BACKGROUND: Smoking is one of the known major risk factors of coronary artery disease and previous studies have shown that the risk of mortality declines after cessation of smoking. The goal of this study was to determine the influence of smoking on mortality after percutaneous coronary intervention, which has still not been established in Korea. METHODS: Patients who had undergone successful percutaneous coronary intervention at Asan Medical Center between January 1996 and June 1997 were classified into nonsmokers (n=306), ex-smokers (n=178), and current smokers (n=360). According to subsequent smoking status, current smokers were divided into quitters (n=152), persistent smokers (n=173), and unknown status (n=35). The data of the death Roll was from the National Statistical Office. RESULTS: The maximum follow-up was 119 months (mean+/-SD=100+/-26.5). The total smoking rate was 42.7%. The mortality rates of nonsmokers, ex-smokers and current smokers were 17.6%, 20.8%, and 17.2%, respectively. In analyses adjusted for base line characteristics, the relative risk of death among current smokers was 1.57 (95% confidence interval [CI], 0.98 to 2.53) and among ex-smokers was 1.37 (95% CI, 0.80 to 2.35) compared with nonsmokers. The persistent smokers had a greater relative risk of death from all causes (relative risk, 2.20 [95% CI, 1.08 to 4.48]) as compared with the quitters. CONCLUSION: The persistent smokers were at greater risk for death than the quitters. Therefore, patients undergoing percutaneous intervention should be encouraged to stop smoking.
Chungcheongnam-do ; Coronary Artery Disease ; Follow-Up Studies ; Humans ; Korea ; Mortality* ; Percutaneous Coronary Intervention* ; Risk Factors ; Smoke* ; Smoking Cessation* ; Smoking*

Intracranial neoplasms usually have definitive symptoms, causing a need for medical intervention, but a few cases result in sudden unexpected death even before diagnosis. In these cases, autopsy or post-mortem imaging may be the only way of identifying the existence of a tumor, so investigators or forensic specialists who participate in the post-mortem inspection should be aware of these possibilities. We report on a case of a 26-year-old woman without any medical history found dead in her home. A 5-cm intraventricular tumor was found during autopsy, which was histologically consistent with anaplastic ganglioglioma a very rare type of neuroglial tumor with the potential for malignant behavior. The tumor showed the characteristic features of anaplastic ganglioglioma, such as increased cellularity, a high Ki-67 proliferative index, and necrosis. There were signs of increased intracranial pressure, including flattened gyri and dilated ventricles, which led to the conclusion that this brain tumor was the cause of death.
Adult ; Autopsy ; Brain Neoplasms ; Cause of Death ; Diagnosis ; Female ; Ganglioglioma* ; Humans ; Intracranial Pressure ; Necrosis ; Neoplasms, Unknown Primary ; Research Personnel ; Specialization

In some cases, it is difficult to determine a single cause of death even after conducting full autopsy and additional tests. A 49-year-old man, reportedly having diabetes mellitus, was found unconscious by his mother and revealed to be dead. He had several contusions all over his body, including the right periocular area, but they did not appear fatal. A focal area of polymicrogyria and cortical dysplasia was found on the right preoccipital notch, accompanied with dystrophic calcification and leptomeningeal angiomatosis. These findings were considered indicative of Sturge-Weber syndrome, a rare neurocutaneous disorder, of atypical type without facial lesions. Blood level of beta-hydroxybutyrate was 859 microg/mL, implying that he also had diabetic ketoacidosis. His ketoacidosis may not have been corrected appropriately because of status epilepticus in association with brain lesion, resulting in his death, but neither direct evidence nor statement was obtained. In cases with several apparent causes of death, the examiner's assumption should be based not on imagination but on evidence, and logic should not be overlooked. It is more helpful for the investigators or the bereaved to obtain more detailed information rather than come to a hasty conclusion.
3-Hydroxybutyric Acid ; Angiomatosis ; Autopsy ; Brain ; Cause of Death ; Contusions ; Diabetes Mellitus ; Diabetic Ketoacidosis ; Humans ; Imagination ; Ketosis ; Logic ; Malformations of Cortical Development ; Middle Aged ; Mothers ; Neurocutaneous Syndromes ; Research Personnel ; Status Epilepticus ; Sturge-Weber Syndrome*

