A 35 year old woman, gravid 5, multiparous, was admitted to our department at 6 weeks and 5 days of gestation after being diagnosed with cervical pregnancy. Before the evacuation, the uterine arteries were embolized using angiographic techniques. As a result, dilatation and curettage were performed with minimal hemorrhage. We report one case of cervical pregnancy managed, successfully with preoperative uterine artery embolization and evacuation.
Adult ; Dilatation and Curettage ; Female ; Hemorrhage ; Humans ; Pregnancy* ; Uterine Artery Embolization* ; Uterine Artery*

Milk of calcium located in the breast is typically a benign entity. However, carcinoma may incidentally arise adjacent to or even within milk of calcium. Consequently, the characteristics of all observed calcific particles should be carefully analyzed. In this study, we report a case of carcinoma presented as malignant microcalcifications mixed within milk of calcium in a breast.
Breast Neoplasms/*chemistry/radiography ; Calcium Carbonate/*analysis ; Carcinoma, Ductal/*chemistry/radiography ; Female ; Humans ; Mammography ; Middle Aged

Penicillin resistance in Streptococcus pneumoniae has increased sharply within the past few years and extended-spectrum cephalosporins haute been recommended for the empiric therapy of bacterial meningitis. However, therapeutic failure are being reported with increasing frequency due to extended-spectrum cephalosporin-resistant strains. We report two cases of meningitis caused by S. pneumoniae resistant to penicillin and cefotaxime. Both patients were recovered after ceftriaxone and vancomycin treatment, but one of them was left with neurological sequelae because of a delay in the institution of an antibiotic therapy appropriate for resistant pneumococci. This report indicates that extended-spectrum cephalosporin-resistance must be considered In all clinical isolates of S. pneumoniae and in vitro susceptibility testings should be performed promptly and accurately to detect antibiotic resistance.
Cefotaxime ; Ceftriaxone ; Cephalosporins ; Drug Resistance, Microbial ; Humans ; Meningitis* ; Meningitis, Bacterial ; Penicillin Resistance ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus* ; Vancomycin

BACKGROUND: The epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), became an attractive therapeutic option for advanced non-small-cell lung cancer (NSCLC). Several studies suggested that there might be some different efficacy or response predictors between gefitinib and erlotinib. We compared the efficacy and toxicity of gefitinib and erlotinib in Korean patients with advanced NSCLC and evaluated specific predictors of response for both gefitinib and erlotinib. METHODS: We collected the clinical information on patients with advanced NSCLC, who were treated with gefitinib or erlotinib at the Ewha Womans University Hospital, between July 2003 and February 2009. Median survival times were calculated using the Kaplan-Meier method. RESULTS: Eighty-six patients (52 gefitinib vs. 34 erlotinib) were enrolled. Patient median age was 64 years; 53 (62%) subjects were male. Out of the 86 patients treated, 83 received response evaluation. Of the 83 patients, 35 achieved a response and 12 experienced stable disease while 36 experienced progressive disease, resulting in a response rate of 42% and a disease control rate of 57%. After a median follow-up of 502 days, the median progression-free and overall survival time was 129 and 259 days, respectively. Comparing patients by treatment (gefitinib vs erlotinib), there were no significant differences in the overall response rate (44% vs. 39%, p=0.678), median survival time (301 days vs. 202 days, p=0.151), or time to progression (136 days vs. 92 days, p=0.672). Both EGFR-TKIs showed similar toxicity. In a multivariate analysis using Cox regression model, adenocarcinoma was an independent predictor of survival (p=0.006; hazard ratio [HR], 0.487; 95% confidence interval [CI], 0.292-0.811). Analyses of subgroups did not show any difference in response predictors between gefitinib and erlotinib. CONCLUSION: Comparing gefitinib to erlotinib, there were no differences in the response rate, overall survival, progression-free survival, or toxicity. No specific predictor of response to each EGFR-TKI was identified.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lung ; Lung Neoplasms ; Male ; Multivariate Analysis ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride

Objective: To investigate the clinical feasibility of synthetic diffusion-weighted imaging (sDWI) at different b-values in patientswith breast cancer by assessing the diagnostic image quality and the quantitative measurements compared with conventionaldiffusion-weighted imaging (cDWI). Materials and Methods: Fifty patients with breast cancer were assessed using cDWI at b-values of 800 and 1500 s/mm2 (cDWI800and cDWI1500) and sDWI at b-values of 1000 and 1500 s/mm2 (sDWI1000 and sDWI1500). Qualitative analysis (normal glandulartissue suppression, overall image quality, and lesion conspicuity) was performed using a 4-point Likert-scale for all DWI setsand the cancer detection rate (CDR) was calculated. We also evaluated cancer-to-parenchyma contrast ratios for each DWI setin 45 patients with the lesion identified on any of the DWI sets. Statistical comparisons were performed using Friedman test,one-way analysis of variance, and Cochran’s Q test. Results: All parameters of qualitative analysis, cancer-to-parenchyma contrast ratios, and CDR increased with increasingb-values, regardless of the type of imaging (synthetic or conventional) (p< 0.001). Additionally, sDWI1500 provided better lesionconspicuity than cDWI1500 (3.52 ± 0.92 vs. 3.39 ± 0.90, p< 0.05). Although cDWI1500 showed better normal glandular tissuesuppression and overall image quality than sDWI1500 (3.66 ± 0.78 and 3.73 ± 0.62 vs. 3.32 ± 0.90 and 3.35 ± 0.81, respectively;p< 0.05), there was no significant difference in their CDR (90.0%). Cancer-to-parenchyma contrast ratios were greater insDWI1500 than in cDWI1500 (0.63 ± 0.17 vs. 0.55 ± 0.18, p< 0.001). Conclusion sDWI1500 can be feasible for evaluating breast cancers in clinical practice. It provides higher tumor conspicuity,better cancer-to-parenchyma contrast ratio, and comparable CDR when compared with cDWI1500.

The antepartum death of a fetus in a twin pregnancy may cause significant risk of mortality and morbidity in the surviving infant. Especially, one fetal demise of a twin pregnancy in the second or third trimester is an uncommon and difficult problem in the management of pregnancy. In this report, we present a case of single intrauterine death in a twin gestation diagnosed in the 27th week of pregnancy and the surviving fetus exhibits multicystic encephalomalacia three weeks later, antenatally.
Encephalomalacia* ; Female ; Fetus ; Humans ; Infant ; Mortality ; Pregnancy ; Pregnancy Trimester, Third ; Pregnancy, Twin

BACKGROUND: Community-acquired pneumonia (CAP) remains a common and serious condition worldwide. The mortality from severe CAP remains high, and this has reached 50% in some series. This study was conducted to determine the mortality and predictors that contribute to in-hospital mortality for patients who exhibit CAP and acute respiratory failure that requires mechanical ventilation. METHODS: We retrospectively reviewed the medical records of 85 patients with severe CAP as a primary cause of acute respiratory failure, and this required mechanical ventilation in a setting of the medical intensive care unit (ICU) of a tertiary university hospital between 2000 and 2003. RESULTS: The overall in-hospital mortality was 56% (48/85). A Cox-proportional hazard model revealed that the independent predictive factors of in-hospital mortality included a PaCO2 of less than 45 mmHg (p<0.001, relative risk [RR]: 4.73; 95% confidence interval [CI]: 2.16-10.33), a first 24-hour urine output of less than 1.5 L (p=0.006, RR: 2.46, 95% CI: 1.29-4.66) and a high APACHE II score (p=0.004, RR: 1.09, 95% CI: 1.03-1.16). CONCLUSIONS: Acute respiratory failure caused by severe CAP and that necessitates mechanical ventilation is associated with a high mortality rate. Initial hypercapnia and a large urine output favored survival, whereas a high APACHE II score predicted mortality.
Aged ; Aged, 80 and over ; Community-Acquired Infections/complications/mortality/therapy ; Female ; Hospital Mortality ; Humans ; Hypercapnia ; Male ; Middle Aged ; Pneumonia, Bacterial/complications/*diagnosis/*mortality/therapy ; Predictive Value of Tests ; Prognosis ; Respiration, Artificial ; Respiratory Insufficiency/*diagnosis/etiology/*mortality/therapy ; Retrospective Studies ; Treatment Outcome

