PURPOSE: Current evidence indicates that ultrasonography of the breast is an important adjunct to mammography and clinical examination in the diagnosis of palpable breast abnormalities. An assessment of the value of office-based ultrasonography of a palpable breast mass performed by a breast surgeon was the aim of this work. METHODS: A 7.5 MHz linear probe was used to perform office-based ultrasonography in 109 consecutive female patients having a palpable solid breast mass between August 1998 and December 1999. Breast masses diagnosed histologically as fibroadenomas or breast cancer were included in this study. The clinical impression from the physical examination (PE), the result of officed-based ultrasonography done by a surgeon (OUSG), and comprehensive judgement engaging both PE and OUSG (PEUSG) were recorded in each patient's hospital record as benign or malignant at the first visit. The diagnostic values of PE, OUSG, PEUSG, mammography (MMG), and ultrasonography done by a radiologist (USG) were compared. RESULTS: Of 109 masses, a fibroadenoma was diagnosed in 73 patients while a carcinoma was established in 36 patients. The sensitivity, the specificity, the accuracy rate, and the kappa coefficient were 91.7%, 89.0%, 89.9%, and 0.780 for PE; 100%, 90.4%, 93.6%, and 0.862 for OUSG; 97.2%, 97.3%, 97.2%, and 0.938 for PEUSG; 90.4%, 89.4%, 90%, and 0.630 for MMG; and 88.9%, 90.9%, 90% and 0.798 for USG. The diagnostic accuracy of PEUSG was significantly higher than those of PE and MG (p<0.05). CONCLUSION: These data suggest that office-based ultrasonography of the breast performed by a surgeon is a useful adjunct to clinical evaluation of the breast mass and permits timely and cost-effective patient care.
Breast Neoplasms ; Breast* ; Diagnosis* ; Female ; Fibroadenoma ; Hospital Records ; Humans ; Mammography ; Patient Care ; Physical Examination ; Prospective Studies* ; Sensitivity and Specificity ; Ultrasonography*

No abstract available.
Pituitary Neoplasms*

Various methods of nasal reconstruction were performed over time. The physiology and anatomy of nose were clarified and its aesthetic subunits were employed, more improvement and modification were performed. The bilobed flap is particularly suitable for reconstruction of small or medium sized nasal defect up to 1.5 cm in diameter. Authors performed 6 cases of the bilobed flap for the defect of nasal dorsum (4 cases: basal cell carcinoma, 2 cases: compound nevus) from March 2000 to February 2001. The bilobed flap was medially based and second lobe was positioned on the nasal alar groove. This flap results in little or no distortion around tissue, by which scars of nasal dorsum and dog-ear deformity are reduced. Moreover we could achieve better cosmetic results for the scar, primary repair site of the second lobe, which is concealed by nasal alar groove.
Carcinoma, Basal Cell ; Cicatrix ; Congenital Abnormalities ; Nose ; Physiology

PURPOSE: This study was performed to investigate the effects of environmental factors, genetic polymor phisms of cytochrome P450 2E1 (CYP2E1) and N-acetyltransferase 2 (NAT2), and their interactions on mutations of p53 and Ki-ras genes in Korean stomach cancer. METHODS: One hundred nine stomach cancer patients and 211 age- and sex-matched controls were enrolled in this study. Direct interview with a structured questionnaire was performed to get informations on the level of exposure to environmental factors. For genotyping of the metabolic enzymes, PCR-RFLP methods were used. RT-PCR and direct sequencing were carried out to detect mutations in the p53 and the Ki-ras genes of stomach cancer tissue. To evaluate the risk of stomach cancer, we calculated odds ratios for environmental and genetic factors, and their combinations. RESULTS: Past medical histories of gastritis, diabetes and asthma allergic rhinitis were significant risk factors for stomach cancer. Fried potatoes, squid and octopus, welsh onions and chestnuts and gingkonuts had protective effects against stomach cancer. On the contrary, chicken, soybean paste stew, and soybean milk were significantly related to an increased stomach cancer risk. The NAT2 rapid acetylator turned out to be a marginally significant risk factor for gastric cancer. Mutations of the p53 and the Ki-ras genes were detected in 27.5% and 10.7% of stomach cancer tissues, respectively. Frizzled rice, potato, beef, lard, pickled fish, chicken stew, anchovies, tempura, Welsh onions, eggs, bean-curd, Qing-style soybean paste stew, and ice cream were protective against p53 mutation whereas yogurt was a risk factor for p53 mutation in stomach cancer tissue. Ki-ras mutation was associated with less intake of pears and persimmons, melons, strawberries, grapes and milk and with more intake ofsoybean paste stew. In a multiple logistic analysis including genetic polymorphism, past medical history and diet intake, past history of gastritis, chicken, soybean paste stew, and soybean milk were significant risk factors for stomach cancer whereas past history of diabetes, squid and octopus, and Welsh onions were protective factors against stomach cancer. CONCLUSION: These results suggest that past medical history and diet are more important risk factors for stomach cancer than genetic polymorphism and that mutations of the p53 and the Ki-ras genes would be induced by the respective risk factors.
Asthma ; Carcinogenesis* ; Carcinogens, Environmental* ; Chickens ; Cucurbitaceae ; Cytochrome P-450 CYP2E1* ; Decapodiformes ; Diet ; Diospyros ; Eggs ; Fragaria ; Gastritis ; Genes, ras ; Humans ; Ice Cream ; Milk ; Octopodiformes ; Odds Ratio ; Onions ; Ovum ; Polymorphism, Genetic* ; Pyrus ; Surveys and Questionnaires ; Rhinitis ; Risk Factors ; Solanum tuberosum ; Soybeans ; Stomach Neoplasms ; Vitis ; Yogurt

