A Case of Complete Remission from Pancreatic Cancer Following Palliative Chemotherapy / 대한췌담도학회지

The prognosis for pancreatic cancer is still poor with a 5-year survival rate around 10%. We report a case of complete remission after palliative chemotherapy for pancreatic cancer in a 61-year-old-female. She presented with indigestion and weight loss. A computed tomography scan revealed a 1.8 cm mass in the pancreatic head. Carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) levels were elevated. The patient underwent endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) and the pathologic examination showed adenocarcinoma. Positron emission tomography (PET) and magnetic resonance imaging (MRI) of the pancreas showed a metastatic nodule in the S6 segment of the liver and a metastatic portocaval lymph node. The final diagnosis was stage IV pancreatic cancer. The patient received 24 cycles of palliative FOLFIRINOX regimen. Response evaluation demonstrated disappearance of all the lesions. She underwent pyloruspreserving pancreatoduodenectomy (PPPD). The pathologic examination of the surgical specimen showed complete remission of the pancreatic cancer. The patient is currently undergoing adjuvant chemotherapy.

Effectiveness and Biocompatibility of Decellularized Nerve Graft Using an In Vivo Rat Sciatic Nerve Model

BACKGROUND@#Decellularized nerve allografting is one of promising treatment options for nerve defect. As an effort to develop more efficient nerve graft, recently we have developed a new decellularization method for nerve allograft. The aim of this study was to evaluate the effectiveness and biocompatibility of nerve graft decellularized by our newly developed method. @*METHODS@#Forty-eight inbred male Lewis rats were divided into two groups, Group I (autograft group, n = 25), Group II (decellularized isograft group, n = 23). Decellularized nerve grafts were prepared with our newly developed methods using amphoteric detergent and nuclease treatment. Serum cytokine level measurements at 0, 2, and 4 weeks and histologic evaluation for inflammatory cell infiltration at 6 and 16 weeks after nerve graft. @*RESULTS@#There was no significant difference in mean maximum isometric tetanic force and weight of tibialis anterior muscle or ankle angle at toe-off phase between two groups at 6 and 16 weeks survival time points (p > 0.05). There was no inflammatory cell infiltration in either group and histomorphometric assessments of 6- and 16-week specimens of the isograft group did not differ from those in the autograft group with regard to number of fascicle, cross sectional area, fascicle area ratio, and number of regenerated nerve cells. @*CONCLUSION@#Based on inflammatory reaction, axonal regeneration, and functional outcomes, our newly developed decellularized nerve grafts were fairly biocompatible and had comparable effectiveness to autografts for nerve regeneration, which suggested it would be suitable for nerve reconstruction as an alternative to autograft.

Effectiveness and Biocompatibility of Decellularized Nerve Graft Using an In Vivo Rat Sciatic Nerve Model

BACKGROUND@#Decellularized nerve allografting is one of promising treatment options for nerve defect. As an effort to develop more efficient nerve graft, recently we have developed a new decellularization method for nerve allograft. The aim of this study was to evaluate the effectiveness and biocompatibility of nerve graft decellularized by our newly developed method. @*METHODS@#Forty-eight inbred male Lewis rats were divided into two groups, Group I (autograft group, n = 25), Group II (decellularized isograft group, n = 23). Decellularized nerve grafts were prepared with our newly developed methods using amphoteric detergent and nuclease treatment. Serum cytokine level measurements at 0, 2, and 4 weeks and histologic evaluation for inflammatory cell infiltration at 6 and 16 weeks after nerve graft. @*RESULTS@#There was no significant difference in mean maximum isometric tetanic force and weight of tibialis anterior muscle or ankle angle at toe-off phase between two groups at 6 and 16 weeks survival time points (p > 0.05). There was no inflammatory cell infiltration in either group and histomorphometric assessments of 6- and 16-week specimens of the isograft group did not differ from those in the autograft group with regard to number of fascicle, cross sectional area, fascicle area ratio, and number of regenerated nerve cells. @*CONCLUSION@#Based on inflammatory reaction, axonal regeneration, and functional outcomes, our newly developed decellularized nerve grafts were fairly biocompatible and had comparable effectiveness to autografts for nerve regeneration, which suggested it would be suitable for nerve reconstruction as an alternative to autograft.

