Background/Aims: The alcoholic hepatitis histologic score (AHHS) is a recently developed clinical model for predicting short-term mortality in Caucasian patients with alcoholic hepatitis (AH). The AHHS has not been extensively validated in other ethnic populations. This study validated the AHHS in a Korean patient cohort. Methods: We conducted a pro-spective cohort study of hospitalized Korean patients with AH between January 2010 and August 2017. Histopatho-logical findings were assessed to determine the AHHS in all study subjects. Histopathological risk factors were examined by Cox regression analysis to predict overall survival (OS).Kaplan-Meier curves were plotted to assess the diagnostic performance of the AHHS. Results: We recruited a total of 107 patients with biopsy-proven AH. None of the individual AHHS components were associated with 3-month mortality.However, the bilirubinostasis type and fibrosis severity were significantly associated with AH mortality beyond 6 months (all p<0.05, except fibrosis severity for 6-month mortality) and OS (all p<0.05). The modified AHHS classification as a binary variable (<5 vs ≥5) was also associated with OS (haz-ard ratio, 2.88; 95% confidence interval [CI], 1.50 to 5.56;p=0.002), and had higher predictive performance for OS (concordance index [C-index], 0.634; 95% CI, 0.561 to 0.707) than the original AHHS classification (mild vs moderate vs severe: C-index, 0.577; 95% CI, 0.498 to 0.656). This differ-ence was statistically significant (p=0.045). Conclusions In this prospective Korean AH cohort, the modified AHHS was significantly associated with OS. Therefore, the AHHS might be a useful histological prognosticator for long-term progno-sis in patients with nonsevere AH.

We herein report a case of large cell neuroendocrine carcinoma (NEC) of the gallbladder confirmed by laparoscopic surgery. A 60-year-old male was HBsAg-positive. Abdominal computed tomography showed a 2.5 x 2.5 cm enhancing polypoid mass in the gallbladder and multiple masses in liver segments 4 and 5 that enhanced in the arterial phase and washed out in the delayed phase. Liver biopsy findings showed only poorly differentiated morphology. A laparoscopic operation was performed for diagnosis of the masses because curative resection seemed impossible to perform, which showed unusual findings of either hepatocelluar carcinoma or gallbladder cancer. Therefore, laparoscopic liver biopsy and cholecystectomy were performed. The final pathologic results of the masses showed large cell NEC of the gallbladder with liver metastasis. Central bisegmentectomy and extensive lymph node dissection were ultimately performed. The patient was still alive 16 months after diagnosis.
Biopsy ; Carcinoma, Neuroendocrine ; Cholecystectomy ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Laparoscopy ; Liver ; Lymph Node Excision ; Male ; Neoplasm Metastasis

BACKGROUND/AIMS: Early detection of polyp is important for the prevention of colorectal cancer (CRC). There have been few studies to investigate the relationship between colorectal adenoma and family history of CRC (FHCRC) in Korea. The aim of this study was to identify the relationship between colorectal adenoma and FHCRC. METHODS: Between March 2009 and September 2010, 225 patients with adenomatous polyps were included. Their medical records with clinical history and size, numbers, histology of polyps were reviewed. Immunohistochemical staining using Bcl-2, Bax, p-AKT, NF-kappaB, and beta-catenin antibodies were performed. We compared the histology of adenoma and expression of immunohistochemical staining according to the existence of FHCRC. RESULTS: The incidence of colorectal adenoma increased in case of FHCRC (p=0.029). In patients with FHCRC, the mean age of patients was 49 years old and younger than patients without FHCRC. In addition in patients with FHCRC, the incidence of advanced adenoma was significantly higher than in patients without FHCRC (p=0.001). The expression of Bax was significantly lower in patients with FHCRC than without FHCRC (p=0.046). CONCLUSIONS: There was a tendency for polyp to develop in their younger ages and to be more advanced adenomas in patients with FHCRC. The low expression of Bax, tumor suppressor gene, might be associated with the development of polyps in patient with FHCRC. Therefore, patients with FHCRC may be better to start screening colonoscopy earlier than patient without FHCRC.
Adenoma/*diagnosis/epidemiology/metabolism ; Adult ; Age Factors ; Aged ; Colonoscopy ; Colorectal Neoplasms/*diagnosis/epidemiology/metabolism ; *Family Health ; Female ; Humans ; Immunohistochemistry ; Incidence ; Male ; Middle Aged ; Proto-Oncogene Proteins c-akt/metabolism ; Proto-Oncogene Proteins c-bcl-2/metabolism ; Retrospective Studies ; Risk Factors ; Transcription Factor RelA/metabolism ; bcl-2-Associated X Protein/metabolism ; beta Catenin/metabolism

