Successful One-Stage Transabdominal Excision of Intravenous Leiomyomatosis with Extension into the Right Atrium / 대한혈관외과학회지

Intravenous leiomyomatosis is a rare benign tumor originating from the uterus that spreads through vessels. In rare cases, intracaval and intracardiac involvement has been described. We report a case of a 64-year-old woman who presented intravenous leiomyomatosis, which originated from the right uterine vein and extended through the inferior vena cava into the right atrium. The tumor was completely removed through a one-stage transabdominal approach with transesophageal echocardiography monitoring. Sparing thoracotomy is important in order to reduce postoperative morbidity and tumor removal by pulling down was technically possible without the risk of embolization.

Chronic allograft injury by subclinical borderline change: evidence from serial protocol biopsies in kidney transplantation / 대한외과학회지

PURPOSE: This study investigated the impact of subclinical borderline changes on the development of chronic allograft injury in patients using a modern immunosuppression protocol. METHODS: Seventy patients with stable renal allograft function and who underwent protocol biopsies at implantation, 10 days and 1 year after transplantation were included and classified based on biopsy findings at day 10. The no rejection (NR) group included 33 patients with no acute rejection. The treatment (Tx) group included 21 patients with borderline changes following steroid pulse therapy, and the nontreatment (NTx) group included 16 patients with borderline changes nontreated. RESULTS: The Banff Chronicity Score (BChS) and modified BChS (MBChS) were not different among the three groups at implantation (P = 0.48) or on day 10 (P = 0.96). Surprisingly, the NTx group had more prominent chronic scores at the 1-year biopsy, including BChS (3.07 +/- 1.33, P = 0.005) and MBChS (3.14 +/- 1.41, P = 0.008) than those in the Tx and NR group, and deterioration of BChS was more noticeable in the NTx group (P = 0.037), although renal function was stable (P = 0.66). No difference in chronic injury scores was observed between the Tx and NR groups at the 1-year biopsy. CONCLUSION: Subclinical borderline changes can be a risk factor for chronic allograft injury and should be considered for antirejection therapy.

Simultaneous Liver, Kidney Transplantation: A Single Center Experience / 대한이식학회지

BACKGROUND: Simultaneous liver and kidney transplants have proved to be a favorable treatment for combined renal and hepatic end-stage diseases. However, it is extremely difficult to find a simultaneous liver and kidney donor in Korea due to the narrow requirements. This study had three aims: to explore the therapeutic experience of simultaneous liver and kidney transplants in Seoul National University Hospital (SNUH), to compare the overall survival outcome between simultaneous liver and kidney transplants and liver transplants alone in patients with liver and renal failure, and to determine the indications for simultaneous liver and kidney transplants. METHODS: The clinical data of 8 simultaneous liver and kidney transplants at SNUH from November 2004 to October 2010 were retrospectively studied. Indications for simultaneous liver and kidney transplants, patient and graft survival, and the causes of death were analyzed and compared with 5 liver transplants alone performed on patients experiencing liver and renal failure. RESULTS: The clinical characteristics of the recipients for simultaneous liver and kidney transplants and liver transplants alone were similar with regards to age, renal function, and the Model for End-Stage Liver Disease (MELD) score (all P>0.05). One patient died at 15 months after simultaneous liver and kidney transplants due to HBV related HCC recurrence, and three patients died at 2, 3, and 21 months after liver transplants due to ARDS, bleeding, and hepatic failure, respectively. Only one liver graft loss in simultaneous liver and kidney transplant cases occurred on POD 3 due to primary non-function. The outcome analysis demonstrated a superior overall survival in simultaneous liver and kidney transplants recipients compared with recipients of only liver transplants (P=0.041). CONCLUSIONS: Simultaneous liver and kidney transplants showed a superior outcome in patients with end-stage liver disease and chronic renal failure compared with liver transplants alone. The allocation criteria of simultaneous liver and kidney transplants in Korea should be changed to expand its indications.

Simultaneous Liver, Kidney Transplantation: A Single Center Experience / 대한이식학회지

BACKGROUND: Simultaneous liver and kidney transplants have proved to be a favorable treatment for combined renal and hepatic end-stage diseases. However, it is extremely difficult to find a simultaneous liver and kidney donor in Korea due to the narrow requirements. This study had three aims: to explore the therapeutic experience of simultaneous liver and kidney transplants in Seoul National University Hospital (SNUH), to compare the overall survival outcome between simultaneous liver and kidney transplants and liver transplants alone in patients with liver and renal failure, and to determine the indications for simultaneous liver and kidney transplants. METHODS: The clinical data of 8 simultaneous liver and kidney transplants at SNUH from November 2004 to October 2010 were retrospectively studied. Indications for simultaneous liver and kidney transplants, patient and graft survival, and the causes of death were analyzed and compared with 5 liver transplants alone performed on patients experiencing liver and renal failure. RESULTS: The clinical characteristics of the recipients for simultaneous liver and kidney transplants and liver transplants alone were similar with regards to age, renal function, and the Model for End-Stage Liver Disease (MELD) score (all P>0.05). One patient died at 15 months after simultaneous liver and kidney transplants due to HBV related HCC recurrence, and three patients died at 2, 3, and 21 months after liver transplants due to ARDS, bleeding, and hepatic failure, respectively. Only one liver graft loss in simultaneous liver and kidney transplant cases occurred on POD 3 due to primary non-function. The outcome analysis demonstrated a superior overall survival in simultaneous liver and kidney transplants recipients compared with recipients of only liver transplants (P=0.041). CONCLUSIONS: Simultaneous liver and kidney transplants showed a superior outcome in patients with end-stage liver disease and chronic renal failure compared with liver transplants alone. The allocation criteria of simultaneous liver and kidney transplants in Korea should be changed to expand its indications.

Clinical Features of Colorectal Cancer Detected by the National Cancer Screening Program

PURPOSE: Since 2004, the National Cancer Screening Program of Korea has included colorectal cancer screening based on primary screening with the fecal occult blood test (FOBT). We report on the clinical features of colorectal cancer detected by the National Cancer Screening Program. METHODS: We retrospectively analyzed 577 patients who underwent elective surgery for colorectal cancer at the Seoul National University Hospital between January 2008 and December 2009. We compared the clinical features of colorectal cancers detected by the National Cancer Screening Program (NCSP group) with those of the control group in terms of age, gender, preoperative symptom, location of the tumor, surgical technique and tumor-node-metastasis (TNM) stage. RESULTS: Age, gender, location of the tumor and operation types were not different between the two groups. The proportion of asymptomatic patients was significantly higher in the NCSP group than it was in the control group (86.5% vs. 20.0%; P < 0.001). The proportion of less invasive lesions (T1 or T2) was significantly higher in the NCSP group (46.3% vs. 27.7%; P = 0.002). The pathologic stages of the colorectal cancers in the NCSP group were I, 40.3%; II, 17.9%; III, 40.3% and IV, 1.5% whereas in the control group, they were I, 20.8%; II, 32.9%; III, 34.9% and IV, 11.4%. The proportion of stage I cancer was significantly higher in the NCSP group than in the control group (40.3% vs. 20.8%; P = 0.006). CONCLUSION: Our study demonstrates the FOBT in the NCSP is effective in early detection of colorectal cancer.