Embryonal carcinoma, a very rare ovarian germ cell tumor, involves pure and mixed phenotypes. Pure-type embryonal carcinoma has never been reported in postmenopausal women. The current case was, thus, misdiagnosed as an epithelial ovarian carcinoma based on radiologic findings. Herein, we describe the case of ovarian embryonal carcinoma in a 75-year-old woman along with a literature review. Magnetic resonance imaging findings were suggestive of epithelial ovarian malignancy associated with endometrioma, including ureteral invasion. The patient underwent complete surgical staging, and a pathologic diagnosis of pure-type embryonal carcinoma was made. The patient’s postoperative course was uneventful, and adjuvant chemotherapy was administered. Embryonal carcinoma in the postmenopausal woman is a clinical challenge owing to the possibility of its misdiagnosis as epithelial ovarian carcinoma. To the best of our knowledge, this is the first report of pure-type ovarian embryonal carcinoma in a postmenopausal woman, with a description of the clinicopathologic characteristics and review of the relevant literature.

Estimation of the minimum post-mortem interval (PMI-min) by means of forensic entomology is mainly based on the results of the growth rate studies on necrophagous flies. However, results of these studies are difficult to use because these studies have only been undertaken for a select few necrophagous flies, and experimental methods and results processing have not been standardized. In this review, we have summarized the current state of growth rate studies on necrophagous fly species that are frequently found in human cadavers. Criteria have been suggested in order to select reliable data, and the accumulated degree hours and base temperatures to be used in the calculation of PMI-min for each species have been tabulated.

Hydatid disease in humans is a parasitic disease typically caused by the larvae of Echinococcus granulosus. Although the disease can occur in any body part, it most frequently affects the liver. Hydatid disease is usually diagnosed incidentally and presents with various types of cystic lesion in the infected anatomical locations. Among the many potential complications of hepatic hydatid cysts, including rupture, infection, biliary communication, and peritoneal seeding, spontaneous rupture of the cyst into the hollow viscera is exceptionally rare and has been reported in less than 0.5% of cases. We report the case of a patient with hepatic hydatid disease complicated by spontaneous rupture into stomach causing gastric ulcer and peritoneal seeding.

Carotid artery rupture during head and neck surgery is a catastrophic, life-threatening emergency. Although recent incidence has declined, it still occurs in many patients. Hemorrhage from the carotid artery is usually massive and uncontrollable. Fast, aggressive treatment to prevent hemodynamic instability is required. Even if patients survive this event, they may experience severe neurological sequelae. A ruptured carotid artery is usually controlled by direct compression and arterial ligation. However, apart from the inherent difficulty of operation, these traditional surgical treatments are associated with high morbidity and mortality. In the past two decades, endovascular management has become a mainstay of carotid rupture treatment. We report a case of successful recovery without any sequelae after cardiovascular collapse due to an unintentional common carotid artery (CCA) rupture during neck surgery. The exposed CCA was treated with a covered stent. In such a case, multidisciplinary cooperation is crucial.
Anesthesia ; Carotid Arteries ; Carotid Artery, Common* ; Emergencies ; Head ; Hemodynamics ; Hemorrhage ; Humans ; Incidence ; Ligation ; Mortality ; Neck* ; Radiology, Interventional ; Rupture* ; Stents*

PURPOSE: The 21-gene (Oncotype DX) recurrence score (RS) assay is useful in predicting the benefits of adjuvant chemotherapy for early breast cancer patients and is widely used in Western countries. However, to date, it has not gained much popularity in East Asia. We analyzed the results from five institutions' experience from using the 21-gene assay and examined the impact of assay results on decision making of chemotherapy in Korean breast cancer patients and the associations between RS and clinicopathologic characteristics. MATERIALS AND METHODS: The 21-gene assay was performed on 212 patients with estrogen receptor-positive early breast cancer in five institutions. Each center made systemic treatment decisions both before and after the knowledge of assay results. RESULTS: Among the 212 patients, 132 (62.3%) had a low RS of < 18, 60 (28.3%) had an intermediate RS of 18-30, and 20 (9.4%) had a high RS of > or = 31. Histologic grade, presence of micrometastases, Ki-67, and presence of lymphatic invasion were statistically associated with the RS results. Treatment decisions were changed in 115 of 212 patients (54.2%) in 109 of 212 (51.4%) from chemotherapy plus hormone therapy to hormone therapy, and in six of 212 (2.8%) from hormone therapy to chemotherapy plus hormone therapy. CONCLUSION: The 21-gene breast cancer assay proved to have a significant impact on treatment decision- making. The test reduces chemotherapy use in more than 50% of Korean estrogen receptor-positive, early breast cancer patients.
Breast Neoplasms* ; Chemotherapy, Adjuvant ; Decision Making ; Drug Therapy ; Estrogens ; Far East ; Humans ; Korea ; Neoplasm Micrometastasis ; Recurrence*

