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A colonic pseudo-obstruction is a disorder that causes abdominal distension and abdominal pain similar to a mechanical obstruction, but there are no structural lesions that can obstruct the gastrointestinal tract. This condition can be acute or chronic. An acute colonic pseudo-obstruction, also called Ogilvie's syndrome, is believed to be a condition induced by other causes that are different from a chronic colonic pseudo-obstruction. The pathogenesis involves abnormalities in the autonomic nervous system induced by systemic diseases or medications, and it often improves when the primary causes are treated. On the other hand, a chronic colonic pseudo-obstruction can occur repeatedly without a particular cause. The authors encountered neuroleptic malignant syndrome that caused acute colonic pseudo-obstruction. This paper reports a case with a review of the relevant literature. This is the first case reported in Korea. This case shows that physicians should consider neuroleptic malignant syndrome as a cause of an acute colonic pseudo- obstruction.

Background and Study Aims Endoscopic submucosal dissection (ESD) is the most effective treatment for early gastric cancer or gastric adenoma . However, ESD results in iatrogenic ulcers and postoperative bleeding from ulcers. This study aimed to evaluate the effect of using a proton pump inhibitor (PPI) alone, a PPI + rebamipide combination therapy, and an H2 receptor antagonist (H2RA) + rebamipide combination therapy on ulcer healing after ESD. Patients and Methods A total of 204 patients who underwent ESD from April 2014 to July 2017 at Dong-A University Hospital were randomly assigned to the following groups: PPI-alone group, PPI + rebamipide combination therapy group, and H2RA + rebamipide combination therapy group. However, only 156 patients were studied since we excluded those who were lost to follow-up or had diseases other than early gastric cancer or gastric adenoma. Twenty-eight days after ESD, we evaluated the ulcer residual ratio, S stage rates, ulcer bleeding ratio, and gastric pH. Results This study included 156 patients (PPI-alone group: 52 patients; PPI + rebamipide group: 52 patients; H2RA + rebamipide group: 52 patients). The ulcer residual ratios were 24.3 ± 14.2%, 17.0 ± 12.1%, and 21.0 ± 13.8% in the PPI alone, PPI + rebamipide, and H2RA + rebamipide groups, respectively (P = 0.048). Conclusions PPI + rebamipide was more effective in reducing the ulcer residual ratio after ESD. There was no statistical difference in ulcer stage and delayed bleeding after ESD among the groups. These findings showed that PPI + rebamipide had limited benefits after ESD.

We investigated the prognostic influences of BCL1 and BCL2 expression on disease-free survival in breast cancer patients. BCL1 and BCL2 expression statuses were assessed by immunohistochemistry using tissue microarrays from 393 breast cancer patients. The Kaplan–Meier estimator and log-rank test were used for survival analyses. The Cox proportional hazards model was used to calculate hazard ratio (HR) and the 95% confidence interval (CI) of survival analyses. BCL1 expression revealed no impact on survival. The high BCL2 group showed superior disease-free survival compared with the low BCL2 group (p = 0.002), especially regarding local recurrence-free survival (p = 0.045) and systemic recurrence-free survival (p = 0.002). BCL2 expression was a significant prognostic factor by univariable analysis (HR, 0.528; 95% CI, 0.353–0.790; p = 0.002) and by multivariable analysis (HR, 0.547; 95% CI, 0.362–0.826; p = 0.004). High BCL2 expression was associated with higher disease-free survival in the hormone receptor (HRc)-positive and human epidermal growth factor receptor 2 (HER2)-negative (HRc(+)/HER2(−)) subtype only (p = 0.002). The high BCL2 group was associated with positive estrogen receptor (ER), positive progesterone receptor (PR), low histologic grade, and age ≤ 50 years. BCL1 expression had no prognostic impact, but BCL2 expression was a significant independent prognostic factor. High BCL2 expression was associated with higher disease-free survival, especially regarding local recurrence and systemic recurrence. The prognostic effect of BCL2 expression was effective only in the HRc(+)/HER2(−) subtype. Favorable clinicopathologic features and a strong association with the ER/PR status could partly explain the superior prognosis of the high BCL2 group. BCL2 expression could be utilized to assess the prognosis of breast cancer patients in clinical settings.

Cecal intubation is essential during colonoscopy, and observation of the terminal ileum is performed in most clinical practices. However, data on terminal ileal (TI) ulcers observed incidentally during colonoscopy are rare. We aimed to identify the characteristics and clinical course of TI ulcers observed incidentally during colonoscopy. Between January 2008 and December 2018, medical records from multi-centers reporting asymptomatic subjects who underwent biopsy on TI ulcers during colonoscopy were retrospectively reviewed. The characteristics of endoscopic findings and clinical course of TI ulcers were analyzed, and the factors affecting the clinical course of TI ulcers were evaluated. The median follow-up durations from first to second colonoscopy and from second to third colonoscopy were 20 months (interquartile range, 12–36) and 24 months (interquartile range, 12–34), respectively. A total of 134 subjects were included in the analysis. The histopathologic findings of TI ulcers were mostly chronic or active ileitis/inflammation (92.7%). On the second colonoscopy, 59 (44.0%) patients had no ulcers, 38 (28.4%) showed a decrease in size or number, and 37 (27.6%) patients showed no change in ulcers. Among 62 subjects who underwent a third colonoscopy, 14 (10.4%) had decreased size or number, 10 (7.5%) had no ulcer change, and two (1.5%) had increased ulcer size or number. In multivariate logistic regression analysis, a star shape was the only factor affecting continuation without improvement of incidental TI ulcers. Most TI ulcers observed incidentally showed no unusual findings on biopsy and improved on follow-up colonoscopy without treatment.

