Angiosarcoma is a malignant endothelial cell tumor of lymphatic or vascular origin and is most commonly found in the skin and soft tissue. Primary mesenteric angiosarcoma has rarely been reported. Here, we present a case of primary mesenteric angiosarcoma manifesting as a gradually enhancing mass along with necrosis and hemorrhage.

Angiosarcoma is a malignant endothelial cell tumor of lymphatic or vascular origin and is most commonly found in the skin and soft tissue. Primary mesenteric angiosarcoma has rarely been reported. Here, we present a case of primary mesenteric angiosarcoma manifesting as a gradually enhancing mass along with necrosis and hemorrhage.

PURPOSE: To evaluate the ultrasonographic and CT findings of hepatosplenic tuberculosis MATERIALS AND METHODS: We retrospectively reviewed the ultrasonographic and CT findings of confirmed hepatosplenic tuberculosis in 12patients. Six were men and six were women ; their average age was 41, and most were in their twenties. Lesions ofthe liver and spleen, as well as associated findings such as abdominal tuberculosis and other organ involvement oftuberculosis were analyzed. RESULTS: There were three cases of hepatic tuberculosis, seven of splenictuberculosis, and two of hepatosplenic involvement of tuberculosis. On the basis of the ultrasonographic and CTfindings, hepatosplenic tuberculosis was classified as one of two patterns : miliary or micronodular, ormacronodular. The micronodular type was more common (9/12 cases) being characterized by innumerable micronodules,and with easy coalescence in the liver and spleen in five of the nine cases. The macronodular type of low densitymass was noted in the other three patients. Splenomegaly was noted in 12 cases and hepatomegaly in ten. Pulmonarytuberculosis-including the miliary type(n=5)-was noted in eight patients. Associated abdominal tuberculosis suchas lymphadenopathy with central low density and peripheral rim enhancement (n=6), tuberculous peritonitis(n=3),highly attenuated ascites(n=6), adrenal tuberculosis(n=1), renal tuberculosis(n=1), ovarian abscess(n=1), psoasabscess(n=1), and systemic tuberculosis such as central nervous system tuberculoma(n=2), cervicallymphadenopathy(n=4) and tuberculous spondylitis(n=1) were noted. CONCLUSION: Ultrasonography and CT werevaluable in the detection and diagnosis of hepatosplenic tuberculosis
Central Nervous System ; Diagnosis ; Female ; Hepatomegaly ; Humans ; Liver ; Lymphatic Diseases ; Male ; Retrospective Studies ; Spleen ; Splenomegaly ; Tuberculosis* ; Tuberculosis, Gastrointestinal ; Tuberculosis, Hepatic ; Ultrasonography

PURPOSE: The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and “a good death” affect attitudes toward terminal care.METHOD: Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the Scheffé test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program).RESULTS: Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of “a good death”) were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (β=.20, p=.035), a sense of closeness(β=.19, p=.041), and the perception of a life-sustaining treatment decision (β=.22, p=.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p < .001, Adj R2=.140).CONCLUSION: A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of “a good death” and perceptions of life-sustaining treatment decisions.
Critical Care ; Hospitals, University ; Intensive Care Units ; Methods ; Terminal Care

Purpose: The purpose of this study is to compare the predictive validity of pressure injury risk assessment, Braden, Braden Q and Braden QD for pediatric patients. Methods: Prospective observational study included patients under the age of 19 who were hospitalized to general wards, intensive care units of a children’s hospital.Characteristics related to pressure injury were collected, and predicted validity was compared by calculating the areas under the curve (AUC) of the Braden, Braden Q, and Braden QD scales. Results: A total of 689 patients were included in the study. A total of 13 (1.9%) patients had pressure injuries, and the number of pressure injuries was 17. Factors related to the occurrence of pressure injuries were 9 (52.9%) immobility-related and 8 (47.1%) medical device-related. The AUC for each scale was .91 (95% CI .89~.94) for Braden, .92 (95% CI .90~.95) for Braden Q, and .94(95% CI .92~.96) for Braden QD. The optimal cut-off points were identified as 16 for Braden (sensitivity=88.8%, specificity=86.4%), 17 for Braden Q(sensitivity=63.6%, specificity=94.9%), and 12 for Braden QD (sensitivity=94.4%, specificity=88.7%). Conclusion The Braden QD scale demonstrated the highest predictive validity for pressure injuries in pediatric patients and is expected to be valuable tool in preventing pediatrics pressure injuries.

