Prognostic Factors of Atypical Meningioma: Overall Survival Rate and Progression Free Survival Rate

OBJECTIVE: Atypical meningioma is rare tumor and there is no accurate guide line for optimal treatment. This retrospective study analyzed the prognostic factors, the effect of different methods of treatments and the behavior of atypical meningioma. METHODS: Thirty six patients were diagnosed as atypical meningioma, among 273 patients who were given a diagnosis of meningioma in the period of 2002 to 2015. Age, gender, tumor location, Ki 67, Simpson grade and treatment received were analyzed. We studied the correlation between these factors with recurrence, overall survival rate and progression free survival. RESULTS: Median overall survival time and progression free survival time are 60 and 53 (months). Better survival rate was observed for patients less than 50 years old but with no statistical significance (p=0.322). And patients with total resection compared with subtotal resection also showed better survival rate but no statistical significance (p=0.744). Patients with a tumor located in skull base compared with patients with a tumor located in brain convexity and parasagittal showed better progression free survival (p=0.048). Total resection is associated with longer progression-free survival than incomplete resection (p=0.018). CONCLUSION: We confirmed that Simpson grade was significant factor for statistically affect to progression free survival in univariate analysis. In case of skull base atypical tumor, it is analyzed that it has more recurrence than tumor located elsewhere. Overall survival was not affected statistically by patient age, gender, tumor location, Ki 67, Simpson grade and treatment received in this study.

Pancreaticopleural Fistula Treated by Endoscopic Pancreatic Stenting in a Patient with Recurrent Pancreatitis / 대한내과학회지

Pancreatic duct disruption associated with pancreatitis can lead to the development of pseudocysts, pancreatic ascites, and pleural effusion. A 50-year-old male presented with a 1-month history of postprandial epigastric pain. A chest X-ray showed right pleural effusion. Diagnostic thoracentesis revealed an amylase-rich exudate consistent with pancreatic effusion. Magnetic resonance cholangiopancreatography demonstrated a pancreaticopleural fistula tract, and endoscopic retrograde pancreatography confirmed the presence of pancreatic ductal disruption and leakage at the genu portion. The pancreaticopleural fistula was treated by transpapillary pancreatic stenting. Percutaneous drainage of the pleural effusion and octreotide injection were also performed. Follow-up endoscopic retrograde pancreatography at 8 weeks revealed no leakage of contrast media from the main pancreatic duct. Endoscopic pancreatic stenting can be an efficacious nonsurgical treatment of pancreaticopleural fistula following pancreatitis.

A Case of Duodenal Brunner's Gland Adenoma Treated by Endoscopic Rescetion / 영남의대학술지

Brunneroma, also known as Brunner's gland adenoma or harmatoma, is a very rare benign tumor of the duodenum, which is usually asymptomatic, and is discovered incidentally during endoscopic exam. These lesions are most commonly located in the duodenal bulb and clinical manifestations are variable. We report on a case of a large Brunner's gland adenoma in a 54-year-old man, which was successfully removed by endoscopic resection without complications, such as bleeding or perforation. Microscopically, it was composed entirely of variable Brunner's gland.

Therapy by traditional veterinary medicine in a case with canine fibrocartilaginous embolic myelopathy / 대한수의학회지

A 6-year old, female, Schnauzer dog with chief complaint of tetraparesis was referred to the Veterinary Medicine Teaching Hospital of Chungnam National University. On physical examination, neulologic examinations and magnetic resonance imaging, this patient was diagnosed into fibrocartilaginous embolic myelopathy. Although conventional treatment such as prednisolone, cefotaxime and enrofloxacin revealed no improvement, this patient showed favorable therapeutic response by combined therapy with aquapuncture with prednisolone, modified moxibustion, herbal medicine and massage.

A Case of Primary Rectal Colon Mucosa associated Lymphoid Tissue Lymphoma / 영남의대학술지

The gastrointestinal tract(GI) is the most frequently involved site of mucosa associated lymphoid tissue (MALT) lymphoma. Stomach is the most common site of involvement among the GI tract. In some case of MALT lymphoma, it is detected in colon. Almost all diagnosis is established by pathological examination of the surgical or endoscopic specimens. We reported a case of rectal MALT lymphoma by colonoscopic polypectomy.