Life-Threatening Acute on Chronic Pulmonary Thromboembolism Requiring Extracorporeal Membrane Oxygenation

A 71-year-old female patient was admitted to the emergency department with sudden aggravation of chest pain and severe dyspnea. Computed tomography showed extensive pulmonary thromboembolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was instituted due to sudden bradycardia and hypotension. An emergency operation was performed. However, chronic pulmonary thromboembolism combined with an acute pulmonary embolism was detected in the operating room. Embolectomy and endarterectomy were performed. ECMO was then discontinued. The patient was discharged on postoperative day 13 with warfarin for anticoagulation. The patient was followed up for 46 months as an outpatient without further thromboembolic events.

New Recorded Species in Three Genera of the Sordariomycetes in Korea

In an ongoing survey of Korean indigenous fungi, three fungal strains belonging to the Sordariomycetes were isolated from soil samples. These strains were designated KNU16-001, KNU16-002, and KNU16-009, and identified as Ambrosiella grosmanniae, Acremonium sclerotigenum, and Trichocladium asperum, respectively, based on morphological characterization and phylogenetic analysis using internal transcribed spacer region sequences of ribosomal DNA. This is the first report of these species in Korea.

Relationship Between Cognitive Perceptual Abilities and Accident and Penalty Histories Among Elderly Korean Drivers

OBJECTIVE: To investigate the relationship between cognitive perceptual abilities of elderly drivers based on the Cognitive Perceptual Assessment for Driving (CPAD) test and their accident and penalty histories. METHODS: A total of 168 elderly drivers (aged ≥65 years) participated in the study. Participant data included CPAD scores and incidents of traffic accidents and penalties, attained from the Korea Road Traffic Authority and Korea National Police Agency, respectively. RESULTS: Drivers' mean age was 70.25±4.1 years and the mean CPAD score was 52.75±4.72. Elderly drivers' age was negatively related to the CPAD score (p<0.001). The accident history group had marginally lower CPAD scores, as compared to the non-accident group (p=0.051). However, incidence rates for traffic fines did not differ significantly between the two groups. Additionally, the group that passed the CPAD test had experienced fewer traffic accidents (3.6%), as compared to the group that failed (10.6%). The older age group (12.0%) had also experienced more traffic accidents, as compared to the younger group (2.4%). CONCLUSION: Overall, elderly drivers who experienced driving accidents had lower CPAD scores than those who did not, without statistical significance. Thus, driving-related cognitive abilities of elderly drivers with insufficient cognitive ability need to be further evaluated to prevent traffic accidents.

A Case of Intrahepatic Sarcomatoid Cholangiocarcinoma Mimicking Liver Abscess / 대한췌담도학회지

Sarcomatoid transformation of intrahepatic cholangiocarcinoma is rarely found but usually has very poor prognosis due to the lack of effective approaches for early detection and its aggressive nature. We report a case of this tumor type, in a 60-year-old man who was referred to our hospital for further evaluation of screening-detected, asymptomatic hepatic lesion. Clinical diagnosis was elusive despite performance of different imaging modalities and a transcutaneous liver biopsy. Pathology of the surgically resected tumor demonstrated intrahepatic sarcomatoid cholangiocarcinoma. In our case, tumor cells expressed strong immunoreactivity to both cytokeratin-19 and vimentin. We assume the relatively good prognosis of this patient would be expected because surgery played a critical role at an early stage of the tumor.