Colonoscopy is a safe and extremely popular diagnostic and therapeutic procedure. The most common complications are bleeding and perforation. Hemoperitoneum is a rare complication after a colonoscopy and is usually associated with splenic injury or solid organ pathology. This is potentially serious and can be life threatening. With the increasing number of colonoscopies performed, there has also been an increasing trend in reports of rare complications, such as pneumothorax, pneumomediastinum, appendicitis, small bowel perforation, septicemia, mesenteric tear, retroperitoneal abscess, and hemoperitoneum. This paper reports a unique case of hemoperitoneum after a recent colonoscopy without a splenic rupture or intra-abdominal abnormality, or external trauma. Most hemoperitoneum occurs within 48 hours after the inciting colonoscopy. In the present case, however, hemoperitoneum appeared 10 days after the colonoscopy. This case emphasizes that physicians should consider hemoperitoneum in a differential diagnosis of abdominal pain in patients after colonoscopy.

Adenoma detection rate (ADR) is an important quality indicator of colonoscopy. High-definition (HD) colonoscopy has been reported to increase ADR compared to standard-definition (SD) colonoscopy. Although there are few reports comparing the latest generation and the previous generation of HD colonoscopy equipment, there are reports that the latest generation colonoscopy equipment improves ADR. However, there are no reports on the impact of the latest generation HD colonoscopy on the ADR of trainee endoscopists. The aim of this study was to investigate whether the latest generation HD colonoscopy increases the ADR of trainee endoscopists compared with the previous generation HD colonoscopy. We conducted a retrospective review of medical records of patients aged 40–79 years old, who underwent screening or surveillance colonoscopy performed by nine gastroenterology fellows at Dong-A University Hospital from March 2019 to February 2020. We calculated the overall ratios of the ADR: the ADRs of the group using the older generation HD colonoscopy equipment and the group using the latest HD colonoscopy equipment. Polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and advanced neoplasia detection rate (ANDR) were calculated for each group. Factors related to adenoma detection were identified using logistic regression analysis. Altogether, 2189 patients were included in the study (the older HD colonoscopy group comprising 1183 and the latest HD colonoscopy group comprising 1006). We found that PDR (45.98 vs. 51.69%, p = 0.008) and ADR (35.67 vs. 40.85%, p = 0.013) were significantly higher in the latest generation HD colonoscopy group. The generational differences were not statistically significant for SSPDR (1.94 vs. 2.78%, p = 0.195) or ANDR (4.65 vs. 4.97%, p = 0.726). In the multivariate regression analysis, age, male sex, the latest generation HD colonoscopy, and long withdrawal time were the most significant factors affecting adenoma detection. The latest generation HD colonoscopy improved PDR and ADR by trainee endoscopists. These findings suggest that latest generation, higher-resolution colonoscopy equipment can improve the quality of colonoscopy for less experienced endoscopists.

Multiple primary malignancies are defined as the presence of more than one malignant neoplasm with a distinct histology occurring at different sites in the same individual. They are classified as synchronous or metachronous according to the diagnostic time interval of different malignancies. Diagnosis of multiple primary malignancies should avoid misclassification from multifocal/multicentric tumors or recurrent/metastatic lesions. In multiple primary malignancies, with increase in the number of primary tumors, the frequency rapidly decreases. Here, we report an exceptionally rare case of a woman who was diagnosed with metachronous sporadic sextuple primary malignancies including bilateral breast cancers (gastric cancer, ovarian Sertoli-Leydig cell tumor, left breast cancer, thyroid cancer, right breast cancer, and rectal neuroendocrine tumor). The sextuple primary malignancies in this case involved 5 different organs: the stomach, ovary, thyroid, rectum, and bilateral breasts. Further studies are needed to elucidate the current epidemiologic status of patients with multiple primary malignancies.