OBJECTIVE: The authors present eight cases of immediate post-operative epidural hematomas(EDHs) adjacent to the craniotomy site, describe clinical details of them, and discuss their pathogenesis. METHODS: Medical records of eight cases were retrospectively reviewed and their clinical data, operation records, and radiological findings analyzed. Any risk factors of the EDHs were searched. RESULTS: In 5 of 8 cases, adjacent EDHs developed after craniotomies for the surgical removal of brain tumors. Three cases of adjacent EDHs developed after a pterional approach and neck clipping of a ruptured anterior communicating artery aneurysm, a ventriculoperitoneal shunt, and a craniotomy for a post-traumatic EDH, respectively. In all eight cases, brain computed tomography (CT) scans checked immediately or a few hours after the surgery, revealed large EDHs adjacent to the previous craniotomy site, but there was no EDH beneath the previous craniotomy flap. After emergent surgical removal of the EDHs, 7 cases demonstrated good clinical outcomes, with one case yielding a poor result. CONCLUSION: Rapid drainage of a large volume of cerebrospinal fluid or intra-operative severe brain collapse may separate the dura from the calvarium and cause postoperative EDH adjacent to the previous craniotomy site. A high-pressure suction drain left in the epidural space may contribute to the pathogenesis. After the craniotomy for brain tumors or intracranial aneurysms, when remarkable brain collapse occurs, an immediate postoperative brain CT is mandatory to detect and adequately manage such unexpected events as adjacent EDHs.
Brain ; Brain Neoplasms ; Cerebrospinal Fluid ; Craniotomy* ; Drainage ; Epidural Space ; Hematoma* ; Intracranial Aneurysm ; Medical Records ; Neck ; Retrospective Studies ; Risk Factors ; Skull ; Suction ; Ventriculoperitoneal Shunt

The purpose of this study was to evaluate the migration of medical image data stored thorough mini-PACS to full-PACS at Yonsei University Medical Center (YUMC). The image data to be migrated were 2.7 TB stored through approximately 4,500 CD archives at Yongdong Severance hospital and 4.7 TB (2:1 compression) stored through 196 digital linear tape (DLT) archives at Severance hospital. Prior to carrying out the migration, principles, methods and expected practical affairs for the migration were discussed and planned to optimize the migration work by considering the cost and the effectiveness of migration work. Migration gateway workstations were set up and a migration software tool was developed. Real migration works were performed based on the results of several migration simulations. Severance hospital decided to migrate all stored image data. The CD image data of 2.7 TB were estimated total 2,250 hr (about 94 days) migration time, but the practical migration work was completed within 3 months by using maximum 5 workstations. The DLT data of 4.7 TB were estimated total 100 days migration time by applying 16 hr working time per day with single workstation, however, the practical migration work was taken 5 months. Meanwhile, 20% of the DLT image data were not able to migrate because the DLT were partially damaged due to frequent access. In conclusion, a migration plan should be carefully prepared by considering the individual hospital environments because the server system, archival media, the network, and the policy of data management may be unique.
Academic Medical Centers

