A 64-year-old man was treated with sunitinib as a first-line therapy for metastatic renal cell carcinoma. He was given oral sunitinib in cycles of 50 mg once daily for 2 weeks followed by a week off. During the 5th week of treatment right upper quadrant pain developed, but this resolved spontaneously during the 6th week (off treatment). However, on the 8th week of treatment, he was admitted to hospital because the acute right upper quadrant pain recurred with nausea, vomiting, and fever. Acute acalculous cholecystitis was then diagnosed by ultrasonography and CT. In addition, his laboratory findings indicated disseminated intravascular coagulation. Accordingly, sunitinib therapy was discontinued and broad-spectrum antibiotics initiated. He subsequently recovered after emergent percutaneous cholecystostomy. His Naranjo Adverse Drug Reaction Probability Scale score was 7, indicaing a probable association of the event with sunitinib. Suspicion of sunitinib-related acute cholecystitis is required, because, although uncommon, it can be life-threatening.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Carcinoma, Renal Cell ; Cholecystitis, Acute ; Cholecystostomy ; Disseminated Intravascular Coagulation ; Drug-Related Side Effects and Adverse Reactions ; Fever ; Humans ; Middle Aged ; Nausea ; Ultrasonography ; Vomiting

Breast cancer is the most common cancer in Korean women since 2001 and needs national interests. The incidence of breast cancer is increasing with new breast cancer cases reaching more than 10,000 cases annually. But, there are some difficulties in breast cancer control; first, the National Cancer Screening Program is ineffective and of low quality, second, the lack of psychosocial care for mastectomized patients, third, the lack of national care for terminal cancer patients. For effective breast cancer control, we need special support for breast cancer awareness campaign, activation of breast cancer registry, development of clinical practice guideline, development of hospice program, breast cancer research, and upgrading its guarantee on breast cancer treatment. The Korean Breast Cancer Society should have the leading role in solving the current problems, but moreover, we cannot overemphasize the need for national support.
Breast Neoplasms* ; Breast* ; Early Detection of Cancer ; Female ; Hospice Care ; Humans ; Incidence

No abstract available.
Humans ; T-Lymphocytes*

OBJECTIVE: To evaluate the diagnostic value of plain abdominal radiography in stroke patients with bowel dysfunction. METHODS: A total of 59 stroke patients were recruited and assigned into constipation or non-constipation group. Patients were interviewed to obtain clinical information, constipation score, and Bristol stool form scale. The total and segmental colon transit time (CTT) was measured using radio-opaque markers (Kolomark). The degree of stool retention was evaluated by plain abdominal radiography and scored by two different methods (Starreveld score and Leech score). The relationship between the clinical aspects, CTT, and stool retention score using plain abdominal radiography was determined. RESULTS: Average constipation score was 4.59+/-2.16. Average Bristol stool form scale was 3.86+/-1.13. The total and segmental CTTs showed significant differences between the constipation and non-constipation groups. There was statistically significant (p<0.05) correlation between the total CTT and constipation score or between Starreveld score and Leech score. Each segmental CTT showed significant correlation (p<0.05) between segmental stool retention scores. CONCLUSION: The stool retention score showed significant correlation with constipation score as well as total and segmental CTT. Thus, plain abdominal radiography is a simple and convenient method for the evaluation of bowel dysfunction in stroke patients.
Colon ; Constipation ; Humans ; Radiography, Abdominal* ; Stroke*

Malignant mixed miillerian tumors(MMMTs) are uncommon neoplasms of the female genital tract that are histologically defined by the presence of malignant epithelial and stromal elements. MMMTs can arise hom the uterine body, cervix, vagina, ovary, and fallopian tube and constitute less than 1% of all overian malignancies. These tumors are usually advanced when diagnosed and follow an aggressive clinical course. We had experienced a cas#e of MMMT of the ovary and presented with a brief review of literature.
Cervix Uteri ; Fallopian Tubes ; Female ; Humans ; Ovary* ; Vagina