PURPOSE: To evaluate the radiologic features of fibrothecoma of the ovary, which is a rare solid tumor originating from the ovarian sex cord-stroma. MATERIALS AND METHODS: The radiologic findings of 29 patients with pathologically-proven fibrothecoma of the ovary were retrospectively evaluated for bilaterality, size, shape, margin, echogenecity, CT attenuation, signal intensity on magnetic resonance imaging, calcification, and amount of ascites. RESULTS: All fibrothecomas were unilateral, and had well defined margins. The diameter of the mass was 4-18(mean, 9.6)cms. Elghteen of 29 tumors were round or oval with a smooth margin, and eleven were lobulated. The internal architecture of the tumor was purely solid in 21 patients, predominantly solid in six, and pre-dominantly cystic in two. A broad spectrum of sonographic features was apparent, including a homogeneously hypoechoic mass (with posterior shadowing in four cases, and without posterior shadowing in ten), a homoge-neously hyperechoic mass in seven cases, an anechoic mass with septatations in two, and a mixed echoic mass in six. On precontrast CT scans, the mass was isodense to the uterine myometrium in eight of nine cases, while on postcontrast scans the lesion was slightly hypodense to the myometrium in seven cases and isodense in one. On T1-weighted MR images, nine of ten cases showed a relatively homogeneous low signal intensity, while on T2-weighted images, signal intensity was homogeneously low in two patients and predominantly low with focal high intensity in seven of the other eight. On gadolinium-enhanced T1-weighted images, most tu-mors showed slight heterogeneous enhancement. Calcifications were present in two cases, and in two others there was a large amount of ascites. CONCLUSION: The characteristic finding of ovarian fibrothecomas is a well-defined, oval or lobulated homoge-neously solid mass, which on CT scans enhances less than uterine myometrium and demonstrates a predomi-nantly low signal intensity on both T1- and T2-weighted images. However, a predominantly solid mass with cystic components or a predominantly cystic mass may also be presented.
Animals ; Ascites ; Female ; Humans ; Magnetic Resonance Imaging ; Mice ; Myometrium ; Ovary ; Retrospective Studies ; Shadowing (Histology) ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: This study describes the CT findings of changes in the maxillary sinus after the Caldwell-Luc procedure. MATERIALS AND METHODS: The maxillary sinus-related findings in 35 cases among 20 patients(17 cases in 10 males and 18 cases in 10 females)who had undrgone the Caldwell-Luc procedure mean 14.6 years earlier were reviewed. CT scans were obtained in the axial and coronal planes, with 5mm thickness. By means of the t test, changes in the size of the bony wall of the maxillary sinus, as well as antral volume change, were compared with the normal maxillary sinus group(41 male and 23 female cases). Males and females were compared separately, and surgical bony defect of nasolabial antrotomy and nasoantral window, fibroosseous proliferation, compartmentation and mucosal thickening of the postoperative maxillary sinus were evaluated, as were findings of chronic or recurrent maxillary sinusitis and postoperative complications. RESULTS: Naso-labial antrotomy was clearly identified in 27 of 35 cases, and irregular bony surface in the remaining eight, as were 27 bony defects and one irregular bony margin among a total of 28 cases of nasoantral window. Due to shortening of the height of the orbit, reductions in maxillary width, nasoantral communication width and anteroposterior diameter of the maxilla, and widening of the width of the inferior meatus, the maxillary sinus tended to become hypoplastic and centripetally contracted. Reduced cavitary volume of the maxillary sinus was noted(p<0.05), and fibro-osseous proliferation(n=29), compartmentation(n=11), and mu-cosal thickening(n=22) of the postoperative maxillary sinus were also seen. There were findings of chronic si-nusitis(n=22), as well as complications of postoperative mucocele(n=3) and oroantral fistula(n=2) of the maxillary sinus. CONCLUSION: The characteristic maxillary sinus-related findings seen after the Caldwell-Luc procedure are helpful in distinguishing postoperative change from recurrent paranasal diseases and resulting complications.
Female ; Humans ; Male ; Maxilla ; Maxillary Sinus* ; Maxillary Sinusitis ; Orbit ; Paranasal Sinuses ; Postoperative Complications ; Tomography, X-Ray Computed

