No abstract available.
Female ; Humans ; Plasma* ; Pregnant Women*

This study shows a case of neoadjuvant chemotherapy application for the management of a 34-year-old male patient diagnosed with invasive intraductal papillary mucinous neoplasm (IPMN), for which curative margin-negative resection initially seemed challenging. Five cycles of the FOLFIRINOX regimen (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) were administered preoperatively, resulting in a significant reduction of the intraductal mass size and deformity of the main vessels. The patient subsequently underwent a successful robotic pylorus-preserving pancreatoduodenectomy. Postoperatively, the patient received adjuvant chemotherapy with FOLFIRINOX, and after 5 months, showed no signs of tumor recurrence or specific complications. These findings suggest that neoadjuvant therapy can be a potentially effective strategy even in advanced invasive IPMN. Further research is necessary to establish guidelines for its application.

Annuloaortic ectasia, cystic medial degeneration of the afflicted aortic wall leading to progressive dilatation, is often accompanied by Marfan's syndrome. Some portions of intimal flap is commonly demonstrated along the aorta in the noninvasive diagnosis of aortic dissection. We report the first case of circumscribed aortic dissection developed in a 28 year old obese non-Marfanoid patient. He was transferred after thrombolytic therapy at a community hospital because of severe chest pain and ST segment elevation. Transthoracic echocardiography showed markedly dilated aortic root, moderate amount of pericardial effusion, mild aortic regurgitation in spite of normal regional wall motion of left ventricle. Intimal flap, characteristic of aortic dissection, was not seen with computed tomography. Intimal tear was demonstrated just above aortic valve only by transesophageal echocardiography. Two parallel intimal tear and small circumscribed dissection was demonstrated by autopsy.
Adult ; Aorta ; Aortic Valve ; Aortic Valve Insufficiency ; Autopsy ; Chest Pain ; Diagnosis ; Dilatation ; Dilatation, Pathologic* ; Echocardiography ; Echocardiography, Transesophageal ; Heart Ventricles ; Hospitals, Community ; Humans ; Marfan Syndrome ; Pericardial Effusion ; Thrombolytic Therapy

Objective: Air pollutants have attracted increasing interest worldwide, including Korea. Acute and chronic exposure to air pollutants has adverse effects on health. Therefore, this study examined the association of air pollutants with myocardial infarction. Methods: This study included 542 patients who underwent coronary angiography and were diagnosed with acute coronary artery occlusion after visiting a local emergency medical center from January 1, 2016, to December 31, 2018. The days (1,096) were divided into two groups: myocardial infarction days group (the days when symptoms of myocardial infarction developed) and non-myocardial infarction days group (the days when symptoms of myocardial infarction did not develop). This study compared the air pollutants (PM10, PM2.5, O3, SO2, CO, and NO2) and prognosis (survivor, death) from two days ago to the days between the myocardial infarction days and non-myocardial infarction days. Results: The PM10 and PM2.5 of the myocardial infarction days group were 44.332±18.892 and 25.193±12.009 μm/m3, respectively, and those of the non-myocardial infarction days group were 41.906±19.263 and 23.693±12.053 μm/m3, respectively. On day one before symptom development, the PM2.5 of the myocardial infarction days group was 25.316± 11.977 μm/m3, which was higher than that of the non-myocardial infarction days groups (23.642±12.053 μm/m3), and there were no significant differences between the gaseous air pollution and the number of occlusions, except on a 0 day of ozone. The PM2.5 (proximal, middle, and distal according to the vessel size) at day 0 was 25.747±12.361, 22.941± 11.477, and 21.486±10.924 μm/m3, respectively; the proximal group had the highest value. During the study days, the PM10 of the death and survival groups was 51.440 (±20.140)-56.924 (±25.225) μm/m3 and 41.155 (±18.544)-43.002 (±18.858) μm/m3, respectively. PM2.5 of the death and survival groups was 26.968 (±14.140)-30.145 (±12.829) and 23.770 (±11.685)-24.170 (±12.696) μm/m3, respectively. Conclusion Myocardial infarction was found to develop more on the day with the highest PM2.5 and PM10 on day 0 and -1. A high PM2.5 is related to an occlusion of the proximal coronary artery. Therefore, PM2.5 has a stronger association with myocardial infarction than PM10. Furthermore, increased particulate air pollution for three consecutive days is associated with a poor prognosis.

