Congenital anomalies occur in 2-3% of neonates and have unknown and variable causes. It's occurance rate is higher in twin gestations than in singleton gestations, especially in monozygotic twins. In most cases of twin anomalies, one fetus is normal and the other fetus is not. When an anomaly is found in one fetus, various tests, such as chorionic villus sampling, amniocentesis, and umbilical cord aspiration are strongly recommended in high risk groups of chromosmal anomaly for accurate diagnosis and proper treatments. A case of congenital anomalies in both twins diagnosed in a 35 year old multiparous woman is presented with brief review of literatures.
Adult ; Amniocentesis ; Anencephaly ; Chorionic Villi Sampling ; Diagnosis ; Down Syndrome ; Female ; Fetus ; Humans ; Infant, Newborn ; Pregnancy ; Twins* ; Twins, Monozygotic ; Umbilical Cord

We report an extraordinary case of diffuse large B-cell lymphoma arising in a cystic necrotic mass in a 35-year-old man who presented with a soft tissue mass at the site of previous surgery. A benign mass was surgically removed 17 years ago, after which a cystic lesion gradually developed at the same site. The resected mass appeared as a thick-walled cyst filled with brown necrotic and hemorrhagic material. On microscopic examination, the cyst wall was primarily necrotic tissue with some aggregates of large atypical lymphoid cells. These atypical cells were diffusely positive for CD20 and showed a high proliferation index, Epstein-Barr virus positivity, and clonal rearrangement of the immunoglobulin gene. His present condition was diagnosed as Epstein-Barr virus-associated diffuse large B-cell lymphoma arising from chronic inflammation. It is important to be aware of the clinical manifestations and histological features of this rare disease in light of diagnosis and treatment.
Adult ; B-Lymphocytes ; Epstein-Barr Virus Infections ; Genes, Immunoglobulin ; Herpesvirus 4, Human ; Humans ; Incidental Findings ; Inflammation ; Light ; Lymphocytes ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Rare Diseases

Ribonucleic acid (RNA) has potential use in forensic science for the determination of postmortem interval. We report the first study on serial sampling of messenger RNA (mRNA) from surgical specimens to determine if there is a correlation between mRNA quantity and elapsed time. Skin tissues were collected from modified radical mastectomy specimens. After a defined period of time, bisected skin sections were cut and frozen in liquid nitrogen. Serial collection of the specimens was conducted, and frozen sections were obtained from all samples. Quantitative real-time reverse transcription-polymerase chain reaction was performed using the extracted RNA to measure the transcriptional activity of 2 selected housekeeping genes. The selected loci were mRNA sequences that exhibited time-dependent quantitative changes in a previous study. We collected 44 samples from 9 different patients, with 3-10 samples collected per patient. The amount of mRNA transcripts present in the serial samples showed a weak time-dependent correlation trend only in some cases. Further studies to evaluate different target mRNA sequences are necessary, as is exploration of additional methods to evaluate mRNA transcript degradation.
Forensic Sciences ; Frozen Sections ; Genes, Essential ; Humans ; Mastectomy, Modified Radical ; Nitrogen ; RNA ; RNA Stability ; RNA, Messenger ; Skin

Purpose: This study aimed to provide compelling evidence of anti-staphylococcal beta-lactam use for methicillin-susceptible Staphylococcus aureus bloodstream infection (MSSA BSI). Materials and Methods: We retrospectively collected data on patients with MSSA BSI who were admitted to two academic tertiary-care hospitals from 2010 to 2018. Only patients who received nafcillin, cefazolin, vancomycin, or teicoplanin as definitive therapy were included. The primary outcome was 28-day mortality. To perform unbiased comparisons between both treatments, we used inverse probability of treatment weighting (IPTW) analysis. Results: A total of 359 patients were divided into two groups based on the definitive therapy used: beta-lactams (n=203), including nafcillin or cefazolin; and glycopeptides (n=156), including vancomycin or teicoplanin. In the IPTW analysis, glycopeptides were associated with significantly increased odds of 28-day mortality (adjusted odds ratio, 3.37; 95% confidence interval, 1.71– 6.61; p<0.001). The rate of primary outcome in prespecified subgroups was largely consistent with the main analysis. Conclusion Definitive therapy with beta-lactams in patients with MSSA BSI was associated with lower 28-day mortality compared to definitive therapy with glycopeptides.