Standard clinical care in neonatal and pediatric intensive-care units (NICUs and PICUs, respectively) involves continuous monitoring of vital signs with hard-wired devices that adhere to the skin and, in certain instances, can involve catheter-based pressure sensors inserted into the arteries. These systems entail risks of causing iatrogenic skin injuries, complicating clinical care and impeding skin-to-skin contact between parent and child. Here we present a wireless, non-invasive technology that not only offers measurement equivalency to existing clinical standards for heart rate, respiration rate, temperature and blood oxygenation, but also provides a range of important additional features, as supported by data from pilot clinical studies in both the NICU and PICU. These new modalities include tracking movements and body orientation, quantifying the physiological benefits of skin-to-skin care, capturing acoustic signatures of cardiac activity, recording vocal biomarkers associated with tonality and temporal characteristics of crying and monitoring a reliable surrogate for systolic blood pressure. These platforms have the potential to substantially enhance the quality of neonatal and pediatric critical care. Soft electronic patches worn on the skin of infants or children in intensive-care units have a wide range of capabilities in aiding critical care, including monitoring of hemodynamic parameters, cardiac activity, movement and crying.

BACKGROUND Paragonimiasis is a food-borne parasitic infection caused by lung flukes of the genus Paragonimus. Although the most common site of infection is the pleuropulmonary area, the parasite can also reach other parts of the body on its journey from the intestines to the lungs, ending up in locations such as the brain, abdomen, skin, and subcutaneous tissues. Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease. CASE SUMMARY Here, we report a rare case of simultaneous breast and pulmonary paragonimiasis in a woman presenting painless breast mass and lung nodule with a history of eating raw trout. To confirm the diagnosis, serologic testing and tissue confirmation of the breast mass were performed. The patient was treated with surgical resection of the mass and praziquantel medication. CONCLUSION Ectopic paragonimiasis is difficult to diagnose due to the rarity of this disease. Thus, thorough history-taking and clinical suspicion of parasitic infection are important.

Intussusception is a rare disease in adults. A demonstrable etiology is found in approximately 85% of all cases, and approximately 40% of them are caused by malignant tumors. A 65-year-old patient visited the outpatient department with mild abdominal pain without other symptoms. The initial laboratory test and simple X-ray showed normal findings. CT revealed intussusception in the ileocecal area. The initial colonoscopic biopsy revealed atypical cells. Follow up colonoscopy showed spontaneous reduction of the intussusception. Diffuse large B-cell lymphoma was suspected in the second colonoscopic biopsy. An elective operation was performed. This case reports a case of a spontaneous reduction of adult intussusception with a brief review of literature.

Background: The coronavirus disease 2019 (COVID-19) has become a global pandemic. Healthcare workers are at a higher risk for exposure to COVID-19 infection than the general population. During the COVID-19 pandemic, endoscopists are recommended to wear personal protective equipment (PPE), including face shields, to prevent COVID-19 transmission. However, to the best of our knowledge, there are no reports on the impact of face shields on the quality of colonoscopy. This study aimed to determine whether the use of PPE, including face shields, affects the quality of colonoscopy during the COVID-19 pandemic.Methods: We retrospectively reviewed the medical records of patients who underwent screening or surveillance colonoscopy performed at Dong-A University Hospital between June 2020 and March 2021 during the COVID-19 pandemic. Endoscopists wore isolation gowns, disposable gloves, and KF94 masks from June 2020 to October 2020. From November 2020, endoscopists additionally wore face shields. Therefore, we compared the colonoscopy quality indicators during the 5 months without the use of face shields and the 5 months with the use of face shields. We calculated the overall adenoma detection rates (ADRs) of the group using face shields and the group not using face shields. Further, the polyp detection rate (PDR), sessile serrated lesion detection rate (SSLDR), advanced neoplasia detection rate (ANDR), polyp per colonoscopy, and adenoma per colonoscopy were calculated for each group.Results: In total, 1,359 patients were included in the study; the face shield and non-face shield groups comprised 679 and 680 patients, respectively. We found no statistically significant differences in the PDR (49.04 vs. 52.50%, p=0.202), ADR (38.59 vs. 38.97%, p=0.884) SSPDR (1.91 vs. 1.32%, p=0.388), and ANDR (3.98 vs. 3.97%, p=0.991) between the groups. In both the experienced endoscopist group and trainee endoscopist group, there was no difference in the colonoscopy quality indicators between the groups of patients examined by endoscopists with and without face shields.Conclusions: The quality indicators of colonoscopy were not affected by face shields during the COVID-19 pandemic.

Wearable electronics with dual-sensing modalities enable artifact-free health monitoring through differential detection., Soft, skin-integrated electronic sensors can provide continuous measurements of diverse physiological parameters, with broad relevance to the future of human health care. Motion artifacts can, however, corrupt the recorded signals, particularly those associated with mechanical signatures of cardiopulmonary processes. Design strategies introduced here address this limitation through differential operation of a matched, time-synchronized pair of high-bandwidth accelerometers located on parts of the anatomy that exhibit strong spatial gradients in motion characteristics. When mounted at a location that spans the suprasternal notch and the sternal manubrium, these dual-sensing devices allow measurements of heart rate and sounds, respiratory activities, body temperature, body orientation, and activity level, along with swallowing, coughing, talking, and related processes, without sensitivity to ambient conditions during routine daily activities, vigorous exercises, intense manual labor, and even swimming. Deployments on patients with COVID-19 allow clinical-grade ambulatory monitoring of the key symptoms of the disease even during rehabilitation protocols.