STATEMENT OF PROBLEM: Temporary soft relining materials are used in a diverse clinical situations such as tissue conditioner, relining material, functional impression by varying its viscoelasticity. However, reproduction of consistent viscoelasticity has been not possible. MATERIALS AND METHODS: Considering setting mechanism of this material, this study has measured the effect of varying amount of void in dynamic viscoelasticity of soft relining material, with three different mixing methods. In each methods 10 specimens were made and subjected to dynamic viscoelastic test which were measured at specific times over period of 72 hours. RESULTS: The analysis of the result shown that there was no statistically significant differences between different mixing methods. CONCLUSION: Different mixing methods had no effect over control of viscoelasticity of soft lining material. Further research is recommended for under similar oral environmental condition.
Reproduction

PURPOSE: This study aimed to assess the usefulness of second-look ultrasounds performed on suspicious lesions found from breast MRIs which were taken as preoperative evaluations of breast cancer. MATERIALS AND METHODS: From May 2008 to July 2011, second-look ultrasounds were performed for 98 lesions in 80 patients that were initially detected on preoperative breast MRIs for known breast cancer. In this study, identification was made on the findings from second-look ultrasounds on the target lesions. The histopathological results were used to assess the effects of second-look ultrasounds on the treatment plans for patients, in the context of operation records. RESULTS: Among the total 98 lesions, sonographic correlation was made in 85 lesions (87%). In total, 82 lesions were identified with histopathological results. Among them were 18 malignancies (22%) and 64 benign lesions (78%). Sonographically-correlated lesions showed a higher prevalence for malignancy (20% [17/85]) than non-correlated lesions (8% [1/13]). From 44% (43/98) of the total target lesions, the unnecessary expansion of the extent of surgical resection was suppressible through second-look ultrasounds. CONCLUSIONS: Second-look ultrasounds subsequent to breast MRIs in patients with breast cancer are useful for preoperative evaluation and enables them to make the histopathological confirmation of suspicious lesions conveniently found from breast MRIs.
Breast ; Breast Neoplasms ; Humans ; Magnetic Resonance Imaging ; Prevalence

Background: Physicians and caregivers are conflicted over whether to inform patients that their disease is terminal. Studies examining the effect of awareness of prognosis on the survival and quality of life of terminally ill cancer patients report conflicting results. This study aimed to assess the effects of prognosis awareness on the survival time and psychological health of terminally ill cancer patients. Methods: Patients in the hospice wards of two general hospitals were asked to complete a questionnaire. All were mentally alert and could express themselves clearly. Awareness of prognosis was defined as knowing both the diagnosis and exact prognosis. Survival time was defined as the time from hospital admission to death. Multiple psychological examinations were conducted to verify the effect of prognosis awareness on psychological health. Results: Of the 98 subjects who met the inclusion criteria, 65 (66.3%) were aware of their terminal status. The patients’ awareness was significantly related to survival time after adjusting for clinical variables with a hazard ratio of 1.70 (95% confidence interval [CI], 1.01–2.86). Furthermore, the unaware group had a higher risk of cognitive impairment (Mini-Mental State Examination <24; adjusted odds ratio [aOR], 3.65; 95% CI, 1.26–10.59) and a poorer quality of life (physical component summary of the Short Form 36-item Health Survey <20; aOR, 3.61; 95% CI, 1.12– 11.60) than the aware group. Conclusion Knowledge of the exact prognosis might have a positive effect on the survival and quality of life of terminally ill cancer patients.

A 38-year-old female presented with abdominal pain, radiating to her back. Her medical history included type 2 diabetes, which had been uncontrolled for 8 months. Her initial laboratory tests showed marked hyperglycemia, metabolic acidosis, and elevated serum amylase and lipase levels, although the results were inconclusive in terms of a direct diagnosis of acute pancreatitis (AP). Abdominal computed tomography showed only minimal fluid collection at the pancreas tail. As her serum triglyceride (TG) level was 9,884 mg/dL, we made a working diagnosis of AP due to hypertriglyceridemia, and she was treated with massive hydration with an insulin infusion. Subsequently, she recovered rapidly from the abdominal pain, her serum glucose was controlled, and her serum TG decreased. Hypertriglyceridemia is a well-accepted underlying cause of AP. When extremely high hypertriglyceridemia is detected in patients with type 2 diabetes or metabolic syndrome, complications should be considered and managed.
Abdominal Pain ; Acidosis ; Adult ; Amylases ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Diagnosis ; Female ; Humans ; Hyperglycemia ; Hypertriglyceridemia ; Insulin ; Lipase ; Pancreas ; Pancreatitis* ; Triglycerides