Pheochromocytoma is derived from the chromaffin cells and patients with pheochromocytoma present with several signs and symptoms by producing, storing and secreting catecholamine. Spontaneous rupture or necrosis of pheochromocytoma is extremely rare, but it can be lethal because of the dramatic change in the circulation such as an acute abdominal emergency or shock. Spontaneous remission of the clinical symptoms due to necrosis of the pheochromocytoma is rare. We describe such a case that presented with cardiogenic shock due to extensive necrosis of the pheochromocytoma and this was followed by spontaneous remission of the clinical symptoms without removal of the pheochromocytoma.
Chromaffin Cells ; Emergencies ; Humans ; Necrosis ; Pheochromocytoma ; Remission, Spontaneous ; Rupture, Spontaneous ; Shock ; Shock, Cardiogenic

Capsule endoscopy (CE) is a valuable modality for directly examining the small bowel in a relatively noninvasive and safe manner. CE is being increasingly used for obscure gastrointestinal bleeding, Crohn's disease, drug induced ulcer and small bowel tumor. Although capsule retention is a relatively infrequent complication, small bowel obstruction and strictures have been considered contraindications to CE. But some authors have reported that capsule endoscopy can be safely used to help identify the etiology and site of small bowel obstruction, and the retention of the capsule indicates the presence of a lesion requiring surgery. We report here on a case of small bowel obstruction and capsule retention by a small bowel ulcer, and the small bowel ulcer was not found when performing capsule endoscopy.
Capsule Endoscopy ; Constriction, Pathologic ; Crohn Disease ; Endoscopy ; Hemorrhage ; Retention (Psychology) ; Ulcer

PURPOSE: We wanted to develop and test an artificial intelligence (AI) to assist physicians in making the thin-section CT diagnosis of diffuse pulmonary diseases. MATERIALS AND METHODS: The AI was composed of knowledge bases (KB) of 12 diffuse pulmonary diseases and an inference engine (IE). The KB of a disease included both the inclusion criteria (IC) and the exclusion criteria (EC), which were the clinical or thin-section CT findings that were known to be present or absent in that particular disease, respectively. From imputing the clinical or thin-section CT findings by the operator who was reading the thin-section CT, AI instantly executed the following two steps. First, the IE eliminated all diseases from the list which the EC had for those particular findings. Next, from a list of remaining diseases, the AI selected those diseases having those findings in its IC to formulate the 1st-step differential diagnosis (DD1). For the differential diagnosis in the next step, the reader could choose one more clinical or thin-section CT finding from the new list: [(all the findings in the IC or EC of DD1) - (the findings in the IC common to all the DD1s)]. The reader could proceed even further if needed. The system was tested on 10 radiology residents who solved 24 problems (two problems for each of 12 diffuse pulmonary diseases) without and then with the aid of the AI. The scores were compared using the Wilcoxon signed rank test. RESULTS: An AI was made; it was composed of 280 rules (214 IC and 66 EC) and three interfaces (two for program management and another for problem solving). Contestants scored higher (p = 0.0078) using the AI (167 vs. 110 respectively), and they responded that they felt that the program was helpful in making decisions. CONCLUSION: AI appeared to be helpful in making thin-section CT diagnosis.
Artificial Intelligence* ; Diagnosis* ; Diagnosis, Differential ; Knowledge Bases ; Lung ; Lung Diseases*

