Adenoid cystic carcinoma of the uterine cervix is a rare tumor accounting for less than 1% of all cervical adenocarcinoma. This tumor is characterized by aggressive biological behavior with frequent local recurrence or metastatic spread, postmenopausal onset, and occasional association with conventional squamous cell carcinoma. The cytologic diagnosis of adenoid cystic carcinoma in the uterine cervix is often difficult because of negative smear due to intact overlying mucosa, cytologic findings mimicking endometrial cells, and masquerade as squamous cell carcinoma. Recently we have experienced a case of adenoid cystic carcinoma arising in the uterine cervix, which was identified on the routine Papanicolaou smear and was histologically confirmed by the consequent biopsy. The smear showed abundant cellularity composed of relatively uniform cells. The tumor cells were arranged in small clusters, acini, naked cells, and loose sheets with abortive cribriform pattern. There were scattered globoid basement membrane-like materials and tumor diathesis. The nuclei were pleomorphic and showed hyperchromatic and coarsely granular choromatin with inconspicuous nucleoli. The punch biopsy of the uterine cervix showed typical histologic findings of adenoid cystic carcinoma characterized by tumor nests composed of hyperchromatic uniform basaloid cells, cribriform pattern, and cylindrical hyaline bodies.
Adenocarcinoma ; Adenoids* ; Biopsy ; Carcinoma, Adenoid Cystic* ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Diagnosis ; Disease Susceptibility ; Female ; Hyalin ; Mucous Membrane ; Papanicolaou Test ; Recurrence

Purpose: This study aimed at investigating the nutritional status, nutritional support, and nutritional indicators of critically ill patients on extracorporeal membrane oxygen (ECMO) in intensive care units (ICU). Methods: This descriptive study obtained data from the medical records of 37 patients who were treated using ECMO at a university hospital in Korea. The patients were admitted to the Korea University Anam Hospital ICU with acute or serious damage to vital organs from January 1, 2014 to June 30, 2016. Results: Although 32 patients (86.5%) were at a high risk of malnutrition, 26 patients (70.3%) were considered normal in terms of nutritional status by the nutritionist at the beginning of their ICU stay. However, after two weeks, nine patients had passed away and only one patient maintained normal status. Parenteral nutrition was started first but took 4.25 ± 6.95 days till initiation. Only eight patients (21.6%) were able to meet their requirement for both calories and protein. The group provided with adequate calorie and protein showed significantly longer use of the ECMO and respirator and longer ICU and total hospital stay than their counterparts. Normal levels of serum albumin and protein of the group at low-risk for malnutrition on the day of initiation of ECMO, which were significantly higher than the high-risk group, declined by the last day of ECMO leading to a lack of significant differences between the two groups. Conclusion Considering that the nutritional indicators of patients deteriorated as the days on ECMO increased, more aggressive nutritional management to ensure adequate nutritional support should be emphasized from the beginning and throughout the ICU stay.

PURPOSE: This study was designed to evaluate the clinical charateristics, surgical treatment and outcome of carcinoid tumors of the rectum. METHODS: A retrospective review of the charts of all patients treated for rectal carcinoid tumors at Kangbuk Samsung Medical Center between Jan 1989 and April 1998. Thirteen patients with rectal carcinoids tumors were treated. Follow-up data, histopathological information and surgical procedures were obtained from case notes. RESULTS: There were 10 men and 3 women. The ages ranged from 28 to 60 years (mean 41.1 years for all, 43.8 years for men and 32 years for women). Eight patients (61.5%) had no symptoms. Of the five patients, four complained of rectal bleeding (30.8%), and one complained of defecational difficulty (7.7%). Size of rectal carcinoid tumor was less than 1 cm in 7 patients (53.8%), between 1 cm and 2 cm in 2 patients (15.4%), in four patients (30.8%) larger than 2 cm. Three patients were treated in Abdominoperineal resection. Two patients underwent stapled low anterior resection. The remaining 8 patients underwent conservative resection (3 colonoscopic polypectomy and electrocauterization, 2 colonoscopic snaring biopsy, 2 transanal resection and one Mason's operation). The depth of invasion was contained within sutmucosa in 3 patients. Liver metastasis was found in 2 patients. Average follow-up time was 35.6 months. Two patients died of mutiple mestastasis (liver, bone, peritoneum) 9 and 30months later. CONCLUSION: We concluded that tumors smaller than 1 cm could be managed by local treatment whereas larger than 2 cm should be managed by radical treatment.
Biopsy ; Carcinoid Tumor* ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver ; Male ; Neoplasm Metastasis ; Rectum ; Retrospective Studies ; SNARE Proteins