BACKGROUND: Three-dimensional echocardiography has good feasibility and real image display in dynamic and spatial cardiac structures. So we designed this study to assess both the feasibility and potential role of three-dimensional echocardiography for the evaluation of cardiac structures and adjacent relationships. METHOD: We studied 25 patients with various heart structures. Cross-sectional images of specific interesting region were acquired from multiplane transesophageal echocardiography and reconstructed to three-dimensional images by TomTec image processing system. These images were presented in volume-rendered dynamic display for assessing of additonal informations. RESULTS: Three-dimensional reconstructions of usual viewpoints and interesting cut planes were possible in all patients. When compared with standard two dimensional images, additional informations were provided in all reconstructed cases. Among these images, mitral valve morphology, aortoseptal continuity and interatrial septum were the structures for which three-dimensional echocardiography were most useful. CONCLUSION: Although it was preliminary datas which needs large-scale randonmized prospective studies, three-dimensional echocardiograpy may be most potent and promising methods in evaluating anatomic and functional assessment of heart structures.
Echocardiography, Three-Dimensional* ; Echocardiography, Transesophageal ; Heart ; Humans ; Imaging, Three-Dimensional ; Mitral Valve

No abstract available.
Hypertension, Pulmonary* ; Pulmonary Veno-Occlusive Disease*

We report a 63-years-old woman who developed a nodular lesion in right upper lobe (RUL) of lung after achieving a partial response with salvage chemotherapy for relapsed non-Hodgkin's lymphoma (NHL). Previously, she had been diagnosed as NHL and tuberculous lymphadenitis resulting a complete response with 8 cycles of CHOP regimen and anti-tuberculosis medication for 1 year. CT scan of the chest showed an irregular marginated soft tissue density in RUL with internal punctate calcifications and this lesion was difficult to discriminate between pulmonary tuberculosis and parenchymal involvement of NHL. Because the pulmonary infiltrations progressed despite empirical anti-tuberculosis medication, we performed bronchoscopic biopsy, showing diffuse large B-cell lymphoma. Thereafter, the pulmonary infiltrations were markedly improved with salvage chemotherapy. However, she died of refractory NHL despite high-dose chemotherapy with autologous peripheral blood stem cell transplantation.
Biopsy ; Diagnosis ; Drug Therapy ; Female ; Humans ; Lung ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin* ; Pathology ; Peripheral Blood Stem Cell Transplantation ; Thorax ; Tomography, X-Ray Computed ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary

Objectives: Since endoscopic findings of primary gastric lymphoma are ambiguous and diverse, it is not easy to distinguish them from gastric adenocarcinoma or secondary gastric lymphoma. The aim of this study was to investigate the difference in clinical and endoscopic features between primary gastric lymphoma and gastric involvement of lymphoma. Methods: Forty-eight patients were enrolled in this retrospective study between June 2008 and February 2017. The patients were divided into primary gastric lymphoma group (primary group, n = 18) and gastric involvement group (secondary group, n = 30) based on whether or not they carried gastric lesions alone. Patients’ clinical characteristics, endoscopic findings and pathologic data were retrospectively reviewed based on electronic medical records. Results: The mean age of patients was 63.3 ± 13.1 years and 29 patients were female (60.4%). Diffuse large B-cell lymphoma pathology (81.3%), gastric body involvement (47.9%) and ulceroinfiltrative morphology on endoscopy (43.8%) were common features. Regardless of the two groups, the initial endoscopic diagnosis was considered as lymphoma only in 41.7%. Compared with the primary group, fundus (P = 0.035) and regional lymph node (P < 0.001) were significantly associated with the secondary group. However, there was no significant difference in endoscopic findings including location, size, number, and morphology of lesion. Conclusions Endoscopic diagnosis of gastric lymphoma is a challenge. There is no difference in endoscopic findings between the primary and secondary groups even when confirmed separately. However, when the lesion is present in the fundus, we keep in mind the possibility of secondary gastric lymphoma.