In medicolegal investigations, correct identification of the necrophagous fly species collected around and on the corpse is an essential step for estimating the postmortem interval (PMI). Therefore, forensic pathologists and entomologists investigating deaths due to violent crimes need a rapid, easy-to-use protocol to identify fly species found on corpses. A rapid and robust DNA-based tool that can distinguish between various immature and mature species from the Calliphoridae, Muscidae, and Sarcophagidae families would be ideal for such investigations. To date, the DNA barcode initiative is the best approach for identifying species-specific nucleotide sequences. We have developed 3 sequence-characterized amplified region (SCAR)-based identification systems derived from the Abdominal-B homeobox sequences of 17 fly species belonging to the Muscidae and Sarcophagidae. The flies used in this study were collected in Korea. These assay systems can classify 17 forensically important fly species into the dipteran family group and reliably distinguish them from inter- and intraspecific fly species through a 2-step multiplex PCR. This novel approach may also be used as an alternative to conventional DNA-based identification methods.
Base Sequence ; Cadaver ; Crime ; Diptera ; DNA ; Genes, Homeobox ; Humans ; Korea ; Multiplex Polymerase Chain Reaction ; Muscidae ; Sarcophagidae

BACKGROUND/AIMS: The aim of this study was to compare polyethylene glycol (PEG) 4 L, split method of PEG 4 L and PEG 2 L plus sodium phosphate (NaP) in the aspect of bowel preparation quality, safety, patients' compliance and preference. METHODS: Total 249 subjects were prospectively enrolled and received bowel preparation for colonoscopy from August to October in 2010; PEG 4 L (93 subjects), split method of 4 L PEG (74 subjects) and PEG 2 L plus NaP 90 mL group (82 subjects). To investigate the completion, preference for bowel preparation and safety, a questionnaire survey was conducted before colonoscopy. RESULTS: There were no significant intergroup differences in the aspect of completion of preparation, cecal intubation time and success rate. Satisfaction and preference were higher in PEG 2 L plus NaP 90 mL and split method of 4 L PEG compared with PEG 4 L. In the aspect of the bowel preparation quality PEG 4 L showed significantly higher quality in the morning colonoscopy (p<0.001). However, in the afternoon colonoscopy PEG 2 L plus NaP 90 mL showed better result than PEG 4 L (p=0.009). Hyperphosphatemia was most frequently observed in PEG 2 L plus NaP 90 mL, but no severe adverse events occurred (p<0.001). CONCLUSIONS: PEG 4 L showed better result than split method of 4 L PEG or PEG 2 L plus NaP 90 mL in the aspect of bowel preparation quality and safety.
Adult ; Aged ; Cathartics/adverse effects/*pharmacology ; Colon/anatomy & histology/*drug effects ; Colonoscopy ; Female ; Humans ; Hyperphosphatemia/etiology ; Male ; Middle Aged ; Patient Compliance ; Phosphates/adverse effects/*pharmacology ; Polyethylene Glycols/adverse effects/*pharmacology ; Prospective Studies ; Questionnaires ; Time Factors