A Case of Spine Origin Chondroblastoma Metastasis to Lung / Journal of the Korean Cancer Association, 대한암학회지

Chondroblastoma is a rare benign cartilaginous neoplasm that accounts for approximately 1% of all bone tumors and characteristically arises in the epiphysis of a long bone, particularly the humerus, tibia, and femur. Chondroblastoma can affect people of all ages. It is, however, most common in children and young adults between the ages of 10 and 20 years. Although most chondroblastomas are cured by limited surgical procedures, occasional lesions behave more aggressively and may even metastasis. In this case a young man with pulmonary metastatic chondroblastoma on spine is presented. Unlike previously published examples of metastatic chondroblastoma, these metastasis developed before any operative manipulation of the primary tumor. And primary tumor site was also unusual. The histologic characteristics of the primary, metastatic tumors were those of a conventional chondroblastoma.

Application of Advance Directives for Patients with End Stage Renal Disease / 대한신장학회지

PURPOSE: In other countries, government guidelines related to chronic illness are being used to enhance supportive care of renal patients. In Korea, the number of old ages and hemodialysis patients with many complications has been increased. But we don't have any guidelines for palliative care of end stage renal disease. This paper reports a study exploring decisions about end-of-life treatment (e.g. cardiopulmonary resuscitation, renal replacement therapy) via routine use of advance directives in people with end stage renal disease undergoing hemodialysis. METHODS: 1) We revised advance directives in Seoul Medical Center. 2) We recommended the routine use of advance directives to patients who were treated in hemodialysis room of Seoul Medical Center from Jan, 2007 to Jun, 2007. So 35 patients were enrolled. 3) They had been interviewed about end- of-life treatment plans and filled up advance directives. RESULTS: 23 males and 12 females in total were enrolled. The advance directives include 18 questions about patient preferences for treatment of end-of-life. The majority of hemodialysis patients replied "I will follow doctor's decisions including cardiopulmonary resuscitation and renal replacement therapy" 8 females (67%), 15 diabetes (53%) and 11 geriatric patients above 60yrs old (52%), however, were against cardiopulmonary resuscitation. CONCLUSION: Routine use of advance directives will provide basic sources for end-of-life decisions in the care of end stage renal patients. And they would like to keep the high quality of life with the help of prepared therapeutic plan of care and well-dying presented advance directives.

A Case of Cutaneous Spindle Cell Squamous Cell Carcinoma / 대한피부과학회지

Spindle cell squamous cell carcinoma (SCSCC) is rare. As in many rare cases, the dignity is difficult to determine. A comprehensive immunohistochemical analysis was conducted, and histopathological findings were also assessed prior to diagnosis. A 77-year-old female patient presented with a dome-shaped ulcerative nodule on her left cheek which was 1.5 cm in diameter and expanding slowly. After resection, conventional histopathological investigation showed spindle-shaped cells with hyperchromatic nuclei infiltrating the dermis in a whorl-like pattern. Furthermore, immunohistochemical investigation revealed SCSCC was positive for cytokeratins (cam 5.2, 34betaE12), and mesenchymal marker (vimentin), but was negative for pancytokeratin (AE1/3). The SCSCC was surgically removed 12 months ago and no relapse has been observed since the removal. Comprehensive immunohistochemical analysis is essential, along with assessment of morphological findings prior to diagnosis. In addition, more case reports on SCSCC should be cumulated to determine a precise prognosis.

A Metastatic Giant Cell Tumor of the Soft Tissue of the Thoracic Wall: A case report / 대한흉부외과학회지

A giant cell tumor of bone is a benign bone tumor, but has very high local recurrence rate and, very rarely metastasizes to the lung or a distant area. We report a case of a 29-year-old male patient presenting with a metastatic giant cell tumor of the soft tissue of the chest wall, who underwent a total resection of the radius for recurrence of the giant cell tumor. The tumor was not related to any bony structure of the thorax. We resected the tumor with a wide surgical margin. No evidence of malignancy was seen in the frozen and permanent pathological report.

A Cases of Paraganglioma in Bladder of Patient who Visited with Acute Renal Failure / 대한신장학회지

Pheochromocytoma is a catecholamines secreting tumor that usually appears in the adrenal medulla, sympathetic ganglia and extra-adrenal chromaffin tissue. About 10% of this disease is detected in the extra-adrenal chromaffin tissue which is called paraganglioma. The three major clinical symptoms of pheochromocytoma are headache, syncope and hypertension. Approximately 0.1% of hypertensive patients have pheochromocytoma. The extra-adrenal paraganglioma is found in abdominal sympathetic nerve ganglion or Zukerkandle's organ with great frequency, but it also appears, albeit rare, in the cervical ganglion, thoracic cavity, bladder, and pelvic cavity. Some cases of paraganglioma in bladder are being reported internationally, but domestic reports are rare. We report a case of paraganglioma originating in the urinary bladder of patient who visited with acute renal failure associated with malignant hypertension. We treated him with phenoxybenzamine and later with partial cystectomy. High blood pressure was well controlled and acute renal failure was resolved.

