Myxofibrosarcomas (MFSs), which consist of multiple nodules with a variable cellular population in a myxoid matrix, are primarily located in subcutaneous tissue. Pleomorphic hyalinizing angiectatic tumors (PHATs) are rare soft-tissue tumors characterized by a proliferation of highly pleomorphic spindle or polygonal cells and abundant ectatic blood vessels in cellular or myxoid stroma. We present here an unusual case of a high-grade MFS with a PHAT-like appearance. A 67-year-old man presented with an asymptomatic subcutaneous mass in the right forearm. The tumor had myxoid, hypo-, and hypercellular areas with highly pleomorphic spindle or polygonal tumor cells that showed frequent mitoses and nuclear pseudoinclusions. Foci of punctuate necrosis and inflammatory infiltration were present throughout the tumor, and abundant ectatic, thick-walled vessels containing blood clots were noted. The tumor cells were immunohistochemically positive for vimentin but negative for CD34, S-100 protein, smooth muscle actin, desmin, and bcl-2.
Actins ; Aged ; Blood Vessels ; Desmin ; Forearm ; Humans ; Hyalin ; Mitosis ; Muscle, Smooth ; Necrosis ; S100 Proteins ; Sarcoma ; Subcutaneous Tissue ; Vimentin

Purpose: In 2014, Pusan National University Hospital developed an electronic system for the monitoring and management of adverse drug reactions (ADRs) to iodinated contrast media (ICM) and premedication. We analyzed the prevalence of hypersensitivity reactions (HRs) and the effect of premedication after system development. Methods: We analyzed immediate HRs to ICM recorded from January 2015 to September 2018 and the annual incidences were compared. Results: Patients with immediate HRs to ICM were at a mean age of 54.6 ± 14.3 years and 53.8% were female. The overall frequency of HRs was 0.328%. In the classification according to the degree of severity, 87.2% of the cases were mild, 11.0% were moderate, and 1.8% were severe. The ICM most commonly inducing an HR was iomeprol (0.529%), followed by iohexol (0.371%), ioversol (0.359%), iobitridol (0.310%), iopamidol (0.152%), iopromide (0.128%), and iodixanol (0.036%). ICM was readministered to 49.2% of the patients, and immediate HRs recurred in 16.2%. There was no correlation between premedication with an antihistamine and HR recurrence, but premedication with corticosteroids reduced the rate significantly. After development of the electronic monitoring and management system, the HR incidence increased 1.25-fold per year, but most cases were mild and the rate of severe reactions tended to decrease. Conclusion Because ADRs to ICM are difficult to predict, appropriate strategies to prevent their development are needed. A system that documents ADRs to ICM can improve patient management.

BACKGROUND: The diagnostic accuracy of fine needle aspiration cytology (FNAC) of salivary lesions is relatively high, but cytologic interpretation might be confusing if the sample is lacking typical cytologic features. METHODS: There were 77 cases of benign salivary lesions, consisting of pleomorphic adenoma (PA) in 61 cases, Warthin's tumor (WT) in 12 cases, and other benign lesions in 4 cases. The causes of the discrepancies between the FNAC and the histologic diagnoses were evaluated. RESULTS: Major discrepancies were noted in 4 of the 61 PA cases, and in 1 of 12 WT cases. The causes of the major discrepancies were a mislabeled site in 1 PA and 1 WT case, and an interpretation error in 3 PA cases. Minor discrepancies were more common in the WT cases (7 of 12 cases) than in the PA cases (11 of 61 cases). The causes of the minor discrepancies were a mislabeled site in 1 PA and 1 WT case, an inadequate sample in 7 PA and 2 WT cases, a lack of typical cytomorphology in 2 PA and 2 WT cases, and an interpretation error in 1 PA and 2 WT cases. CONCLUSIONS: To increase the diagnostic accuracy in the benign salivary lesions, recognition of both characteristic and less typical cytomorphology is needed.
Adenoma, Pleomorphic ; Biopsy, Fine-Needle ; Salivary Glands

OBJECTIVES: Seoul-Activities of Daily Living(S-ADL) was developed to assess elderly person's basic activities of daily living. This study aims to develop standardized ADL assessment scale and confirm the reliability and validity of the S-ADL. METHODS: It was participated in 336 controls and 145 patients diagnosed Alzheimer's disease. RESULTS: In controls, it was statistically significant to age, but not sex, education, region and presence of spouse. Also, reliability and validity were statistically significant. Principal axis factoring analysis revealed three factors that accounted for 66.67% of the total variance(1.self-care/hygiene, 2.ambulation, 3.toileting). According to each CDR stage, there were significant difference, except for CDR 0.5 and CDR 1 suggesting early dementia. Particularly, it was remarkable for functional impairment in CDR 2 and CDR 3 suggesting moderate to severe dementia. The order of the loss of function was (1) self-care/hygiene, (2) toileting, and (3) ambulation. CONCLUSIONS: Our study showed that the S-ADL could be a very reliable and valid tool for the assessment of functional disabilities of Korean dementia patients. Particularly, S-ADL would be useful in assessing daily function of moderate to severe AD.
Activities of Daily Living ; Aged ; Alzheimer Disease ; Axis, Cervical Vertebra ; Dementia ; Education ; Humans ; Reproducibility of Results* ; Spouses ; Walking