BACKGROUND/AIMS: Colorectal cancer (CRC) with microsatellite instability (MSI) has a better prognosis than CRC with microsatellite stable (MSS). Recent studies have reported biological differences according to tumor location in CRC. In this study, we investigated the clinical significance of MSI in patients with right-sided CRC. METHODS: The medical records of 1,009 CRC patients diagnosed at our institute between October 2004 and December 2016 with MSI test results were retrospectively reviewed. The long-term outcomes of CRC patients with MSI were assessed with respect to tumor location using Kaplan-Meier curves and Cox regression models. RESULTS: The median follow-up duration for all 1,009 study subjects was 25 months (interquartile range, 15–38). One hundred twenty-four of the study subjects had MSI (12.3%) and 250 had right-sided CRC (24.8%). The patients with MSI and right-sided CRC had better disease-free survival (DFS) than those with MSS as determined by the log-rank test (p=0.013), and this result was significant in females (p=0.035) but not in males with right-sided CRC. Multivariate Cox regression analysis showed MSS significantly predicted poor DFS in patients with right-sided CRC (hazard ratio 3.97, 95% CI 1.30–12.15, p=0.016) and in female patients (hazard ratio 4.69, 95% CI 1.03–21.36, p=0.045). CONCLUSIONS: The study shows MSI is a useful predictor of DFS in patients with right-sided CRC, especially in female patients.
Colorectal Neoplasms ; Disease-Free Survival ; Female ; Follow-Up Studies ; Gender Identity ; Humans ; Male ; Medical Records ; Microsatellite Instability ; Microsatellite Repeats ; Prognosis ; Retrospective Studies

BACKGROUND: We have analyzed the outcome and prognostic factors for 61 patients with acute myelogenous leukemia (AML) who were treated with idarubicin(IDA)/N 4-behenoyl- 1-beta-D-arabinofuranosylcytosine(BH-AC) regimen at Chonnam National University Hospital between April 1994 and December 1998. METHODS: Fifty-six patients with newly diagnosed AML and 5 patients failed by IDA/ara- C were eligible to analysis. Remission induction chemotherapy consisted of IDA (12 mg/m2/day IV over 30 minutes on days 1~3) and BH-AC (age < or =40 years: 300 mg/m2/day IV over 4 hours on days 1~7; age >40 years: 200 mg/m2/day). After achievement of a complete remission (CR), four polychemotherapy cycles, allogeneic BMT or autologous PBSCT were given as consolidation. RESULTS: Median age was 38 years (range, 17 to 65). Of 61 patients, 43 (70.5%) achi-eved CR and 6 (9.8%) died of early complications. The Kaplan-Meier estimated overall survival rate was 51.8+/-7.7%, 43.1+/-8.5% and 29.6+/-8.8% at 1 year, 2 year and 3 year respectively, and the disease free survival rate was 58.4+/-9.7%, 43.3+/-10.4% and 24.0+/-12.2 % at 1 year, 2 year and 3 year, respectively. Unfavorable prognostic variables for achieving CR were age >55 years (P =0.006), FAB subtypes (P=0.005) and poor risk cytogenetic abnormalities (P=0.021), and FAB subtypes for overall survival (P=0.0064). CONCLUSION: IDA/BH-AC combination chemotherapy is an effective and well-tolerated regimen for induction treatment of AML.
Chromosome Aberrations ; Disease-Free Survival ; Drug Therapy ; Drug Therapy, Combination ; Humans ; Idarubicin ; Induction Chemotherapy* ; Jeollanam-do ; Leukemia, Myeloid, Acute* ; Remission Induction ; Survival Rate