Sparganosis is a parasitic infestation caused by sparganum, a plerocercoid tapeworm larva of the genus Spirometra. Since the first case of human sparganosis reported in 1908, sparganosis has been a global disease, and is common in China, Japan, and Southeast Asian countries. Consumption of raw snakes, frogs, fish, or drinking contaminated beverages are sources of human infections. Human sparganosis usually manifests in subcutaneous fat in areas such as the abdomen, genitourinary tract, and limbs. Breast sparganosis cases are rare, representing less than 2% of total cases of human infections. Complete surgical extraction of the sparganum is the treatment of choice. Because of the rarity of the disease, clinical suspicion is vital to reach the diagnosis of breast sparganosis. Here we report 2 rare cases of breast sparganosis presenting with a painless breast lump, both treated with surgical excision and sparganum extraction.

Significance Continuous measurements of health status can be used to guide the care of patients and to manage the spread of infectious diseases. Conventional monitoring systems cannot be deployed outside of hospital settings, and existing wearables cannot capture key respiratory biomarkers. This paper describes an automated wireless device and a data analysis approach that overcome these limitations, tailored for COVID-19 patients, frontline health care workers, and others at high risk. Vital signs and respiratory activity such as cough can reveal early signs of infection and quantitate responses to therapeutics. Long-term trials on COVID-19 patients in clinical and home settings demonstrate the translational value of this technology., Capabilities in continuous monitoring of key physiological parameters of disease have never been more important than in the context of the global COVID-19 pandemic. Soft, skin-mounted electronics that incorporate high-bandwidth, miniaturized motion sensors enable digital, wireless measurements of mechanoacoustic (MA) signatures of both core vital signs (heart rate, respiratory rate, and temperature) and underexplored biomarkers (coughing count) with high fidelity and immunity to ambient noises. This paper summarizes an effort that integrates such MA sensors with a cloud data infrastructure and a set of analytics approaches based on digital filtering and convolutional neural networks for monitoring of COVID-19 infections in sick and healthy individuals in the hospital and the home. Unique features are in quantitative measurements of coughing and other vocal events, as indicators of both disease and infectiousness. Systematic imaging studies demonstrate correlations between the time and intensity of coughing, speaking, and laughing and the total droplet production, as an approximate indicator of the probability for disease spread. The sensors, deployed on COVID-19 patients along with healthy controls in both inpatient and home settings, record coughing frequency and intensity continuously, along with a collection of other biometrics. The results indicate a decaying trend of coughing frequency and intensity through the course of disease recovery, but with wide variations across patient populations. The methodology creates opportunities to study patterns in biometrics across individuals and among different demographic groups.

We report the development of a skin-conformable wireless sensor capable of assessing scratching for the quantification of itch., Itch is a common clinical symptom and major driver of disease-related morbidity across a wide range of medical conditions. A substantial unmet need is for objective, accurate measurements of itch. In this article, we present a noninvasive technology to objectively quantify scratching behavior via a soft, flexible, and wireless sensor that captures the acousto-mechanic signatures of scratching from the dorsum of the hand. A machine learning algorithm validated on data collected from healthy subjects (n = 10) indicates excellent performance relative to smartwatch-based approaches. Clinical validation in a cohort of predominately pediatric patients (n = 11) with moderate to severe atopic dermatitis included 46 sleep-nights totaling 378.4 hours. The data indicate an accuracy of 99.0% (84.3% sensitivity, 99.3% specificity) against visual observation. This work suggests broad capabilities relevant to applications ranging from assessing the efficacy of drugs for conditions that cause itch to monitoring disease severity and treatment response.

Capabilities in continuous monitoring of key physiological parameters of disease have never been more important than in the context of the global COVID-19 pandemic. Soft, skin-mounted electronics that incorporate high-bandwidth, miniaturized motion sensors represent a powerful class of technology for digital, wireless measurements of mechano-acoustic (MA) signatures of both core vital signs (heart rate, respiratory rate, and temperature) and underexplored biomarkers (coughing count) with high fidelity and immunity to ambient noises. Here, we introduce an effort that integrates such an MA sensor, a cloud data infrastructure and data analytics approaches based on digital filtering and convolutional neural networks for comprehensive monitoring of COVID-19 infections in sick and healthy individuals in a population, both in the hospital and the home. This hardware/software system extracts diverse signatures of health status in an automated fashion from a single device and time series data stream. Unique features are in quantitative measurements of coughing and other vocal events, as indicators of both disease and infectiousness. Systematic imaging studies demonstrate direct correlations between the time and intensity of coughing, speaking and laughing and the total droplet production, as an approximate indicator of the probability for disease spread. The sensors, deployed on COVID-19 patients along with healthy controls in both inpatient and home settings, record coughing frequency and intensity continuously, along with a comprehensive collection of other biometrics, with recording times for individuals of more than a month after disease diagnosis. These pilot studies include 3,111 hours of data spanning 363 days from 37 COVID-19 patients (20 females, 17 males) with 27,651 coughs detected in total along with continuous measurements of heart rate, respiratory rate, physical activity, and skin temperature. Manual labeling of randomly sampled 10,258 vocal events from 11 COVID-19 patients (6 females, 5 males) suggests a sensitivity of 85% and a specificity of 96% in cough detection using automated algorithms. The collective results indicate a decaying trend of coughing frequency and intensity through the course of disease recovery, but with wide variations across patient populations. The methodology also opens opportunities to study patterns in biometrics across individuals and among different demographic groups.