Objective: This study aimed to investigate the changes in interpersonal relationships, behavioral patterns, and emotional states of children and adolescents with psychiatric disorders and their caregivers immediately after the coronavirus disease of 2019 (COVID-19) outbreak in Daegu, South Korea. Methods: A total of 147 patients and 147 caregivers participated in the Survey for Outing and Time Usage for Child, Adolescent, and Parents and the COVID-19 Visual Analog Scale for Emotion. We classified the patients and their caregivers into the internalizing disorder (ID) and externalizing disorder (ED) groups and compared the changes. Results: Parent–child relationships for adolescent patients and caregivers were interrupted, and friend relationships in all participants were disrupted, while sibling relationships improved in adolescent patients. They experienced negative emotional changes. Time spent outdoor decreased and digital screen time increased for all participants. Friend and parent–child relationships were interrupted in the ED group compared to those in the ID group. ED patients experienced negative changes in emotional states, while ID patients showed no significant changes. Conclusion Results are meaningful as a reference for predicting changes in interpersonal relationships and mental status of pediatric psychiatric patients and for determining healthcare system adaptations to allow mental health support during the COVID-19 outbreak.

Objective: This study aimed to investigate the changes in interpersonal relationships, behavioral patterns, and emotional states of children and adolescents with psychiatric disorders and their caregivers immediately after the coronavirus disease of 2019 (COVID-19) outbreak in Daegu, South Korea. Methods: A total of 147 patients and 147 caregivers participated in the Survey for Outing and Time Usage for Child, Adolescent, and Parents and the COVID-19 Visual Analog Scale for Emotion. We classified the patients and their caregivers into the internalizing disorder (ID) and externalizing disorder (ED) groups and compared the changes. Results: Parent–child relationships for adolescent patients and caregivers were interrupted, and friend relationships in all participants were disrupted, while sibling relationships improved in adolescent patients. They experienced negative emotional changes. Time spent outdoor decreased and digital screen time increased for all participants. Friend and parent–child relationships were interrupted in the ED group compared to those in the ID group. ED patients experienced negative changes in emotional states, while ID patients showed no significant changes. Conclusion Results are meaningful as a reference for predicting changes in interpersonal relationships and mental status of pediatric psychiatric patients and for determining healthcare system adaptations to allow mental health support during the COVID-19 outbreak.

We isolated Triton X-100 solubilized protein (TSP) antigen which may be preferentially associated with the cell wall of M. tuberculosis. In this study, the proliferative activities and cytokine mRNA expression patterns of the TSP antigen were investigated in peripheral blood mononuclear cells (PBMCs) and lymph node mononuclear cells (LNMCs) from 4 patients with tuberculous lymphadenitis. The results of the TSP antigen were compared with those of the PPD antigen, known as a major seretory protein antigen of M. tuberculosis. The peak proliferative response to the TSP by PBMCs was observed at 0.1 ug/ml, whereas that of LNMCs was at 1.0 ug/ml. All of the patients showed greater blastogenic responses for the PPD than those for the TSP. IFN-r, IL-2, and IL-2Ru mRNA production from PBMCs after stimulation with the TSP were greatly augmented after 48 hrs, whereas IL-4 and IL-10 mRNA were gradually suppressed. In addition, high levels of IL-12 p40 mRNA were detected by PBMCs to the TSP antigen at 3 hrs. Elevated IFN-r and IL-2 mRNA production were observed in freshly isolated LNMCs, whereas IL-4 mRNA production was undetectable in either freshly isolated or mycobacterial antigen-stimulated LNMCs. Furthermore, IL-10 mRNA expression from LNMCs was markedly increased by the PPD antigen, but it was considerably reduced by the TSP antigen after 18 hrs. These data suggest that the TSP antigen may be a strong inducer of cytokine mRNA such as IFN-r, IL-2, and IL-12 which are involved in Thl cell and macrophage activation, and inhibit IL-10 mRNA production in LNMCs. In conclusion, the TSP antigen can be used as a preferential Thl cell immunogen in tuberculous lymphadenitis.
Cell Wall ; Humans ; Interleukin-10 ; Interleukin-12 ; Interleukin-2 ; Interleukin-4 ; Lymph Nodes* ; Macrophage Activation ; Mycobacterium tuberculosis* ; Mycobacterium* ; Octoxynol ; RNA, Messenger* ; Tuberculosis ; Tuberculosis, Lymph Node*

