BACKGROUND/AIMS: Detection of proximal serrated polyps (PSPs) is increasingly recognized as a new qualitative target for colonoscopy. The aims of this study were to assess the detected prevalence of PSPs and synchronous adenomas in an asymptomatic average-risk screening cohort and to evaluate potential factors associated with detection of PSPs. METHODS: The study included 1,375 asymptomatic average-risk Korean patients (aged 50 years or older) who underwent screening colonoscopy. In total, 1,710 polyps were evaluated pathologically. RESULTS: The overall PSP detection rate (PSPDR) was low at 3.1%, despite high polyp (54.0%) and adenoma detection rates (ADRs, 43.5%). ADR did not correlate with PSPDR, but it was strongly correlated with PDR (r=0.810; p<0.001). Patients with PSPs were more likely to have longer withdrawal time and more proximal colon adenomas than patients without PSPs (adjusted odds ratio [OR], 1.19; 95% confidence interval [CI], 1.09 to 1.31; p<0.001) (adjusted OR, 2.03; 95% CI, 1.06 to 3.88; p=0.031, respectively). CONCLUSIONS: The detected prevalence of PSPs was low (<5%) in an asymptomatic average-risk screening Korean population, despite the high prevalence of conventional adenomas. A longer mucosal inspection of the proximal colon may serve as a practical method to enhance detection of PSPs.
Adenoma ; Cohort Studies ; Colon ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Mass Screening ; Odds Ratio ; Polyps ; Prevalence

PURPOSE: The aim of this study was to evaluate the impact of extended resection of primary tumor on survival outcome in unresectable colorectal cancer (UCRC). METHODS: A retrospective analysis was conducted for 190 patients undergoing palliative surgery for UCRC between 1998 and 2007 at a single institution. Variables including demographics, histopathological characteristics of tumors, surgical procedures, and course of the disease were examined. RESULTS: Kaplan-Meier survival curve indicated a significant increase in survival times in patients undergoing extended resection of the primary tumor (P < 0.001). Multivariate analysis showed that extra-abdominal metastasis (P = 0.03), minimal resection of the primary tumor (P = 0.034), and the absence of multimodality adjuvant therapy (P < 0.001) were significantly associated poor survival outcome. The histological characteristics were significantly associated with survival times. Patients with well to moderate differentiation tumors that were extensively resected had significantly increased survival time (P < 0.001), while those with poor differentiation tumors that were extensively resected did not have increase survival time (P = 0.786). CONCLUSION: Extended resection of primary tumors significantly improved overall survival compared to minimal resection, especially in well to moderately differentiated tumors (survival time: extended resection, 27.8 ± 2.80 months; minimal resection, 16.5 ± 2.19 months; P = 0.002).
Colorectal Neoplasms* ; Colorectal Surgery ; Demography ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Palliative Care ; Retrospective Studies

BACKGROUND: Two distinct types of fms-like tyrosine kinase 3 (FLT3) gene mutations have been identified in acute myeloid leukemia (AML): D835 and internal tandem duplication (ITD) mutations. These mutations are known to cause the proliferation of leukemic cells and inhibit the apoptosis of leukemic cells due to ligand-independent activation of their receptors. Therefore, the current study attempted to investigate the frequency of FLT3 gene mutations and their prognostic implications for AML in terms of treatment response, survival, and relapse. METHODS: Polymerase chain reaction (PCR) was performed to detect D835 and ITD mutations in 84 newly diagnosed AML patients from February 2001 to October 2004. Restriction fragment length polymorphism (RFLP) and direct sequencing were performed to analyze the D835 mutations. The results were examined based on a comparison with previously known prognostic factors, and the treatment outcomes analyzed according to the existence of the mutations in relation to the event free survival (EFS), overall survival (OS), and complete remission (CR) rates. RESULTS: D835 and IDT mutations were detected in 4.7% (4/84) and 19.0% (16/84), respectively, of the AML patients. The FLT3 gene mutations were not found to be associated with previously known prognostic factors, such as the WBC count, age, and cytogenetic risk group, but were associated with the lactate dehydrogenase levels. The EFS and OS rates were also significantly lower in the FLT3 gene mutation group, especially in AML with normal karyotypes. CONCLUSIONS: FLT3 gene mutations were observed in 23.8% of AML patients and appeared to have a prognostic implication on patient survival. Accordingly, the presence of FLT3 gene mutations, which could be tested easily by using PCR/RFLP methods, should be investigated routinely at the time of diagnosis.
Apoptosis ; Cytogenetics ; Diagnosis ; Disease-Free Survival ; fms-Like Tyrosine Kinase 3 ; Humans ; Karyotype ; L-Lactate Dehydrogenase ; Leukemia, Myeloid, Acute* ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Recurrence