International audience; Indwelling arterial lines, the clinical gold standard for continuous blood pressure (BP) monitoring in the pediatric intensive care unit (PICU), have significant drawbacks due to their invasive nature, ischemic risk, and impediment to natural body movement. A noninvasive, wireless, and accurate alternative would greatly improve the quality of patient care. Recently introduced classes of wireless, skin-interfaced devices offer capabilities in continuous, precise monitoring of physiologic waveforms and vital signs in pediatric and neonatal patients, but have not yet been employed for continuous tracking of systolic and diastolic BP—critical for guiding clinical decision-making in the PICU. The results presented here focus on materials and mechanics that optimize the system-level properties of these devices to enhance their reliable use in this context, achieving full compatibility with the range of body sizes, skin types, and sterilization schemes typically encountered in the PICU. Systematic analysis of the data from these devices on 23 pediatric patients, yields derived, noninvasive BP values that can be quantitatively validated against direct recordings from arterial lines. The results from this diverse cohort, including those under pharmacological protocols, suggest that wireless, skin-interfaced devices can, in certain circumstances of practical utility, accurately and continuously monitor BP in the PICU patient population.

Introduction More than 22 million Americans are estimated to have obstructive sleep apnea (OSA), though this disease remains perpetually underdiagnosed. Undiagnosed OSA contributes to poor clinical outcomes, large healthcare costs and an economic burden in excess of $150 billion dollars annually. While polysomnography (PSG) is considered the gold standard to diagnose OSA home sleep apnea testing (HSAT) is now used for most patient cohorts. Wireless sensors may offer a lower cost and less burdensome approach to home testing than traditional HSAT. Methods We performed a fully remote, national, single-arm, open-label, prospective clinical study to evaluate the performance of a wireless, two sensor experimental system (ANNETM One, Sibel Health) against a Type III HST system. A total of 154 individuals completed screening with 62 screening in as high risk for OSA using the STOP-BANG questionnaire. Ultimately 60 participants were enrolled, and 46 completed a successful home testing night wearing both the commercially available HSAT (Philips Alice NightOne Home Sleep, Koninklijke Philips N.V) and the wireless experimental system. A board-certified sleep medicine physician determined the apnea-hypopnea index (AHI) for the HSAT defined by American Academy of Sleep Medicine v2.6 guidelines. Two study investigators, blinded to the HSAT results, scored the experimental system to determine AHI based on similar guidelines. An independent study investigator conducted the final analysis of comparative performance. Participants completed a psychometric survey of their preferences, experience, and usability of the two testing systems. Results We demonstrated a high level of agreement between the HSAT and experimental system for AHI (r2=0.81, p15) was 85% and 95%, respectively. The experimental system had a significantly higher Systems Usability Scale score compared to HSAT (61 vs 48, p Conclusion This study provides compelling evidence that the experimental system was highly acceptable and comparable to a currently used HSAT. Continued innovation in reliable, cost-effective, low profile technologies will be critical to address the unmet needs of sleep diagnostic testing. Support (if any) Anthem and Sibel Inc.

To control such a hemorrhage, a displaced pelvic ring must be rapidly reduced and stabilized with a pelvic binder, an external fixator, or a pelvic clamp. Among them, pelvic clamps can be life-saving but pin malposition may cause vascular complications. We present a case of superior gluteal artery pseudoaneurysm caused by AO pelvic C-clamp pin malposition.

Purpose To evaluate the clinicopathological and imaging features of mammography, ultrasonography, and magnetic resonance imaging (MRI) for breast cancer in Korean women under 40 years of age according to molecular subtypes. Materials and Methods We included 183 breast cancers in 176 consecutive women under 40 years old who had been diagnosed with breast cancer between January 2012 and November 2014. The patients' clinical and pathologic records were available as electronic medical records. A retrospective review of the pre-operative imaging studies was performed with 177 mammographies, 183 ultrasonographies, and 178 MRIs. Results Eighty-six percent (158/183) of lesions were symptomatic, with masses (147/183) as the most common presentation. Eighty percent (22/25) of the asymptomatic lesions were diagnosed via screening ultrasonography. The luminal A subtype was the most common (n = 79, 43%), human epidermal growth factor receptor 2-enriched subtype showed indistinct margins on mammography (p = 0.006), the triple negative subtype depicted a posterior enhancement on ultrasonography (p < 0.001) and rim enhancement on MRI (p < 0.001). Conclusion Breast cancers in Korean women under 40 years of age are commonly presented with a palpable mass, and luminal A is the most common molecular subtype. In our study, the imaging and pathologic characteristics of breast cancer in younger women were similar to those previously reported for older patients.