PURPOSE: This study was aimed at deciding the surgical selection criteria in laterality of donor nephrectomy. MATERIALS AND METHODS: We studied 179 patients undergoing living donor nephrectomy for renal transplantation. We performed preoperative studies, including blood ABO type, optimum HLA typing, renal arteriography, check of child-bearing age, excretory urography and a DTPA renal scan for differential renal function. RESULTS: Of the 179 patients, 139 underwent donor nephrectomy on the left side, and 40 on the right side. Of the 139 patients undergoing surgery on the left side, 135 had a single renal artery, with the other 4 having both left and right multiple renal arteries. Of the 40 patients undergoing surgery on the right side, 18 had a right single renal artery, with multiple left renal arteries. Of all the patients, 15 were of child-bearing aged women, 1 had a left double ureter and 6 had a better functioning kidney on the left side inform the DTPA renal scan. CONCLUSIONS: A DTPA renal scan for the evaluation of differential renal function contributed to our decision, especially in making surgical selection criteria of laterality, in order to reserve the better functioning kidney in donors.
Angiography ; Female ; Histocompatibility Testing ; Humans ; Kidney ; Kidney Function Tests ; Kidney Transplantation ; Living Donors* ; Nephrectomy* ; Patient Selection* ; Pentetic Acid ; Renal Artery ; Tissue Donors ; Ureter ; Urography

PURPOSE: Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of all cases of childhood leukemia. We investigated epidemiology, clinical and laboratory features and treatment outcome of the children with ALL in Korea during recent 5 years. METHODS: One thousand forty nine patients were enrolled between January 1994 and December 1998 from 37 major hospitals in Korea. The data regarding the clinical and laboratory features including age, WBC counts at diagnosis, immunophenotype, morphology, cytogenetics and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed. The differences between groups analyzed by log-rank test. RESULTS: There were 597 males and 452 females. The distribution between the age 2 and 5 years is most common in 46.1%. The annual incidence rate per 100,000 population varied from 1.6 to 2.2. The 5 year event free survival (EFS) rates according to good prognostic factors were as follows: 67% bet ween 1-9 year of age at diagnosis, 69% in under 10,000/mm3of initial WBC count, 74% in early pre-B cell CALLA ( ) immunophenotype, 65% in L3 morphology, 68% in no CNS invasion. Most of patients were treated by CCG treatment protocol. The 5 year EFS was 63%. Main complications were sepsis (21.8%) and hemorrhage (12.5%). The relapse rate was 15.6%. The common causes of death were sepsis, DIC, pneumonia, relapse. CONCLUSION: Our results could provide the most recent and important information about acute lymphoblastic leukemia of children in Korea.
Cause of Death ; Child ; Clinical Protocols ; Cytogenetics ; Dacarbazine ; Diagnosis ; Disease-Free Survival ; Epidemiology* ; Female ; Hemorrhage ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Leukemia ; Male ; Medical Records ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Recurrence ; Retrospective Studies ; Sepsis ; Treatment Outcome

PURPOSE: The continuing shortage of donors has escalated the waiting times for kidney transplantation in most nations. In instances where first-degree relatives of the patient are not appropriate, living unrelated transplantations are considered as the next possible choice. In this category, genetically unrelated but emotionally related spouses are always preferred for organ donation rather than both genetically and emotionally unrelated donors. The aim of this study was to compare the results of parental donor kidney transplantation with spousal kidney transplantation. METHODS: Patient and graft survival were assessed with the Kaplan- Meier curve and statistical significance was determined by log-rank comparisons. RESULTS: In the spousal group, 1-, 3-, and 5-year graft survival rate were 84.6%, 72.3%, and 66.3%, in the parental donor group, 89.2%, 75.4% and 62.3% respectively. 1-, 3-, and 5-year patient survival rate were 84.6%, 80.4%, and 71.5% in the spousal group and 97.3%, 94.3% and 90.6% respectively in the parental donor group. Survival rate of grafts from spouses was comparable to that of parental-donor grafts, despite the average of 4.1 HLA mismatches in the spousal group, as compared with one haplotype sharing in the latter group (P<0.001) and higher donor age in the parental donor group (P<0.001). The survival rates were similar in the wife-to-husband and the husband-to-wife groups. CONCLUSION: While providing the couple with a better quality of life, spousal kidney transplantation also enables the couple to share the joy of giving and receiving the "gift of life" from one another. We believe that transplantation from a healthy volunteer spouse is a good alternative resource to years of dialysis while waiting for another donor that may never appear, to increase the donor pool and reduce the increasing length of waiting lists.
Dialysis ; Graft Survival ; Haplotypes ; Healthy Volunteers ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Parents* ; Quality of Life ; Spouses ; Survival Rate* ; Tissue and Organ Procurement ; Tissue Donors* ; Transplants ; Unrelated Donors ; Waiting Lists