Gastrointestinal stromal tumor is a common type of gastrointestinal mesenchymal tumor. Depending on the patient's age, compliance and health status, and the level of suspicion of malignancy, tumors < or =3 cm in size are typically monitored annually by endoscopic ultrasonography. The examination interval can be extended if no size change is noted on consecutive examinations. We report here on a 44-year-old female who presented with abdominal discomfort and displayed no size change of her gastrointestinal stromal tumor on three consecutive endoscopies over a 44-month interval. The patient was diagnosed with malignant gastrointestinal stromal tumor on the basis of the evident ulceration seen on esophagogastroduodenoscopy and the inhomogenous echo noted on the endoscopic ultrasonography and the pathologic findings by gastric wedge resection.
Adult ; Compliance ; Endoscopy, Digestive System ; Endosonography ; Female ; Gastrointestinal Stromal Tumors ; Humans ; Ulcer

Minimally invasive surgery is being widely accepted in various fields of surgery. Although several appendectomy techniques have been reported but, there is no standardization. We report here the experiences of transumbilical endoscopic appendectomy in humans. Between July 2008 and September 2010, ten patients with appendicitis successfully underwent transumbilical endoscopic appendectomies. There were 7 cases of suppurative, 2 cases of gangrenous and 1 case of perforated in operative findings. The ages of the patients were 13-56 years (mean age, 32.7 +/- 15.4 years). Under general anesthesia, a 15-mm port was inserted through the umbilicus and then a two-channel endoscope was inserted in the peritoneal cavity. After appendix identification, counter-traction of the appendix with a direct abdominal wall puncture using a straight round needle prolene was performed to achieve good visualization of the operative field. Tissue dissection was performed using an endoscopic needle knife. Tissue grasping and resected appendix retrieval were done with endoscopic forceps. The average operation time was 79.5 +/- 23.6 minutes (range, 45 to 110 minutes). No procedures were converted to laparoscopic or open appendectomy. Hospital stay was 4-6 days. All patients completely recovered without complications. As it is highly maneuverable, we believe transumbilical endoscopic appendectomy can be a feasible method. And, as surgeons want to proceed from laparoscopic surgery to natural orifice transluminal endoscopic surgery, this procedure could be a triable method.
Abdominal Wall ; Anesthesia, General ; Appendectomy* ; Appendicitis ; Appendix ; Endoscopes ; Endoscopy ; Hand Strength ; Humans ; Laparoscopy ; Length of Stay ; Natural Orifice Endoscopic Surgery ; Needles ; Peritoneal Cavity ; Polypropylenes ; Punctures ; Surgical Instruments ; Surgical Procedures, Minimally Invasive ; Umbilicus

The pharmacokinetics and dosage regimen of norfloxacin-glycine acetate (NFLXGA) was investigated in pigs after a single intravenous (i.v.) or oral (p.o.) administration at a dosage of 7.2 mg/kg body weight. After both i.v. and p.o. administration, plasma drug concentrations were best fitted to an open two-compartment model with a rapid distribution phase. After i.v. administration of NFLXGA, the distribution (t1/2alpha) and elimination half-life (t1/2beta) were 0.36 +/- 0.07 h and 7.42 +/- 3.55 h, respectively. The volume of distribution of NFLXGA at steady state (Vdss) was 4.66 +/- 1.39 l/kg. After p.o. administration of NFLXGA, the maximal absorption concentration (Cmax) was 0.43 +/- 0.06 microgram/ ml at 1.36 +/- 0.39 h (Tmax). The mean absorption (t1/2ka) and elimination half-life (t1/2beta) of NFLXGA were 0.78 +/- 0.27 h and 7.13 +/- 1.41 h, respectively. The mean systemic bioavailability (F) after p.o. administration was 31.10 +/- 15.16%. We suggest that the optimal dosage calculated from the pharmacokinetic parameters is 5.01 mg/kg per day i.v. or 16.12 mg/kg per day p.o.
Administration, Oral ; Animals ; Anti-Bacterial Agents/administration & dosage/blood/*pharmacokinetics ; Biological Availability ; Cross-Over Studies ; Glycine/administration & dosage/*analogs & derivatives/blood/pharmacokinetics ; Half-Life ; Injections, Intravenous/veterinary ; Male ; Norfloxacin/administration & dosage/*analogs & derivatives/blood/pharmacokinetics ; Swine/*metabolism ; Time Factors