Flaviviruses have been important human pathogens after emerging and resurging flavivirus diseases over the past decades. Although effective therapeutic agents are not yet commercially available for use in humans, significant progress has been made toward developing effective therapeutics and treatments. Several studies have shown that antibodies against the flaviviral E and NS1 proteins play a central role in prophylaxis and/or treatment of flavivirus infection through passive immunization. In addition, many anti-flavivirals, including interferons, oligonucleotide-based platforms, and small compounds, have been developed and evaluated for their antiviral effects. This review provides an overview of various approaches to the development of anti-flaviviral candidates and new insights that could improve our strategies for designing effective therapeutics against flaviviruses.
Antibodies ; Flavivirus ; Flavivirus Infections ; Humans ; Immunization, Passive ; Interferons ; Proteins

BACKGROUND/AIMS: The identification of significant coronary arterial disease (CAD) is important to reduce perioperative ischemic insult and the possibility of repeated open-chest surgery in patients scheduled to undergo valvular surgery. However, there are no published data on the incidence of significant CAD in these patients. Thus, we examined the prevalence of significant CAD in patients scheduled to undergo valvular surgery. METHODS: From January 2005 to June 2011, all consecutive adult patients diagnosed with significant valvular disease and scheduled for an elective open valvular operation were retrospectively investigated at Chungnam National University Hospital and Chonbuk National University Hospital. Patients who underwent emergent valvular operations due to acute aortic dissection or trauma and concomitant valvular operations at the time of coronary artery bypass graft (CABG) surgery were excluded. RESULTS: During the study period, a total of 431 patients (58 +/- 13 years old, 204 males) were included. The distributions of mitral (241 patients) and aortic valvular disease (230 patients) were similar. Coronary angiography was performed in 297 patients (68.9%). Of these, 36 (12.1%) showed significant CAD and 32 underwent concomitant CABG operations. Based on a multivariate analysis, the presence of CAD was significantly associated with old age (> or = 65 years old) [odds ratio (OR) = 3.081, 95% confidence interval (CI) = 1.372-6.921, p = 0.006], more cardiovascular risk factors (> or = 3) (OR = 3.002, 95% CI = 1.386-6.503, p = 0.005), and the presence of aortic stenosis (OR = 2.763, 95% CI = 1.269-6.013, p = 0.010). CONCLUSIONS: The incidence of significant CAD was 12.1% in adult patients who underwent valvular operations in Korea. CAD was more common in patients with old age, aortic stenosis, and multiple cardiovascular risk factors.
Adult ; Aortic Valve Stenosis ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Heart Valve Diseases ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Risk Factors ; Transplants

PURPOSE: Wound infection after an ileostomy reversal is a common problem. To reduce wound-related complications, purse-string skin closure was introduced as an alternative to conventional linear skin closure. This study is designed to compare wound infection rates and operative outcomes between linear and purse-string skin closure after a loop ileostomy reversal. METHODS: Between December 2002 and October 2010, a total of 48 consecutive patients undergoing a loop ileostomy reversal were enrolled. Outcomes were compared between linear skin closure (group L, n = 30) and purse string closure (group P, n = 18). The operative technique for linear skin closure consisted of an elliptical incision around the stoma, with mobilization, and anastomosis of the ileum. The rectus fascia was repaired with interrupted sutures. Skin closure was performed with vertical mattress interrupted sutures. Purse-string skin closure consisted of a circumstomal incision around the ileostomy using the same procedures as used for the ileum. Fascial closure was identical to linear closure, but the circumstomal skin incision was approximated using a purse-string subcuticular suture (2-0 Polysorb). RESULTS: Between group L and P, there were no differences of age, gender, body mass index, and American Society of Anesthesiologists (ASA) scores. Original indication for ileostomy was 23 cases of malignancy (76.7%) in group L, and 13 cases of malignancy (77.2%) in group P. The median time duration from ileostomy to reversal was 4.0 months (range, 0.6 to 55.7 months) in group L and 4.1 months (range, 2.2 to 43.9 months) in group P. The median operative time was 103 minutes (range, 45 to 260 minutes) in group L and 100 minutes (range, 30 to 185 minutes) in group P. The median hospital stay was 11 days (range, 5 to 4 days) in group L and 7 days (range, 4 to 14 days) in group P (P < 0.001). Wound infection was found in 5 cases (16.7%) in group L and in one case (5.6%) in group L (P = 0.26). CONCLUSION: Based on this study, purse-string skin closure after a loop ileostomy reversal showed comparable outcomes, in terms of wound infection rates, to those of linear skin closure. Thus, purse-string skin closure could be a good alternative to the conventional linear closure.
Body Mass Index ; Fascia ; Humans ; Ileostomy ; Ileum ; Length of Stay ; Operative Time ; Skin ; Sutures ; Wound Infection