We aimed to investigate the potential of preoperative mammographic breast density (MBD) as a prognostic factor in breast cancer. Data of 969 patients with primary breast cancer were analyzed. We defined low MBD as fatty or fibroglandular breast, and high MBD as heterogeneously dense or extremely dense breast, respectively. The high MBD group demonstrated a superior overall survival rate compared to the low MBD group (p 50 years (p 2 (p 50 years and the HRc(+)/HER2(−) subtype. Favorable clinicopathologic features, active treatments, and other factors could contribute to this causality.

Despite the increasing use of alternative analgesic agents, salicylate overdose remains a not-uncommon problem. Severe poisoning is life threatening, so prompt treatment and supportive measures are required to reduce mortality. Generally, salicylate intoxication results in the development of high-anion-gap metabolic acidosis. However, outside of Korea, normal-anion-gap or negative-anion-gap metabolic acidosis with hyperchloremia is rarely reported. We report herein the case of an 83-year-old female patient with chronic aspirin intake who presented with hyperchloremia and a negative anion gap. The patient’s symptoms improved with conservative treatment and hemodialysis; notably, her chloride levels decreased as her blood salicylate concentrations decreased. Salicylate may cause hyperchloremia, demonstrating the importance of careful documentation of patient medication histories. (Korean J Med 2015;89:457-460)

The aims of this study were to determine the malignancy rate of probably benign lesions that show an interval change on follow-up ultrasound and to evaluate the differences seen on imaging between benign and malignant lesions initially categorized as probably benign but with interval change on follow-up breast ultrasound. We retrospectively reviewed 11,323 lesions from ultrasound-guided core-biopsies performed between June 2004 and December 2014 and identified 289 lesions (266 patients) with an interval change from probably benign (Breast Imaging Reporting and Data System [BI-RADS] category 3) in the previous 2 years. Malignancy rates were compared according to the ultrasound findings and the characteristics of the interval changes, including changes in morphology and/or diameter. The malignancy rate for probably benign lesions that showed an interval change on follow-up ultrasound was 6.9% (20/289). The malignancy rate was higher for clustered cysts (33.3%) and irregular or noncircumscribed masses (12.7%) than for circumscribed oval masses (5%) or complicated cysts (5%) seen on initial ultrasound (P = 0.043). Fifty-five percent of the malignancies were found to be ductal carcinoma in situ and there was 1 case of lymph node metastasis among the patients with invasive disease in whom biopsy was delayed by 6 to 15 months. The extent of invasiveness was greater in missed cases. There was a significant difference in the maximal diameter change between the 20 malignant lesions and the 269 benign lesions (4.0 mm vs 2.7 mm, P = 0.002). The cutoff value for maximal diameter change per initial diameter was 39.0% for predicting malignancy (sensitivity 95%, specificity 53.5%). The malignancy rate for morphologically changed lesions was significantly higher than for morphologically stable lesions (13.6% vs 4.9%; P = 0.024) Our 6.9% of probably benign lesions that showed an interval change finally turned out to be malignancy was mostly DCIS. The sonographic features, interval changes in sonographic features, and lesion size might help in the recategorization of these lesions.

Aortoesophageal fistula (AEF) is an extremely rare but lethal cause of massive gastrointestinal hemorrhage. Characteristic symptoms are mid-thoracic pain, sentinel minor hemorrhage, and massive hemorrhage after a symptom-free interval. Prompt diagnosis and immediate treatments are necessary to reduce mortality. However, AEF is difficult to diagnose because it is uncommon and often leads to death with massive bleeding before proper evaluation. We report a case of endoscopic diagnosis of AEF that did not present with hematemesis; it was treated with thoracic endovascular aortic repair (TEVAR) and surgery. A 71-year-old female presented to the emergency department with epigastric discomfort. Endoscopy demonstrated a submucosal tumor-like protrusion and pulsating mass with blood clots. Contrast-enhanced chest CT confirmed AEF due to descending thoracic aortic aneurysm. The patient immediately underwent TEVAR to prevent massive bleeding and subsequently underwent surgery. Endoscopists should consider AEF if they see a submucosal tumor-like mass with a central ulcerative lesion or a pulsating protrusion covered with blood clots in mid-esophagus during an endoscopy.

To evaluate the value of the computer-aided diagnosis (CAD) program applied to diagnostic breast ultrasonography (US) based on operator experience.US images of 100 breast masses from 91 women over 2 months (from May to June 2015) were collected and retrospectively analyzed. Three less experi

The aim of this study was to investigate the follow-up results and characteristics of oval circumscribed lesions with fast initial enhancement on preoperative magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer. Preoperative data from consecutive patients newly diagnosed with breast cancer between 2010 and 2013 were retrospectively reviewed. Only MRI reports containing, “oval shape, circumscribed margin, and fast initial enhancement,” were extracted and analyzed. Follow-up results and clinical and pathological findings were evaluated. A total of 430 oval circumscribed lesions with fast initial enhancement were included. Forty-eight lesions were pathologically confirmed at initial workup and 382 were followed up. Among the 48 lesions, 14 were found to have additional malignancy and 34 were benign. Among the 382 followed-up lesions, only 1 was subsequently confirmed to be malignant. There were no evident changes in any of the remaining lesions during follow-up. The overall rate of malignancy was 3.5% (15/430). When lesions exhibited delayed washout enhancing kinetics (P

