Positive immunostaining of Sal-like protein 4 is associated with poor patient survival outcome in the large and undifferentiated Korean hepatocellular carcinoma

PURPOSE: Previous studies have shown the role of Sal-like protein 4 (SALL4) as a biomarker in hepatocellular carcinoma (HCC), and some studies have shown the relationship between SALL4 and prognosis. Given the debates in study groups differences in terms of etiologic causes between Western and Asian HCC and detection methods, we attempted to verify the features of SALL4 immunoreactivity and its clinical correlation in Korean HCC patients. METHODS: Immunohistochemical staining of SALL4 of tissue microarrays (TMAs) consisting of 213 surgically resected HCC patients' tissue were scored in a semiquantitative scoring system with immunoreactive score and the results analyzed with clinical outcome, in addition to general demographics and clinical characteristics. RESULTS: SALL4 immunoreactivity was expressed in 50 cases. Relevance between SALL4 and α-FP correlated significantly (P = 0.002). Also, the SALL4-positive patients had considerably higher tumor grade (P < 0.001). The survival analysis showed negative correlation with SALL4 immunoreactivity in all HCC patient groups, but SALL4 immunoreactivity in T3 and T4 HCC correlated with poor prognosis. CONCLUSION: Here, we found that positive immunostaining of SALL4 is correlated with poor patient survival outcome in large and undifferentiated Korean HCC. SALL4 expression showed close relationship with clinical outcomes of HCCs in Korean patients.

Positive immunostaining of Sal-like protein 4 is associated with poor patient survival outcome in the large and undifferentiated Korean hepatocellular carcinoma

PURPOSE: Previous studies have shown the role of Sal-like protein 4 (SALL4) as a biomarker in hepatocellular carcinoma (HCC), and some studies have shown the relationship between SALL4 and prognosis. Given the debates in study groups differences in terms of etiologic causes between Western and Asian HCC and detection methods, we attempted to verify the features of SALL4 immunoreactivity and its clinical correlation in Korean HCC patients. METHODS: Immunohistochemical staining of SALL4 of tissue microarrays (TMAs) consisting of 213 surgically resected HCC patients' tissue were scored in a semiquantitative scoring system with immunoreactive score and the results analyzed with clinical outcome, in addition to general demographics and clinical characteristics. RESULTS: SALL4 immunoreactivity was expressed in 50 cases. Relevance between SALL4 and α-FP correlated significantly (P = 0.002). Also, the SALL4-positive patients had considerably higher tumor grade (P < 0.001). The survival analysis showed negative correlation with SALL4 immunoreactivity in all HCC patient groups, but SALL4 immunoreactivity in T3 and T4 HCC correlated with poor prognosis. CONCLUSION: Here, we found that positive immunostaining of SALL4 is correlated with poor patient survival outcome in large and undifferentiated Korean HCC. SALL4 expression showed close relationship with clinical outcomes of HCCs in Korean patients.

Primary renal fibrosarcoma with local invasion into the mesenteric membrane of a mongrel dog / 대한수의학회지

A 14-year-old, 7.4 kg, neutered male mongrel dog presented with vomiting, anorexia, and hematuria starting 3 days prior to admission. Serum biochemical profiles indicated severe azotemia. Computed tomography revealed loss of normal left kidney structure. The organ was 1.5 to 2 times larger than the right kidney with mixed attenuation. Histopathologic examination was performed after nephrectomy. The renal mass and mesenteric membrane were positive for vimentin and stained blue with Masson's trichrome. In conclusion, this was a rare occurrence of primary renal fibrosarcoma, most likely originated from the renal capsule, with local invasion into the mesenteric membrane.

First Report of Nocardia farcinica Bursitis in a Patient with Diabetes Mellitus

No abstract available.

Relationship between the risk of bile duct injury during laparoscopic cholecystectomy and the types of preoperative magnetic resonance cholangiopancreatiocography (MRCP)

BACKGROUNDS/AIMS: Bile duct injury is one of the potential severe complications that can occur during laparoscopic cholecystectomy, which can be cause by anatomic variations in the confluence of the bile duct. Recently magnetic resonance cholangiopancreatiocography (MRCP) has become a helpful tool to detect bile duct variation on a preoperative basis and to prevent bile duct injury during laparoscopic cholecystectomy, as well other hepatic surgeries. This study aimed to clarify the types of bile duct on MRCP and to search for a method of avoiding injury during laparoscopic cholecystectomy. METHODS: Between January 2009 and December 2010, 277 patients underwent laparoscopic cholecystectomy with preoperative MRCP in our institution. On a retrospective basis, the bile ducts were categorized into 5 types according to the Couinaud classification system. RESULTS: The proportion of types was revealed type A (70.4%), type B (8.7%), type C (19.5%), type D (0.7%), type E (0%), and type F (0.7%), respectively. Bile duct injury occurred in 4 cases (1.4%) during laparoscopic cholecystectomy. In particular, the possibility of aberrant extrahepatic confluence (Type C and F) represented the highest risk of duct injury (OR=11.89 [CI: 1.21-116.53]). CONCLUSIONS: Preoperative evaluation of the bile duct anatomy is important to avoid injury of duct during laparoscopic cholecystectomy. Specific types of bile duct variation should be considered as a high risk group for bile duct injury.

