In previous decades, pediatric liver transplantation has become a state-of-the-art operation with excellent success and limited mortality. Graft and patient survival have continued to improve as a result of proper selection criteria for both donors and recipients, improvement in medical, surgical and anesthetic management, organ availability, balanced immunosuppression, and early identification and treatment of postoperative complications. Most of all, refinements of the technique has directly related to good outcome. Therefore rapid establishment of surgical knowhow is mandatory. In pediatric liver transplantation, the utilization of split-liver grafts and grafts for living donors has provided more organs for pediatric patients and has had a significant impact on graft and patient survival. This has been one of the brilliant outcomes of surgical evolution. In addition, new surgical technique of minimal invasive live donor surgery has been recently widening the living donor liver transplantation for children. Although the recent outcome has been rapidly improved and the volume of living donor liver transplantation has been larger and larger in Korea, pediatric liver transplantation has been performed in a very limited large volume centers. Therefore, this review focuses on surgical technique in order to share the experiences and to improve the outcome of pediatric liver transplantation.
Child ; Humans ; Immunosuppression ; Korea ; Liver ; Liver Transplantation ; Living Donors ; Patient Selection ; Postoperative Complications ; Tissue Donors ; Transplants

PURPOSE: The Hedgehog (Hh) signaling pathway is important in embryonic development including cell differentiation and proliferation. Recently, activation of this pathway has been implicated in several forms of solid cancers. We investigated sonic hedgehog (Shh) protein expression and its relation to differentiation and clinicopathologic characteristics in thyroid cancer cell lines and tissues. METHODS: FTC-236, FTC-238, and XTC-1. We made tissue microarray slides using 80 thyroid surgical specimen: 40 benign and 40 malignant lesions. Immunohistochemical staining was performed using anti-Shh antibody. mRNA expression of NIS, thyroglobulin, and CD97 were evaluated by RT-PCR. Cyclopamine was used as a Shh signal inhibitor. RESULTS: Shh expression was more prominent in TPC-1, FTC-133, and XTC-1 cell lines than the others. Cyclopamine downregulated CD97 and upregulated thyroglobulin mRNA expression, but did not induce mRNA expression of NIS. Thyroid tissues showed varied expression of Shh in both benign and malignant diseases. Shh expression was detected in 38 of 50 (76%) normal, in 18 of 25 (72%) non-neoplastic benign, in nine of 15 (60%) benign tumors, and in 31 of 40 (77%) malignant tumors. Shh over-expression was significantly less frequent in papillary thyroid carcinomas than in normal or benign thyroid tissues. In addition, Shh protein expression did not relate to clinicopathologic characteristics in papillary thyroid carcinomas. CONCLUSION: Thyroid tissues and cell lines vary in expression of Shh. Cyclopamine can induce redifferentiation in thyroid cancer cell lines. Shh protein expression, however, is unrelated to clinicopathologic characteristics in papillary thyroid carcinomas.
Cell Differentiation ; Cell Line ; Embryonic Development ; Female ; Hedgehog Proteins* ; Hedgehogs ; Pregnancy ; RNA, Messenger ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms

PURPOSE: Preoperative clinical staging of gastric cancer is very important for determining the treatment plans and predicting the prognosis. The previous reports regarding the accuracy of computed tomography or endoscopic ultrasound for the preoperative staging of gastric cancer have shown various outcomes. We analyzed the diagnostic performance of CT and EUS, which are important staging tools for the staging of TN gastric cancer. MATERIALS AND METHODS: We retrospectively analyzed 1,174 patients who underwent gastrectomy for gastric cancer at Seoul National University Bundang Hostpital from May, 2003 to December, 2007. We derived the Kappa value to examine the agreement of the preoperative staging obtained from CT and EUS with the pathological staging. RESULTS: The mean age of the 1,174 patients was 59.31+/-11.98 years. Six hundred thirty seven patients had early gastric cancer and 536 had advanced gastric cancer. The diagnostic performance between CT and EUS for the T staging showed no significant difference between CT and EUS for the kappa values. The kappa values showed moderate agreement at 0.4039 (P=0.021) and 0.4201 (P=0.026), respectively. This suggests that there is no difference between the two examinations for the overall T staging. Analysis of the discrimination of mucosal and submucosal lesions with EUS showed an accuracy of 58.92% and a Kappa value of 0.206 (P<0.001), suggesting fair agreement and a lower diagnostic performance than expected. To differentiate lesions with stages higher than or equal to T2 or T3 from the lesion with stages lower than T2 or T3, respectively, adoption of the higher stage from the CT staging or the EUS staging showed a larger AUC of 0.84 than that from either stage alone. The CT-derived node stage had the higher diagnostic performance (68.55%) than that of the EUS-derived node stage (60.82%) for the node staging. CONCLUSION: The CT-derived stage and EUS-derived stage showed comparable results for determining the T stage of gastric cancer. Yet the higher stage of the two stages from CT and EUS most accurately discriminated between those lesions with stages higher than T2 and those lesions with stages lower than T2.
Adoption ; Area Under Curve ; Discrimination (Psychology) ; Gastrectomy ; Humans ; Prognosis ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: Liver transplantation (LT) has been advocated as a good management option for patients with hepatocellular carcinoma (HCC). The rate of HCC recurrence after LT is about 20%. Although the median survival time of patients with HCC recurrence is 7~9 months, the role of surgical treatment for metastatic tumors has been reported on. In this study, we evaluated the role of metastasectomy for treating patients with pulmonary metastasis from HCC after LT. METHODS: We retrospectively analyzed 10 patients with pulmonary metastasis after LT and who were treated between April 2005 and October 2007. The underlying liver disease was cirrhosis caused by chronic viral hepatitis. The surveillance protocol for HCC recurrence was as follows: assessing the serum alpha-fetoprotein level every 1 month, chest and abdomen-pelvic computed tomography every 3 months and a bone scan every 1 year or when bone metastasis was suspected. The patients with less than 3 metastatic lesions were recommended to undergo metastasectomy (Group S, n=6) and the patients with more 4 lesions were recommended nonsurgical management, including chemotherapy (Group N, n=4). RESULTS: All the metastatic lesions were detected on the protocol chest CT scans. The median recurrence time was 7.4 months (0.8~18.2) after LT; this was 11.0 (4.8~18.2) months for Group S and 2.0 (0.8~3.3) months for Group N. One patient had a single lesion and the others had multiple lesions on multilobes. The median survival times of Group S were 29.3 (18.5~41.3) months after pulmonary metastasis and 40.3 (23.3~48.0) months after transplantation; 5 patients had no recorded evidence of their disease status. The median survival time of Group N was 4.3 (4.0~6.3) months after metastasis and 6.2 (5.3~7.1) months after transplantation; all the patients have since died. CONCLUSION: The survival outcome seemed to be good for the patients who underwent pulmonary metastasectomy for HCC, if it was detected earlier and it was resectable (< or =3 lesions). However, further study is required for validating the survival benefit of pulmonary metastasectomy.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Fibrosis ; Hepatitis ; Humans ; Liver ; Liver Diseases ; Liver Transplantation ; Metastasectomy ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thorax

PURPOSE: Liver transplantation (LT) has been advocated as a good management option for patients with hepatocellular carcinoma (HCC). The rate of HCC recurrence after LT is about 20%. Although the median survival time of patients with HCC recurrence is 7~9 months, the role of surgical treatment for metastatic tumors has been reported on. In this study, we evaluated the role of metastasectomy for treating patients with pulmonary metastasis from HCC after LT. METHODS: We retrospectively analyzed 10 patients with pulmonary metastasis after LT and who were treated between April 2005 and October 2007. The underlying liver disease was cirrhosis caused by chronic viral hepatitis. The surveillance protocol for HCC recurrence was as follows: assessing the serum alpha-fetoprotein level every 1 month, chest and abdomen-pelvic computed tomography every 3 months and a bone scan every 1 year or when bone metastasis was suspected. The patients with less than 3 metastatic lesions were recommended to undergo metastasectomy (Group S, n=6) and the patients with more 4 lesions were recommended nonsurgical management, including chemotherapy (Group N, n=4). RESULTS: All the metastatic lesions were detected on the protocol chest CT scans. The median recurrence time was 7.4 months (0.8~18.2) after LT; this was 11.0 (4.8~18.2) months for Group S and 2.0 (0.8~3.3) months for Group N. One patient had a single lesion and the others had multiple lesions on multilobes. The median survival times of Group S were 29.3 (18.5~41.3) months after pulmonary metastasis and 40.3 (23.3~48.0) months after transplantation; 5 patients had no recorded evidence of their disease status. The median survival time of Group N was 4.3 (4.0~6.3) months after metastasis and 6.2 (5.3~7.1) months after transplantation; all the patients have since died. CONCLUSION: The survival outcome seemed to be good for the patients who underwent pulmonary metastasectomy for HCC, if it was detected earlier and it was resectable (< or =3 lesions). However, further study is required for validating the survival benefit of pulmonary metastasectomy.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Fibrosis ; Hepatitis ; Humans ; Liver ; Liver Diseases ; Liver Transplantation ; Metastasectomy ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thorax

