Patent ductus arteriosus (PDA) is a rare clinical finding in adult patients. Considering the increase in cases of PDA discovered incidentally on echocardiograms at young ages, and the life-shortening effect of PDA, it is rare to diagnose PDA in old patients. We report a case of an 80-year-old patient who experienced symptoms of congestive heart failure showed findings suggestive of PDA in echocardiogram and confirmed the diagnosis through a cardiac catheterization and a coronary angiography. After percutaneous occlusion of PDA with an Amplatzer duct occlusion device, symptoms related to congestive heart failure improved.
Adult ; Aged ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Angiography ; Ductus Arteriosus, Patent ; Estrogens, Conjugated (USP) ; Heart Failure ; Humans

PURPOSE: Mutated p53 is a tumor suppressor gene, hMLH1 is a mismatch repair gene, and hypermethylation of hMLH1 follows microsatellite instability (MSI). This research's aim is to investigate mutated p53, inactivated hMLH1 and MSI in gastric cancer and their clinicopathologic implications. METHODS: Between 2003 and 2007, 618 patients underwent curative radical gastrectomy for gastric cancer at Seoul National University Bundang Hospital in Korea. We reviewed their medical charts and the pathologic reports with immunohistochemistry for p53, hMLH1 and polymerase chain reaction for MSI in 509, 499, and 561 cases, respectively. These genetic markers were statistically compared with clinicopathologic features and postoperative survival. RESULTS: The expression ratios of mutated p53, inactivated hMLH1, and MSI were 32.8%, 8.4%, and 8.7%, respectively. Mutation of p53 occurred more frequently in aged group (over 40), differentiated group (against the non-differentiated group), intestinal type, infiltrative type and positive lymph node metastasis group. Inactivated hMLH1 occurred more frequently in aged group, differentiated group, intestinal type and expanding growth type group. MSI was found more frequently in aged group, intestinal type and expanding growth type group. All three genetic markers had no significant associations with the 5-year survival. CONCLUSION: We identified significant relationships between mutated p53, inactivated hMLH1, and MSI with some clinicopathologic features of gastric cancer. However, there were no apparent relationships between p53, hMLH1, and MSI and prognosis.
Aged ; DNA Mismatch Repair ; Gastrectomy ; Genes, Tumor Suppressor ; Genetic Markers ; Humans ; Immunohistochemistry ; Korea ; Lymph Nodes ; Microsatellite Instability ; Microsatellite Repeats ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Prognosis ; Stomach Neoplasms ; Succinimides

PURPOSE: To investigate the differentiation of rat bone marrow-derived mesenchymal stem cells (MSCs) into hepatocytes by cell transplantation using fibrin gels in a 70% hepatectomized rat model. METHODS: MSCs were isolated from Sprague-Dawley rats. MSCs (1.5x10(7) cells) were mixed with fibrin gels and injected immediately into the abdominal cavity of 70% hepatectomized rats. Fibrin-gels consisted of 500 IU/ml of thrombin and 90 mg/ml of fibrinogen. Transplanted MSCs in the fibrin scaffold were retrieved from surgically opened peritoneal cavities of rats on days 5, 10, 15, and 21 after the operation. The specimens were analyzed histologically and immunohistochemically. RESULTS: On H&E staining, MSCs from hepatectomized rats had changed to a round shape, while MSCs of the control group kept their spindle shape. When the fibrin matrix was biodegraded at day 15, the morphology of the MSCs had changed to hepatocyte-like cells without sinusoids and the hepatocyte-like cells had formed a three-dimensional tissue permitting cell-to-cell contacts within the matrix. On immunohistochemistry, MSCs expressed the hepatocyte markers cytokeratin 18, albumin, and alpha-fetoprotein, after 15 days of transplantation. CONCLUSION: When bone marrow-derived MSCs are transplanted using fibrin gels in the 70% hepatectomized rat, MSCs differentiate into hepatocyte-like cells and are conglomerated so that they form three-dimensional tissue-like hepatocytes without sinusoids.
Abdominal Cavity ; alpha-Fetoproteins ; Animals ; Bone Marrow ; Cell Differentiation ; Cell Transplantation ; Fibrin ; Fibrinogen ; Gels ; Hepatocytes ; Immunohistochemistry ; Keratin-18 ; Mesenchymal Stromal Cells ; Rats ; Rats, Sprague-Dawley ; Thrombin ; Transplants