PURPOSE: A retrospective review of the medical records of 168 patients who were evaluated for renal transplantation was undertaken to determine whether a voiding cystourethrography (VCUG) influenced the surgi cal care of the recipient. MATERIALS AND METHODS: Between June 1989 to May 1998, 168 patients received a transplantation at our center. These patients proceeded to transplantation, with all of them receiving a VCUG as part of their evaluation. We compared incidence of postoperative complications between normal VCUG group and abnormal group during follow up period (mean 31. 6 months). RESULTS: An urologic abnormality was identified by VCUG in 15 (8.9%) of 168 patients and all of them were vesicoureteral reflux (VUR). In 15 patients with VUR, grade of VUR were grade I in 2, grade II in 10, grade III in 2 and grade IV in 1. None of them with VUR required surgical intervention and had postoperative complications related to VUR. CONCLUSIONS: The VCUG is not essential for the preparation of potential recipients for renal transplantation and should be utilized selectively in individuals with a history of urologic disease or when urinary tract abnormalities are identified by physical examination or an abnormal urine analysis.
Follow-Up Studies ; Humans ; Incidence ; Kidney Transplantation* ; Medical Records ; Physical Examination ; Postoperative Complications ; Retrospective Studies ; Urinary Tract ; Urologic Diseases ; Vesico-Ureteral Reflux

PURPOSE: Survival rate after renal transplantation has increased after intense immunosuppressive agents and sophisticated operative techniques were introduced, but incidences of malignancy increase with time after transplantation. METHODS: We reviewed our experiences about post-transplant malignancy in patients who received renal allografts in our hospital from January 1981 to December 1999. The incidences and types of malignancy were analysed in 241 renal allograft recipients, who were followed-up for 1265 patient-years. RESULTS: Seven malignancies were found in 241 patients (2.9%). The mean age of these patients at diagnosis of malignancy was 45.5 years and the average interval between transplantation and diagnosis of malignancy was 34.9 (9.8-71.6) months. The types of malignancy were non-Hodgkin's lymphoma (n=2; CNS and nasal cavity), colon cancer with metastasis (n=2), in situ carcinoma of uterine cervix (n=1), follicular carcinoma of thyroid (n=1) and transitional cell carcinoma of bladder (n=1). Surgical resection was performed in 5 patients and 2 of them developed distant metastasis during follow-up periods. Radiotherapy was performed in 2 patients with non-Hodgkin's lymphoma and 1 patient with cord compression due to vertebral metastasis. Four patients are now alive and 3 of them have functioning renal allografts. CONCLUSION: We reviewed the incidences and types of post-transplant malignancy in our center and concluded that regular screening for malignancy and meticulous diagnostic approach for suspected symptoms or signs are important to immunosuppressed renal allograft recipients.
Allografts ; Carcinoma, Transitional Cell ; Cervix Uteri ; Colonic Neoplasms ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation* ; Lymphoma, Non-Hodgkin ; Mass Screening ; Neoplasm Metastasis ; Radiotherapy ; Survival Rate ; Thyroid Gland ; Urinary Bladder