BACKGROUND: Follicular thyroid tumors harbor several genetic alterations such as RAS mutations and PAX8/PPARgamma rearrangement. The aims of our study were to investigate the prevalence of RAS mutations and PAX8/PPARgamma rearrangement in follicular thyroid tumors and to correlate RAS mutations and/or PAX8/PPARgamma rearrangement with clinicopathologic features in Korean patients with follicular thyroid carcinomas. METHODS: RAS mutations were investigated by polymerase chain reaction and DNA sequencing in surgical specimens of 37 follicular thyroid carcinomas (FTCs) and 16 follicular thyroid adenomas (FTAs). PAX8/PPARgamma rearrangement was analyzed by fluorescent in situ hybridization in surgical specimens of 31 FTCs and 13 FTAs. RESULTS: RAS mutations were detected in 30% (11 of 37) of FTCs and 19% (three of 16) of FTAs. Three of 11 FTC patients with RAS mutations died of thyroid cancer, but none of the 26 FTC patients without RAS mutations. PAX8/PPARgamma rearrangement was found in 10% (three of 31) of FTCs, but in none of the 13 FTAs. All three FTC patients with PAX8/PPARgamma rearrangement remained in complete remission during follow-up. There were no FTC patients with both RAS mutations and PAX8/PPARgamma rearrangement. CONCLUSION: The prevalence of RAS mutations in our series of follicular tumors was similar to previous studies. The frequency of PAX8/PPARgamma rearrangements in our group of FTC was lower than previous western reports, but higher than Japanese reports. RAS mutations may be associated with hematogeneous metastasis and poor survival while PAX8/PPARgamma rearrangement may be related to more favorable prognosis in Korean patients with FTCs.
Adenocarcinoma, Follicular ; Asian Continental Ancestry Group ; Follow-Up Studies ; Humans ; In Situ Hybridization, Fluorescence ; Korea ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Prevalence ; Prognosis ; Sequence Analysis, DNA ; Thyroid Gland ; Thyroid Neoplasms

Cholesterol granuloma of the breast is a rare, benign disease. Here, we present the unique ultrasonographic findings of breast cholesterol granuloma manifesting as an intracystic mass. The findings of this case report may help expand existing knowledge regarding differential diagnosis of intracystic breast masses, which are found on ultrasonographic examination.
Biopsy, Needle ; Breast Diseases/pathology/surgery/*ultrasonography ; *Cholesterol ; Diagnosis, Differential ; Female ; Granuloma, Foreign-Body/pathology/surgery/*ultrasonography ; Humans ; Mammography ; Middle Aged ; *Ultrasonography, Mammary

Although laryngomalacia is the most common cause of congenital stridor in infancy, it is a benign, self-limited disease which usually resolves by the age of 18 months with no long- term sequelae. Nevertheless, infants who suffered from recurrent stridor and respiratory distress should be evaluated for other causes of stridor such as cardiopulmonary anomalies. We report 3 cases of infants who had recurrent stridor and respiratory distress from their early infancy. Case 1 had a double aortic arch and a tracheomalacia, case 2 had a hypoplasia of the right lung, and case 3 had a horseshoe lung as well as scimitar syndrome. Physicians should be alert for the possibility of the congenital cardiopulmonary abnormalities in infants with recurrent stridor and/or respiratory distress.
Aorta, Thoracic ; Dyspnea ; Humans ; Infant ; Laryngomalacia ; Lung ; Respiratory Sounds ; Scimitar Syndrome ; Tracheomalacia