PURPOSE: To analyze the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after liver transplantation in children. METHODS: From January 1988 to June 2009, we retrospectively reviewed the medical records of 8 PTLD cases among 148 pediatric patients underwent liver transplantation. The age at transplantation, time of presentation after transplantation, clinical manifestations, histologic diagnosis, results of EBV (Epstein-Barr virus) assessments, managements and outcomes of PTLD were investigated. RESULTS: The prevalence of PTLD in liver transplant pediatric recipients was 5.4% (8 of 148). The mean age of patients was 25.4+/-21.3 months (range 10 to 67 months). Seven of 8 patients (87.5%) underwent liver transplantation before 1 year of age. The common clinical presentations were persistent fever (8 of 8, 100%) and bloody diarrhea (6 of 8, 75%). PTLD was diagnosed with gastrointestinal endoscopic biopsies in five patients and surgical biopsies in three. Histologic findings showed early lesion in three patients, polymorphic in two, and monomorphic in three. Burkitt lymphoma and lymphoblastic lymphoma were found in two of 3 monomorphic patients. Seven of 8 patients were found with EBV-positive. Eight patients were treated with dose reduction of immunosuppressants and infusion of ganciclovir. Rituximab was added to four patients. PTLD were successfully managed in all patients except one who died of sepsis during chemotherapy. CONCLUSION: Major risk factor of PTLD was to undergo liver transplantation before 1 year of age. Continuous monitoring for EBV viral load and gastrointestinal endoscopic biopsy may be useful to early detection of PTLD.
Antibodies, Monoclonal, Murine-Derived ; Biopsy ; Burkitt Lymphoma ; Child ; Diarrhea ; Fever ; Ganciclovir ; Herpesvirus 4, Human ; Humans ; Immunosuppressive Agents ; Liver ; Liver Transplantation ; Lymphoproliferative Disorders ; Medical Records ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prevalence ; Retrospective Studies ; Risk Factors ; Sepsis ; Transplants ; Viral Load ; Rituximab

Rate-dependent left bundle branch block during general anesthesia is rare, but its occurrence makes the electrocardiographic diagnosis of acute myocardial ischemia or infarction difficult. It can also be confused with slow rate ventricular tachycardia. Herein, a case of rate-dependent left bundle branch block, in a patient with no previous history of ischemic heart disease, is reported. The administration of esmolol resulted in a decrease in the heart rate, with reversion to normal sinus rhythm.
Anesthesia, General* ; Bundle-Branch Block* ; Diagnosis ; Electrocardiography ; Heart Rate ; Humans ; Infarction ; Myocardial Ischemia ; Tachycardia, Ventricular