12 Background: To evaluate the characteristics and malignancy rate of oval, circumscribed enhancing lesions seen on preoperative breast MRI in patients with breast cancer. Methods: From January 2010 through May 2013, a total number of 502 oval, circumscribed mass was incidentally found in 326 patients with breast cancer who had undergone preoperative breast MRI. Seventy-eight lesions were excluded due to the lack of follow-up imaging or total mastectomy. Biopsy was performed when suspicious enhancing kinetics or interval change were detected on MRI. Otherwise, MRI or ultrasound follow up for correlated lesion were performed at least 2 years. Clinical and imaging features were recorded for analysis. Results: Of the 424 oval, circumscribed enhancing lesions detected on MRI, twelve (2.8%) were malignant and 412 (97.2%) were benign. There was no significant difference in size between malignant (0.72±0.26 cm) and benign (0.71±0.34 cm) lesions (p = 0.932). Among 424 lesions, 43 lesions (10.1%) were pathologically confirmed and twelve were malignant. Positive predictive value (PPV) of malignancy for the biopsy was 27.9%. Among 12 malignant lesions, 7 (58.3%) were invasive ductal carcinoma, 4 (33.3%) were ductal carcinoma in situ, and 1 (8.3%) was tubular carcinoma. Of the pathologically confirmed benign lesions, 8 (25.8%) were fibroadenoma, 7 (22.6%) were intraductal papilloma. Interestingly, there were significantly frequent MRI features with early fast enhancement and delayed washout pattern in malignant (11/12) compared to benign (29/412) lesions (p < 0.001). PPV of malignancy for early fast enhancement and delayed washout pattern in MRI was 27.5%. Conclusions: Cancer yield in patients with oval, circumscribed enhancing lesion on preoperative breast MRI was 12 (2.8%) of 424. MRI features with early fast enhancement and delayed washout pattern strongly suggested malignancy.

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton with involvement of peripheral joints and non-articular structures (1). Indeed, it is best known for its symptom of lower back pain; however, patients often present with hip or groin pain misleading the clinician to think that the cause lies primarily in the hips. Hip involvement as a common problem in AS increases the burden and negative affects its prognosis of AS than any other axial joints (2). Femoroacetabular impingement (FAI) has been recently identified as a major cause of early primary osteoarthritis (OA) of the hip (3). FAI refers to abnormal contact between the femoral head-neck junction or the acetabular rim (4). A number of predisposing conditions have been described with deformities of the femur and the acetabulum which result in FAI including Legg-Calve-Perthes, slipped capital femoral epiphysis, coxa magna, hip dysplasia, and fractures of the femoral neck (5). Though FAI has not been recognized as a common radiologic feature of AS, we noticed FAI like features in hips of AS patients and hypothesized that AS may be predisposed to FAI. To the best of our knowledge, there has been no study about FAI patHip Morphometry of Femoroacetabular Impingement Pattern in Patients with Ankylosing Spondylitis 강직성척추염 환자에서 대퇴비구충돌증후군 고관절 모양에 관한 연구

This study investigated the effect of a manufactured soluble dietary fiber on lipid metabolism in rats fed high cholesterol diets. Soluble dietary fiber was prepared from wood chips of oak (Quercus mongolica). Male Sprague-Dawley rats weighing 100 +/- 10 g were randomly assigned to either a normal diet or five high cholesterol diets containing 1% cholesterol and different fiber supplements. The high cholesterol groups were subdivided into fiber-free diet (FF), 5% pectin (5P), 10% pectin (10P), 5% manufactured soluble dietary fiber (5QM), and 10% manufactured soluble dietary fiber (10QM) groups. Total serum cholesterol concentrations in all soluble dietary fiber-supplemented groups were lower than in the FF group. The high-density lipoprotein-cholesterol concentration in the FF group was significantly lower, compared with the normal group, but was increased in groups supplemented with soluble dietary fiber. Low-density lipoprotein-cholesterol levels and the atherogenic index had the same tendency as total cholesterol concentration. Compared with the FF group, in the 5P, 5QM, 10P, and 10QM groups hepatic triglyceride concentrations were 12%, 16%, 20%, and 24% lower, respectively, and hepatic cholesterol concentrations were 48%, 52%, 52%, and 58% lower, respectively. Hepatic 3-hydroxy-3-methylglutaryl-CoA reductase activity in the soluble fiber groups was significantly higher than in the FF groups, but lower than the normal group. When hepatic tissue was observed under a light microscope, the FF group had completely formed lipomas in the hepatic tissue, which led to fat deposits and then a fatty liver. The size and number of lipomas were lower in the soluble dietary fiber-fed groups, as compared with the group not fed dietary fiber. In conclusion, improvements in lipid metabolism were observed as a result of the manufactured soluble dietary fiber from the oak chips, and were similar to that seen for pectin. The preparation method for the soluble dietary fiber from oak chips successfully produced a functional soluble fiber.

