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Since the incidence of ovarian germ cell tumor (GCT) in pediatric population is low, there is little information regarding this tumor. A synchronous and metachronous bilateral mass is not infrequently observed in GCT patients. It is important to prevent early ovarian failure and preserve fertility.We retrospectively reviewed the medical records of 112 patients less than 18 years surgically treated for ovarian GCT between 2008 and 2021 at the Department of Pediatric surgery of the Seoul National University Hospital (SNUH). Among these, 13 patients (11.6%) had bilateral masses. In metachronous masses, the recurrence period and therapeutic approach were evaluated. When ovarian failure was a concern, fertility preservation was attempted.Mean age was 8.1 ± 4.0 years. Patients with a bilateral mass were older (p = 0.004). Follow-up was 39.6 ± 40.6 months. Five patients had a synchronous mass, and 8 patients experienced metachronous recurrence. Two patients with a synchronous mass had a metachronous neoplasm (n = 1) and recurrence (n = 1). Patients with metachronous recurrence started menstruation except for two patients who had not reached puberty. The mean recurrence interval was 45.9 ± 38.6 months. Ovum banking was requested for 6 patients and performed in 2.During our 17 years of experience, bilaterality was observed in 11.6% of GCT patients. Metachronous mass occurs after 5 years. A longer follow-up plan is needed for early detection. Our multidisciplinary approach to preserve fertility seemed to be successful with close cooperation with gynecologists.

In the era of nucleoside analogs (NA), we investigated liver transplantation (LT) outcomes using hepatitis B surface antigen (HBsAg)-positive(+) grafts and Korean Organ Transplantation Registry (KOTRY) data. The KOTRY database registered 4,265 LTs between April 2014 and January 2020; 20 (0.5%) using HBsAg(+) grafts were identified. HBsAg(+) liver grafts [S(+)] were compared to HBsAg-negative(−) liver grafts (n = 4,100) for LT outcomes. The S(+) group was compared with LTs using HBsAg(−)/hepatitis B core antibody (HBcAb) (+) [C(+), n = 882] and HBsAg(−)/HBcAb(−) [SC(−), n = 3,132] grafts by propensity score matching (PSM) (1:1). Sixteen of 20 HBsAg(+) graft recipients maintained hepatitis B immunoglobulin. Tenofovir is the most commonly used NA. Compared to the HBsAg(II) group, the S(+) group showed no significant differences in patient (P = 0.332) or graft survival (P = 0.152). Age (hazard ratio [HR] = 1.03, P = 0.016), hepatocellular carcinoma (HCC) (HR = 4.61, P < 0.001), the model for end-stage liver disease (MELD) score (HR = 2.82, P = 0.001), ascites (HR = 2.14, P = 0.002), and encephalopathy (HR = 2.53, P < 0.001) were risk factors for patient survival. The graft survival risk factors were HCC (HR = 4.01, P = 0.001), preoperative treatment for HCC (HR = 0.54, P = 0.006), MELD score (HR = 2.14, P = 0.012), ascites (HR = 2.52, P < 0.001), and encephalopathy (HR = 1.99, P < 0.001). PSM between groups S(+) and C(+) and groups S(+) and SC(−) revealed no significant difference in patient survival (P = 0.863 and P = 0.547, respectively) or graft survival (P = 0.576 and P = 0.327, respectively). In hepatitis B virus (HBV)-endemic areas, HBsAg(+) liver grafts can expand the donor pool without compromising outcomes.

