Redo pull-through for postoperative complications following pull-through in Hirschsprung disease: a single center experience

Purpose@#Although surgical management of Hirschsprung disease (HD) is effective in most patients, some patients experience long-term postoperative complications, and require redo pull-through (PT). The present study evaluated clinical outcomes of redo PT in HD patients at a single center. @*Methods@#Patients with HD who underwent redo PT procedures between 2003 and 2019 were retrospectively reviewed. @*Results@#Thirteen patients were included. Five (38.5%) had undergone initial PT surgery at our center and 8 (61.5%) at other centers. Redo PT procedures were transanal endorectal PT in 12 patients (92.3%) and the posterior sagittal approach in 1 patient (7.7%). Indications for redo PT included pathologic misdiagnosis in 8 patients (61.5%); stricture in 2 (15.4%); and rectal stenosis, obstructing Duhamel pouch and remnant septum in 1 each (7.7%). At a median follow-up of 68 months (range, 3–227 months) after redo PT, 8 patients (61.5%) had normal bowel function, 2 (15.4%) had incontinence, and 1 (7.7%) had constipation. @*Conclusion@#Redo PT procedures could be an effective approach for improving obstructive symptoms in HD patients with anatomic or pathologic reasons following primary PT. Careful selection of patients and discreet indications for redo PT are crucial.

Efficacy and safety of autologous adipose tissue-derived stem cell therapy for children with refractory Crohn’s complex fistula: a Phase IV clinical study

Purpose@#Autologous adipose tissue-derived stem cells (ASCs) have been proposed for patients with refractory Crohn disease, but research is lacking in pediatric patients. This Phase IV study evaluated the efficacy and safety of ASCs in children with refractory Crohn’s fistulae. @*Methods@#Patients with a refractory Crohn’s fistula who did not have conventional therapy for more than 3 months or with a recurrent complex Crohn’s fistula were included. All patients were at least 14 years old. Patients with infection, poor condition, or active Crohn disease with a disease activity index of 450 and above were excluded. Five patients were treated with ASCs from 2014 to 2015 in Asan Medical Center. ASC administration was adjusted according to fistula size (1 mL per cm 2 ). We evaluated the efficacy and safety 8 weeks after injection and followed patients for 6 months. @*Results@#Fistulae were healed in 4 patients by 8 weeks after ASC injection. Of these 4 patients, 1 had complete fistula closure and sustainability after 6 months. The other 3 with healing effects had less than 50% fistula closure by 6 months.None of these 4 patients have persistent fistulae. One patient had no healing effect, and seton ligation was performed 8 months after ASC injection. There were no adverse effects related to ASC administration. @*Conclusion@#ASC therapy is a simple and well-tolerated therapeutic option for children with refractory Crohn’s complex fistulae. Complete closure was well-sustained. However, more data from a larger number of patients are needed.

Efficacy and safety of autologous adipose tissue-derived stem cell therapy for children with refractory Crohn’s complex fistula: a Phase IV clinical study

Purpose@#Autologous adipose tissue-derived stem cells (ASCs) have been proposed for patients with refractory Crohn disease, but research is lacking in pediatric patients. This Phase IV study evaluated the efficacy and safety of ASCs in children with refractory Crohn’s fistulae. @*Methods@#Patients with a refractory Crohn’s fistula who did not have conventional therapy for more than 3 months or with a recurrent complex Crohn’s fistula were included. All patients were at least 14 years old. Patients with infection, poor condition, or active Crohn disease with a disease activity index of 450 and above were excluded. Five patients were treated with ASCs from 2014 to 2015 in Asan Medical Center. ASC administration was adjusted according to fistula size (1 mL per cm 2 ). We evaluated the efficacy and safety 8 weeks after injection and followed patients for 6 months. @*Results@#Fistulae were healed in 4 patients by 8 weeks after ASC injection. Of these 4 patients, 1 had complete fistula closure and sustainability after 6 months. The other 3 with healing effects had less than 50% fistula closure by 6 months.None of these 4 patients have persistent fistulae. One patient had no healing effect, and seton ligation was performed 8 months after ASC injection. There were no adverse effects related to ASC administration. @*Conclusion@#ASC therapy is a simple and well-tolerated therapeutic option for children with refractory Crohn’s complex fistulae. Complete closure was well-sustained. However, more data from a larger number of patients are needed.

