Heterotopic pregnancy, simultaneous intrauterine and extrauterine pregnancy, is an extremely rare case. The incidence of heterotopic pregnancy was about 1 to 30,000 pregnancies, but it has increased after wider use of assisted reproductive technology. The rising incidence presents a serious problem as the diagnosis of this potentially fatal condition is often missed. Careful pelvic examination combined with serial beta-hCG determinations, and transvaginal sonography to evaluate the adnexal region are necessary prerequisites for early diagnosis. We report a case of heterotopic pregnancy following in vitro fertilization and embryo transfer(IVF-ET) with a brief review of literature.
Diagnosis ; Early Diagnosis ; Embryo Transfer* ; Embryonic Structures* ; Fertilization in Vitro* ; Gynecological Examination ; Incidence ; Pregnancy ; Pregnancy, Heterotopic* ; Reproductive Techniques, Assisted

We experienced a case of submucosal gastric actinomycosis, presenting as bleeding. The 65-year-old woman had a symptom of epigastric pain, without any other intra-abdominal disease entity. A gastrofiberscopic study demonstrated a submucosal mass lesion with bleeding at the fundus. Because of the bleeding, laparotomy was undertaken, and a abscess containing a large mass was found at the gastric fundus, and total gastrectomy undertaken. Histological examination revealed a giant acute ulcer with a submucosal abscess due to actinomycosis. Because of its rarity, submucosal gastric actinomycosis is an entity overlooked by most surgeons. We report upon this case of submucosal gastric actinomycosis and include a review of the literature.
Female ; Humans

OBJECTIVES: Protein-calorie malnutrition has been shown to be prevalent among patients on chronic dialysis, And assessment of nutritional status of continuous ambulatory peritoneal dialysis(CAPD) patients has assumed greater importance because of the association of protein-calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling and cretinine clearance in CAPD patients. METHODS: We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 82CAPD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling and creatinine clearance with the other parameters of nutritional status. RESULTS: The malnutrition index classified 47(57%) patients as normal, 30(37%) intermediately malnourished, and 5(6%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), triceps skinfold thickness(TSF), mid-arm circumference(MAC), mid-arm muscle area (MAMA), duration of CAPD, subjective symptoms, serum albumin, transferrin, cholesterol, and triglyceride. The malnutrition index also showed a significant correlation with residual renal function(RRF), and standardized creatinine clearance(SCCr). The TWR-Kt/V(total Kt/Vurea per week with consideration of residual renal urea clearance) was significantly lower in the severely malnourished group than in the normal group. Serum alkaline phosphatase and BUN levels were higher in the severely malnourished group than in the normal and inter-mediate groups. CONCLUSION: In assessing the nutrition status of CAPD patients, body weight, TSF, MAC, MAMA, subjective symptoms, serum albumin, transferrin, cholesterol, triglyceride, urea nitrogen, and alkaline phosphatase were considered useful parameters. There was a trend of increased BUN and decreased TWR-Kt/V in severely malnourished patients, and the value of SCCr was significantly lower in malnourished patients. However, no meaningful relationships between TW-Kt/V and malnutrition index or between NPCR(normalized protein catabolic rate) and malnutrition index were found m this cross-sectional study. As the number of patients with longer duration of CAPD or negligible RRF has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and SCCr, may be helpful to assess dialysis adequacy to keep good nutritional status of each CAPD patient.
Alkaline Phosphatase ; Anthropometry ; Body Weight ; Chemistry ; Cholesterol ; Creatinine* ; Cross-Sectional Studies ; Dialysis ; Humans ; Incidence ; Malnutrition ; Mortality ; Nitrogen ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory* ; Protein-Energy Malnutrition ; Serum Albumin ; Transferrin ; Triglycerides ; Urea*

Anti-Bacterial Agents ; Drainage ; Humans ; Mandible ; Mandibular Fractures ; Prognosis ; Titanium