PURPOSE: Although laparoscopic appendectomy is a safe and effective procedure for the management of acute appendicitis, laparoscopic appendectomy in pregnancy has not been considered the preferred procedure until recently. The aim of this study was to evaluate the safety of laparoscopic appendectomy (LA) during pregnancy as compared with the control group that underwent open appendectomy (OA) during pregnancy. METHODS: The clinical data of all the patients who underwent appendectomy during pregnancy at our hospital between 2006 and 2009 was collected and retrospectively analyzed. Nineteen patients underwent LA and 11 patients underwent OA. The general features of the cases, the outcomes and the fetal status were evaluated. RESULTS: There were no significant differences in the length of the procedure, the hospital stay and the complication rate between the LA and OA groups. All the laparoscopic procedures were completed without conversion to an open operation. There were no significant differences between the two groups for premature delivery, the delivery type and the birth weight. There were no fetal losses or abortions. CONCLUSION: Our results demonstrate that LA was not inferior to OA in terms of the operative outcomes, the complication and both the fetal and maternal safety during 1st and 2nd trimesters of pregnancy. LA could be safely performed even in the 1st and 2nd trimesters of pregnancy using careful patient selection, safe operative techniques and the appropriate application of instruments.
Appendectomy ; Appendicitis ; Birth Weight ; Humans ; Length of Stay ; Patient Selection ; Pregnancy ; Retrospective Studies

BACKGROUND: Hepatobiliary and vascular structure anatomy must be understood to ensure donor safety during living donor liver transplantation (LDLT). The purpose of this study was to determine the role of pretransplant magnetic resonance cholangiography (MRC) for understanding the anatomy. METHODS: Eighteen LDLT were analyzed retrospectively through medical records and radiological images. Pretransplant MRC and intraoperative cholangiography (IOC) were reviewed to evaluate the accuracy of pretransplant MRC. RESULTS: The MRC results of 13 donors were acceptable for a living donor operation. However, 5 donor MRC results required further evaluation to identify the biliary anatomy by IOC. In 2 cases, the use of an intravenous low-dose morphine injection helped to obtain a more qualified MRC image. CONCLUSIONS: Despite the small study size, the results showed that MRC can help provide information on donor biliary anatomy to ensure a safe donor operation.
Cholangiography ; Dietary Sucrose ; Humans ; Liver ; Liver Transplantation ; Living Donors ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Medical Records ; Morphine ; Retrospective Studies ; Tissue Donors

Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasive approach to the abdominal cavity is a peroral endoscopic transgastric approach, there are still some challenging issues, such as the risk of infection and leakage, and the method of gastric closure. Hybrid-NOTES is an ideal first step in humans. Human hybrid transvaginal access has been used for years by many surgeons for diagnostic and therapeutic purposes. Here, we report a transvaginal flexible endoscopic appendectomy, with a 5-mm umbilical port using ultrasonic scissors in a 74-year-old woman with acute appendicitis.
Abdominal Cavity ; Aged ; Appendectomy ; Appendicitis ; Biopsy ; Chimera ; Cholecystectomy ; Endoscopy ; Female ; Humans ; Liver ; Natural Orifice Endoscopic Surgery ; Resin Cements ; Splenectomy ; Ultrasonics