Combination of TRAP1 and ERCC1 Expression Predicts Clinical Outcomes in Metastatic Colorectal Cancer Treated with Oxaliplatin/5-Fluorouracil / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The novel heat shock protein tumor necrosis factor receptor-associated protein 1 (TRAP1) is associated with multidrug resistance in colorectal cancer (CRC) cells in vitro. Excision repair cross-complementation group 1 (ERCC1) expression levels in tumor tissues also predict clinical outcomes in metastatic CRC patients receiving combination oxaliplatin and 5-fluorouracil treatment. We investigated whether TRAP1 and ERCC1 protein expression by immunohistochemistry predict clinical outcomes in CRC patients. MATERIALS AND METHODS: The study population consisted of 56 patients with metastatic CRC who received first-line oxaliplatin/5-fluorouracil therapy. Clinical response and overall survival (OS) by levels of the markers TRAP1 and ERCC1 were evaluated. RESULTS: The rates of TRAP1 and ERCC1 expression were 21% and 52%, respectively. Patients negative for ERCC1 expression showed a tendency to respond to chemotherapy (p=0.066). Median OS was significantly longer in patients negative for TRAP1 than those positive for TRAP1 (p=0.023). Patients negative for ERCC1 expression also had a better OS than those positive for ERCC1 (p=0.021). The median OS was 30.9 months for patients negative for TRAP1 and ERCC1 compared to 13.2 months for those positive for TRAP1 and/or positive for ERCC1 expression (p=0.006). The combination of TRAP1 and ERCC1 expression was significantly associated with the response to chemotherapy (p=0.046) and independently predicted median OS in multivariate analysis (hazard ratio, 2.98; 95% confidence interval, 1.18 to 7.49). CONCLUSION: The present study demonstrates that the combination of TRAP1 and ERCC1 expression predicts the survival of metastatic CRC patients who were treated with oxaliplatin/5-fluorouracil.

Coronary artery vasospasm after atrial septal defect surgery / 영남의대학술지

Coronary vasospasm is one of the fatal complications that may occur in patients undergoing open heart surgery. To date, however, there are not many cases in this series and no definite pathophysiology has been documented. We experienced a case of coronary artery vasospasm after atrial septal defect (ASD) surgery and then successfully treated it with both transbrachial intra-aortic balloon pump and percutaneous cardiopulmonary support. Only several hours after ASD surgery, the patient exhibited the cardiovascular collapse, the ST-segment elevation, followed by ventricular fibrillation and normal coronary angiography findings. It is important to make a differential diagnosis of coronary artery vasospasm in patients presenting with ST-segment elevation who had no notable coronary artery diseases. This case indicates that clinicians should be aware of the possibility that the coronary artery vasospasm may also occur in patients undergoing ASD surgery.

Epidural Dexamethasone Decreased Inflammatory Hyperalgesia and Spinal cPLA2 Expression in a Rat Formalin Test

PURPOSE: The aim of this study was to investigate the effect of epidural dexamethasone on analgesia and cytosolic phospholipase A2 (cPLA2) expression in the spinal cord in a rat formalin test. MATERIALS AND METHODS: Epidural dexamethasone injection was performed to Sprague-Dawley rats with a 25 gauge needle under fluoroscopy. Following the epidural injection, a formalin induced pain behavior test was performed. Next, the spinal cords corresponding to L4 dorsal root ganglion was extracted to observe the cPLA2 expression. RESULTS: There were no differences in pain response during phase I among the groups. The phase II pain response in 300 microg of epidural dexamethasone group decreased as compared to control, 30 microg of epidural dexamethasone, 100 microg of epidural dexamethasone, and 300 microg of systemic dexamethasone groups. The expression of cPLA2 decreased in Rexed laminae I-II in 300 microg of the epidural dexamethasone group compared with the ones in the control group. CONCLUSION: Taken together, these results suggest that 300 microg of epidural dexamethasone has an attenuating effect on the peripheral inflammatory tissue injury induced hyperalgesia and this effect is mediated through the inhibition of intraspinal cPLA2 expression and the primary site of action is the laminae I-II of the spinal cord.

Hydromorphone attenuates intercellular adhesion molecule-1 expressions induced by lipopolysaccharide on HCT-116 human colon cancer cells / 대한마취과학회지

No abstract available.

