PURPOSE: ST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains. MATERIALS AND METHODS: This was a retrospective observational cohort study. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated. RESULTS: Of the 513 patients diagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptom onset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality. CONCLUSION: STEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary.
Aged ; Aged, 80 and over ; Chest Pain/*diagnosis ; Electrocardiography ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Myocardial Infarction/mortality/*surgery ; Retrospective Studies

We report a fatal case of Shewanella algae bacteremia accompanied by cellulitis in both legs of a chronic renal failure patient who had not been exposed to sea water or raw fish. A 47-year-old male on hemodialysis was admitted to our clinic due to pain in both legs accompanied by a febrile sensation that started 2 days prior to his visit. A blood culture specimen revealed S. algae, a rare human opportunistic pathogen. In spite of early and appropriate antimicrobial treatment, the patient died of septic shock on the second day of his hospital stay. Recently, serious infections caused by Shewanella species have been reported in increasing frequency. Hepatobiliary diseases have been proposed as predisposing factors, not only for infection by this organism, but also for fatality. However, we should be aware of the significance of S. algae in patients with renal insufficiency, especially those on maintenance hemodialysis. Herein, we report our case with review relevant literature.
Bacteremia ; Cellulitis ; Humans ; Kidney Failure, Chronic ; Leg ; Length of Stay ; Male ; Middle Aged ; Renal Dialysis ; Renal Insufficiency ; Seawater ; Sensation ; Shewanella ; Shock, Septic

Amebic liver abscess (ALA) has been diagnosed in travelers to endemic areas or in patients with immunosuppression secondary to human immunodeficiency virus infection since the late 1990s. Further, it is a rare disease in Korea. ALA should be considered in patients present with fever and right upper quadrant pain along with a risk of exposure to amebiasis. We report an 82-year-old man with symptoms of fever, gross hematuria and severe renal impairment as having amebic liver abscess complicated with the obstruction of the inferior vena cava. Amebic liver abscess was successfully treated with antibiotics alone. Also, hematuria disappeared and renal dysfunction improved after treatment.
Aged, 80 and over ; Amebiasis ; Anti-Bacterial Agents ; Fever ; Hematuria ; HIV ; Humans ; Immunosuppression ; Korea ; Liver Abscess, Amebic* ; Rare Diseases ; Renal Insufficiency ; Vena Cava, Inferior*

Aberrant breast tissue is a subset of accessory breast tissue, and it exhibits similar consistency to that of the adjacent normal breast tissue, but it lacks an associated nipple complex. It is a developmental anomaly defined as the persistence of breast tissue along the embryonic mammary line. Aberrant breast tissue is most commonly located in the axilla, though it may be present anywhere along the embryonic mammary line. We report here on an 11-year-old girl with aberrant breast tissue and acanthosis nigricans. She had tender masses that became noticeable with the onset of menarche and mottled hyperpigmentation on both axillae. The histopathologic finding of the lesion revealed the typical features of aberrant breast tissue with acanthosis nigricans.
Acanthosis Nigricans ; Axilla ; Breast ; Child ; Female ; Humans ; Hyperpigmentation ; Menarche ; Nipples

Duodenal tumors may pose diagnostic difficulties in asymptomatic young patients because the duodenum may be overlooked during routine upper gastrointestinal endoscopy and because duodenal tumors are rare and present non-specific signs and symptoms. Although adenomas are the most common duodenal tumors, adenocarcinoma arising from sporadic tubulovillous adenoma without familial adenomatous polyposis is an uncommon condition in young patients. In patients with sporadic duodenal adenomas, the prevalence of colorectal adenomas is higher than prevalence for the general population. Herein, we report the case of a 27-year male with adenocarcinoma arising from a sporadic tubulovillous adenoma of the duodenum. The tumor was completely resected by endoscopic resection. Synchronous colon adenoma was also detected and treated by endoscopic mucosal resection.
Adenocarcinoma ; Adenoma ; Adenomatous Polyposis Coli ; Colon ; Duodenum ; Endoscopy, Gastrointestinal ; Humans ; Male ; Prevalence

Development of biliary casts is very unusual, especially in patients who have not undergone liver transplantation. Variable causes of biliary cast formation in nonliver transplantation patients have been suggested. However, stasis of bile flow and/or gallbladder hypocontractility is known to eventually result in the promotion of biliary sludge and subsequent cast formation. Here we present one case of biliary cast syndrome, which developed in a nonliver transplant patient who had biliary sludge for a long period of time, providing evidence that long-standing biliary sludge may lead to cast formation.
Bile ; Biliary Tract ; Gallbladder ; Humans ; Liver Transplantation ; Sewage ; Superior Mesenteric Artery Syndrome ; Transplants