BACKGROUND: Small intestinal adenocarcinomas (SACs) are rare malignancies of the alimentary tract with uncertain carcinogenesis. METHODS: We investigated the expression of deleted in pancreatic cancer 4 (DPC4) in 188 cases of surgically resected SACs, using tissue microarray technology. RESULTS: Twenty-four of the 188 tumors showed complete loss of Smad4/DPC4 expression in cytoplasm (score, 0; 12.8%). Eighty-four and 31 cases were moderately and strongly positive, respectively (score, 2 and 3; 44.7% and 16.5%, respectively) and 49 cases were focally or weakly stained (score, 1; 29.1%). Immunohistochemistry analysis showed that the expression of Smad4/DPC4 was related to an increased risk of lymphatic invasion but not to other clinicopathological features of the tumors (tumor location, differentiation, growth pattern, T stage, direct invasion, vascular invasion, and nodal metastasis). There was no significant association between Smad4/DPC4 expression and patient survival. CONCLUSIONS: The present research is the first study to evaluate Smad4/DPC4 expression in a large sample of SACs with clinicopathologic correlation. Future studies should focus on the immunohistochemical and molecular characteristics of SACs to clarify their tumorigenesis.
Adenocarcinoma ; Cell Transformation, Neoplastic ; Cytoplasm ; Humans ; Immunohistochemistry ; Intestine, Small ; Pancreatic Neoplasms

Background: This study investigated the real-world efficacy and safety of insulin degludec/insulin aspart (IDegAsp) in Korean adults with type 2 diabetes mellitus (T2DM), whose insulin treatment was switched to IDegAsp. Methods: This was a multicenter, retrospective, observational study comprising two 26-week treatment periods, before and after switching to IDegAsp, respectively. Korean adults with uncontrolled T2DM treated with basal or premix insulin (±oral antidiabetic drugs) were enrolled. The primary objective was to compare the degree of glycosylated hemoglobin (HbA1c) change in each 26-week observation period. The analyses included changes in HbA1c, fasting plasma glucose (FPG), body weight, proportion of participants achieving HbA1c <7.0%, hypoglycemic events, and total daily insulin dose (ClinicalTrials.gov, number NCT04656106). Results: In total, 196 adults (mean age, 65.95 years; mean T2DM duration, 18.99 years) were analyzed. The change in both HbA1c and FPG were significantly different between the pre-switching and the post-switching period (0.28% vs. –0.51%, P<0.001; 5.21 mg/dL vs. –23.10 mg/dL, P=0.005), respectively. After switching, the rate of achieving HbA1c <7.0% was significantly improved (5.10% at baseline vs. 11.22% with IDegAsp, P=0.012). No significant differences (before vs. after switching) were observed in body weight change, and total daily insulin dose. The rates of overall and severe hypoglycemia were similar in the two periods. Conclusion In real-world clinical practice in Korea, the change of insulin regimen to IDegAsp was associated with an improvement in glycemic control without increase of hypoglycemia, supporting the use of IDegAsp for patients with T2DM uncontrolled with basal or premix insulin.

BACKGROUND AND OBJECTIVES: The degree of neointima formation after infliction of a carotid artery balloon injury in rats varies greatly depending on the sex, age, species and operational method. Strong variation is common, even within only a single control. This study attempted to find if there was any significant difference in neointima formation following a carotid artery balloon injury in 6 to 12 week old rats; the age commonly used in these types of experiments. MATERIALS AND METHODS: A balloon injury was inflicted on the carotid arteries of male SpragueDawley rats at 6 (n=9, 250-270 g), 8 (n=8, 280-300 g) and 11 weeks (n=10, 320-340 g) of age. Two weeks postoperation, a histomorphometric analysis was carried out. The vascular smooth muscle cell proliferation was measured in situ via BrdU incorporation 2 days after injury infliction. RESULTS: The neointima areas of the 6 week (0.22+/-0.04 mm2) and 8 week old groups (0.17+/-0.08 mm2) were 3.1 and 2.4 times larger than that of the 11 week old group (0.07+/-0.03 mm2). The mitotic index was significantly reduced in 11 week old group (n=4, 9.22+/-1.51%) compared to those of the 6 (n=4, 25.03+/-3.92%) and 8 week old (n=4, 21.66+/-3.66%) groups. CONCLUSION: Special care should be taken when interpreting neointima formation, as even a slight variation in the age and weight in 6 to 12 week old (250-340 g) rats; the age commonly used in these types of experiments, results in an unexpectedly large difference.
Aging ; Animals ; Bromodeoxyuridine ; Carotid Arteries* ; Carotid Artery Injuries* ; Cell Proliferation ; Humans ; Male ; Mitotic Index ; Muscle, Smooth, Vascular ; Neointima* ; Rats*

