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ABSTRACT: Purpose: Cerebral ischemic lesions are frequently observed after carotid artery stenting (CAS), and anti-platelet agents are used to prevent stent thrombosis and peri-procedural complications. However, despite the premedication, cerebral ischemic lesions are observed, suggesting that they may rather be related to anti-platelet resistance. We, therefore, investigated the effects of anti-platelet resistance on the development of cerebral ischemic lesions after CAS. Materials and Methods: We retrospectively reviewed patients who received CAS and selected patients for whom brain MRI was performed within 24 hours after CAS and for whom anti-platelet resistance was checked. Anti-platelet resistance was examined by the VerifyNow system. We analyzed the correlation between anti-platelet resistance and cerebral ischemic lesions detected on follow-up MRI. Results: Among 76 patients, 45 (59.2%) developed new ischemic lesions after CAS. Twelve (15.8%) patients showed aspirin resistance and 50 (65.8%) patients showed clopidogrel resistance. Patients with a new ischemic lesion demonstrated a significantly greater frequency of clopidogrel resistance than those who had no new ischemic lesion (82.2% versus 41.9%, p=0.001). The frequency of aspirin resistance was not significantly different between the groups of patients with and without new ischemic lesions (20.0% versus 9.7%, p=0.340). In multivariate analysis, clopidogrel resistance was a significant risk factor for post-procedural cerebral ischemia. Conclusion: Anti-platelet resistance can be used to predict new ischemic lesions after CAS. Anti-platelet resistance should be evaluated in all patients prior to CAS to prevent ischemic complications related to CAS.
Yonsei medical journal 03/2013; 54(2):288-94. · 0.77 Impact Factor
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ABSTRACT: Purpose: Late diagnosis and treatment lead to high mortality and poor prognosis in tuberculous meningitis (TbM). A rapid and accurate diagnosis is necessary for a good prognosis. Neuron-specific enolase (NSE) has been investigated as a biochemical marker of nervous tissue damage. In the present study, the usefulness of NSE was evaluated, and a cut-off value for the differential diagnosis of TbM was proposed. Materials and Methods: Patient charts were reviewed for levels of serum and cerebrospinal fluid (CSF) NSE, obtained from a diagnostic CSF study of samples in age- and gender-matched TbM (n=15), aseptic meningitis (n=28) and control (n=37) patients. Results: CSF/serum NSE ratio was higher in the TbM group than those of the control and aseptic groups (p=0.001). In binary logistic regression, CSF white blood cell count and CSF/serum NSE ratio were significant factors for diagnosis of TbM. When the cut-off value of the CSF/serum NSE ratio was 1.21, the sensitivity was 86.7% and the specificity was 75.4%. Conclusion: The CSF/serum NSE ratio could be a useful parameter for the early diagnosis of TbM. In addition, the authors of the present study suggest a cut-off value of 1.21 for CSF/serum NSE ratio.
Yonsei medical journal 11/2012; 53(6):1068-72. · 0.77 Impact Factor
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ABSTRACT: A 64-year-old man with a history of gallstones, common bile duct stones, chronic hepatitis B virus infection, and hepatic
cirrhosis with a Child-Pugh score B was satisfactorily treated for hepatocellular carcinoma with radiofrequency ablation and
transarterial chemoembolization. His course, however, was complicated by gallbladder actinomycosis 14 months after treatment,
resulting in acute cholecystitis. Such a chain of events suggests that gallbladder actinomycosis may develop after radiofrequency
ablation and transarterial chemoembolization in patients who are known to have gallstones and that asymptomatic gallstones
should be treated before the application of nonsurgical, but invasive procedures for hepatocellular carcinoma.
KeywordsActinomycosis–Gallstone–Hepatocellular carcinoma–Chemoembolization–Radiofrequency ablation
Central European Journal of Medicine 04/2012; 6(3):300-304. · 0.31 Impact Factor
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ABSTRACT: The levels of interleukin-6 (IL-6) are proportionate to injury; it is the most commonly used quantitative marker in surgical studies. Cytokines and the acute-phase response play an important role in controlling the human immune system. The objective of this study was to compare the systemic acute cytokine response and clinical outcomes of conventional laparoscopic and single port laparoscopic cholecystectomy. We compared patients who underwent single port laparoscopic cholecystectomy (the single port group) with patients who underwent conventional laparoscopic cholecystectomy (the conventional group) according to the clinical variables, IL-6, leukocyte subpopulations, and visual analog scale (VAS) pain score. The mean age in the single port group was significantly younger (P = 0.010) and the mean operation time in the conventional group was significantly shorter (P = 0.002). Postoperative 4-hour VAS pain score was slightly worse in the single port laparoscopic cholecystectomy group, but was not significantly different. We found no difference in clinical outcomes, the level of serum IL-6, C-reactive protein, leukocyte subpopulations, and complications between the two groups. Stress response in single port laparoscopic cholecystectomy is equal to conventional surgery. Postoperative 4-hour VAS pain score was slightly worse and the operation time is significantly longer in the single port laparoscopic cholecystectomy group.
The American surgeon 04/2012; 78(4):485-91. · 1.28 Impact Factor
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ABSTRACT: Many studies which focus on the molecules and mechanisms related to the characteristics of the cancer have been performed. In particular, cell adhesion molecules (CAMs) are known to play a central role in the adhesion of cancer cells to vascular endothelial cells. In this study, the expression of CAMs in hepatocellular carcinoma (HCC) cell lines was analyzed and correlated with the characteristics of various HCC cell lines. Eight human HCC cell lines were used in this study. We analyzed the expression of ICAM-1, E-selectin and the integrin subunits of HCC cell lines by western blot analysis and ELISA kit. We estimated the expression of integrin-α5 using western blot analysis and RT-PCR to compare the expression at the gene level with the protein level. In addition, we determined the expression of TGF-β1, as one of the markers for the cellular activity compared to the levels of expression with the expression of integrin-α3 and -α5. ICAM-1 was highly expressed in all of the cell lines except SNU398 and Hep3B, which exhibit a more aggressive nature among the studied HCC cell lines. E-selectin and integrin subunits varied in all HCC cell lines. In particular, integrin-β2 was highly expressed on all HCC cell lines. In conclusion, the levels of expression of the CAMs may not affect cellular activity, morphology or tumorigenicity. However, most HCC cell lines show various expressions of CAMs, suggesting that HCC cell lines expressing the major CAMs remain candidates for molecular targeted therapy, which may need to be patient-tailored for therapy according to the molecular profile.
International Journal of Molecular Medicine 03/2012; 29(6):1158-64. · 1.98 Impact Factor
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ABSTRACT: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm that accounts for about 1 to 2 per cent of all pancreatic tumors. The aim of this study was to delineate the clinicopathological characteristics and surgical outcomes of solid pseudopapillary neoplasm of the pancreas. We retrospectively reviewed the clinicopathological characteristics and surgical outcomes of 18 patients who underwent surgery for SPN of the pancreas between January 1, 2001 and November 1, 2010. The patient group was comprised of 14 females and four males and the median patient age at diagnosis was 32.4 years (range 10∼68 years). Eleven of the 18 patients were symptomatic at the time of diagnosis. The type of surgery was selected according to the location and presentation of the tumor. The resection margins were negative in all patients. One patient had distant metastasis and recurrent mass node repetitively. She underwent seven operations for recurrence of SPN during the follow-up period of 218 months. Complete surgical excision is the treatment of choice for SPN of the pancreas and can give a good prognosis. Although sometimes patients have repetitive metastases or recurrences, patients undergoing complete surgical excision of the tumor will have a good outcome.
The American surgeon 02/2012; 78(2):216-9. · 1.28 Impact Factor
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ABSTRACT: Most morbidity and mortality are caused by a pancreatic fistula after pancreaticoduodenectomy (PD), and its prevention is the major concern. We applied the omental roll-up technique around pancreaticojejunostomy and investigated the effectiveness of this technique to prevent a pancreatic fistula.
Retrospective study.
Tertiary hepatobiliary and pancreas surgery clinic, Korea University Guro Hospital, Seoul.
Between March 1, 2009, and March 31, 2011, 68 patients underwent PD. The patients were divided into 2 groups according to the surgical application of the omental roll-up technique around the PJ site: group 1 (those who did not undergo the omental roll-up technique) compared with group 2 (those who did undergo the omental roll-up technique).
The occurrence of a pancreatic fistula.
No differences were noted in the clinical characteristics, including patients' demographics and operation-related factors, between the 2 groups. A pancreatic fistula occurred in 23 of 39 patients in group 1 (59%) and in 6 of 29 patients in group 2 (20.7%). Group 2 had a significantly lower incidence of pancreatic fistula (P = .002), and these fistulas were classified as being grade A using the International Study Group on Pancreatic Fistula Definition showing a transient high amylase level in the drainage fluid without significantly affecting the patient's recovery. Drain removal was performed earlier in group 2 (P < .001). Mean postoperative hospital stay was 23.4 days in group 1 compared with 15.9 days in group 2 (P = .009). Overall mortality was 1.5%; however, no deaths were related to a pancreatic fistula.
The omental roll-up technique for the PJ site definitely reduced the occurrence of a pancreatic fistula. Therefore, the omental roll-up technique is a simple and effective strategy to prevent a pancreatic fistula.
Archives of surgery (Chicago, Ill.: 1960) 02/2012; 147(2):145-50. · 4.32 Impact Factor
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Tae-Jin Song,
Yuman Fong,
Sung-Jin Cho,
Mithat Gönen,
Michael Hezel,
Scott Tuorto,
Sang-Yong Choi,
Young-Chul Kim,
Sung-Ock Suh,
Bum-Hwan Koo,
Yang-Seok Chae,
William R Jarnagin,
David S Klimstra
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ABSTRACT: Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Although some epidemiologic and etiologic differences between Asian and Western HCC are known, detailed comparative studies with pathologic correlations have not been performed.
Paraffin sections of resected HCC specimens from Memorial Sloan-Kettering Cancer Center and Korea University Medical Center were used to construct tissue microarrays. Immunohistochemical staining of microarray sections was performed using antibodies against markers of proliferation and regulators of cell cycle. Patient data were correlated with staining results.
When comparing both cohorts, significant differences were found in expression of p53 and MDM2. In the Asian group, more frequent positive staining for p53 (24%) was observed compared with the American group (9%; P = 0.037). For MDM2, 26% of American cases stained positive compared with 2% of Asian cases (P = 0.0003). No significant differences were found in expression of Ki67, p21, p27, cyclin D1, or bcl2. Female gender, vascular invasion, and lack of viral hepatitis infection correlated with positive MDM2 staining.
These data likely correlate with differences in molecular pathogenesis of HCC based on racial and regional differences. These findings may have implications in choice of molecular targeted therapies based on patient ethnicity.
Journal of Surgical Oncology 01/2012; 106(1):84-8. · 2.10 Impact Factor
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ABSTRACT: Patients with umbilical hernias complicated by liver cirrhosis have an increased likelihood of complications following herniorrhaphy. The aim of this study was to investigate the clinical outcomes in patients with umbilical hernias complicated by liver cirrhosis.
Between 2001 and 2010, 44 patients were enrolled in this study. The comparison between non-operative and operative group was performed. Patients who underwent emergency versus elective surgery were also compared.
Of the 44 patients, there were 33 men and 11 women. Thirty-one patients (70.5%) underwent surgery and 13 patients (29.5%) were treated conservatively. Overall morbidity and mortality rates following herniorrhaphy were 42% and 6.5%. The mean albumin level was significantly lower and total bilirubin, creatinine and mean model of end-stage liver disease score were significantly higher in non-operative group than in operative group. Combined resection was performed more frequently in the emergency group than in elective group. A significantly higher proportion of patients in emergency operation group had postoperative complications (P=0.01), especially ascites (P=0.02). The operative time and postoperative hospital stay were significantly shorter in the elective operation group than in emergency operation group.
Early, elective repair of umbilical hernias in cirrhotic patients should be advocated considering the hepatic reserve and patient's condition. Ascites control is the mainstay of post-operative management.
Digestive and Liver Disease 08/2011; 43(12):991-5. · 3.05 Impact Factor
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ABSTRACT: Single port laparoscopic surgery has come to the forefront of minimally invasive surgery. For those familiar with conventional techniques, however, this type of operation demands a different type of eye/hand coordination and involves unfamiliar working instruments. Herein, the authors describe the learning curve and the clinical outcomes of single port laparoscopic cholecystectomy for 150 consecutive patients with benign gallbladder disease.
All patients underwent single port laparoscopic cholecystectomy using a homemade glove port by one of five operators with different levels of experiences of laparoscopic surgery. The learning curve for each operator was fitted using the non-linear ordinary least squares method based on a non-linear regression model.
Mean operating time was 77.6 ± 28.5 min. Fourteen patients (6.0%) were converted to conventional laparoscopic cholecystectomy. Complications occurred in 15 patients (10.0%), as follows: bile duct injury (n = 2), surgical site infection (n = 8), seroma (n = 2), and wound pain (n = 3). One operator achieved a learning curve plateau at 61.4 min per procedure after 8.5 cases and his time improved by 95.3 min as compared with initial operation time. Younger surgeons showed significant decreases in mean operation time and achieved stable mean operation times. In particular, younger surgeons showed significant decreases in operation times after 20 cases.
Experienced laparoscopic surgeons can safely perform single port laparoscopic cholecystectomy using conventional or angled laparoscopic instruments. The present study shows that an operator can overcome the single port laparoscopic cholecystectomy learning curve in about eight cases.
Journal of hepato-biliary-pancreatic sciences. 07/2011; 18(4):510-5.
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ABSTRACT: We report herein a case of hyperacute onset of spontaneous cervical spinal subdural hematoma treated with methylprednisolone pulse therapy that showed good results. A 57-year-old man was admitted for posterior neck pain and paraparesis which occurred an hour ago. MRI revealed a ventral subdural hematoma distributed from the level of C1 down to T3, compressing the spinal cord. Conservative management with methylprednisolone pulse therapy was administered considering the patient's poor general condition. Although emergent surgical decompression is necessary in most cases of spinal subdural hematoma, conservative management with steroid therapy could be effective.
Yonsei medical journal 07/2011; 52(4):692-4. · 0.77 Impact Factor
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ABSTRACT: Hypoxia-inducible factor-1 (HIF-1) is a master transcription factor that plays a central role in the hypoxic expression of various genes. Vascular endothelial growth factor (VEGF), a known target gene of HIF-1α, has been shown to be induced by hypoxia through a HIF-1α-independent pathway. HIF-1α dominant-negative lentiviral vectors were introduced to decrease the expression of HIF in Hep3B cells. Cells were incubated under normoxic or hypoxic conditions. We performed a VEGF enzyme-linked immunosorbent assay (ELISA) using cell culture supernatants, and Western blotting using cell lysates. To validate signaling via HIF-1-dependent or HIF-1-independent pathways, we treated cells with an extracellular signal-regulated kinase (ERK) kinase inhibitor, a phosphoinositide 3-kinase (PI3K) inhibitor, and transfected cells with siSP1. HIF-1α protein expression was induced and the levels of VEGF increased under hypoxic conditions. Cells were transfected with siHIF-1α and incubated under normoxic or hypoxic conditions. We found that a significant amount of VEGF was produced by a HIF-1-independent pathway. PI3K inhibitor treatment and siSP1 transient transfection decreased VEGF expression in siHIF-1α-transfected cells. Therefore, VEGF regulation in Hep3B cells is primarily controlled by the Akt/PI3K and SP1 pathways and is independent of HIF-1 under hypoxic conditions.
International Journal of Molecular Medicine 06/2011; 28(3):449-54. · 1.98 Impact Factor
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ABSTRACT: Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis in patients with situs inversus totalis (SIT). Nowadays, single-incision multiport laparoscopic surgery is safe and feasible for treating benign gallbladder disease. We report a case of successful single-incision multiport laparoscopic cholecystectomy for a patient with SIT, and describe its technical advantages.
Surgery Today 06/2011; 41(6):877-80. · 1.22 Impact Factor
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ABSTRACT: Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications. We determined whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. The medical records of 116 patients with acute gangrenous cholecystitis admitted to the Korea University Guro Hospital between January 2005 and December 2009 were reviewed. The early operation group, those patients who had cholecystectomies within 4 days of the diagnosis, was compared with the delayed operation group, who had cholecystectomies 4 days after the diagnosis. Of the 116 patients, 57 were in the early operation group and 59 were in the delayed operation group. There were no statistical differences between the groups with respect to gender, age, body mass index, operative methods, major complications, duration of symptoms, mean operative time (98 vs 107 minutes), or postoperative hospital stay. However, the total hospital stay was significantly longer in the delayed operation group. More patients underwent preoperative percutaneous cholecystostomy in the delayed operation group (3.5 vs 15.3%). Early laparoscopic cholecystectomy for acute gangrenous cholecystitis is safe and feasible. There is no advantage to postponing an urgent operation in patients with acute gangrenous cholecystitis.
The American surgeon 04/2011; 77(4):401-6. · 1.28 Impact Factor
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ABSTRACT: Duchenne muscular dystrophy usually affects males. However, females are also affected in rare instances. Approximately 8% of female Duchenne muscular dystrophy (DMD) carriers are manifesting carriers and have muscle weakness to some extent. We investigated the clinical features of 3 female patients with dystrophinopathy diagnosed by clinical, pathological, and genetic studies at our neuromuscular disease clinic. The onset age of manifesting symptoms varied (8-28 years). Muscle weakness grade varied as follows: patient 1 showed asymmetrical bilateral proximal upper and lower extremities weakness, patient 2 showed asymmetrical bilateral upper extremities weakness similar to scapulohumoral muscular dystrophy, and patient 3 had only bilateral asymmetric proximal lower extremities weakness. Two patients had familial histories of DMD (their sons were diagnosed with DMD), but the 1 remaining patient had no familial history of DMD. The serum creatine kinase level was elevated in all patients, but it was not correlated with muscular weakness. An electromyography study showed findings of myopathy in all patients. One patient was diagnosed with a DMD carrier by a muscle biopsy with an immunohistochemical stain (dystrophin). The remaining 2 patients with familial history of DMD were diagnosed by multiplex ligation-dependent probe amplification (MLPA). There were inconsistent clinical features in the female carriers. An immunohistochemical analysis of dystrophin could be useful for female carrier patients. Also, multiplex ligation-dependent probe amplification is essential for the diagnosis of a manifesting female carrier DMD in female myopathic patients because conventional multiplex PCR could not detect the duplication and is less accurate compared to MLPA.
Yonsei medical journal 01/2011; 52(1):192-5. · 0.77 Impact Factor
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ABSTRACT: Claude's syndrome is a distinctive brainstem syndrome characterized by ipsilateral third cranial nerve palsy with contralateral hemiataxia and is due to an intrinsic or extrinsic lesion in the midbrain. We report a case of Claude's syndrome caused by neurocysticercosis infection. A 68 year-old Asian man was admitted to our hospital because of ataxia, left ptosis, and diplopia. Brain magnetic resonance imaging (MRI) showed a cystic lesion in the midbrain, which was surrounded by ring enhancement and peripheral edema. Neurocysticercosis infection was diagnosed by the cerebral spinal fluid study. The patient was treated with albendazole and steroids. A follow-up brain MRI three months later demonstrated the disappearance of a surrounding brain edema and rim enhancement. The most common cause of Claude's syndrome is cerebrovascular disease and malignancy. However, there is no report caused by neurocysticercosis infection. Therefore, if we encounter Claude's syndrome, we should consider neurocysticercosis infection as one of the etiologic factors.
Yonsei medical journal 11/2010; 51(6):978-9. · 0.77 Impact Factor
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ABSTRACT: Central nervous system dysfunction, such as hyperexcitation, irritability, and disturbance of consciousness, may occur in patients with thyrotoxicosis. There are also a few case reports of seizures attributed to thyrotoxicosis. The objective of the present study was to determine the prevalence of seizures that appeared to be related to the thyrotoxic state in patients with thyrotoxicosis.
We retrospectively determined the prevalence and clinical features of seizures in 3382 patients with hyperthyroidism. Among patients with seizures, we excluded those with other causes of seizures or a history of epilepsy. We did not exclude two patients in whom later work-up showed an abnormal magnetic resonance imaging, as their seizures resolved after they became euthyroid.
Among the 3382 patients with hyperthyroidism, there were seven patients (0.2%) with seizures who met our criteria. Primary generalized tonic-clonic seizures occurred in four patients (57%), complex partial seizures with secondary generalized tonic-clonic seizures occurred in two patients (29%), and one patient had a focal seizure (14%). The initial electroencephalography (EEG) was normal in two patients (29%), had generalized slow activity in four patients (57%), and had diffuse generalized beta activity in one patient (14%). On magnetic resonance imaging, one patient had diffuse brain atrophy, and one had an old basal ganglia infarct. After the patients became euthyroid, the EEG was repeated and was normal in all patients. During follow-up periods ranging from 18 to 24 months, none of the patients had seizures.
Hyperthyroidism is the precipitating cause of seizures in a small percentage of these patients. In these patients, the prognosis is good if they become euthyroid. The prevalence of thyrotoxicosis-related seizures reported here can be used in conjunction with the prevalence of thyrotoxicosis in the population to estimate the prevalence of thyrotoxicosis-related seizures in populations.
Thyroid: official journal of the American Thyroid Association 09/2010; 20(9):955-8. · 2.60 Impact Factor
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ANZ Journal of Surgery 09/2010; 80(9):670. · 1.25 Impact Factor
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ABSTRACT: Depth of tumor invasion is an important prognostic factor for gallbladder cancer. The aim of this study was to investigate the clinicopathological prognostic factors of T2 gallbladder cancer.
We retrospectively reviewed the clinicopathological data and survival for 83 patients with T2 gallbladder cancers who underwent surgical resection between January 1995 and December 2007.
The overall survival rates were 48.9% at 3 years and 29.3% at 5 years. Univariate analysis revealed that R0 resection (P < 0.001), extended surgery (P = 0.028), lymph node dissection (P = 0.024), non-infiltrative tumors (P = 0.001), well differentiation (P = 0.001), absence of lymphatic (P = 0.025), perineural (P = 0.001), and vascular (P = 0.025) invasion, absence of lymph node metastasis (P = 0.001), negative resection margin (P = 0.016), and stage (P = 0.002) were significantly better predictors for survival. A significant difference in survival between Rx and R1 was not found. R0 resection, lymph node dissection, well differentiation, and absence of perineural and vascular invasion were significantly independent prognostic factors for overall survival. Recurrence occurred in 48 patients (57.8%). Age older than 65 years, R0 resection, non-infiltrative tumors, and good differentiation were significant independent predictors of disease-free survival by multivariate analysis.
For T2 tumors, radical surgery including lymph node dissection should be performed to achieve R0 resection. Tumors with infiltrative types and suspicious lymph node metastasis in the intraoperative findings were candidates for aggressive surgical management to improve patient survival.
Journal of Gastrointestinal Surgery 04/2010; 14(4):668-78. · 2.83 Impact Factor
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ABSTRACT: Iliopsoas abscesses can be caused by a secondary adjacent infectious source in the bowel. Complicated retroperitoneal abscesses involving the iliopsoas muscle and the lateral abdominal wall can develop as a serious complication of a perforated acute appendicitis. A 73-year-old man with a history of recurrent iliopsoas abscess was referred to our clinic. He had earlier been treated for recurrent right iliopsoas abscess by a percutaneous catheter and operative drainage and antibiotics in another hospital 3 times for 6 years at 2 or 3 year intervals. At the fourth episode, the abscess was proven to be caused by perforated appendicitis on laparoscopic exploration. The main drainage procedure of the abscess, as well as the appendectomy, was performed through a laparoscopic approach.
Surgical laparoscopy, endoscopy & percutaneous techniques 04/2010; 20(2):e69-72. · 1.23 Impact Factor
