This study investigated the impact of menopause on the progression and management of common benign gynecological conditions such as polycystic ovary syndrome, endometriosis, uterine fibroids, and adenomyosis. These conditions often present with menstruationrelated symptoms such as irregular cycles, heavy bleeding, and pelvic pain. While these symptoms typically subside after menopause, the underlying pathology of such benign gynecological conditions may be differentially affected by the physiological changes associated with menopause, sometimes leading to exacerbation or additional management challenges. Although rare, the potential for malignant transformation remains a concern. This study aims to elucidate the shifts in management strategies from the reproductive years to postmenopause. It highlights the necessity for a tailored approach to hormone therapy and surgical interventions based on the individual patient’s health profile and the specific characteristics of each condition.

This study investigated the impact of menopause on the progression and management of common benign gynecological conditions such as polycystic ovary syndrome, endometriosis, uterine fibroids, and adenomyosis. These conditions often present with menstruationrelated symptoms such as irregular cycles, heavy bleeding, and pelvic pain. While these symptoms typically subside after menopause, the underlying pathology of such benign gynecological conditions may be differentially affected by the physiological changes associated with menopause, sometimes leading to exacerbation or additional management challenges. Although rare, the potential for malignant transformation remains a concern. This study aims to elucidate the shifts in management strategies from the reproductive years to postmenopause. It highlights the necessity for a tailored approach to hormone therapy and surgical interventions based on the individual patient’s health profile and the specific characteristics of each condition.

This study investigated the impact of menopause on the progression and management of common benign gynecological conditions such as polycystic ovary syndrome, endometriosis, uterine fibroids, and adenomyosis. These conditions often present with menstruationrelated symptoms such as irregular cycles, heavy bleeding, and pelvic pain. While these symptoms typically subside after menopause, the underlying pathology of such benign gynecological conditions may be differentially affected by the physiological changes associated with menopause, sometimes leading to exacerbation or additional management challenges. Although rare, the potential for malignant transformation remains a concern. This study aims to elucidate the shifts in management strategies from the reproductive years to postmenopause. It highlights the necessity for a tailored approach to hormone therapy and surgical interventions based on the individual patient’s health profile and the specific characteristics of each condition.

Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.
Antiretroviral Therapy, Highly Active* ; Extracorporeal Membrane Oxygenation* ; HIV ; Humans ; Mortality ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Salvage Therapy

OBJECTIVE: To evaluate the sonographic features of invasive apocrine carcinoma (IAC) of the breast. MATERIALS AND METHODS: This study included five pathologically proven cases of IAC, and their sonographic features were retrospectively analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. RESULTS: All five lesions involved the left breast and were seen as irregularly shaped masses. All lesions, except one, had a parallel orientation to the chest wall. All five lesions showed noncircumscribed margins and heterogeneous echotexture; however, they showed various posterior features. One lesion had edema as an associated feature. Sonographic assessments were classified as BI-RADS category 4 in all five cases. CONCLUSION: Invasive apocrine carcinoma sonographic findings are difficult to differentiate from those of invasive ductal carcinoma of no special type.
Aged ; Apocrine Glands/pathology/ultrasonography ; Breast Neoplasms/*diagnosis/pathology/ultrasonography ; Carcinoma/*diagnosis/pathology/ultrasonography ; Female ; Humans ; Middle Aged ; Neoplasm Invasiveness ; Positron-Emission Tomography ; Receptor, ErbB-2/metabolism ; Receptors, Estrogen/metabolism ; Receptors, Progesterone/metabolism ; Tomography, X-Ray Computed ; Tumor Suppressor Protein p53/metabolism

A large outbreak of Shigella sonnei gastrointestinal infections occurred at Cheju Island in Korea from May to August 2000. We selected 54 strains which were isolated from the primary treatment failure cases in the outbreak, and characterized the resistance-determining region of the R-plasmid. The 54 strains showed same antimicrobial resistance patterns; resistance against ampicillin, streptomycin, tetracycline, and trimethoprim-sulfamethoxazole. The resistance to ampicillin, streptomycin, and tetracycline were mediated by a conjugable plasmid of about 80 kb size, but the trimethoprim- sulfamethoxazole resistance was not transferred by this plasmid. The R-determining region of the plasmid was cloned and characterized. The 8,384 bp sequences contained resistance genes in the following order:strA, strB, tetR, tetA, and sul1. Fifty four isolates harbored the same sized plasmid and showed same ribotyping patterns, which suggested the clonal spread of S. sonnei in the outbreak.
Ampicillin ; Clone Cells ; Jeju-do* ; Korea ; Plasmids* ; Ribotyping ; Shigella sonnei* ; Shigella* ; Streptomycin ; Sulfamethoxazole ; Tetracycline ; Treatment Failure ; Trimethoprim, Sulfamethoxazole Drug Combination