Hemodialysis(HD)-associated hypotension is a frequent complication, but it is difficult to manage. Until now, several maneuvers have been tried to prevent the HD-associated hypotension. Of these, the sodium content of dialysate was regarded as an important factor for maintaining blood pressure during HD. In this study, we evaluated the effect of hypertonic dialysate on blood pressure, interdialytic weight gain and the incidence of thirst. The study was done for 6 weeks successively with 3 different groups. Each patient was dialysed with 3 different dialysates for 2 weeks: Group I(Conventional HD: sodium concentration: 137 mEq/L), Group II(Hypertonic HD: 147 mEq/L) and Group III (Sequential HD: from 147 to 140 mEq/L). Hemodynamic parameters(blood pressure, pulse rate and ultrafiltration rate), biochemical parameters(hematocrits, blood urea nitrogen, creatinine, osmolality, sodium, potassium, chloride, fasting blood sugar) and complications (interdialytic weight gain &thirsty sensation) were compared among 3 groups. The results were as follows: 1. Decline of systolic blood pressure and diastolic blood pressure at the time of a 3 hour check during hemodialysis was lower in the Group II than Group I and III (p=0.002; p=0.012). and decline of diastolic blood pressure at the time of a 4 hour check during hemodialysis was lower in the Group II and III than Group I(p=0.04). 2. ncidence of hypotensive episodes during dialysis was significantly lower in Group II than group I (p=0.0287). 3. The ultrafiltration in Group III at the time of 1 hour, 2 hour and 3 hour check during hemodialysis was higher than that in Group I and II at the time of 1 hour, 2 hour and 3 hour check during emodialysis respectively (p=0.0001; p=0.0001; p=0.0004). 4. Interdialytic weight gain was higher in Group II(3.1+/-0.8) than GroupI(2.8+/-0.8) and III (2.9+/-0.9) (p=0.0422). 5. Hematologic and biochemical results were not significantly different among 3 Groups. 6. Frequency of thirst was different in Group I, II and III, 0.05+/-0.12, 0.41+/-0.24 and 0.22+/-0.29 respectively (p=0.0259). The results suggest that hypertonic HD was effective in preventing HD-associated hypotension but interdialytic weight gain and thirst sensations were increased as compared with a conventional method. In this situation, sequential HD seems to be an alternative method to minimizes the side effect of hypertonic HD.
Blood Pressure* ; Blood Urea Nitrogen ; Creatinine ; Dialysis ; Dialysis Solutions ; Fasting ; Hemodynamics* ; Humans ; Hypotension ; Incidence* ; Osmolar Concentration ; Potassium ; Renal Dialysis* ; Sensation ; Sodium ; Thirst* ; Ultrafiltration* ; Weight Gain*

PURPOSE: Kawasaki disease(KD) may be linked to primary infection by certain common viruses. KD concurrent with Epstein-Barr virus(EBV) suggests the possibility of an etiologic agent related to the KD rather than to the EBV infection itself, but, the influence on coronary complication is unclear. To establish whether infection with EBV contributed to the outcome of coronary artery lesions in patients with KD is the purpose of this study. METHODS: Retrospective studies were performed on 96 cases(age 2.48+/-1.94 years) of KD evaluated with serologic studies of EBV(EBV EA IgM, EBV EA IgG, EBNA IgG) at admission. We evaluated the clinical features and coronary outcome between a control group with KD and an EBV associated group with KD. RESULTS: On serologic studies of EBV, 62 patients(64.6%) with one more than positive results were in the EBV associated group with KD, in 30 patients with recent EBV infection, and in 32 patients with previous EBV infection. There were no significant differences between the control group and the EBV associated group in age, sex, and other clinical findings. Eighten patients (18.7%) had abnormal baseline echocardiogram, 13 patients(21.0%) among them were in the EBV associated group and 5 patients(14.7%) were in the control group; there was no significant difference between the two groups. Significantly 11 of 13 patients(84.6%) with coronary lesions had positive result of EBNA IgG, suggesting previous infection. There were no significant differences in retreatment and recurrence incidence. After retreatment, in 3 of 6 cases with the EBV associated group, and in no cases with the control group, cardiac complications were observed. CONCLUSION: Previous or chronic EBV infection may influence the occurrence of coronary lesion in patients with KD, even though patients with cardiac complication improved later.
Coronary Vessels* ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Recurrence ; Retreatment ; Retrospective Studies

Proliferating trichilemmal tumor is one of rare benign tumors of the skin appendages, considering as hamartoma of the terminal hair follicle, isthmic segment of the outer root sheath. We report a case of numerous proliferating trichilemmal tumors admixed with ordinary trichilemmal cysts with femilial history in 64-year-old man. He has total 157 lesions, which are chiefly located in scalp (48), back (32), and also face, neck, trunk, extremities. Histologically, the tumor is composed of irregularly arranged and ansatomosed trabeculae, lobules, or sheets of proliferated trichilemmal squamous epithelium with peripheral palisading of the basaloid cells. Several layers of squamoid or ovoid cells have PAS-positive clear cytoplasm. And it also shows abrupt amorphous, trichilemmal keratinization. Some squamous eddies with mild cellular atypism are associated, but definite invasion or other evidence of the malignancy is not found. usual multiple trichilemmal cysts are admixed with tumor and occasionally exhibit connection between them.
Cysts ; Hamartoma