Well differentiated papillary mesothelioma (WDPM) is an unusual variant of epithelial mesothelioma. Most WDPMs exhibit either benign or indolent behavior. Making the differential diagnosis between this rare tumor and serous papillary carcinoma can be problematic. We report here on a case of a 43-year-old woman with a WDPM of the surface. She presented to our hospital for a routine gynecologic evaluation, and she had no specific symptoms or a history of asbestos exposure. Gynecologic ultrasonography revealed a right ovarian mass that measured 6 x 3.8 x 3 cm in size. No ascites was detected. Right salpingo-oophorectomy was performed; grossly, the tumor was a yellowish firm, multinodular mass. Microscopically, the tumor consisted of numerous papillae that were lined by a single layer of uniform mesothelial cells. Nuclear pleomorphism and mitoses were not found. On immunohistochemical study, the tumor cells were positive for calretinin and cytokeratin, but they were negative for CEA. It is important to differentiate WDPM from serous papillary carcinoma or other malignant tumors to avoid treating them as malignant tumors.
Adult ; Asbestos ; Ascites ; Calbindin 2 ; Carcinoma, Papillary ; Diagnosis, Differential ; Female ; Humans ; Keratins ; Mesothelioma* ; Mitosis ; Ovary ; Ultrasonography

BACKGROUND: Pain on injection of rocuronium is a common clinical problem. We compared the efficacy of lidocaine, ketorolac, and the 2 in combination as pretreatment for the prevention of rocuronium-induced withdrawal movement. METHODS: For this prospective, randomized, placebo-controlled, double-blind study a total of 140 patients were randomly allocated to one of 4 treatment groups to receive intravenously placebo (saline), lidocaine (20 mg), ketorolac (10 mg), or both (n = 35 for each group), with venous occlusion. The tourniquet was released after 2 min and anesthesia was performed using 5 mg/kg thiopental sodium followed by 0.6 mg/kg rocuronium. The withdrawal response was graded on a 4-point scale in a double-blind manner. RESULTS: The overall incidence of withdrawal movements after rocuronium was 34.3% with lidocaine (P = 0.001), 40% with ketorolac (P = 0.004), and 8.6% with both (P < 0.001), compared with 74.3% with placebo. There was a significantly lower incidence of withdrawal movements in patients receiving the lidocaine/ketorolac combination than in those receiving lidocaine or ketorolac alone (P = 0.009 and 0.002, respectively). The incidence of moderate to severe withdrawal movements was 14.3% with lidocaine, 17.2% with ketorolac, and 2.9% with lidocaine/ketorolac combination, as compared to 45.7% with the placebo. There was no significant difference in withdrawal movement between the lidocaine group and the ketorolac group. CONCLUSIONS: Ketorolac pretreatment had an effect comparable to that of lidocaine in attenuating rocuronium-induced withdrawal movements and the lidocaine/ketorolac combination pretreatment, compared with lidocaine or ketorolac alone, effectively reduced withdrawal movements during rocuronium injection.
Androstanols ; Anesthesia ; Double-Blind Method ; Humans ; Incidence ; Ketorolac ; Lidocaine ; Prospective Studies ; Thiopental ; Tourniquets

STATEMENT OF PROBLEM: Insertion of endosseous implants in the atrophic maxilla is often complicated because of lack of supporting bone. Augmentation of the floor of the maxillary sinus with autogenous bone & bone substitute graft has been proven to be a reliable treatment modality, at least in the short term. The aim of this study is to evaluate the factors of implant survival rate associated with maxillary sinus lift with grafts. MATERIAL AND METHODS: The sinus floor was augmented with bone grafts derived from modified Caldwell-luctechnique (71 subject, 93 sinus, 180 implants), the autogenous bone or autogenous + Bio-oss. Before implant installation the width and height of the alveolar crest were increased in the first stage procedure in 10 patients while in the other 61 patients augmentation and implant installation could be performed simultaneously width and height of the alveolar crest > 4 mm) or delayed installation. RESULTS: In all case bone volume was sufficients for implant insertion. 14 of 180 inserted implants were lost during follow up and the healing period Patient received implant supported overdenture (5 patients) or fixed bridge (62 patients). CONCLUSION: Within the limit of the result of this study, we conclude that bone grafting of the floor of the maxillary sinus floor with bone for the insertion of implants might be a reliable treatment modality and the autogenous bone graft and delayed installation method might be the factors for good results.
Bone Substitutes ; Bone Transplantation ; Denture, Overlay ; Denture, Partial, Fixed ; Floors and Floorcoverings ; Follow-Up Studies ; Humans ; Maxilla ; Maxillary Sinus ; Minerals ; Retrospective Studies ; Survival Rate ; Transplants