Klebsiella pneumoniae causes pyogenic infections in various sites, with the risk of which increases in patients with diabetes mellitus. Recently, K. pneumoniae has emerged as a leading cause of pyogenic liver abscess. Primary liver abscess caused by K. pneumoniae in the absence of underlying hepatobiliary disease is commonly associated with metastatic infections such as endophthalmitis, meningitis, brain abscess and infection in other sites. We experienced a case of K. pneumoniae liver abscess associated with septic metastatic lesions including pyomyositis and infected aneurysm of aorta. Despite the aggressive management with antibiotics, surgical pus drainage and aortic bypass graft, patient died of ventilator associated pneumonia and multiorgan failure. Our experience suggests that clinicians should be alert to septic metastatic infections when they treat a patient with K. pneumoniae liver abscess.
Aneurysm, Infected ; Anti-Bacterial Agents ; Aorta ; Aortic Aneurysm ; Brain Abscess ; Diabetes Mellitus ; Drainage ; Endophthalmitis ; Humans ; Klebsiella ; Klebsiella pneumoniae ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic ; Meningitis ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pyomyositis ; Suppuration ; Transplants

A large outbreak of Shigella sonnei gastrointestinal infections occurred at Cheju Island in Korea from May to August 2000. We selected 54 strains which were isolated from the primary treatment failure cases in the outbreak, and characterized the resistance-determining region of the R-plasmid. The 54 strains showed same antimicrobial resistance patterns; resistance against ampicillin, streptomycin, tetracycline, and trimethoprim-sulfamethoxazole. The resistance to ampicillin, streptomycin, and tetracycline were mediated by a conjugable plasmid of about 80 kb size, but the trimethoprim- sulfamethoxazole resistance was not transferred by this plasmid. The R-determining region of the plasmid was cloned and characterized. The 8,384 bp sequences contained resistance genes in the following order:strA, strB, tetR, tetA, and sul1. Fifty four isolates harbored the same sized plasmid and showed same ribotyping patterns, which suggested the clonal spread of S. sonnei in the outbreak.
Ampicillin ; Clone Cells ; Jeju-do* ; Korea ; Plasmids* ; Ribotyping ; Shigella sonnei* ; Shigella* ; Streptomycin ; Sulfamethoxazole ; Tetracycline ; Treatment Failure ; Trimethoprim, Sulfamethoxazole Drug Combination

Klebsiella pneumoniae causes pyogenic infections in various sites, with the risk of which increases in patients with diabetes mellitus. Recently, K. pneumoniae has emerged as a leading cause of pyogenic liver abscess. Primary liver abscess caused by K. pneumoniae in the absence of underlying hepatobiliary disease is commonly associated with metastatic infections such as endophthalmitis, meningitis, brain abscess and infection in other sites. We experienced a case of K. pneumoniae liver abscess associated with septic metastatic lesions including pyomyositis and infected aneurysm of aorta. Despite the aggressive management with antibiotics, surgical pus drainage and aortic bypass graft, patient died of ventilator associated pneumonia and multiorgan failure. Our experience suggests that clinicians should be alert to septic metastatic infections when they treat a patient with K. pneumoniae liver abscess.
Aneurysm, Infected ; Anti-Bacterial Agents ; Aorta ; Aortic Aneurysm ; Brain Abscess ; Diabetes Mellitus ; Drainage ; Endophthalmitis ; Humans ; Klebsiella ; Klebsiella pneumoniae ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic ; Meningitis ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pyomyositis ; Suppuration ; Transplants

OBJECTIVES: Body mass index (BMI) is commonly used in epidemiological study or clinical center. However, it is not exactly correlated with body fat composition and does not reflect sex, age, or race. The aim of this article is to evaluate the validity of BMI standards relative to total body fat (TBF) and to estimate new BMI criteria that correspond to TBF for obesity, especially for Asian postmenopausal women. METHODS: A total 3,936 patients were included in this cross-sectional study, including 1,565 premenopausal and 2,371 postmenopausal women. At the time of visit, demographic data were collected. We demonstrated the validity of BMI cut-point of 25 kg/m2 by using area under the curve (AUC), and presented the empirical optimal BMI cut-point by using Youden's index and overall accuracy in both premenopausal and postmenopausal women. RESULTS: BMI-defined obesity (≥ 25 kg/m2) represents high AUC values (> 0.9) for each TBF. In premenopausal women, TBF ≥ 38% and corresponding BMI value was 29.45 kg/m2 indicated the highest both Youden's index and overall accuracy. In comparison, postmenopausal women who were TBF ≥ 38% showed the highest Youden's index and overall accuracy, and corresponding BMI value was 26.45 kg/m2. CONCLUSIONS: We proposed new BMI criteria for obesity by using TBF reference. With application of bioelectrical impedance analysis, the diagnosis of obesity using BMI criteria may differ between premenopausal and postmenopausal women.
Adipose Tissue ; Area Under Curve ; Asian Continental Ancestry Group ; Body Mass Index ; Continental Population Groups ; Cross-Sectional Studies ; Diagnosis ; Electric Impedance ; Epidemiologic Studies ; Female ; Humans ; Menopause ; Obesity