BACKGROUND: The purpose of this study was to compare the postoperative analgesic effects and side effects of an intra-articular PCA infusion of bupivacaine and morphine using an intravenous PCA infusion of morphine following arthroscopic shoulder surgery. METHODS: Seventy-one patients, undergoing arthroscopic shoulder surgery under general anesthesia, were randomly assigned to one of two groups. In group 1 (n = 32), morphine and ondansetron, 8 and 4 mg, respectively, were intravenously injected following surgery, with the subsequent infusion of normal saline 100 ml, including morphine and ondansetron, 32 and 12 mg, respectively, through an intra-venous PCA catheter. In group 2 (n = 39), 0.25% bupivacaine, 40 ml, including an intra-articular injection of morphine, 3 mg, followed by an infusion of 0.25% bupivacaine, 100 ml, including morphine, 5 mg, were administered through an intra-articular PCA catheter. In groups 1 and 2, the PCA infusion rate was 2 ml/h, with a bolus dose of 0.5 ml, with a lock out time of 8 min. The VAS for pain at rest, and the range of motion (ROM) exercise and side effects were assessed 0.5, 1, 2, 4, 12, 18 and 24 h postoperatively. RESULTS: The patients in group 2 had significantly lower VAS for pain for the ROM than those in group 1 30 min postoperatively. However, the VAS for pain at rest was significantly lower in group 1 than 2 after 18 and 24 h, but the VAS for pain for the ROM was significantly lower in group 1 than 2 24 h postoperatively. There was no significant difference in the side effects between the two groups, with the exception of dizziness, which was more severe in group 2 at 1, 2 and 4 h postoperatively. CONCLUSIONS: An intra-articular PCA infusion of bupivacaine and morphine is no more effective than an intra-venous PCA infusion of morphine and ondansetron with respect to postoperative analgesia and side effects.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia, General ; Bupivacaine ; Catheters ; Dizziness ; Humans ; Injections, Intra-Articular ; Morphine ; Ondansetron ; Passive Cutaneous Anaphylaxis ; Range of Motion, Articular ; Shoulder*

BACKGROUND/AIMS: Combined hepatocellular and cholangiocarcinoma (HCC-CC) is a rare form of primary liver carcinoma which contains characteristics of both hepatocellular carcinoma and cholangiocarcinoma. The aim of this study was to evaluate the prognostic factors of combined HCC-CC after curative resection. METHODS: Between January 1987 and December 2005, pathologically confirmed combined HCC-CC patients who underwent curative resection at Seoul National University Hospital were evaluated. We reviewed the medical records and evaluated the time-to-recurrence (TTR), overall survival (OS) and prognostic factors of combined HCC-CC. RESULTS: A total of 31 patients were evaluated (M:F=27:4; median age, 61 years). According to the American Joint Committee on Cancer system, patients with stage I, II, III(A), III(B) and III(C) at the time of resection were 4, 16, 7, 2 and 2, respectively. Twenty six patients (83.9%) had tumor recurrence during the follow-up period and their median TTR was 5.7 months. Twenty one patients received additional treatment while 5 patients did not. As a result, median OS was 21.6 months and 3 year survival rate was 15.4%. In multivariate analysis, stage III than stage I or II at resection was an independent prognostic factor associated with shortened TTR (p<0.01). Older age (p=0.03), stage III(C) rather than stage I, II, III(A) at time of resection (p=0.02), and Child-Pugh B rather than A (p<0.01) were independent prognostic factors associated with shortened OS. CONCLUSIONS: Even after curative resections, patients with combined HCC-CC show poor prognosis with early recurrence and poor survival. However, surgical treatment should be warranted for relatively young patients in early stage with well preserved liver function.
Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*mortality/pathology/surgery ; *Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular/*mortality/pathology/surgery ; Cholangiocarcinoma/*mortality/pathology/surgery ; Female ; Hepatectomy ; Humans ; Liver Neoplasms/*mortality/pathology/surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis ; Neoplasm Staging ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Survival Analysis ; Tomography, X-Ray Computed

BACKGROUND: Heart Rate Variability (HRV) is a valuable marker of autonomic tone and may assist evaluating the prognosis in patients with heart disease. The purpose of this study was to assess whether preoperative heart rate variability analysis predicts atrial fibrillation in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: This study was designed as a prospective observational study. After IRB approval was obtained by our institution, 76 patients scheduled for elective CABG surgery underwent a 10-min electrocardiogram recordings 1~2 hours prior to surgery. Heart rate variability analysis was performed with spectral analysis and point correlation dimension. RESULTS: There was no significant difference in the low and high frequency component (LF/HF) ratio preoperatively between patients with atrial fibrillation and patients with normal sinus rhythm postoperatively (3.0+/-2.45, 4.25+/-3.70, p=0.085). Baseline peak point correlation dimension (pPD2) was significantly higher in patients with atrial fibrillation than in patients with normal sinus rhythm postoperatively (4.2+/-0.8, 3.8+/-0.7, p=0.042). CONCLUSIONS: Patients who developed atrial fibrillation postoperatively had a higher baseline pPD2 value preoperatively. Point correlation dimensions may predict the occurrence of postoperative atrial fibrillation after CABG surgery. However, further studies are needed to confirm whether point correlation dimensions are an effective predictor for postoperative atrial fibrillation.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Coronary Artery Bypass* ; Coronary Vessels* ; Electrocardiography ; Ethics Committees, Research ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Observational Study ; Prognosis ; Prospective Studies ; Transplants