Changes in the Clinical and Pathological Characteristics of Gastric Cancer during the Last 16 Years: A Study of a Single Institution in Korea

BACKGROUND/AIMS: The incidence of gastric cancer (GC) in Korea is very high compared to that in other countries. The aim of this study was to investigate the trends of GC in patients for over 16 years. MATERIALS AND METHODS: A total of 1,227 patients with GC were prospectively enrolled at Seoul National University Bundang Hospital between 2003 and 2018. Age, sex, histologic type (Lauren classification), and Helicobacter pylori (H. pylori) infection status were compared between three periods (2003~2007, 2008~2012, and 2013~2018). H. pylori infection status was evaluated based on histology, rapid urease test, culture, serology, and history of H. pylori eradication. Patients with severe atrophy or intestinal metaplasia based on histology were assumed to have previous H. pylori infection. RESULTS: Most patients with GC underwent endoscopic mucosal resection/endoscopic submucosal dissection or another type of surgery. Early GC (EGC) and advanced GC (AGC) were detected in 769 (62.7%) and 458 (37.3%) patients, respectively, and intestinal and diffuse types were detected in 714 (58.2%) and 485 (39.5%) patients, respectively. The prevalence of EGC increased from 54.0% (252/467) to 63.5% (359/565) to 81.0% (158/195) in 2003~2007, 2008~2012, and 2013~2018, respectively. The prevalence of H. pylori-positive GC decreased from 93.4% (436/467) to 88.5% (500/565) to 82.1% (160/195) during these three periods, respectively (P<0.001). Multivariate logistic analysis showed that diffuse-type GC was continuously more prevalent in those who were younger than 50 years, who were female, and who harbored the predominant AGC type. CONCLUSIONS: Over 16 years, the prevalence of EGC increased with a decrease in H. pylori infection rate. Diffuse-type GC was continuously more common in young and female patients.

Anatomical popliteal artery entrapment syndrome

PURPOSE: The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure. METHODS: A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities. RESULTS: We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12–206 months). CONCLUSION: We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.

In vitro immune cell monitoring as a guide for long-term immunosuppression in adult liver transplant recipients

BACKGROUNDS/AIMS: We evaluated the clinical usability of immune cell monitoring in adult liver transplantation (LT) recipients. METHODS: This study was composed of two parts as using calcineurin phosphatase (CNP) activity assay and ImmuKnow assay independently as in vitro monitoring tools of immune cell function in adult LT recipients. RESULTS: There was a rough correlation between CNP activity and tacrolimus concentration in 33 patients. This association was evident in patients who were only administered tacrolimus, but disappeared after the co-administration of mycophenolate. In 118 healthy individuals, the mean proportion of helper T-cells was 37.4+/-8.1%. According to ImmuKnow assay, their immune responses were strong in 12 patients (10.2%), moderate in 92 patients (78.0%), and low in 14 patients (11.9%). In 85 patients waiting for LT, there was a rough correlation between the ImmuKnow ATP level and age. Their immune responses were strong in 0 patients (0%), moderate in 8 patients (9.4%), and low in 77 patients (90.6%). There was a difference in the ImmuKnow ATP levels between healthy individuals and patients with liver disease. In 137 LT recipients, there was no correlation between the ImmuKnow ATP levels and tacrolimus concentration. This trend did not change after grouping the patients according to co-administration with mycophenolate. Eight recipients experienced acute rejection, but none showed strong immune response. CONCLUSIONS: We think that both CNP activity assay and ImmuKnow assay are too limited to objectively determine the level of immunosuppression. Further studies should be performed to identify other methods for immune function monitoring.