PURPOSE: The education for self-management of asthma is considered as an essential component to control asthma and improve outcomes. This study aimed to develope an educational game for increasing knowledge of asthma management among children and their caregivers. METHODS: Three subspecialists of pediatric allergy and respirology, 1 pediatrician, 3 pediatric residents and 15 medical students conducted this study. An instructional systemic design using analysis, design, development, implementation and evaluation (ADDIE) model was applied in the entire process of game production. We surveyed the demands of asthma education in 19 caregivers of children who were in the treatment of asthma in Korea University Anam Hospital and reflected its results on the construction of game. For the evaluation of the objective effects of developed game, the comparison study was performed between the patients who had experienced the game (n=20) and those who had not (n=22) by using questionnaire about the knowledge of asthma. RESULTS: The game was developed as a form of board game and had contents including precipitating factors, symptoms and treatment of asthma. The patients older than elementary student easily understood the mode and substances of game, and participated with their concentrations throughout approximately 2 hours' operating time. In analysis of the knowledge level of asthma, the patients who had experienced board game showed significantly higher knowledge level than those who had not (74.0+/-17.6 vs. 55.0+/-17.1, P=0.006). CONCLUSION: We developed a family board game for the asthma education through the systematic production process. The board game may increase the knowledge level in asthmatic children, which would improve the ability of self-management.
Asthma ; Caregivers ; Child ; Humans ; Hypersensitivity ; Korea ; Precipitating Factors ; Surveys and Questionnaires ; Self Care ; Students, Medical

OBJECTIVE: To report the feasibility of magnetic resonance imaging (MRI)-guided intervention for diagnosing suspicious breast lesions detectable by MRI only, using the freehand technique with a 3.0-T closed-bore MRI scanner. MATERIALS AND METHODS: Five women with 5 consecutive MRI-only breast lesions underwent MRI-guided intervention: 3 underwent MRI-guided needle localization and 2, MRI-guided vacuum-assisted biopsy. The interventions were performed in a 3.0-T closed-bore MRI system using a dedicated phased-array breast coil with the patients in the prone position; the freehand technique was used. Technical success and histopathologic outcome were analyzed. RESULTS: MRI showed that four lesions were masses (mean size, 11.5 mm; range, 7-18 mm); and 1, a nonmass-like enhancement (maximum diameter, 21 mm). The locations of the lesions with respect to the breast with index cancer were as follows: different quadrant, same breast - 3 cases; same quadrant, same breast - 1 case; and contralateral breast - 1 case. Histopathologic evaluation of the lesions treated with needle localization disclosed perilobular hemangioma, fibrocystic change, and fibroadenomatous change. The lesions treated with vacuum-assisted biopsy demonstrated a radial scar and atypical apocrine hyperplasia. Follow-up MRI after 2-7 months (mean, 4.6 months) confirmed complete lesion removal in all cases. CONCLUSION: MRI-guided intervention for breast lesions using the freehand technique with a 3.0-T closed-bore MRI scanner is feasible and accurate for diagnosing MRI-only lesions.
Adult ; Biopsy, Needle ; Breast Neoplasms/*pathology ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Feasibility Studies ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Magnetic Resonance Imaging/*instrumentation ; Magnetic Resonance Imaging, Interventional/*methods ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Vacuum

PURPOSE: Good adherence of caregivers is essential for successful health outcomes in the treatment of childhood asthma. The purpose of this study was to identify the factors contributing to good adherence of maintenance treatment in children with well-controlled asthma. METHODS: Children with well-controlled asthma being treated with a daily controller for at least 3 months in Korea University Anam Hospital were selected. Their caregivers who had good adherence to maintenance treatment were recruited. Qualitative study through in-depth interviews was conducted with 18 caregivers who agreed to the study. RESULTS: The 18 caregivers (mean age, 40.0 years) consisted of 15 mothers, 2 grandmothers, and 1 father. The resulting consensus were identified and grouped into 2 domains: the caregiver/patient aspect with 8 theme factors and the treatment aspect with 4 theme factors. The main theme factors in the caregiver/patient aspect were enabling participation in physical activities and exercise (77.8%), perceptions regarding asthma and the need for long-term treatment (50.0%), and perceived value of the medications outweighing the risk of side effects (38.9%). The main theme factors in the treatment aspect were trust in the physician (77.8%), general satisfaction with the manner and attitude of the physician (77.8%) and verification of the necessity of further treatment by performing tests (38.9%). CONCLUSION: Efforts to improve caregivers' adherence to the treatment of childhood asthma must include a range of factors related to both caregiver/patient aspects and treatment aspects. Among all of these factors, it may be most important to establish a physician-caregiver partnership.
Asthma ; Caregivers ; Child ; Consensus ; Fathers ; Humans ; Korea ; Mothers ; Motor Activity