Hypothermia ; Male ; Myocardial Ischemia* ; Myocardium ; Norwood Procedures* ; Perfusion