Anatomical Popliteal Artery Entrapment Syndrome Caused by an Aberrant Plantaris Muscle

PURPOSE: We report on cases of anatomical popliteal artery entrapment syndrome (PAES) caused by an aberrant plantaris muscle and highlight the involvement of this muscle in PAES. MATERIALS AND METHODS: Seven symptomatic PAES legs in six patients treated at The Division of Vascular Surgery, Asan Medical Center, Seoul, Korea, between 1995 and 2011 were included in this study. We retrospectively analyzed patient records, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans of the knee joint, Doppler pressure studies, CT angiographies, and conventional femoral arteriographies. RESULTS: Five males and one female patient with a median age of 32 (18-53) years old were enrolled in the study. All patients complained of intermittent claudication of the affected leg. All aberrant plantaris muscles were higher and more medially located than normal plantaris muscles, causing occlusion of the popliteal artery upon forced plantar flexion of the ankle. For arterial lesions, five occlusions of the popliteal artery and two patent popliteal arteries with positive provocation were noted. As for treatment, myotomy of the aberrant plantaris muscle was done for two non-occlusive PAES legs. For occlusive PAES legs, one thrombectomy, one saphenous vein graft interposition of the popliteal artery followed by myotomy, and two below-knee femoro-popliteal bypasses were performed. The median follow-up period was 88 (7-148) months. CONCLUSION: An aberrant plantaris muscle can cause anatomical PAES. Classification or diagnosis of PAES should be based on axial studies using CT scans or MRI using various reconstruction methods. Treatment, including myotomy of the plantaris muscle, should be individualized.

Balloon dilation of jejunal afferent loop functional stenosis following left hepatectomy and hepaticojejunostomy long time after pylorus-preserving pancreaticoduodenectomy: a case report

We present a rare case of functional stenosis of the jejunal loop following left hepatectomy and hepaticojejunostomy long after pylorus-preserving pancreaticoduodenectomy (PPPD), which was successfully managed by balloon dilation. A 70-year-old Korean man had undergone PPPD 6 years before due to 1.8 cm-sized distal bile duct cancer. Sudden onset of obstructive jaundice led to diagnosis of recurrent bile duct cancer mimicking perihilar cholangiocarcinoma of type IIIb. After left portal vein embolization, the patient underwent resection of the left liver and caudate lobe and remnant extrahepatic bile duct. The pre-existing jejunal loop and choledochojejunostomy site were used again for new hepaticojejunostomy. The patient recovered uneventfully, but clamping of the percutaneous transhepatic biliary drainage (PTBD) tube resulted in cholangitis. Biliary imaging studies revealed that biliary passage into the afferent jejunal limb was significantly impaired. We performed balloon dilation of the afferent jejunal loop by using a 20 mm-wide balloon. Follow-up hepatobiliary scintigraphy showed gradual improvement in biliary excretion and the PTBD tube was removed at 1 month after balloon dilation. This very unusual condition was regarded as disuse atrophy of the jejunal loop, which was successfully managed by balloon dilation and intraluminal keeping of a large-bore PTBD tube for 1 month.

The Role of Allergy in the Severity of Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although allergic rhinitis is one of the most common factors associated with the development of chronic rhinosinusitis, the role of allergy in the severity of chronic rhinosinusitis was not well defined. This study is aimed to determine whether the allergy or factors such as nasal polyp, asthma, aspirin sensitivity can induce more extensive chronic rhinosinusitis, and to determine whether the severity of chronic rhinosinusitis depends on the severity of allergy. MATERIALS AND METHODS: A total of 98 chronic rhinosinusitis patients who underwent endoscopic sinus surgery were evaluated. The severity of chronic rhinosinusitis was assessed by CT scores and symptom scores. An allergic prick test, MAST (Multiple-antigen simultaneous test), the total IgE, and a serum eosinophil count were evaluated for diagnosis and assessment of the severity of allergy. Influences of another factors such as nasal polyp, asthma, and aspirin sensitivity to the severity of chronic rhinosinusitis were evaluated. RESULTS: Although the symptom scores of allergic chronic rhinosinusitis patients were greater than those of non-allergic chronic rhinosinusitis patients, there were no CT score differences between the two groups. Differences in the CT scores and symptom scores in allergic chronic rhinosinusitis patients according to the severity of allergy were statistically insignificant. Nasal polyp, asthma, and aspirin sensitivity did not induce more severe chronic rhinosinusitis. CONCLUSION: Allergy may be associated with the development of chronic rhinosinusitis, but the severity of allergy is not correlated to the severity of chronic rhinosinusitis.