Posttransplant anemia is a common complication after kidney transplantation. Parvovi rus B19 (PVB19) infection can induce pure red cell aplasia (PRCA) in immunosuppressed transplant patients. We herein report a case of recurrent PVB19-associated PRCA in a kidney transplant patient. A 49-year-old woman presented with anemia and normal renal function 1 year after a deceased-donor kidney transplantation for immunoglobulin A ne phropathy-related end-stage renal disease. She received desensitization therapy, and 2 years later, she underwent transplantation with thymoglobulin induction. Despite repeat ed red cell transfusion and erythropoietin therapy, her anemia aggravated progressively. Bone marrow biopsy revealed normocytic normochromic PRCA. Real-time polymerase chain reaction detected a high plasma load of PVB19. Administration of intravenous im munoglobulin (IVIG) at 2 g/kg with adjuvant reduction of tacrolimus and discontinuation of myfortic acid effectively treated the anemia. However, the PVB19 load remained high, and PRCA recurred 7 months after the initial IVIG treatment. Tacrolimus was switched to cyclosporine in the second IVIG treatment, which successfully improved PRCA and reduced the PVB19 load. Our case suggested that PVB19-associated PRCA should be suspected when persistent anemia is observed in kidney transplant patients with heavy immunosuppression and that PVB19-associated PRCA can recur in the presence of per sistent PVB19 viremia.

For successful human leukocyte antigen-incompatible (HLAi) or ABO-incompatible (ABOi) living-donor kidney transplantations (LDKTs), pretransplant desensitization is essential; however, early antibody-mediated rejection (ABMR) remains the most important complication after HLAi or ABOi transplantation. Here, we report a case of early acute ABMR in simultaneous HLAi and ABOi LDKT with preformed donor-specific antibody (DSA), despite desensitization. Dialysis-dependent, severe ABMR occurred with a rebound of pre-existing DSA and appearance of de novo DSA after initial normalization of renal function, 8 days postoperatively. However, a low anti-ABO antibody titer (1:8) was maintained after transplantation. Combination therapy of plasmapheresis, high-dose intravenous immunoglobulin, and bortezomib improved both ABMR and renal functions. Thus, an appropriate preventive and therapeutic management for early ABMR is important among high-risk LDKT patients. Furthermore, early AMBR can occur despite pretransplant desensitization as seen in this case, and close monitoring of the patient and prompt management are considered vital for better therapeutic outcomes.

A 76-year-old man was referred to our clinic after a foreign body seen in his sigmoid colon during a colonoscopy. He had undergone three operations for a left inguinal hernia within the previous 8 years, and the first procedure was a laparoscopic totally extraperitoneal approach. Four years later, removal of migrated and infected mesh was conducted by open approach. He then had a positive stool occult blood test for routine check-up 4 years after the remnant mesh removal. An ill-defined lesion was identified on colonoscopy. CT revealed a 2.7 cm diameter enhancing lesion in the sigmoid colon. Laparoscopic sigmoidectomy was performed, and remnant mesh fragment was found in the sigmoid colon and removed. The migrated mesh could not be wholly removed by open abdominal approach and the remnant mesh fragment migrated to sigmoid colon. It suggests the importance of a laparoscopic approach to remove the entire mesh.

This study was performed to evaluate the sedative and analgesic effects of xylazine (X) and tramadol (T) intravenously (IV) administered to horses. Six thoroughbred saddle horses each received X (1.0 mg/kg), T (2.0 mg/kg), and a combination of XT (1.0 and 2.0 mg/kg, respectively) IV. Heart rate (HR), respiratory rate (RR), rectal temperature (RT), indirect arterial pressure (IAP), capillary refill time (CRT), sedation, and analgesia (using electrical stimulation and pinprick) were measured before and after drug administration. HR and RR significantly decreased from basal values with X and XT treatments, and significantly increased with T treatment (p < 0.05). RT and IAP also significantly increased with T treatment (p < 0.05). CRT did not change significantly with any treatments. The onset of sedation and analgesia were approximately 5 min after both X and XT treatments; however, the XT combination produced a longer duration of sedation and analgesia than X alone. Two horses in the XT treatment group displayed excited transient behavior within 5 min of drug administration. The results suggest that the XT combination is useful for sedation and analgesia in horses. However, careful monitoring for excited behavior shortly after administration is recommended.