Surgical Treatment for Carcinoid Tumor of Ampulla of Vater

Carcinoid tumors of ampulla of Vater are rare and slow growing neoplasms that are composed of variable numbers of cells that contain endocrine secretory granules in their cytoplasm, which can be identified by immunohistochemistry, and electron microscopy. Symptoms of Carcinoid tumors of ampulla of Vater are jaundice, hemorrhage, abdominal discomfort, duodenal obstruction or carcinoid syndrome. The incidence of Carcinoid tumors of ampulla of Vater is 1% of all gastrointestinal carcinoid tumors in Western countries. We report a case of no recurrence for 53 months after pylorus preserving pancreaticoduodenectomy for carcinoid tumor of ampulla of Vater

Undiffentiated Carcinoma with Osteoclast-like Giant Cells of the Pancreas / 대한소화기학회지

Undifferentiated carcinoma with osteoclast-like giant cells is a rare neoplasm of exocrine pancreas. Till recently, some cases have been reported, however histogenesis of the tumors are controversial and their characteristic findings have not been described yet. Thirty five-year-old men and 75-year-old men were presented with upper abdominal pain and a palpable mass. On computed tomography, one case showed a well enhancing solid tumor with low density and the other was showed a mainly cystic tumor with peripheral enhancement in the body and tail of the pancreas. One case accompanied multiple metastatic liver masses with subhepatic lymph node enlargement. Tumor staining was seen on angiography. Biopsy and pancreatectomy were performed. Pathological findings revealed tumors composed of neoplastic spindle shaped or pleomorphic large cells with scattered non-neoplastic osteoclast-like giant cells. In one case, there were small foci of adenocarcinoma components in the periphery of the tumor. On immunohistochemical stain, neoplastic cells showed focal positivity for epithelial membrane antigen and vimentin. Tumors were diagnosed as undifferented carcinoma with osteoclast-like giant cells. We report these rare cases with a review of literature.

A Case of Intramural Duodenal Hematoma Presenting with Acute Duodenal Obstruction

Intramural duodenal hematoma (IDH) is a quite rare disese entity which results from the collection of blood and body fluid between mucosa and serosa. Various degrees of duodenal obstruction may be caused by IDH as it gradually enlarges and compresses the mucosa against the opposite side of duodenum. The most common cause of IDH is blunt abdominal trauma and the spontaneous IDHs are generally casused by coagulation disorder such as blood dyscrasia, anticoagulation treatment or pancreaticoduodenal aneurysm. The diagnosis is usually made by the typical imaging on abdominal computed tomographic scan with a previous history of blunt abdominal trauma. For spontaneous IDH without coagulation disorder, an abdominal angiogram may be considered to exclude vascular anomalies. Medical treatment is recommended unless the associated visceral injuries require immediate laparotomy. Here, we report a case of acute duodenal obstruction due to IDH which had resolved completely without an operative management.

A Case of Nonspecific Interstitial Pneumonitis Improved After Cyclosporin Therapy / 결핵

Idiopathic interstitial pneumonia is a group of lung disease classified by clinical, radiological and pathologic findings. Steroid is described in many reports as an effective treatment for the idiopathic interstitial pneumonitis. For the treatment of steroid non-responders, immuno-suppressive or cytotoxic agents are used as second line drug of choice. We experienced a case of nonspecific interstitial pneumonitis who was treated initially with glucocorticoid and antibiotics without effects, but later did respond to cyclosporin treatment. This 63 year-old patient was admitted due to dyspnea, cough, and sputum production. He was started on glucocorticoid and antibiotics after he was diagnosed as having nonspecific interstitial pneumonitis by open lung biopsy. The initial steroid treatment was not effective, however, after cyclosprin treatment, the patient showed clinical and radiologic improvements.