BACKGROUND: Although core needle biopsy (CNB) is considered to be the standard technique for histological diagnosis of breast lesions, it is less reliable for diagnosing atypical ductal hyperplasia (ADH). We therefore assessed the characteristics of CNB-diagnosed ADH that are more likely to be associated with more advanced lesions on subsequent surgical excision. METHODS: We retrospectively examined 239 consecutive CNBs, 127 of which were diagnosed as ADH following surgical excision, performed at Asan Medical Center between 1995 and 2010. Archival slides were analyzed for the number of cores per specimen, the number of ADH foci, and the ratio of ADH foci to number of cores (FC ratio). RESULTS: We found that ADH foci in 3 or more cores (p=0.003) and the presence of ADH in 3 or more foci (p=0.002) were correlated with malignancy following excision lesion. Moreover, an FC>1.1 was significantly associated with malignancy in the subsequent excision (p=0.000). CONCLUSIONS: Including the number of ADH foci, the number of cores involved according to ADH, FC ratio, and histologic type in a pathology report of CNB may help in making clinical decisions about surgical excision.
Biopsy, Large-Core Needle ; Breast ; Breast Neoplasms ; Hyperplasia ; Needles ; Retrospective Studies

BACKGROUND: Periampullary cancer is a relatively common malignancy, and its incidence is increasing. A pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancer. However, leakage of the pancreaticojejunal anastomosis has been a major complication after a pancreaticoduodenectomy, with a frequently reported incidence of 5 percent to 25 percent. The ideal management of the pancreatic stump has not yet been determined. Thus we tried to find a safe and effective pancreatic stump management technique and to monitor the security of the pancreatic stump anastomosis by using the body fluid amylase level. PATIENTS AND METHODS: Forty six (46) consecutive patients who had undergone a pancreaticoduodenectomy, between January 1990 and January 1998, were evaluated retrospectively. Before June 1997, we did 36 pancreaticojejunostomies without long stent insertion into the pancreatic duct (group 2). After that, we did 10 P-Jstomies with long stent insertion (group 1). A long silicone stent was used for intubation of the anastomosis. Also the amount of pancreatic juice drainage from the long pancreatic duct tube was checked daily. We placed two Penrose drains and one Jackson-Pratt drain near the anastomosis. Patients were monitored for clinical evidence of a pancreatic fistula by evaluation of the amylase concentration in serum and the peritoneal drainage at postoperative day 7. The normal range of body fluid amylase was defined to be within five times of the normal serum amylase level. Cholangiography, which was obtained through a T-tube or a percutaneous transhepatic catheter, was performed on postoperative day 7 and was used to assess to leakage from or the obstruction at any of the three reconstructive anastomoses. RESULTS: In group 1, there was no leakage from the P-Jstomy site. The daily mean pancreatic juice amount and body fluid amylase level were 76.6 ml/day (range, 0.4-137.4 ml/day) and 147.4 U/L (range,44-323 U/L). In group 2, there were 4 cases of leakage at the P-Jstomy site (11.1%). CONCLUSION: An external long pancreatic duct stent insertion is an effective and safe method for management of a pancreatic remnant. We could check the amount of the daily pancreatic juice precisely. Effective decompression of the P-Jstomy was achieved by long stent insertion. We could monitor the security of the pancreatic stump anastomosis by the body fluid amylase level. We suggest that our method, which monitors the body fluid amylase level, is effective in early detection and treatment of P-Jstomy site leakage. The effort to find the best method for management of the pancreatic remnant should be continued.
Amylases ; Body Fluids ; Catheters ; Cholangiography ; Decompression ; Drainage ; Humans ; Incidence ; Intubation ; Pancreatic Ducts* ; Pancreatic Fistula ; Pancreatic Juice ; Pancreaticoduodenectomy ; Pancreaticojejunostomy* ; Reference Values ; Retrospective Studies ; Silicones ; Stents*