Liver Transplantation for a Cirrhotic Patient with Situs Inversus

Situs inversus refers to a mirror image of the viscera, while situs solitus is defined as the normal anatomical situation. Several cases of successful liver transplantation for situs inversus recipients have been reported, and modifications of the standard surgical techniques were used. We report here on a case of cadaveric liver transplantation in an end-stage liver disease patient with situs inversus. The donor liver was rotated clockwise 90 degrees to the left with the right lobe lying in the left upper quadrant and the left lobe pointing down into the left iliac fossa. The donor's suprahepatic vena cava was oversewn and the infrahepatic vena cava anastomosed end to side to the recipient's inferior vena cava. The postoperative course was good until the postoperative 26th day, when rupture of a hepatic artery pseudoaneurysm occurred. An emergency laparotomy was done and the hepatic artery was ligated. Despite the hepatic artery ligation, the liver function recovered quite well. But sudden intracranial hemorrhage developed on the postoperative 28th day and sadly, the patient expired on the postoperative 30th day. Complete preoperative evaluation of the recipient is essential for the operative planning, and careful donor selection should be attempted to obtain a smaller graft to allow maximum flexibility for placing the donor liver. The use of a reduced-sized graft should be considered in the case for which a smaller graft is not available. In conclusion, adult situs inversus is no longer a contraindication for a liver transplant, although technical difficulties do exist for this procedure.

Development and Pilot Applications of Simulation-Based Comprehensive Emergency Airway Management Courses

PURPOSE: Adequate training in managing the emergency airway requires a comprehensive learning program and training using an integrated simulator can facilitate such a comprehensive learning experience. This report describes two pilot simulation-based comprehensive emergency airway management (EAM) courses that we developed and ran, primarily for emergency medicine residents and nurses in an emergency department. METHODS: We developed two simulation-based comprehensive EAM courses. Six-hour advanced and full-day basic courses were consisted of pre-test simulations, plenary lectures, small-group hand-on workshops, cadaver workshops, realistic patient simulations using a moderatefidelity integrated simulator, and course evaluations. Participants evaluated the programs using a five-point Likert scale and open comments were also encouraged. RESULTS: Fifteen trainees participated in a pilot advanced course and a total of 48 trainees participated in two pilot basic courses. The evaluation scores of the advanced course were as follow: quality of content, 4.30+/-0.74; clinical utility, 4.63+/-0.56; quality of facility, 4.73+/-0.44; quality of faculty, 4.66+/-0.49; and time allocation, 4.01+/-0.94. For the basic courses, the score were: quality of content, 4.55+/-0.54; clinical utility, 4.50+/-0.59; quality of facility, 4.59+/-0.54; quality of faculty, 4.64+/-0.64; and time allocation, 4.25+/-0.85. Overall response to the courses was very positive with many trainees described the course as filling an important void in their training in EAM. The most common request was for more time for skills training and simulation experiences. CONCLUSION: The simulation-based comprehensive EAM program is a very useful way to integrate individuals' knowledge and skills into the context of managing the emergency airway. Continuous education along with additional efforts to develop various simulation scenarios and performance checklists are recommended.

Xanthogranulomatous Cholecystitis: Clinical review of 14 cases

PURPOSE: Xanthogranulomatous cholecystitis_(XGC) is an unusual and destructive inflammatory process of the gallbladder and it's characterized by severe proliferative fibrosis. XGC usually presents with features of chronic cholecystitis or acute cholecystitis, yet clinically, radiologically and macroscopically, XGC may be difficult to differentiate from gallbladder cancer. The purpose of our study was to evaluate the radiologic features of XGC and their correlation with the clinical, pathologic and surgical findings. METHODS: We performed retrospective analysis on 14 cases of XGCs that were operated on between March 1999 and December 2005. The clinical features, preoperative radiologic findings, operative findings and postoperative courses were reviewed. RESULTS: Fourteen cases of XGC were found among 1451 cases of cholecystectomy (0.96%). Mirizzi's syndrome was observed in 35.7% of the patients. Cholelithiasis and a thickened gallbladder wall were frequent findings. The most characteristic CT finding was hypodense intramural nodule like microabscess, and this was seen in 42.8% of the patients. The most characteristic sonographic finding was the presence of hypoechoic nodule in the gallbladder wall, and this was seen in 55.5% of the patients. 9 patients underwent open cholecystectomy including one case of T-tube choledocholithotomy. Four of five patients who underwent laparoscopic cholecystectomy required conversion to open surgery. A malignant lesion was suspected preoperatively in two cases, and both underwent frozen biopsy during surgery. CONCLUSIONS: Although the preoperative diagnosis of XGC is difficult, the presence of hypodense intramural nodule on CT or hypoechoic nodule in the gallbladder wall on sonography is highly suggestive of XGC. As XGC may resemble malignancy, differentiation is essential, via intraoperative frozen biopsy to deliver the optimal surgical treatment.