Plasma volume expanders: classification and characteristics of colloids

Fluid therapy remains an important therapeutic maneuver in managing surgical, medical, and the critically ill intensive care patient. However, the ideal volume replacement strategy remains under debate. The debate on whether patients should be managed with crystalloids, colloids, or both has for many years been mainly a debate about effectiveness. The dispute over crystalloids versus colloids has been enlarged to a colloid versus colloid debate because of the varying properties of different colloids. The natural colloid albumin and artificial colloids such as gelatin, dextran, and hydroxyethyl starch continue to enjoy widespread usage for clinical fluid management. Colloid is an effective plasma volume expander and is able to restore the hemodynamic profile with less total volume than crystalloid. However, colloid is associated with coagulation abnormalities, renal impairment, and allergic reactions. Albumin is considered to be one of the safe colloids. However, due to its cost, albumin cannot be recommended for hypovolemia. Gelatin and dextran can also cause coagulation abnormalities and renal impairment. Dextran is not used anymore due to its high anaphylactic potency. Each hydroxyethyl starch has different properties by concentration, mean molecular weight, molar substitution, and its C2/C6 ratio. New hydroxyethyl starches with a lower mean molecular weight and molar substitution than the old hydroxyethyl starch may be promising by improving volume management therapy with lower risks of coagulation abnormalities and renal impairment. The selection of colloid for plasma volume expansion should be based on the patients' clinical conditions and the characteristics of each colloid.

Repeat Vertebroplasty for the Subsequent Refracture of Procedured Vertebra

Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the 1st and 4th (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.

Fiberoptic intubation through a laryngeal mask airway as a management of difficult airwary due to the fusion of the entire cervical spine: A report of two cases / 대한마취과학회지

Patients with cervical spine instability and limited range of motion are challenge to anesthesiologists. It is important to consider alternatetive methods for securing the airway while maintaining neutral position and minimizing neck motion, because these patients are at increased risk for tracheal intubation failure and neurologic injury during airway management or position change. We experienced two cases that patients had cervical spine instability and severe limited range of motion due to the fusion of the entire cervical spine. One patient was a 6-year-old girl weighing 12.7 kg and had Klippel-Feil syndrome with Arnold-Chiari malformation, the other was a 24-year-old female weighing 31 kg and had juvenile rheumatoid arthritis. We successfully performed the intubation by using the fiberoptic intubation though a laryngeal mask airway in these two cases.

A Research Using PHQ-15 on the Somatic Symptoms of the First Visiting Patients with Depressive Disorder at a University Hospital

OBJECTIVES: Somatic symptoms are mostly accompanied with depression and the evaluation about the aspect of somatic symptoms of depressive patients helps diagnose, treat and the prognosis. This clinical study was performed to acquire the characteristics of somatic symptoms of depression and their relations with other factors. METHODS: The PHQ-15 was administered to analyze the aspect and the frequency of somatic symptoms among depressive patients. In addition, the associations between the PHQ-15 score and BDI score, GARS score, sociodemographic factors and clinical characteristics were analyzed. RESULTS: Of 201 patients, fatigue (93.6%) and sleep difficulty (81.7%) included in DSM-IV depression diagnosis category showed the most frequency. A headache (68.4%), gastrointestinal symptoms (79.8%) and unspecific pain (91.6%) were highly reported. PHQ-15 total score was significantly associated with female patients, blue-collar workers and unemployed state, higher GARS score, and the case consulted by other physicians. However, it was not significantly associated with the age. CONCLUSION: In this study, headaches were significantly more common than gastrointestinal symptoms among patients with depression, and these findings suggest changes of somatic symptoms tendency of depressive patients in South Korea. A severity of somatic symptoms were associated with the female, high GARS score, blue-collar workers and at the case consulted by other physicians. In conclusion, the materials from PHQ-15 in somatic symptoms are valuable to diagnose and treat depressive patients.