H. pylori Infection and Gastric Carcinogenesis

In spite the fact that H. pylori infection might be the causative organisms of acute and chronic gastritis, peptic ulcer diseases and the definition as the class I carcinogen by WHO IARC, still debates exist about the relationship between H. pylori and gastric carcinogenesis. Epidemiological and animal studies demonstrated a link between gastric cancer and chronic infection with H, pylori, but the exact mechanism responsible for the development of gastric cancer in H. pylori-infected patients still remain obscure. In order to declare the clear association, definate evidences like that decrement in the incidence of gastric cancer after the eradication of H. pylori in designated area compared to non- eradicated region or the blockade of specific mechanism acting on the carcinogenesis by H. pylori infection. The other way is to identify the upregulating oncogenes or downregulating tumor suppressor genes specifically invovled in H. pylori-associated carcinogenesis. For that, we established the animal models using C57BL/6 mice strain. Already gastric carcinogenesis was developed in Mongolian gerbils infected with H. pylori, but there has been no development of gastric cancer in mice model infected with H. pylori after long-term evaluation. Significant changes such as atrophic gastritis were observed in mice model. However, we could observe the development of mucosal carcinoma in the stomach of transgenic mice featuring the loss of TGF-beta sig naling by the expressions of dominant negative forms of type II receptor specifically in the stomach. Moreover, the incidence of gastric adenocarcinoma was significantly increased in group administered with both MNU and H. pylori infection than MNU alone, signifying that H. pylori promoted the gastric carcinogenesis and there might be host susceptibility genes in H. pylori-associated gastric carcinogenesis. Based on the assumption that chronic, uncontrolled inflammation might predispose to carcinogenesis, there have been several evidences showing chronic atrophic gastritis predisposed to gastric carcinogenesis in H. pylori infection. Although definite outcome of chemoprevention was not drawn after the long-term administration of anti-inflammatory drug in H. pylori infection, the actual incidence of atrophic gastritis and molecular evidence of chemoprevention could be obtained. Selective COX-2 inhibitor was effective in decreasing the development of gastric carcinogenesis provoked by H. pylori infection and carcinogen like in chemoprevention of colon carcinogenesis.

Analysis of the Factors Determining the Changes of Serum Albumin in Stable Patients on Peritoneal Dialysis / 대한신장학회잡지

BACKGROUND: Hypoalbuminemia is the most important risk factor for death in dialysis patients. But, it is not well known the factors determining the changes of serum albumin with time. The present study attempts to address the changes of serum albumin with time and the factors determining the changes of serum albumin in stable patients on peritoneal dialysis. METHODS: Fifty-four peritoneal dialysis patients in stable condition were included. Serum albumin, peritoneal equilibration test, weekly urea clearance (Kt/V), weekly creatinine clearance(CCr) and normalized protein catabolic rate(nPCR) were determined two times(mean 5.8+/-2.3 months and 31.3+/-6.5 months after initiation of peritoneal dialysis). RESULTS: Initially lower serum albumin group patients(below 3.7 g/dL) showed significantly increased serum albumin level with time(3.2+/-0.43 g/dL vs 3.57+/-0.52 g/dL, p=0.006) and initially higher serum albumin group patients(above 3.7 g/dL) showed decreased serum albumin level with time(4.07+/-0.32 g/dL vs 3.97+/-0.3 g/dL, p=0.15). Serum albumin changes(delta) were significantly higher in initially lower serum albumin group than higher serum albumin group(0.37+/-0.6 g/dL vs -0.11+/-0.3 g/dL, p < 0.01). There were negative correlations between delta serum albumin and delta D/PCr with time in initially lower and initially higher serum albumin groups(0.37+/-0.56 g/dL vs -0.02+/-0.11, -0.11+/-0.33 g/dL vs 0.05+/-0.12, respectively, r=-0.308, p=0.008). The group which increased serum albumin level with time showed significantly lower initial serum albumin(3.32+/-0.51 g/dL vs 3.98+/-0.46 g/dL, p < 0.001) and significantly decreased D/P(Cr) changes(-0.03+/-0.09 vs 0.06+/-0.10, p= 0.02) than the group which decreased serum albumin level with time. With multiple regression analysis, initial serum albumin level and the change of D/P(Cr) were significant predictors of the change of serum albumin with time. CONCLUSION: Initial serum albumin and the change of D/PCr were identified as the predictors of the change of serum albumin in stable peritoneal dialysis patients.