Cruciate paralysis, an unusual clinical entity, is "frequently undiagnosed or misunderstood", and can simulate the acute cervical central-cord injury syndrome. This rare injury pattern is characterized by weakness of upper extremities with little or no compromise of lower limb function following trauma to the superior cervical cord. The pattern of injury and clinical findings support selective damage to the corticospinal tract or upper motor neurons subserving upper limb function with the pyramidal decussation. Authors experience a case of curciate paralysis due to type 2 odontoid fracture and atlas dislocation.
Central Cord Syndrome ; Dislocations* ; Lower Extremity ; Motor Neurons ; Odontoid Process* ; Paralysis ; Pyramidal Tracts ; Upper Extremity

PURPOSE: The purpose of this study was to develop an educational program for parents of children with epilepsy. METHOD: The first step was to survey the need for information and social support for these parents. The second step was to design the educational program based on the survey results, literature review, and the theory of chronic sorrow that provided a framework for understanding and working with people suffering a loss of health. RESULT: The information which these parents were most anxiously seeking was information on the causes of seizures, appropriate steps deal with seizures, and appropriate and supportive parental role for their children. The educational program for parents of children with epilepsy included understanding the responses to loss, increasing the parents' knowledge about how to care for their children, managing their stress, enhancing the psychosocial adaptation of children, and encouraging the participation of the family. CONCLUSION: The educational program developed by the researcher can used with parents of children with epilepsy, and is expected to enhance the psychosocial adaptation of these children.
Child* ; Epilepsy* ; Humans ; Parents* ; Program Development ; Seizures

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency. The clinical presentation can be similar to that of primary adrenal insufficiency, but most of them may be nonspecific. A female patient of 25 months of age, complainig short stature, showed hypocortisolemia without ACTH & cortisol stimulation by insulin-induced hypoglycemia test. All the other hormone state was normal. Left hand AP view revealed delayed bone age(3 month) compared with chronological age. No radiologic abnormality was found in sella MRI and adrenal CT. Here we report a case of isolated ACTH deficiency presented by short stature.
Addison Disease ; Adrenocorticotropic Hormone ; Female ; Hand ; Humans ; Hydrocortisone ; Hypoglycemia ; Magnetic Resonance Imaging

PURPOSE: Owing to the recommendations of the Surviving Sepsis Campaign guidelines, protocol-based resuscitation or goal-directed therapy (GDT) is broadly advocated for the treatment of septic shock. However, the most recently published trials showed no survival benefit from protocol-based resuscitation in septic shock patients. Hence, we aimed to assess the effect of GDT on clinical outcomes in such patients. MATERIALS AND METHODS: We performed a systematic review that included a meta-analysis. We used electronic search engines including PubMed, Embase, and the Cochrane database to find studies comparing protocol-based GDT to common or standard care in patients with septic shock and severe sepsis. RESULTS: A total of 13269 septic shock patients in 24 studies were included [12 randomized controlled trials (RCTs) and 12 observational studies]. The overall mortality odds ratio (OR) [95% confidence interval (CI)] for GDT versus conventional care was 0.746 (0.631-0.883). In RCTs only, the mortality OR (95% CI) for GDT versus conventional care in the meta-analysis was 0.93 (0.75-1.16). The beneficial effect of GDT decreased as more recent studies were added in an alternative, cumulative meta-analysis. No significant publication bias was found. CONCLUSION: The result of this meta-analysis suggests that GDT reduces mortality in patients with severe sepsis or septic shock. However, our cumulative meta-analysis revealed that the reduction of mortality risk was diminished as more recent studies were added.
Humans ; *Observational Studies as Topic ; *Randomized Controlled Trials as Topic ; Resuscitation/*methods ; Shock, Septic/mortality/*therapy

