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

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

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: 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: 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: 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.

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