Effect of continuous psoas compartment block and intravenous patient controlled analgesia on postoperative pain control after total knee arthroplasty / 대한마취과학회지

BACKGROUND: Total knee arthroplasty (TKA) generates severe postoperative pain in 60% of patients and moderate pain in 30% of patients. Because inadequate postoperative pain control can hinder early physiotherapy and rehabilitation, it is the most influential factor dictating a good outcome. The purpose of this study was to evaluate the effectiveness of continuous psoas compartment block (PCB) in comparison to intravenous patient-controlled analgesia (IVPCA) in TKA patients. METHODS: 40 TKA patients were randomly divided into 2 groups. Group IVPCA (n = 20) received intravenous patient controlled analgesia (IVPCA) for 48 hours. Group PCB (n = 20) received continuous PCB for 48 hours at the fourth intertransverse process of the lumbar using the C-arm. Pain scores, side effects, satisfaction, the length of hospital stay, rescue antiemetics, and analgesics were recorded. RESULTS: Pain scores (VNRS 0-100) were higher in Group IVPCA than in Group PCB. Nausea and sedation occurred more frequently in Group IVPCA than in Group PCB. There were no differences between the groups in the length of the hospital stay, satisfaction scores, and the use of rescue antiemetics and analgesics. CONCLUSIONS: Continuous PCB seemed to be an appropriate and reliable technique for TKA patients, because it provided better analgesia and fewer side effects such as nausea and sedation when compared to IVPCA.

Spontaneous Vertebral Reduction during the Procedure of Kyphoplasty in a Patient with Kummell's Disease

Kummell's disease is a spinal disorder characterized by delayed post-traumatic collapse of a vertebral body with avascular necrosis. Although definitive treatment for Kummell's disease has not been established, it has been reported that percutaneous vertebroplasty or kyphoplasty has shown good results. However, these procedures are not recommended for severely collapsed vertebral bodies because of the risk of cement leakage or technical difficulties. Authors report a rare case of spontaneous reduction in vertebral height by the insertion of a working cannula into the vertebral body in Kummell's disease.

A Case of Infected Left Atrial Myxoma With Concomitant Mitral Valve Endocarditis

Myxoma is the most common primary tumor in the heart. Cardiac myxomas can present in various manners including embolization and fever, sometimes simulating endocarditis. However, they are rarely infected. We report here a case of an infected left atrial myxoma that seeded a normal mitral valve and atypically presented with multiple embolic events in the lower extremities along with multiple splenic and a cerebellar infarction.

Long-term outcomes of a 5-year follow up of patients with immune thrombocytopenic purpura after splenectomy / 대한혈액학회지

BACKGROUND: The long-term outcomes of adult patients with immune thrombocytopenic purpura (ITP) after splenectomy are not clear. METHODS: We retrospectively analyzed 31 patients who underwent splenectomy after diagnosis of ITP at our institution between 1990 and 2009. Long-term follow-up was defined as a follow-up that lasted 1 year or more from splenectomy to the last follow-up. RESULTS: The overall response rate to splenectomy was 84%. However, the response rate at 6 and 12 months decreased to 77% and 68%, respectively. During the 6 years of median follow-up after splenectomy, 11 patients (35%) relapsed. The long-term response rate was 55%. The long-term follow-up of 26 patients after responding to splenectomy showed that the median time from splenectomy to relapse was 19 months in the partial response (PR) group; however, there was no relapse after 9 months in the complete response (CR) group. Variables, including age, were not predictive of the long-term response after splenectomy. Additional treatment in patients who did not respond or relapsed after splenectomy was mostly effective. After a median follow-up of 7 years (range: 1-25 years) from the diagnosis, there were 2 deaths, including one due to spontaneous bleeding after repair of duodenal ulcer perforation. CONCLUSION: Although splenectomy is safe and effective, the response rate after splenectomy continuously decreases over time. The duration of response is different between the patients that achieved CR and those that achieved PR. Factors, including age, were not predictors of a response to splenectomy.

Nephrotic Syndrome Disappeared after Gemcitabine Combination Therapy in a Patient with Progressive Non-small Cell Lung Cancer / 대한신장학회지

Nephrotic syndrome has been reported to accompany a malignancy. Since the first case of the nephrotic syndrome associated with extra-renal malignancy was reported in 1922, only a few cases of nephrotic syndrome accompanying other malignancies have been reported. Previous reports on such cases indicated a pattern of improvement in nephropathy as malignancy improved. But the cases of resolved nephropathy with aggravated cancer have scarcely been documented. Here we report a case of a 69 year-old male with nephrotic syndrome accompanying non-small cell lung cancer, whose proteinuria was normalized after chemotherapy while his cancer was aggravated.