Yonsei medical journal
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Yonsei medical journal · Mar 2021
Case ReportsCytomegalovirus-Associated Hemophagocytic Syndrome Diagnosed by Liver Biopsy in a Kidney Transplant Recipient.
Hemophagocytic syndrome (HPS) is a rare but potentially life-threatening disease in kidney transplant recipients, and is caused by systemic proliferation of macrophages actively phagocytizing other blood cells in the bone marrow, lymph nodes, and the spleen. Here, we report a 40-year-old male kidney transplant recipient who presented with fever, bicytopenia, and elevated liver enzymes 2 months after transplantation. Given that cytomegalovirus antigenemia and real-time polymerase chain reaction tests were positive, liver biopsy was performed under an assumption of cytomegalovirus-induced hepatitis. ⋯ As laboratory findings such as hyperferritinemia, elevated serum lactate dehydrogenase, low natural killer cell activity, and high soluble interleukin-2 receptor were also compatible with HPS, the recipient was diagnosed as having cytomegalovirus-induced hepatitis combined with reactive HPS. Following intravenous ganciclovir therapy with continuous administration of tacrolimus and corticosteroid, the symptoms resolved and laboratory findings were normalized. As far as we know, this is the first report of cytomegalovirus-induced hepatitis combined with reactive HPS in a kidney transplant recipient that is diagnosed by liver biopsy.
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Yonsei medical journal · Mar 2021
ReviewOptimal Complete Rectum Mobilization Focused on the Anatomy of the Pelvic Fascia and Autonomic Nerves: 30 Years of Experience at Severance Hospital.
The primary goal of surgery for rectal cancer is to achieve an oncologically safe resection, i.e., a radical resection with a sufficient safe margin. Total mesorectal excision has been introduced for radical surgery of rectal cancer and has yielded greatly improved oncologic outcomes in terms of local recurrence and cancer-specific survival. Along with oncologic outcomes, functional outcomes, such as voiding and sexual function, have also been emphasized in patients undergoing rectal cancer surgery to improve quality of life. ⋯ With the adoption of minimally invasive surgery, visualization of nerve structure and meticulous dissection for the mesorectum are now possible. As the leading hospital employing this technique, we have adopted minimally invasive platforms (laparoscopy, robot-assisted surgery) in the field of rectal cancer surgery and standardized this technique globally. Here, we review a standardized technique for rectal cancer surgery based on our experience at Severance Hospital, suggest some practical technical tips, and discuss a couple of debatable issues in this field.
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Yonsei medical journal · Mar 2021
Comparative StudyComparison of Automated Brain Volume Measures by NeuroQuant vs. Freesurfer in Patients with Mild Cognitive Impairment: Effect of Slice Thickness.
This study aimed to examine the inter-method reliability and volumetric differences between NeuroQuant (NQ) and Freesurfer (FS) using T1 volume imaging sequence with different slice thicknesses in patients with mild cognitive impairment (MCI). ⋯ Inter-method reliability between NQ and FS was good-to-excellent in most regions with improvement with a 1-mm slice thickness. This finding indicates that the potential effects of slice thickness should be considered when performing volumetric measurements for cognitive impairment.
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This study aimed to present our experience with failures in C-TDR and revision surgery outcomes. ⋯ C-TDR is good surgical option. However, it is very important to adhere to strict surgical indications and contraindications to avoid failure of C-TDR. The results of reoperations were good regardless of the approach. Therefore, various reoperation options could be considered in patients with failed C-TDR.
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Yonsei medical journal · Mar 2021
Associations between Frailty in Older Adults and Malnutrition in Rural Areas: 2019 Updated Version of the Asian Working Group for Sarcopenia.
The purpose of this study was to evaluate the prevalence of frailty among an older adult population living in rural communities and to determine if frailty is associated with nutritional status after adjusting for sarcopenia and depression. ⋯ For older adults, MNA is a suitable tool of use in assessing both nutritional status and frailty. Moreover, the nutritional status of older adults appears to be associated with frailty, even after corrections for physical and psychological function.