BACKGROUND AND OBJECTIVES: Early glottic cancer can be effectively treated with conservation laryngeal surgery, radiation therapy, and endoscopic laser surgery. The aim of this study was to compare the clinical results between laser cordectomy and radiation therapy for early glottic cancer and to evaluate the role of laser cordectomy. MATERIALS AND METHOD: From 1988 to 1998, 89 patients with T1-T2/N0 glottic cancer were treated initially with radiation therapy or laser cordectomy. There were 67 T1 and 22 T2 tumors. Fifty-two patients were treated by radiation therapy (RT), and thirty-seven patients were treated by endoscopic laser cordectomy. The method of primary treatment, local control rate, survival rate and larynx preservation were retrospectively evaluated. RESULTS: With the median follow-up period of 48.2 months, the local control rates in laser cordectomy and radiation therapy were 88.9%, 89.7% for T1, and 90.0% and 61.5% for T2 tumors, respectively. The 3-year survival rate was 88.9% and 87.2% for T1 and 80.0% and 61.5% for T2. Larynx preservation rate was 83.4% in T1 and 70.0% in T2 patients. These results of laser cordectomy were superior to those treated by radiation therapy. CONCLUSION: In T1b glottic cancer, radiation therapy gave better results than laser cordectomy, whereas for T2 glottic cancer, laser cordectomy was superior to radiation therapy in initial control of tumor. Compared with radiation therapy, laser cordectomy afforded a greater likelihood of larynx preservation and more options for further treatment in case of failure. We conclude that the laser cordectomy is a good surgical alternative for properly selected early glottic cancer.
Follow-Up Studies ; Humans ; Larynx ; Laser Therapy ; Retrospective Studies ; Survival Rate

Background: This study aimed to determine the parameters for worsening oxygenation in non-severe coronavirus disease 2019 (COVID-19) pneumonia. Methods: This retrospective cohort study included cases of confirmed COVID-19 pneumonia in a public hospital in South Korea. The worsening oxygenation group was defined as that with SpO2 ≤94% or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the non-worsening oxygenation group that did not experience any respiratory event. Parameters were compared, and the extent of viral pneumonia from an initial chest computed tomography (CT) was calculated using artificial intelligence (AI) and measured visually by a radiologist. Results: We included 136 patients, with 32 (23.5%) patients in the worsening oxygenation group; of whom, two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups; however, univariate logistic regression analysis revealed that a variety of parameters on admission were associated with an increased risk of a desaturation event. A subset of patients was studied to eliminate potential bias, that ferritin ≥280 μg/L (p=0.029), lactate dehydrogenase ≥240 U/L (p=0.029), pneumonia volume (p=0.021), and extent (p=0.030) by AI, and visual severity scores (p=0.042) were the predictive parameters for worsening oxygenation in a sex-, age-, and comorbid illness-matched case-control study using propensity score (n=52). Conclusion Our study suggests that initial CT evaluated by AI or visual severity scoring as well as serum markers of inflammation on admission are significantly associated with worsening oxygenation in this COVID-19 pneumonia cohort.

Objective: The Montreal Cognitive Assessment (MoCA) is recommended for general cognitive evaluation in Parkinson’s disease (PD) patients. However, age- and education-adjusted cutoffs specifically for PD have not been developed or systematically validated across PD cohorts with diverse education levels. Methods: In this retrospective analysis, we utilized data from 1,293 Korean patients with PD whose cognitive diagnoses were determined through comprehensive neuropsychological assessments. Age- and education-adjusted cutoffs were formulated based on 1,202 patients with PD. To identify the optimal machine learning model, clinical parameters and MoCA domain scores from 416 patients with PD were used. Comparative analyses between machine learning methods and different cutoff criteria were conducted on an additional 91 consecutive patients with PD. Results: The cutoffs for cognitive impairment decrease with increasing age within the same education level. Similarly, lower education levels within the same age group correspond to lower cutoffs. For individuals aged 60–80 years, cutoffs were set as follows: 25 or 24 years for those with more than 12 years of education, 23 or 22 years for 10–12 years, and 21 or 20 years for 7–9 years. Comparisons between age- and education-adjusted cutoffs and the machine learning method showed comparable accuracies. The cutoff method resulted in a higher sensitivity (0.8627), whereas machine learning yielded higher specificity (0.8250). Conclusion Both the age- and education-adjusted cutoff methods and machine learning methods demonstrated high effectiveness in detecting cognitive impairment in PD patients. This study highlights the necessity of tailored cutoffs and suggests the potential of machine learning to improve cognitive assessment in PD patients.

PURPOSE: High Gleason score (8 to 10) is a poor prognostic factor regardless of treatment. Pathological downgrading sometimes occurs in high grade prostate cancer. The aim of this study is to evaluate treatment outcomes in patients with high grade prostate cancer on biopsy who were pathological downgrading after radical prostatectomy (RP). The impact on outcomes according to changes in the Gleason score after RP was evaluated. MATERIALS AND METHODS: Of 3,236 men who underwent RP between September 1995 and December 2014, 541 patients with biopsy Gleason score 8 to 10 were retrospectively reviewed. We analyzed incidence and biochemical recurrence (BCR) free probability in this downgraded group according to the Gleason grade of cancer in the RP specimen. RESULTS: Of 541 patients had a prostate biopsy Gleason score of 8 to 10. Two hundred ten patients showed pathological downgrading after RP (38.8%). Five-year BCR-free probability of patients who had Gleason score of 7 or less after RP was 46.8%. However, 5-year BCR-free probability of patients who remained Gleason scores 8 to 10 after RP was 28.5%. There was a significantly higher BCR-free probability in pathological downgrading group (p<0.001). On multivariate analysis, biopsy Gleason 8, lower PSA, clinical T2 stage was a significant predictor of downgrading. CONCLUSIONS: In this study, 38.8% of patients with high grade prostate cancer had a Gleason score of 7 or less in the RP specimen. Downgraded prostate cancer had more favorable treatment outcome. Serum PSA, clinical stage and biopsy Gleason score were the predictive factors for pathological downgrading.
Biopsy* ; Humans ; Incidence* ; Male ; Multivariate Analysis ; Neoplasm Grading* ; Prostate* ; Prostatectomy* ; Prostatic Neoplasms* ; Recurrence ; Retrospective Studies ; Treatment Outcome*