The objective of this study was to develop an experimental animal model of fulminant hepatic failure to test the efficacy of the bioartificial liver system. The portal vein and the hepatic artery were clamped intermittently and then the hepatic artery was ligated (ligation group, n=5). Pigs whose hepatic arteries were not ligated after clamping were assigned to the non-ligation group (n=5). The biochemical changes in blood, histologic alterations of the liver and neurologic examination for pigs were checked up. All animals died within 17 hr in the ligation group. On the other hand, all animals survived more than 7 days in the non-ligation group. In the ligation group, the levels of ammonia, lactic acid and creatinine showed a progressively increasing pattern. Prothrombin time was also prolonged gradually. Cytoplasmic condensation and nuclear pyknosis of hepatocytes were detected histologically at autopsy. Neurologic findings such as decreased pain sensation, tachypnea and no light reflex of pupils were observed. The findings shown in the ligation group are similar to the clinical features of fulminant hepatic failure in human and this animal model is reproducible. Therefore, this can be a suitable animal model to evaluate the efficacy of the bioartificial liver system for treating fulminant hepatic failure.
Acidosis/etiology/prevention & control ; Ammonia/blood ; Animals ; Aspartate Aminotransferases/blood ; Bilirubin/blood ; Blood Glucose/metabolism ; Blood Urea Nitrogen ; Comparative Study ; Creatinine/blood ; *Disease Models, Animal ; Female ; Hepatic Artery/surgery ; Lactic Acid/blood ; Ligation/adverse effects ; Liver Failure, Acute/blood/*pathology ; Portal Vein/surgery ; Potassium/blood ; Prothrombin Time ; Research Support, Non-U.S. Gov't ; Sodium Bicarbonate/pharmacology ; Swine

PURPOSE: To study the availability of the radiological classification for incongruent hallux valgus deformities, which has been used as the key to the algorithm for selecting surgical options. MATERIALS AND METHODS: To determine radiological severity, 257 cases of incongruent hallux valgus deformities were studied. The hallux valgus angle (HVA) and the 1/2 intermetatarsal angle (IMA) were measured in each case. Following Mann's radiological classification system, the HVA and IMA were compared to determine any similarity in severity. The distal metatarsal articular angle (DMAA) was also measured to observe the extent of its effect on the incongruent deformity. RESULTS: The HVA was 36.1degrees on average (range, 16-60degrees) and the 1/2 IMA was 15.8degrees on average (range, 5-30degrees). In 126 cases (49.1%), the severity between the 1/2 IMA and HVA coincided with the index classification, whereas. 131 cases (50.9%) did not correspond. Overall, the severity of approximately half the cases, could not be graded. The DMAA was 15.6degrees on average (range, 0-40degrees) and 133 cases (51.8%) demonstrated a value above normal value (>15degrees). CONCLUSION: The radiological classification system used as a guide for surgical decision-making needs to be revised, due to the overt limits of correspondence between the severity of the 1/2 IMA and HVA. Because the HVA would be influenced by both the lateral subluxation and bony deformity around the first metatarsophalangeal joint, it is reasonable to consider these factors on the HVA as elements to be corrected individually, instead of the HVA alone.
Classification* ; Congenital Abnormalities* ; Hallux Valgus* ; Hallux* ; Metatarsal Bones ; Metatarsophalangeal Joint ; Reference Values