Pseudohypoparathyroidism type Ia (PHP Ia) is a disorder characterized by multiform hormonal resistance including parathyroid hormone (PTH) resistance and Albright hereditary osteodystrophy (AHO). It is caused by heterozygous inactivating mutations within the Gs alpha-encoding GNAS exons. A 9-year-old boy presented with clinical and laboratory abnormalities including hypocalcemia, hyperphosphatemia, PTH resistance, multihormone resistance and AHO (round face, short stature, obesity, brachydactyly and osteoma cutis) which were typical of PHP Ia. He had a history of repeated convulsive episodes that started from the age of 2 months. A cranial computed tomography scan showed bilateral calcifications in the basal ganglia and his intelligence quotient testing indicated mild mental retardation. Family history revealed that the patient's maternal relatives, including his grandmother and 2 of his mother's siblings, had features suggestive of AHO. Sequencing of the GNAS gene of the patient identified a heterozygous nonsense mutation within exon 11 (c.637 C>T). The C>T transversion results in an amino acid substitution from Gln to stop codon at codon 213 (p.Gln213*). To our knowledge, this is a novel mutation in GNAS.

Background: Clinical diagnosis of multiple system atrophy (MSA) relays on signs and symptoms that are often difficult to identify particularly at early stage. Indeed neuropathological studies have demonstrated that Parkinson variant of MSA (MSA-P) is the first cause of misdiagnosis in a cohort of patients presenting with parkinsonian features. But accurate diagnosis of these disorders is important for deciding on treatment, appropriate advice and prognosis since atypical parkinsonian disorders are characterized by poor response to dopaminergic treatment and more rapid disease progression. Therefore, we conducted this study to investigate difference of perfusion Single Photon Emission Computed Tomography (SPECT) in patients with the early phase of MSA-P using SPM program. Methods: We recruited consecutively 21 patients with MSA-P and 48 age-matched healthy controls. All subjects underwent Tc-99m HMPAO perfusion SPECT and this perfusion images were analyzed. Results: For MSA-P, only hypoperfusion was seen in the middle frontal gyrus of left frontal lobe, superior frontal gyrus of right frontal lobe, precentral gyrus of left frontal lobe, middle frontal gyrus of right frontal lobe and precentral gyrus of right frontal lobe with respect to healthy subjects. Conclusions: We cautiously assume that perfusion SPECT may offer significant advantages compared to other imaging techniques in the assessment of neuronal degeneration in MSA-P and may help the clinician in the diagnostic characterization of patients presenting with atypical parkinsonism. Received: May 16, 2014 Revision received: May 28, 2014 Accepted: May 28, 2014

Hutchinson-Gilford progeria syndrome (HGPS) is a rare condition originally described by Hutchinson in 1886. Death result from cardiac complications in the majority of cases and usually occurs at average age of thirteen years. A 4-yr old boy had typical clinical findings such as short stature, craniofacial disproportion, alopecia, prominent scalp veins and sclerodermatous skin. This abnormal appearance began at age of 1 yr. On serological and hormonal evaluation, all values are within normal range. He was neurologically intact with motor and mental development. An echocardiogram showed calcification of aortic and mitral valves. Hypertrophy of internal layer at internal carotid artery suggesting atherosclerosis was found by carotid doppler sonography. He is on low dose aspirin to prevent thromboembolic episodes and on regular follow up. Gene study showed typical G608G (GGC- > GGT) point mutation at exon 11 in LMNA gene. This is a rare case of Hutchinson-Gilford progeria syndrome confirmed by genetic analysis in Korea.

Purpose: To report early results of supportive bone cement replacement for medium to large size osteonecrotic femoral heads in young patients. Materials and Methods: Forty-one osteonecrotic femoral heads in 38 patients, who received operation from Mar. 1998 to Feb. 2000, were reviewed. The mean age of the patients was 34.2 years (men; 33, women; 5). The preoperative mean Harris score was 48.6. Radiologic staging of Ficat showed I in 2 hips (5%), II-A in 7 hips (17%), II-B in 8 hips (20%) and III in 24 hips (59%). According to the index of necrotic extent (INE) by MRI, 8 hips (20%) were grade B and the remaining 33 hips (80%) were grade C. The operative method used was debridement of necrotic bone and bone cement replacement. Mean length of follow-up was 24.6 months. Three hips were lost to final follow-up. Results: Postoperative immediate pain relief was observed in 38 hips (86%). Mean Harris score at the final follow-up was 77.3. Radiologic progression of stage was observed in 11 hips (27%), and no progression in the remaining 30 hips (73%). Arthoplasty was performed in 6 hips (15%), which were INE C in all cases. Conclusion: Supportive bone cement replacement is easier than other salvage techniques and produced a good result. INE was an important factor effecting postoperative results. Long term follow up is necessary.