A 43-year-old male patient visited our hospital because of intermittent chest pain and exertional dyspnea. This patient was diagnosed as suffering with pulmonary stenosis that was caused by muscle hypertrophy of the subpulmonic area, and the diagnosis was made by performing echocardiography and cardiac catheterization. A sternal foramen of the chest wall was found on the operation field. We report here on this case and we also review the relevant literature.
Adult ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Dyspnea ; Echocardiography ; Humans ; Hypertrophy ; Male ; Muscles ; Pulmonary Valve Stenosis ; Stress, Psychological ; Thoracic Wall

Post-transplantation diabetes mellitus (PTDM) is reversible in a considerable number of patients. We examined the prevalence and predictive factors of transient PTDM following liver transplantation. Forty-two of 74 PTDM patients showed the clinical features of transient PTDM. Compared with the persistent PTDM patients, they were characterized by younger age at the time of transplantation (49+/-7 vs. 53+/-8 yr, P<0.05), longer time before the development of PTDM (44+/-59 vs. 13+/-20 days, P<0.05), lower rate of hepatitis c virus seropositivity (0.0 vs. 9.4%, P<0.05), and use of mycophenolate mofetil (59.5 vs. 28.1%, P<0.05). Among these risk factors, age at the time of transplantation is the single independent predictive factor associated with the reversibility of PTDM.
Adult ; Age Factors ; Diabetes Mellitus/diagnosis/*epidemiology ; Female ; Hepacivirus/isolation & purification ; Humans ; *Liver Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Mycophenolic Acid/analogs & derivatives/metabolism ; Predictive Value of Tests ; Prevalence ; Risk Factors

Liposarcoma is a mesenchymal malignant tumor which occurs most frequently in the limbs, retroperitoneum, and trunk: Although primary liposarcoma may occur anywhere adipose tissue is found, visceral locations are only rarely represented. Moreover, primary gastric liposarcoma is extremely rare. So, only a few cases of primary gastric liposarcoma have been reported in English literature. We describe the case of a 43-year-old woman presenting with melena, epigastric pain, general weakness. Esophagogastroduodenoscopy (EGD) showed a 6x4x3 cm sized-mass which was located on the posterior gastric wall. By endoscopic ultrasonography and abdominal CT scan, we suspected gastric lipoma and performed the laparoscopic transgastric tumor resection by eversion method. Finally, it was confirmed as a gastric liposarcoma pathologically. Herein, we present a case of gastric liposarcoma which was resected by laparoscopic transgastric wedge resection.
Adipose Tissue ; Adult ; Endoscopy, Digestive System ; Endosonography ; Extremities ; Female ; Humans ; Lipoma ; Liposarcoma* ; Melena ; Tomography, X-Ray Computed

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*

Coronary artery vasospasm results in transient, abrupt chest pain that's due to the increased vasomotor tone of the coronary artery, and this can cause myocardial ischemia. We report here on one case of the right coronary artery vasospasm after aortic valve replacement surgery, and this was due to severe aortic regurgitation.
Aortic Valve Insufficiency ; Aortic Valve* ; Chest Pain* ; Coronary Vasospasm* ; Coronary Vessels* ; Myocardial Ischemia ; Thorax*