How Knowledge-only Reinforcement Can Impact Time-related Changes in Basic Life Support (BLS) Skills of Medical Students on Clinical Clerkship

PURPOSE: Some report that basic life support (BLS) skills decay rapidly, mostly by three months after initial training. Retraining at specific intervals or with more effective methods is necessary to delay this decay. This study was undertaken to determine the effects of the time interval from initial training and to evaluate the impacts of a knowledge-only reinforcement on BLS skills in medical students and interns. METHODS: We tested the single-rescuer BLS performance of 92 medical students and interns with Resusci(R) Anne SkillReporter(TM) and BLS performance criteria. All trainees had been instructed by senior residents in 1~24 months before the test and were assigned into four groups by interval from initial training [group A: 1~3 months (n=21), group B: 4~7 (n=26), group C: 8~15 (n=20), group D: 16~24 (n=25)]. Groups C and D had 1-hour knowledge-only lectures. RESULTS: The performance criteria score of group B was lower than that of group A (p=0.005), but that of group C was higher than that of group B (p=0.025). The percent correct of ventilation (PCV) and compression (PCC) decreased surprisingly during the first three months after initial training. There was no difference in the PCC among the four groups. However, the PCV in group C was lower than that in group A (p=0.047). The PCV and the interval from initial training had a negative correlation (R=-0.273, p=0.009). CONCLUSION: Overall BLS performance of medical students and interns on clinical clerkship, without reinforcement, decreases more significantly after three months compared to the first three months from initial training. The accuracy of the skills decreases rapidly from the time of initial training. A knowledge-only reinforcement could temporally improve overall BLS performance. However, the accuracy of the ventilation skill decays regardless of reinforcement.

Living Donor Liver Transplantation in a Child with Unresectable Hepatoblastoma / 대한이식학회지

Hepatoblastoma is the most common primary malignant liver tumor encountered during childhood. Complete surgical resection is the most important factor in predicting which children would achieve cure. Some chemotherapy regimens are effective in reducing tumor size, often rendering initially unresectable lesions amenable to complete surgical resection, and dramatically improving disease-free survival. Liver transplantation provides an additional treatment option for patients whose tumor remains unresectable even after preoperative chemotherapy. We report a case of unresectable hepatoblastoma in a child who underwent living related liver transplantation with pre and post-operative chemotherapy.

Primary Duodenal Cancer Combined with Gastric Cancer after Treatment of Cervical Cancer -triple primary cancer

Multiple primary tumors are defined as cases involving primary malignant tumors of different histologic origins in one person. The absolute number of reported cases of double primary malignant tumors has increased in recent years diagnostic procedures. Primary adenocarcinoma of duodenum is a rare disease and represents less than 0.5% of all gastrointestinal malignancies. Therefore, synchronous multiple primary cancers of the stomach and duodenum are very rare. Recently, we experienced a case of triple primary malignant tumors of different site originating from the stomach, duodenum and cervix in 71- year-old woman. She had had radiation therapy and chemotherapy for squamous cell carcinoma of the uterine cervix 8 years previously. We performed subtotal gastrectomy and pancreaticoduodenectomy with radical lymph node dissection. She remained healthy without any evidence of recurrence 12 months after the operation.

Recurrent Strangulated Obturator Hernia

An obturator hernia is a rare condition, occurring most frequently in elderly and debilitated women. The diagnosis is difficult, and delayed treatment is associated with serious complications. In most cases, it produces a small bowel obstruction with high morbidity and mortality. We experienced an unusual case of a left recurrent obturator hernia. The patient was a 76-year-old woman with atrial fibrillation, presented with intermittent generalized abdominal pain and distension. The patient underwent a laparotomy because of a left incarcerated obturator hernia 2 years ago. The abdominal plain X-ray showed evidence of a small bowel obstruction. A CT scan established a correct diagnosis. Consequently, the patient underwent an immediate laparotomy. There were a few necrotic foci on the herniated small bowel wall. Therefore, a segmental resection of the small bowel was performed. To prevent a recurrence, the hernial defect was closed with several interrupted sutures between the peritoneum and periosteum of the obturator foramen. As patients with an obturator hernia are almost elderly women, and often have multiple concurrent medical problems. An immediate CT scan of the abdomen, including the pelvic area, should achieve an early diagnosis. Early surgical intervention should be done without serious medical diseases. Besides definitive surgery is needed to prevent a recurrence.