PURPOSE: Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology and the optimal treatment remains controversial. The aim of this study is to evaluate the efficacy of surgically complete excision in patients with idiopathic granulomatous mastitis. METHODS: Between March 2005 and November 2008, we treated 14 cases that were diagnosed with idiopathic granulomatous mastitis. Prospectively, we treated the cases with complete surgical excision with or without steroid therapy in all patients. RESULTS: The mean age of the patients was 36 years (range 30 to 53 years). All cases performed were complete excision with or without steroid therapy. The median follow up period was 26 months (range 5 to 50 months) and all cases had no recurrence. 13 patients out of the 14 were satisfied with the cosmesis of the treated breast. CONCLUSION: We conclude that the treatment of choice for idiopathic granulomatous mastitis is surgically complete excision.
Breast ; Breast Diseases ; Follow-Up Studies ; Granulomatous Mastitis ; Humans ; Prospective Studies ; Recurrence

We present here a case of recurrent rectal cancer liver metastasis that was managed with ante situm liver resection under total vascular exclusion (TVE) and venovenous bypass with hypothermic perfusion. A 58-year-old man who suffered with rectal cancer liver metastasis was transferred to our hospital in January 2006. A left lateral sectionectomy had been previously performed. Recurrent lesion developed in segments I, IV and VIII one year after the first hepatectomy. The tumor was 5 cm in diameter and it involved the confluence of the hepatic veins and the retrohepatic vena cava. An incomplete tumor-free margin and massive bleeding were expected with performing a conventional liver resection, together with vena cava reconstruction. Therefore, we planned an ante situm liver resection under TVE and venovenous bypass with hypothermic perfusion. After adhesiolysis, hilar dissection was carried out. The inflow to the medial segment was interrupted, and then the liver and inferior vena cava (IVC) were mobilized fully. During controlling the bleeding of a short hepatic vein, we found adhesion of the hepatocaval portion. Therefore, TVE and venovenous bypass were performed along with suprahepatic IVC transection. The long conduit of V5 was preserved during hepatic parenchymal dissection, and the paracaval portion of the caudate lobe was readily detached from the IVC. The suprahepatic IVC was reconstructed after V5 reconstruction with using the saphenous vein. Portal vein anastomosis was then conducted. After reperfusion, an end-to-side anastomosis was performed between the saphenous vein graft and the IVC. Finally, a Roux-en-Y hepaticojejunostomy was carried out. The patient remains well without recurrence 12 months after the last operation.
Ants ; Hemorrhage ; Hepatectomy ; Hepatic Veins ; Humans ; Liver ; Middle Aged ; Neoplasm Metastasis ; Perfusion ; Portal Vein ; Rectal Neoplasms ; Recurrence ; Reperfusion ; Saphenous Vein ; Transplants ; Vena Cava, Inferior

Inflammatory bowel disease, such as ulcerative colitis and Crohn's disease, has a potential risk of developing into colorectal cancer. However, there is little relationship between intestinal tuberculosis and colon cancer because intestinal tuberculosis is a curable disease and has a relatively short disease course. Nevertheless, there have been a few case reports of intestinal tuberculosis associated with colon cancer. There was a case report in which the carcinoma facilitated entry of tubercle bacilli with development of a secondary infection, and ulcerative lesions of tuberculosis may be precursors of carcinomas. We experienced a 77-year-old woman who had intestinal tuberculosis combined with ascending colon cancer. She visited our hospital because of abdominal pain and constipation. Colonoscopy showed a luminal obstruction mass in the ascending colon. Histologic examination revealed an adenocarcinoma. After surgery, the surgical specimen disclosed an adenocarcinoma in the cecum and ascending colon and intestinal tuberculosis around the cancer site of the cecum. Herein, we report a rare case of colon cancer co-existing with colonic tuberculosis with a review of the literature.
Female ; Humans ; Adenocarcinoma

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires