Perioperative Outcomes of Different Surgical Methods Among Bladder Cancer Patients Undergoing Radical Cystectomy With Neobladder Urinary Diversion

Purpose@#To compare perioperative outcomes according to surgical methods among bladder cancer patients who underwent radical cystectomy (RC) with neobladder urinary diversion. @*Materials and Methods@#Between June 2007 and January 2020, 89 bladder cancer patients who received RC with neobladder urinary diversion were enrolled in this study. Patients were stratified into surgical methods – (1) open RC with neobladder (ONB) reconstruction, (2) robotassisted RC (RARC) with extracorporeal neobladder (ECNB) reconstruction, and (3) RARC with intracorporeal neobladder (ICNB) reconstruction. Perioperative outcomes were compared among the 3 groups, with major complications defined according to Clavien-Dindo grades III–V within 90 days. Logistic regression analysis was performed to identify significant factors for postoperative complications. @*Results@#Of 89 patients, 28 (31%) had ONB, 31 (35%) had ECNB, and 30 (34%) had ICNB. The median operative time was 471 minutes, and the ICNB group (424.5 minutes) was significantly less than ONB (444.5 minutes) and ECNB groups (542.9 minutes) (p=0.001). Transfusion rate was also significantly less in the ICNB group (13%) (p=0.001). Complications were recorded in 67 patients (75%) and major complications in 22 of all patients (25%). The major complication rate was significantly less in ICNB (13.4%) than in ONB (25%) and ECNB (35%) (p=0.003). Multivariate analysis showed surgical methods (ICNB) (odds ratio [OR], 0.709; p=0.003) and age (OR, 1.150; p=0.001) were significant factors related to occurrence of major postoperative complications. @*Conclusions@#RARC with ICNB reduces postoperative complications compared to ONB and ECNB.

Clinical Outcomes of Surgical Repair with a Composite Graft for Abdominal Aortic Aneurysm Accompanied by Iliac Artery Aneurysm

Background@#Iliac artery aneurysm is frequently found in patients undergoing surgical repair of an abdominal aortic aneurysm. The use of commercial bifurcated grafts is insufficient for aorto-biiliac replacement with complete iliac artery aneurysm resection. We evaluated the effectiveness of handmade composite grafts for this purpose. @*Methods@#A total of 233 patients underwent open surgery for abdominal aortic aneurysm between 2003 and 2019, including 155 patients (67%) treated with commercial grafts and 78 patients (33%) treated with handmade composite grafts. Their operative characteristics, postoperative outcomes, and late outcomes were retrospectively reviewed. @*Results@#The early mortality rate did not differ significantly between the groups. On average, the handmade composite graft technique took approximately 15 minutes longer than the commercial graft technique (p=0.037). Among patients who underwent elective surgery, no significant differences between the conventional and composite groups were observed in the major outcomes, including red blood cell transfusion volume (2.8±4.7 units vs. 3.1±4.7 units, respectively; p=0.680), reoperation for bleeding (2.7% vs. 3.1%, respectively; p>0.999), bowel ischemia (0% vs. 1.6%, respectively; p=0.364), and intensive care unit stay duration (1.9±6.6 days vs. 1.6±2.4 days, respectively; p=0.680). The incidence of target vessel occlusion also did not differ significantly between groups. @*Conclusion@#The increased technical demand involved with handmade composite grafting did not negatively impact the outcomes. This technique may be a viable option because it overcomes problems associated with commercial grafts.

Minimally Invasive Redo Mitral Valve Replacement under Fibrillatory Arrest in a Patient with a Calcified Aorta and Patent Previous Bypass Grafts

A 73-year-old woman who underwent combined bioprosthetic mitral valve replacement, tricuspid ring annuloplasty, and coronary artery bypass grafting 12 years previously visited our clinic due to aggravated dyspnea caused by structural valve deterioration of the mitral prosthesis. Because aortic or femoral artery cannulation and cross-clamping would have a high risk of stroke owing to severe calcification of the ascending aorta and ilio-femoral vessels, and because there was a risk of redo sternotomy due to the patent bypass grafts, a comprehensive approach including axillary artery cannulation, a minimally invasive right thoracotomy approach, and a clampless hypothermic fibrillatory arrest technique was used during redo mitral valve replacement.

Gelidium amansii extract ameliorates obesity by down-regulating adipogenic transcription factors in diet-induced obese mice

BACKGROUND/OBJECTIVES: In this study, we investigated whether Gelidium amansii extract (GAE) ameliorates obesity in diet-induced obese (DIO) mice. MATERIALS/METHODS: The mice were maintained on a high-fat diet (HD) for 5 weeks to generate the DIO mouse model. And then mice fed HD plus 0.5% (GAE1), 1% (GAE2) or 2% (GAE3) for 8 weeks. RESULTS: After the experimental period, GAE-supplemented groups were significantly lower than the HD group in body weight gain and liver weight. GAE supplemented groups were significantly lower than the HD group in both epididymal and mesenteric adipose tissue mass. The plasma leptin level was significantly higher in the HD group than in GAE-supplemented groups. The leptin level of HD+GAE3 group was significantly lower than that of the HD+conjugated linoleic acid (CLA) group. In contrast, plasma adiponectin level of the HD group was significantly lower than those of HD+GAE2 and HD+GAE3 groups. The expression levels of adipogenic proteins such as fatty acid synthase, sterol regulatory element-binding protein-1c, peroxisome proliferator-activated receptor γ, and CCAAT/enhancer binding protein α in the GAE supplemented groups were significantly decreased than those in HD group, respectively. In addition, the expression levels of HD+GAE2 and HD+GAE3 groups are significantly decreased compared to those of HD+CLA group. On the contrary, the expression levels of hormone-sensitive lipase and phospho-AMP-activated protein kinase, proteins associated with lipolysis, were significantly increased in the GAE supplemented groups compared to those in the HD group. HD+GAE3 group showed the highest level among the GAE supplemented groups. CONCLUSIONS: These results suggested that GAE supplementation stimulated the expressions of lipid metabolic factors and reduced weight gain in HD-fed C57BL/6J obese mice.

Extra-Anatomic Ascending Aorta to Abdominal Aorta Bypass in Takayasu Arteritis Patients with Mid-Aortic Syndrome

BACKGROUND: We evaluated the operative outcomes of an extra-anatomic bypass from the ascending aorta to the abdominal aorta in patients with type II or III Takayasu arteritis (TA) with mid-aortic syndrome. METHODS: From 1988 to 2014, 8 patients with type II (n=2) or III (n=6) TA underwent an ascending aorta to abdominal aorta bypass. The mean patient age was 43.5±12.2 years and the mean peak pressure gradient between the upper and lower extremities was 54.8±39.0 mm Hg. The median follow-up duration was 54.4 months (range, 17.8 to 177.4 months). RESULTS: There were no cases of operative mortality. The mean peak pressure gradient significantly decreased to −2.4±32.3 mm Hg (p=0.017 compared to the preoperative value). Late death occurred in 2 patients. The symptoms of upper extremity hypertension and claudication improved in all patients. The bypass grafts were patent at 47.1±58.9 months in 7 patients who underwent follow-up imaging studies. CONCLUSION: An extra-anatomic ascending aorta to abdominal aorta bypass could be an effective treatment option for severe aortic steno-occlusive disease in patients with type II or III TA, with favorable early and long-term outcomes.

Indentation in the Right Ventricle by an Incomplete Pericardium on 3-Dimensional Reconstructed Computed Tomography

We report the case of a 17-year-old girl who presented with an indentation in the right ventricle caused by an incomplete pericardium on preoperative 3-dimensional reconstructed computed tomography. She was to undergo surgery for a partial atrioventricular septal defect and secundum atrial septal defect. Preoperative electrocardiography revealed occasional premature ventricular beats. We found the absence of the left side of the pericardium intraoperatively, and this absence caused strangulation of the diaphragmatic surface of the right ventricle. After correcting the lesion, the patient’s rhythm disturbances improved.

Cardiac Resynchronization Therapy Defibrillator Treatment in a Child with Heart Failure and Ventricular Arrhythmia

Cardiac resynchronization therapy (CRT) is a new treatment for refractory heart failure. However, most patients with heart failure treated with CRT are adults, middle-aged or older with idiopathic or ischemic dilated cardiomyopathy. We treated a 12-year-old boy, who was transferred after cardiac arrest, with dilated cardiomyopathy, left bundle-branch block, and ventricular tachycardia. We performed cardiac resynchronization therapy with a defibrillator (CRT-D). After CRT-D, left ventricular ejection fraction improved from 22% to 44% assessed by echocardiogram 1 year postoperatively. On electrocardiogram, QRS duration was shortened from 206 to 144 ms. The patient's clinical symptoms also improved. For pediatric patients with refractory heart failure and ventricular arrhythmia, CRT-D could be indicated as an effective therapeutic option.

A Case of Penile Cutaneous Metastasis from Gastric Carcinoma / 대한피부과학회지

Metastatic carcinoma of the penis is rare and in most cases is associated with primary malignancy of the pelvic organs with widespread metastasis. A 64-year-old man presented with a 2 month history of skin-colored papules on his penis. He also had a history of total gastrectomy and chemotherapy due to advanced gastric carcinoma. Skin biopsy from the lesion revealed atypical polygonal cells with hyperchromatic & pleomorphic nuclei in the dermis. Results of immunohistochemical staining showed a positive reaction of CK7, and a negative reaction of CK20, PSA, and CD68. We report herein a case of metastatic cancer of the penis from gastric carcinoma.

Phosphatidylcholine Formula for the Treatment of Lipoma / 대한피부과학회지

BACKGROUND: Lipomas are benign neoplasms composed of mature fat cells. Current treatments are invasive and carry the risk of scarring. For this reason, phosphatidylcholine (PPC) formula has been widely used to treat areas of localized fat accumulation. However, there are few reports on injection lipolysis with injection of PPC formula. OBJECTIVE: The purpose of this study was to investigate whether injection lipolysis with PPC formula is an effective therapeutic option for patients with lipoma. METHODS: Twenty-two lipomas in 7 patients were included. Three sessions at intervals of 6 to 8 weeks were done. Sonographic measurements of lipoma size were repeated before each session. Any side-effects and the patients' satisfaction were noted. In one lipoma, histological changes after lipolysis were described. RESULTS: After three sessions, a significant reduction in lipoma size of 47.4% was achieved. Histology showed a fibrosis with loss of adipocytes. Inflammation occurred in one case, so the patient was excluded from this study. Transient burning sensation and swelling at the injection site were the most common adverse effects. No severe side-effects or systemic reactions were observed. CONCLUSION: Treatment of lipoma with PPC formula has the potential to be a patient-friendly and well-tolerated therapy that can achieve cosmetically pleasing treatment outcomes.

A Case of Syringoma Confined to Both Forearms and the Dorsa of the Hands / 대한피부과학회지

Syringomas confined to the distal extremities are very rare. A 62-year-old man presented with an 8-month history of multiple, light brown, flat-topped papules on both forearms and the dorsa of the hands. Histopathologic examination showed multiple dilated eccrine ducts lined by two rows of epithelial cells. There has currently been less than 10 reported cases of syringoma confined to both forearms and the dorsa of the hands in the world medical literature.

A Clinical Study of Self-Inflicted Dermatosis / 대한피부과학회지

BACKGROUND: Self-inflicted dermatosis is a kind of self-inflicted skin disease. Most Vietnam veterans from Korea have visited the Veterans Hospitals for dermatological examination to determine the relationship between their skin diseases and Agent Orange. We were suspicious of the possibility that several Vietnam veterans intentionally produced their own skin lesions. OBJECTIVE: We conducted this study to determine the clinical characteristics of self-inflicted dermatoses of Korean Vietnam veterans. METHODS: From January, 1999 to December, 2007, a total 24 Vietnam veterans who were diagnosed as having self-inflicted dermatoses during their dermatological examinations at our hospital were included in this study. We investigated their clinical presentation, the laboratory examinations, the pathologic examinations, the medical records and the associated diseases. RESULTS: Itching was the most common subjective complaint and the duration of the itching was as follows; 20 to 30 yrs (50.0%), 1 to 10 yrs (25.0%), 10 to 20 yrs (20.8%) etc. The skin lesions were all multiple, and the involved area was as follows; upper extremities (83.3%), trunk (75.0%), lower extremities (70.8%) etc. There were two categories of clinical skin presentation. The first was the cases with lesion that were thought to be made by physical trauma such as stinging or excoriation, and the second more common cases had lesions that were thought to be made by chemical agents (70.8%). These cases resembled allergic or toxic irritant dermatitis and the lesions were composed of vesicles, erosions, ulcers and crusts that were within an arm's reach. Only 4 cases admitted to intentionally inflicting their skin lesions because of intense itching, and the others denied that they made the skin lesions by themselves. Skin biopsies were carried out in 19 of the total 24 cases, and the most common finding was spongiotic dermatitis (57.8%). CONCLUSION: This study showed the distribution and characteristics of self-inflicted dermatoses, and the study provides fundamental data for dermatologists to assess patients with self-inflicted dermatoses.

A Case of Malignant Fibrous Histiocytoma That Metastasized to the Skin / 대한피부과학회지

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma. It is regarded as an undifferentiated pleomorphic sarcoma with an unproven histogenesis. It most commonly occurs in the skeletal muscles of the extremities or the retroperitoneum of adults. It often metastasizes to the lungs, lymph nodes, bones and liver, but rarely to the skin. We report here a case of malignant fibrous histiocytoma that metastasized to the skin.

A Case of Leukocytoclastic Vasculitis after Use of Sorafenib (Nexavar(R)) / 대한피부과학회지

Sorafenib (Nexavar(R)) is an oral multikinase inhibitor that was recently approved for use in metastatic renal cancer. It is currently undergoing investigation for the treatment of locally advanced renal cancer and in other tumor types. It has a broad spectrum of activity in treating multiple tyrosine kinases, including angiogenic factors VEGFR and PDGFR. Common cutaneous toxicities experienced with sorafenib include facial and scalp erythema, hand-foot syndrome, splinter hemorrhages, and alopecia. We report a case of a 57 year-old man diagnosed as renal cell carcinoma with distant metastaisis, who developed a leukocytoclastic vasculitis on the extremities after use of sorafenib.

A Case of Pseudoangiomatous Spindle Cell Lipoma / 대한피부과학회지

Spindle cell lipoma, an entity first described in 1975, accounts for about 1.5% of adipocytic neoplasms and is outnumbered by conventional benign lipomas by approximately 60 to 1. We report an unusual pseudoangiomatous variant of spindle cell lipoma on the right thigh of a 78-year-old man. The lesion had the features of typical spindle cell lipoma which was composed of mature fat cells and uniform spindle cells in a mucoid matrix with collagen bundles. In addition, the lesion exhibited irregular, branching spaces with villiform connective tissue projections, giving a striking angiomatoid appearance. Immunohistochemically, the spindle cells were positive for CD34, and lining cells of pseudoangiomatous spaces were negative for CD31, factor VIII-Ag.

A Case of Borderline Tuberculoid Leprosy with Type 1 Reaction / 대한피부과학회지

While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. We report a case of leprosy type 1 reaction as the first manifestation of borderline tuberculoid leposy. The patient was a 71-year-old woman who had never received treatment for leprosy. She developed multiple erythematous, swollen lesions on has face, extremities and trunk within a few weeks and suffered from paresthesia, numbness and tenderness on those sites. General symptoms were accompanied by fever, malaise, fatigue and loss of appetite. Histological examination revealed multiple tuberculoid granulomas along with neurovascular bundles. A few acid-fast bacilli were detected on AFB stain. The disease was classified as borderline tuberculoid leprosy. The acute neuritis followed by skin lesions represented leprosy with type 1 reaction.

A Case of Scalp Metastasis Manifested as the Presenting Sign of Thyroid Carcinoma / 대한피부과학회지

Cutaneous metastasis from the papillary thyroid carcinoma is rare. An otherwise asymptomatic 57-year-old man presented with a 3 year history of a steadily-enlarging scalp nodule. The histopathologic features showed a complicated pattern of follicular architecture formed by papilliform fibrovascular stroma. The tumor cells stained positive for thyroglobulin. A subsequent thyroid sonogram revealed multiple nodules in both lobes and resection of the thyroid gland identified papillary thyroid carcinoma. The solitary scalp nodule was presenting sign of an occult thyroid carcinoma. We report a case of cutaneous metastasis from the papillary thyroid carcinoma.

Patterns of Serum Interleukin-6 Concentration after Initial Successful Cardiopulmonary Resuscitation

OBJECTIVE: To investigate patterns of serial serum interleukin-6(IL-6) concentrations after initial successful cardiopulmonary resuscitation, and to access differences in serum IL16 concentrations in patients with Cerebral Performance Category(CPC, 1-2) and CPC(3-5) at the 5th day after cardiacpulmonary resuscitation(CPR). METHODS: We studied prospectively 12 patients with spontaneous circulation after cardiopulmonary resuscitation. Venous blood samples were taken 2,4,12,24,48 and 72 hours after restoration of spontaneous circulation to measure serum IL-6 levels by the enzyme-linked immunosorbent assay. RESULTS: Serum IL-6 concentrations in the severe neurologically disabled group(CPC, 3-5) were significantly increased at 2, 24 and 48 hours after restoration of spontaneous circulation compared with the less neurolgically disabled group. Also, serum IL-6 concentrations in the severe neurologic disabled group showed dual peak at 4 and 24 hours. CONCLUSION: Our study demonstrates significant incense of seam IL-6 in patients with CPC(3-5) after successful cardiopulmonary resuscitation and the significant correlation between early increase of serum IL-6 and poor neurologic outcome. It suggests that early increase of serum IL-6 can be used as a prognostic marker after successful cardiopulmonary resuscitation.