PURPOSE: Long-term exposure to extremely low-frequency (60 Hz) electromagnetic fields (ELF-EMF) raises the questions of the induction of biological effects including tumorigenesis. One mechanism through which ELF-MFS could influence neoplastic development is the imbalance of cellular proliferation and cell apoptosis. The present study investigated the effect of ELF-EMF on chemically-induced thyroid carcinogenesis in a rat. METHODS: We examined cellular proliferation index measured by anti-Ki-67 antigen, apoptosis, apoptosis related proteins such as caspase 3 and p53, and cell cycle-related proteins (cyclin D1 and p21(WAF1/Cip1)). Forty Male F344 rats received a subcutaneous N-bis(2-hydroxypropyl)nitrosamine (DHPN, 2,800 mg/kg) injection, and 1 week later were allowed free access to drinking water containing sulfadimethoxine (0.1%) for 12 weeks. Twenty rats were exposed by ELF-EMF. During the carcinogenesis, sequential histological changes from hyperplasia, adenoma, and ultimately to overt carcinomas were noted. RESULTS: The exposure group of ELF-EMF, significantly increases the number size of carcinomas. Also, the proliferative and apoptotic indices were significantly increased in the ELF-EMF exposure group than in the control group. The caspase 3 protein expression did not show any significant changes between ELF-EMF group and control group. The p53 protein was not detected in both ELF-EMF exposure and control group. Among the cell cycle related proteins, cyclin D1, not p21(WAF1/Cip1), was significantly increased in adenomas and carcinomas in ELF-EMF exposure group compared with the control group. CONCLUSION: Exposure of ELF-EMF effects on chemically-induced rat thyroid carcinogenesis as results of altered increase of cellular proliferation, apoptosis, and cyclin D1 expression.
Adenoma ; Animals ; Apoptosis ; Caspase 3 ; Cell Cycle ; Cell Proliferation ; Cell Transformation, Neoplastic ; Cyclin D1 ; Drinking Water ; Electromagnetic Fields ; Humans ; Hyperplasia ; Male ; Nitrosamines ; Proteins ; Rats ; Rats, Inbred F344 ; Sulfadimethoxine ; Thyroid Gland

PURPOSE: The purpose of this study is to compare three different CAD/CAM systems through the fracture strength of zirconia core and to evaluate the clinical availability of each system. MATERIAL AND METHODS: The following three groups of 30 maxillary mesial incisor core for all-ceramics(each group 10) were fabricated as follows: group 1. Adens(R) CAD/CAM system, group 2. Cerasys(R) CAD/CAM system, group 3. 3M LAVA(R)CAD/CAM system. All specimens were manufactured consistently thickness 0.5mm and relief 40 micrometer. Specimens were subjected to compressive loading on the lingual area by Z250/SN5S(R). Each group's mean and standard deviation were calculated and Kruskal Waillis test, Wilcoxon Rank Sum test were utilized to find out the relationship among the groups. RESULTS: The results were as follows: 1. The mean fracture strength of Adens(R) system was 615.89+/-156.1N, the Cerasys(R) system was 863.98+/-151.5N, and the 3M LAVA(R) system was 1143.1+/-286.6N. 2. The fracture strength of the systems showed the significant statistical differences in order of 3M LAVA(R) system, Cerasys(R) system, Adens(R) system. CONCLUSION: In this study, in spite of the differences among the groups, every group showed clinically useful results. It is necessary to study further clinical experiments on a long term basis.
Incisor ; Zirconium

PURPOSE: This study comparedthe effectiveness and safety of laparoscopic adrenalectomy with conventional open adrenalectomy for the treatment of pheochromocytoma. METHODS: Medical records of 100 patients who underwent surgical removal of pheochromocytoma (open adrenalectomy, n=59; laparoscopic adrenalectomy, n=39) at Samsung Medical Center from June 1995 to August 2007 were retrospectively reviewed. RESULTS: To draw an appropriate comparison, patients with a tumor less than 7 cm in size were evaluated (open adrenalectomy, n=23; laparoscopic adrenalectomy n=31). No statistically significant differences were evident according to age, gender and tumor size. The mean operating time was 158 min for the open surgery group and 114 minfor the laparoscopic group (P<0.01). The mean postoperative hospital stay was 10.4 days following open surgery and 5.6 days following laparoscopic surgery (P<0.01). The mean volume of the estimated blood loss for the laparoscopic surgery group (482 ml) was less than for the open surgery group (mean 229 ml) (P=0.06), and the time to first oral intake was 1.7 days after laparoscopic adrenalectomy and 3.5 days after open surgery (P<0.01). The frequency of using analgesics for postoperative pain after laparoscopic adrenalectomy was markedly lower than following conventional open adrenalectomy. There was no recurrence or complications during the follow-up periods (mean: 30 months). CONCLUSION: Laparoscopic adrenalectomy offers advantages of less postoperative pain, shorter operative time and a shorter hospital stay as compared with conventional open adrenalectomy. Laparoscopic adrenalectomy for treating pheochromocytoma is a minimally invasive alternative to conventional open adrenalectomy.
Adrenalectomy* ; Analgesics ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Medical Records ; Operative Time ; Pain, Postoperative ; Pheochromocytoma* ; Recurrence ; Retrospective Studies