BACKGROUND: There are several risk factors in the development of arteriosclerosis, including lipid parameters, inflammatory markers, and hemostatic factors. Efforts should be undertaken to identify the relationship among risk factors and underlying mechanisms of arteriosclerosis to improve long-term survival in dialysis patients. This study was performed to evaluate correlations among these risk factors and cardiac troponin T (cTnT) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS: Seventy-seven CAPD pateints (M: 50, F: 27; mean age 52.8+/-12.4 years) were enrolled in this study. We measured blood level of total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), apolipoprotein A-1 (apoA-1), apolipoprotein B (apoB), C-reactive protein (CRP), fibrinogen, d-dimer, von Willebrand factor (vWF), and cTnT monthly for three times. Thallium SPECT was performed in 32 of 77 patients. RESULTS: Significant positive correlation was found between CRP and fibrinogen (r=0.71, p<0.001). CRP was also positively correlated with vWF (r=0.29, p=0.01). Significant inverse correlation was observed between prealbumin and CRP (r=-0.33, p=0.004). HDL-C and apoA-1 were also inversely correlated with CRP (r=-0.26, p=0.04; r=-0,27, p=0.02) and apoB was positively correlated with CRP (r=0.24, p=0.02). Multivariate analysis revealed that fibrinogen, prealbumin, HDL-C, and apoA-1 correlated independently with CRP. In patients with diabetes (n=35), cTnT levels were sigificantly higher than those in patients without diabetes (p<0.001), whereas albumin and prealbumin levels were significantly lower in patients with diabetes than those in patients without diabetes (p<0.001, p=0.002). Serum apoB, triglyceride, and total cholesterol were higher among patients with positive results in thallium SPECT than those with negative results. CONCLUSION: It seems that inflammation is associated with an enhanced cardiovascular risk profile such as hemostatic factors and apolipoproteins. cTnT may be a useful predictive marker for mortality in dialysis patients.
Apolipoprotein A-I ; Apolipoproteins B ; Apolipoproteins* ; Arteriosclerosis ; C-Reactive Protein* ; Cholesterol ; Dialysis ; Fibrinogen ; Humans ; Inflammation ; Mortality ; Multivariate Analysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Prealbumin ; Risk Factors ; Thallium ; Tomography, Emission-Computed, Single-Photon ; Triglycerides ; Troponin T* ; Troponin* ; von Willebrand Factor

Increasingly aggressive chemotherapy regimens, advances in transplantation technology, and the acquired immunodeficiency syndrome have resulted in a growing number of immunocompromised patients. Infections are a major cause of morbidity and mortality in this population. One of the most ominous complications is the development of typhlitis in this immunocompromised patients. Treatment of this process is controversial, and no consensus has emerged. We report a case of typhlitis who complicated agranulocytosis after exposure to drugs to treat "flu" like illness and recovered completely after two operations of appendectomy and ileocolectomy. Reviewing articles and this case, the favorable outcome seemed to be related to following three factors recognition of the acute surgical abdomen by abdominal CT scan, a prompt return of normal circulating white cells by the use of Granulocyte Colony Stimulating Factor and discontinuation of causative drugs, and an appropriately timed surgical intervention.
Abdomen ; Acquired Immunodeficiency Syndrome ; Agranulocytosis* ; Appendectomy ; Colony-Stimulating Factors ; Consensus ; Drug Therapy ; Granulocytes ; Immunocompromised Host ; Mortality ; Tomography, X-Ray Computed ; Typhlitis*

Mesenchymal hamartoma (MH) of the liver is an uncommon benign lesion related to ductal plate malformation. It is usually cystic and mainly composed of myxoid mesenchymal tissue with tortuous or cystic bile ducts. In order to characterize the clinicopathological features of MH, the Korean Gastrointestinal Pathology Study Group collected a total of 17 MH cases diagnosed in 7 hospitals from 1992 to 2002 and compared the clinicopathologic findings of cystic MH with those of solid variant. Among the 17 cases, 7 (41%) were solid. The solid form showed a higher serum level of alpha-fetoprotein (AFP), the smaller bile ducts, and more frequent proliferation of vessels. Serum AFP level was related to the amount of hepatocytes. Two of seven solid cases harbored a larger amount of evenly distributed hepatocytes and proliferation of small duct with focal hepatocyte-bile duct transition. These histologic findings are similar to those of mixed hamartoma. Therefore, the mixed hamartoma and the MH of both solid and cystic types could be the variants of one disease spectrum. And hepatocytes within MH might be rather a genuine tumor component than entrapped into the tumor. In conclusion, MH can show various clinicopathological features and recognition of these features will facilitate accurate diagnosis of MH.
Adult ; Aged ; Child ; Child, Preschool ; Comparative Study ; Cysts/pathology ; Female ; Hamartoma/*pathology ; Humans ; Infant ; Liver/pathology ; Liver Diseases/*pathology ; Male