Drug-induced neutropenia (DIN), particularly that in which antibiotic-dependent antineutrophil antibodies have been detected, is a rare disorder. We report the case of a child with pneumococcal pneumonia, who experienced severe neutropenia during various antibiotic treatments. We detected 4 kinds (cefotaxim, augmentin, vancomycin, and tobramycin) of antibiotic-dependent antineutrophil antibodies by using the mixed passive hemagglutination assay (MPHA) technique with this child.
Anti-Bacterial Agents/*therapeutic use ; Antibodies, Antineutrophil Cytoplasmic/*blood/immunology ; Autoantibodies/blood/immunology ; Drug Therapy, Combination ; Humans ; Infant ; Male ; Neutropenia/chemically induced/*diagnosis ; Pneumonia, Pneumococcal/complications/*drug therapy ; Tomography, X-Ray Computed

OBJECTIVES: The objectives of this study were to investigate the agreement between medical history questionnaire data and claims data and to identify the factors that were associated with discrepancies between these data types. METHODS: Data from self-reported questionnaires that assessed an individual's history of hypertension, diabetes mellitus, dyslipidemia, stroke, heart disease, and pulmonary tuberculosis were collected from a general health screening database for 2014. Data for these diseases were collected from a healthcare utilization claims database between 2009 and 2014. Overall agreement, sensitivity, specificity, and kappa values were calculated. Multiple logistic regression analysis was performed to identify factors associated with discrepancies and was adjusted for age, gender, insurance type, insurance contribution, residential area, and comorbidities. RESULTS: Agreement was highest between questionnaire data and claims data based on primary codes up to 1 year before the completion of self-reported questionnaires and was lowest for claims data based on primary and secondary codes up to 5 years before the completion of self-reported questionnaires. When comparing data based on primary codes up to 1 year before the completion of self-reported questionnaires, the overall agreement, sensitivity, specificity, and kappa values ranged from 93.2 to 98.8%, 26.2 to 84.3%, 95.7 to 99.6%, and 0.09 to 0.78, respectively. Agreement was excellent for hypertension and diabetes, fair to good for stroke and heart disease, and poor for pulmonary tuberculosis and dyslipidemia. Women, younger individuals, and employed individuals were most likely to under-report disease. CONCLUSIONS: Detailed patient characteristics that had an impact on information bias were identified through the differing levels of agreement.
Bias (Epidemiology) ; Comorbidity ; Data Accuracy ; Delivery of Health Care ; Diabetes Mellitus ; Dyslipidemias ; Female ; Heart Diseases ; Humans ; Hypertension ; Insurance ; Logistic Models ; Mass Screening ; Sensitivity and Specificity ; Stroke ; Tuberculosis, Pulmonary

A 37-year-old female presented with a conjunctival mass discovered 3 years prior. An excisional biopsy revealed a patternless proliferation of round and spindle-shaped cells with an eosinophilic fibrillary cytoplasm and vesicular nuclei with occasional inclusions. Psammoma bodies were arranged around the dilated irregularly-shaped vessels. Differential diagnoses included conjunctival solitary fibrous tumor (SFT), nevus, glomangioma, ectopic meningioma, and mesectodermal leiomyoma. The tumor cells were immunoreactive for CD34, CD99, bcl-2 and vimentin, and were negative for smooth muscle actin, desmin, glial fibrillary acidic protein, S-100 protein, epithelial membrane antigen, and human melanoma black-45. Ultrastructurally, the tumor cells had rough endoplasmic reticulum, free ribosomes, and scattered mitochondria without basal lamina or cellular junctions, which are features of fibroblasts. A diagnosis of SFT was rendered based on the light microscopic, immunohistochemical, and electron microscopic findings. We report here on the second case of a SFT arising in the conjunctiva, which clinically and histologically mimics conjunctival nevus, glomangioma, ectopic meningioma, and a hybrid neurogenic-myogenic tumor such as mesectodermal leiomyoma.
Actins ; Adult ; Antigens, CD34 ; Basement Membrane ; Biopsy ; Chimera ; Conjunctiva ; Cytoplasm ; Desmin ; Diagnosis, Differential ; Electrons ; Endoplasmic Reticulum, Rough ; Eosinophils ; Female ; Fibroblasts ; Glial Fibrillary Acidic Protein ; Glomus Tumor ; Humans ; Leiomyoma ; Light ; Melanoma ; Meningioma ; Mitochondria ; Mucin-1 ; Muscle, Smooth ; Nevus ; Ribosomes ; S100 Proteins ; Solitary Fibrous Tumors ; Vimentin