Primary hepatic lymphoma is extremely rare, representing less than 1% of all extranodal lymphomas. We report MR imaging features and pathologic correlation of a case of primary hepatic lymphoma. MR images showed a large lobulated mass with gradual contrast enhancement, resembling intrahepatic cholangiocarcinoma. However, both hepatobiliary phase image obtained 20 minutes after injection of hepatocyte specific contrast agent and diffusion-weighted image demonstrated characteristic three layered pattern representing viable lymphoma in the outer layer, tumor necrosis in the middle layer and necrotic hepatic parenchyma in the center.
Cholangiocarcinoma ; Hepatocytes ; Liver ; Liver Neoplasms ; Lymphoma ; Necrosis

BACKGROUND: This study was done to obtain comprehensive data on changes in the structural components of the enteric nervous system in pediatric patients with intestinal pseudo-obstruction (IPO). We evaluated routinely processed, in formalin-fixed tissues by quantitative morphometric analysis. In addition, we used formalin-fixed tissue to explore the possibility of using previously proposed diagnostic criteria to evaluate frozen serial sections for intestinal neuronal dysplasia (IND) type B and hypoganglionosis. METHODS: We analyzed data for 19 IPO cases. Morphometric analysis for quantification of ganglia and ganglion cells (GCs) was done for the myentric and the submucous plexus. In addition, we determined the presence of immature GCs and the distribution of nerve fibers and interstitial cells of Cajal (ICC). RESULTS: Nine patients showed combined hypoganglionosis, IND, and decreased ICC; others showed various combinations of these. Several morphometric factors were significantly different between patient groups as well as being different than the control group. CONCLUSIONS: Our pediatric IPO cases showed extensive overlapping of pathological findings. And the findings suggest the utility of using previously proposed morphometrically measured factors in multiple frozen sections as diagnostic criteria for IND type B and hypoganglionosis in formalin-fixed tissue.
Enteric Nervous System ; Frozen Sections ; Ganglia ; Ganglion Cysts ; Humans ; Interstitial Cells of Cajal ; Intestinal Pseudo-Obstruction ; Nerve Fibers ; Neurons ; Submucous Plexus

BACKGROUND: Triple negative breast cancer (TNBC) is defined as a lack of the expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 in breast cancer. Many TNBCs show a profound infiltration of tumor infiltrating lymphocytes (TILs). It is still uncertain whether these TILs are protumoral or antitumoral. Regulatory T cells (Tregs) play a role in inducing immune tolerance to antigens, and they may be selectively recruited by cancer cells. This study was conducted to evaluate the significance of TILs with an emphasis on forkhead box p3 (Foxp3), which is a marker for CD25+CD4+ Treg in TNBC. METHODS: We investigated the Foxp3, CD8 and CD4 expressions in 100 cases of TNBC by immunohistochemistry and using a tissue microarray. The Foxp3 expression was divided as the high and low infiltration groups (cut-off value=20). RESULTS: The high infiltration group was correlated with higher histologic and nuclear grades. However, Foxp3+ Tregs were decreased in the T3 and T4 TNBCs as compared to that of the T1 and T2 TNBCs. No significant differences were found for the nodal status, lymphovascular invasion, stage, recurrence and overall survival. CONCLUSIONS: High Foxp3+ Treg infiltration in TNBC is correlated with the nuclear and histologic grades, but there was no relation to recurrence and overall survival.
Breast ; Breast Neoplasms ; Estrogens ; Forkhead Transcription Factors ; Humans ; Immune Tolerance ; Immunohistochemistry ; Lymphocytes ; Lymphocytes, Tumor-Infiltrating ; Receptor, Epidermal Growth Factor ; Receptor, erbB-2 ; Receptors, Progesterone ; Recurrence ; T-Lymphocytes, Regulatory