BACKGROUND: The authors have modified the method of Ravitch technique. MATERIAL AND METHOD: This technique was applied to 6 patients out of 18 patients who underwent corrective surgery from May 1987 to July 1999. The technique is quite different from that of Ravitch. We did not divide the intercostal muscle bundles from the laterals of sternum and the Akin's struts were placed retrosternally crossing the chest horizontally to prevent flail motion during immediate post-operative period and retraction of the sternum afterwards. Anterior sternal osteotomy instead of the posterior one was performed for the latest 3 cases which made operative procedure more simple and easy. The struts were removed one year later. RESULT: Compared to the hospital stay of the patients who received standard Ravitch method that of the six cases who received our modification was definitely shortened from 13.1 days to 8.3 days(p<0.0000). Flail motion was not noted in any patient and chest wall stability was obtained more easily with this technique. CONCLUSION: Our modification is recommendable for correction of funnel chest in regards to shorter operation time better chest wall stability shorter hospital stay and less complication.
Funnel Chest* ; Humans ; Intercostal Muscles ; Length of Stay ; Osteotomy ; Sternum ; Surgical Procedures, Operative ; Thoracic Wall ; Thorax

Gas-forming infections in the genitourinary tract are usually associated with diabetes mellitus, and emphysematous pyelonephritis is a common disease among them. However, gas forming infection occurring in the scrotum is extremely rare. We experienced a case of gas-forming scrotal wall abscess in a 45-year-old diabetic man, who showed clinical symptoms mimicking acute epididymo-orchitis.
Abscess* ; Diabetes Mellitus ; Humans ; Middle Aged ; Pyelonephritis ; Scrotum

Congenital bronchial atresia is one of the rare bronchopulmonary anomalies which is thought to be caused by a vascular insult of uncertain timing during fefal development. It is defined as an anomaly which does not have communication between a segmental or lobar bronchus and the main airway. Because of the collateral ventilation, almost all of these cases show hyperlucency of the involved segment or lobe in chest roentgenogram. We report an extremely rare case of congenital bronchial atresia with collapse of the right upper lobe which was treated by surgical resection.
Bronchi ; Bronchial Diseases ; Thorax ; Ventilation

A case of true malignant mixed tumor of the parotid gland is reported. The tumor, occuring in a 55-year-old man, started to grow rapidly after a long history of parotid mass. Total parotidectomy was carried out and the resected tumor measured 5x4x3 cm with a cut surface showing grayish-white solid and myxoid appearance. Microscopically, the tumor had both carcinomatous and sarcomatous elements, the former consisting of undifferentiated carcinoma with focal areas of ductal differentiation and the latter consisting of pleomorphic sarcoma with chondrosarcomatous differentiation. A remnant of benign pleomorphic adenoma could also be identified. Immunohistochemical study demonstrated focal cytokeratin reactivity in the carcinoma cells and vimentin in sarcomatous elements. It is assumed from these clinical and histological findings that the tumor had transformed from a pre-existing benign pleomorphic adenoma.
Adenoma