Correlation Between Cyclosporine Trough Levels and 2-Hour Postdose Blood Levels and Target C2 Levels in Patients after 12 Months Post Kidney Transplantation / 대한신장학회잡지

BACKGROUND: Cyclosporine dosing is traditionally based on trough levels(C0 level) rather than area under the concentration-time curve(AUC), although AUC correlates better with post transplantation acute rejection and acute toxicity. It is reported that C2 levels(2-hour postdose blood levels) are single sampling point that best reflects AUC0-4. But there has been no recommended C2 levels for patients after 12 months post kidney transplantation. The purpose of this study was to evaluate the correlation between C0 levels and C2 levels and define recommended target C2 levels in patients after 12 months post kidney transplantation. METHODS: Seventy three patients after 12 months post transplantation were studied. 83 data were obtained from 73 renal transplant patients. Blood C0 levels, blood C2 levels, body weight and serum creatinine level were measured. Blood cyclsporine levels were measured by monoclonal fluorescence polarization immunoassay(mFPIA)(TDX, Abbot). The data of C0 levels were divided into three groups : low group (mean+SD, 197.1 ng/mL). RESULTS: There was a positive correlation between C0 levels and C2 levels, but no correlation between C0 levels and C2 levels when C0 levels were divided into three groups. There was a positive correlation between cyclosporine/body weight and C2 levels in normal C0 group. Recommended C2 levels in normal C0 group is 724.7+/-210.1 ng/mL. CONCLUSION: It is assumed that cyclosporine doses can be individualized by using C2 levels rather than C0 levels in renal transplant patients. However, prospective study may be needed to confirm the improvement of longterm renal allograft survival by individualizing cyclosporine doses based on C2 levels.

A Study on the Complications of Renal Transplant Recipients / 대한이식학회지

PURPOSE: The purpose of this study was to analyze the complications in renal transplant recipients and analyze the factors that affect the survival rate of transplant kidney and patients. METHODS: Between March 1985 and April 2000, 380 cases of renal transplantation were performed at Yeungnam University Hospital. The results were analyzed retrospectively. RESULTS: Infectious complications occurred 612 times in 215 cases and non-infectious complications occurred 200 times in 143 cases. The region of infection was in the order of urinary tract infection (461 times) and pulmonary infection (44 times). Non-infectious complications were as follows; hyperglycemia in 44 cases, de novo hypertension in 27 cases out of 35 previously normotensive patients, nephrotoxicity caused by CsA in 15 cases, myelosuppression in 14 cases, avascular necrosis in 10 cases, and malignancy in 9 cases. Surgical complications were as follows; renovascular bleeding in 15 cases, ureteral obstruction in 5 cases, lymphocele in 4 cases, ureteral leak in 3 cases, and intestinal obstruction in 3 cases. Out of total 380 cases of renal transplant, 113 times of acute rejection occurred in 99 cases. CONCLUSION: Infectious complications were most frequent complication. There were significant differences in graft survival for living non-related donor kidney transplantation by immunosuppressive regimen. CsA+PD+MMF group results in highest graft survival in living non-related donor kidney transplantation and was followed by CsA+PD group, CsA+PD+AZA group. But CsA+PD+MMF regimen has been used in recent years and it needs to be studied prospectively.

The Effects of Catheter Revision and Mupirocin on Exit Site Infection/Peritonitis in CAPD Patients / 영남의대학술지

BACKGROUND: Exit site/tunnel infection causes cosiderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESI/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MATERIALS AND METHODS: We reviewed 139 CAPD patients about the ESI/TI from October 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were T1 symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. RESULTS: The total follow-up was 2401 patient months(pt. mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. The total number of incidences of ESI and peritonitis was 1 per 23.0 pt.mon and 0 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus(26 of 54 isolated cases, 48%), followed by the Methicillin resistant S. auresu(MRSA) (13 cases, 24%). Seven patients(5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration: 14.0 months). The rates of ESI were significantly reduced after using mupirocin than before(1 per 12.7 vs 34.0 pt.mon, p<0.01). CONCLUSION: In summary, revision technique can be regarded as an effective method for refractory ESI/T1 before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.

A Human Case of Hepatic Fascioliasis Accompanied by Egg Granulomas in Common Bile Duct Lymph Node

A 32-year-old housewife who resides in Taegu was admitted in Yeungman University Hospital due to right upper quadrant abdminal pain of 2 mounths'duration. An abdomical CT and ultrasonography revealed a relatively well demarcated low density mass in the right lobe of liver. Right hepatic lobectomy was performed on the clinical impression of hepatoma. On the light microscopic study, the lobulated liver mass showed extensive central necrosis and fibrosis, with large numbers of pseudotubercles therein. The pseudotubercles have distorted helminthic eggs frequently. The submitted common bile duct lymph node also showed a few pseudotubercles. The eggs recovered from the tissue homogenate measured 140~152 micrometer by 75~85 micrometer in size and were unembryonated and light yellow to brown. The eggs were determined as those of Fasciola species. We reported the present case as 11th one of human fascioliasis in korea.