Distribution and Expression of Superoxide Dismutase in Pediatric Tonsils and Adenoid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: B-lymphocytes and other phagocytes which infiltrate into inflammatory sites in pathologic condition are able to make reactive oxygen species such as superoxide free radicals (SFRs) which have toxic effects on foreign bodies including bacteria as well as normal eukaryotic cells. To prevent harmful effects of SFRs, eukaryotic cells can produce antioxidant enzymes such as superoxide dismutase (SOD) and catalase. The purpose of this study is to investigate the protective system of pediatric palatine tonsils and adenoids against the SFRs and to evaluate the clinical factors including otitis media with effusion that are related to the expressions and activities of copper zinc superoxide dismutases (CuZnSODs) in these tissues. MATERIALS AND METHOD: Twenty-one children who were operated for enlarged tonsils and adenoid with or without otitis media with effusion (OME) from December 1999 to Feburary 2000 were studied. Physcial fidings were evaluated and history-taking was carried out. RT-PCR and immunohistochemistry stain against CuZnSOD were conducted. RESULTS: Immunohistochemistry showed that CuZnSODs were found in the crypt epithelium, mucous membrane, mantle zone and in the extrafollicular area of pediatric adenoids as well as palatine tonsils. There were significant correlations between the presence of OME, paranasal sinusitis and the expression of CuZnSOD of adenoid (p<0.05), the frequency of tonsillitis, recent tonsillitis and the expression of CuZnSOD of tonsils (p <0.05). CONCLUSION: In pediatric tonsils and adenoids, the mechanism of tissue protection against infection and frequent inflammatory reactions may be closely related to the CuZnSODs expression.

A Case of Congenital Absence of the Epiglottis in an Adult / 대한이비인후과학회지

Congenital absence of the epiglottis is a rare anomaly of the larynx. We present a case in a young female adult who was identified incidentally as the first case of congenital absence of the epiglottiscase found in an adult. In her history, she had suffered from frequent upper respiratory infections and muffled voice. She had a herniated lumbar nucleus pulposus, and was scheduled to undergo a laminectomy. While inducing general anesthesia on the patient, the anesthesiologists had a great deal of difficulty in intubation of the endotracheal tube by routine procedure and consulted the department of ENT. The absence of the epiglottis was observed as a result of ENT consultation when examining the patient through a fiberoptic endoscope. fiberoptic laryngoscope and neck lateral plain X-ray. Using a fiberoptic laryngoscope and a neck lateral plain X-ray, v,e confirmed a congenital absence of the epiglottis, hypertrophy of aryepiglottic fold and arytenoid region, elongated larynx, a large false vocal cord.

Hearing Loss in Patients with Chronic Renal Failure with Hemodialysis Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hemodialysis (HD) is a valid treatment modality in patients with chronic renal failure, but it has been noted as a possible cause of hearing impairment. There have been many efforts to elucidate the etiologic factors of hearing impairment in patients with chronic renal failure (CRF) with HD. But, there were no identified causes of hearing impairment. This study was undertaken to determine the correlating factors and the degree and types of hearing impairment in patients with CRF with HD treatment. MATERIALS AND METHODS: We studied clinical status of 46 patients (92 ears) with CRF with HD treatment about hearing threshold, blood level of hemoglobin, blood urea nitrogen (BUN), parathyroid hormone (PTH), b2-microglobulin, duration of HD, and erythropoietin treatment between August, 1998 and October, 1998 at hemodialysis room, Uijongbu St. Mary's Hospital. RESULTS: The 33 patients (60 ears) had hearing loss, and 15 patients (22 ears) among them had clinically significant hearing loss. In hearing loss group, 31 patients showed the sensorineural type, one conductive type, and one mixed type. There was no significant correlation between the degree of hearing impairment and duration of HD, level of hemoglobin, BUN, PTH and beta2-microglobulin. The group of CRF with diabetes mellitus (DM) showed high incidence of clinically significant hearing impairment. Erythropoietin treatment was negatively correlated with hearing impairment. CONCLUSION: DM was a probable cause of hearing impairment and treatment of anemia with erythro-poietin administration seemed to be a possible preventing factor.

Evaluation of vitek ANI system for identification of anaerobic bacteria

No abstract available.

Evaluation of rapID ANA II system for identification of anaerobic bacteria

No abstract available.