Objective: Air pollutants have attracted increasing interest worldwide, including Korea. Acute and chronic exposure to air pollutants has adverse effects on health. Therefore, this study examined the association of air pollutants with myocardial infarction. Methods: This study included 542 patients who underwent coronary angiography and were diagnosed with acute coronary artery occlusion after visiting a local emergency medical center from January 1, 2016, to December 31, 2018. The days (1,096) were divided into two groups: myocardial infarction days group (the days when symptoms of myocardial infarction developed) and non-myocardial infarction days group (the days when symptoms of myocardial infarction did not develop). This study compared the air pollutants (PM10, PM2.5, O3, SO2, CO, and NO2) and prognosis (survivor, death) from two days ago to the days between the myocardial infarction days and non-myocardial infarction days. Results: The PM10 and PM2.5 of the myocardial infarction days group were 44.332±18.892 and 25.193±12.009 μm/m3, respectively, and those of the non-myocardial infarction days group were 41.906±19.263 and 23.693±12.053 μm/m3, respectively. On day one before symptom development, the PM2.5 of the myocardial infarction days group was 25.316± 11.977 μm/m3, which was higher than that of the non-myocardial infarction days groups (23.642±12.053 μm/m3), and there were no significant differences between the gaseous air pollution and the number of occlusions, except on a 0 day of ozone. The PM2.5 (proximal, middle, and distal according to the vessel size) at day 0 was 25.747±12.361, 22.941± 11.477, and 21.486±10.924 μm/m3, respectively; the proximal group had the highest value. During the study days, the PM10 of the death and survival groups was 51.440 (±20.140)-56.924 (±25.225) μm/m3 and 41.155 (±18.544)-43.002 (±18.858) μm/m3, respectively. PM2.5 of the death and survival groups was 26.968 (±14.140)-30.145 (±12.829) and 23.770 (±11.685)-24.170 (±12.696) μm/m3, respectively. Conclusion Myocardial infarction was found to develop more on the day with the highest PM2.5 and PM10 on day 0 and -1. A high PM2.5 is related to an occlusion of the proximal coronary artery. Therefore, PM2.5 has a stronger association with myocardial infarction than PM10. Furthermore, increased particulate air pollution for three consecutive days is associated with a poor prognosis.

BACKGROUND: Aldosterone acts as a non-hemodynamic factors on the hypertensive heart regarding sodium retension or myocardial fibrosis. To elucidate whether aldosterone is associated with the specific left ventricular geometry or not, we investigated the relationship between the upright serum aldosterone levels and the echocardiographicleft ventricular structure in the essential hypertension patients never treated. METHODS: Echocardiographic indices included M-mode measured left ventricular mass index (LVMI), relative wall thickness (RWT). Aldosterone is measured by Radioimmunoassay for the serum withdrawn from the subjects at least 3 hours upright position. 63 patients and 20 normal control subjects were evaluated. RESULTS: 1) 84.1% (63/53) of cases showed left ventricular hypertrophy. 7 patients showed normal LVMI, 3 patients showed concentric remodeling geometry. 19 patients had concentric left ventricular hypertrophy (LVH). 34 patients had eccentric LVH. 2) The serum aldosterone level has negative correlation with the RWT (r=-0.27, p=0.03) but not with LVMI (r=0.08, p=NS). There was difference among groups (ANOVA, F=0.009). Serum aldosterone is higher in eccentric LVH group than in concentric LVH group (10.5+/-1.2 ng/dL vs 5.2+/-0.6 ng/dL, p=0.0001) and than in control group (10.5+/-1.2 ng/dL vs 6.6+/-0.8 ng/dL, p=0.01). CONCLUSION: In this study, we observed that the serum aldosterone level was not correlated with the LVMI but with RWT negatively so that eccentric LVH group showed higher serum aldosterone levels than control group and concentric LVH group.
Aldosterone* ; Echocardiography ; Fibrosis ; Heart ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular ; Radioimmunoassay ; Sodium

A 30-year-old female patient with known hypertrophic cardiomyopathy (HCMP) was admitted for recurrent syncope episodes. Electrocardiogram (ECG) showed 2 : 1 atrioventricular (AV) block. Stress echocardiography with bicycle showed high grade AV block at high stage of the exercise associated with exercise intolerance and dyspnea. Twenty-four hour ECG monitoring also revealed high grade AV block and 1 episode of non-sustained ventricular tachycardia. Implantable cardioverter/defibrillator-pacemaker (ICD-P) was inserted. After implantation of ICD-P, conduction disturbance and exercise intolerance were improved. AV block is a rare complication HCMP. There are just a few case reports that present symptoms caused by conduction disturbance in HCMP. This case describes repeated syncope episodes and exercise intolerance caused by conduction disturbance during exercise in HCMP patient. For evaluating the cause of syncope in HCMP, stress echocardiography can be helpful to understand the probable mechanism of syncope.
Adult ; Atrioventricular Block ; Cardiomyopathy, Hypertrophic* ; Dyspnea ; Echocardiography, Stress ; Electrocardiography ; Female ; Humans ; Syncope* ; Tachycardia, Ventricular