Meckel diverticulum is the most common congenital anomaly of the gastrointestinal system. Although it is commonly asymptomatic in adults, Meckel diverticulum can lead to intussusception, volvulus, inflammatory adhesions, or an internal hernia. However, small bowel obstruction due to a mesodiverticular band of Meckel diverticulum is rare. We report a case of a 24-year-old man who complained of abdominal pain and vomiting caused by recurrent small bowel obstruction. He had undergone no previous abdominal surgery. Abdominal computed tomography revealed a transition point at the mid-to-distal ileum. To identify the cause of the obstruction, we performed single-balloon enteroscopy, which revealed extrinsic compression at the proximal ileum 100 cm from the ileocecal valve. After marking the obstruction site, subsequent laparoscopy revealed a Meckel diverticulum with a mesodiverticular band, which entrapped a bowel loop and caused the recurrent small bowel obstruction. The patient was treated successfully with laparoscopic diverticulectomy.
Abdominal Pain ; Adult ; Hernia ; Humans ; Ileocecal Valve ; Ileum ; Intestinal Obstruction ; Intestinal Volvulus ; Intussusception ; Laparoscopy ; Meckel Diverticulum* ; Vomiting ; Young Adult

OBJECTIVE: To describe the endometrial pathologic lesions in premenopausal breast cancer patients with a history of tamoxifen (TMX) use. METHODS: We retrospectively reviewed the medical records of 120 premenopausal breast cancer patients with a history of TMX use that had undergone a gynecological examination. RESULTS: Among 120 patients, 44.2% (n=53) were asymptomatic with an endometrial thickness ≥5 mm, as assessed by transvaginal ultrasonography. Of the patients that reported abnormal uterine bleeding, 5% (n=6) had an endometrial thickness <5 mm and 20% (n=24) had an endometrial thickness ≥5 mm by transvaginal ultrasonography. The final group of patients were asymptomatic, but showed an abnormal endometrial lesion, such as an endometrial polyp, by transvaginal ultrasonography (30.8%, n=37). Of the 56 benign lesions that were histologically reviewed, 50 (41.7%) were endometrial polyps, 3 (2.5%) were submucosal myomas, 2 (1.7%) were endometrial hyperplasias, and 1 (0.8%) was chronic endometritis. There were 64 (53.3%) other non-pathologic conditions, including secreting, proliferative, and atrophic endometrium, or in some cases, there was insufficient material for diagnosis. In our data, only one case was reported as a complex hyperplasia without atypia arising from an endometrial polyp, and one patient was diagnosed with endometrioid adenocarcinoma. CONCLUSION: For premenopausal breast cancer patients with a history of TMX use, the majority of the patients were asymptomatic, and endometrial polyps were the most common endometrial pathology observed. Therefore, we believe that endometrial assessment before starting TMX treatment, and regular endometrial screening throughout TMX treatment, are reasonable suggestions for premenopausal breast cancer patients.
Breast Neoplasms* ; Breast* ; Carcinoma, Endometrioid ; Diagnosis ; Endometrial Hyperplasia ; Endometritis ; Endometrium ; Female ; Gynecological Examination ; Humans ; Hyperplasia ; Hysteroscopy ; Mass Screening ; Medical Records ; Myoma ; Pathology ; Polyps* ; Retrospective Studies ; Tamoxifen* ; Ultrasonography ; Uterine Hemorrhage

PURPOSE: This study investigated the role of the education level (EL) as a prognostic factor for breast cancer and analyzed the relationship between the EL and various confounding factors. MATERIALS AND METHODS: The data for 64,129 primary breast cancer patients from the Korean Breast Cancer Registry were analyzed. The EL was classified into two groups according to the education period; the high EL group (≥ 12 years) and low EL group (< 12 years). Survival analyses were performed with respect to the overall survival between the two groups. RESULTS: A high EL conferred a superior prognosis compared to a low EL in the subgroup aged > 50 years (hazard ratio, 0.626; 95% confidence interval [CI], 0.577 to 0.678) but not in the subgroup aged ≤ 50 years (hazard ratio, 0.941; 95% CI, 0.865 to 1.024). The EL was a significant independent factor in the subgroup aged > 50 years according to multivariate analyses. The high EL group showed more favorable clinicopathologic features and a higher proportion of patients in this group received lumpectomy, radiation therapy, and endocrine therapy. In the high EL group, a higher proportion of patients received chemotherapy in the subgroups with unfavorable clinicopathologic features. The EL was a significant prognosticator across all molecular subtypes of breast cancer. CONCLUSION: The EL is a strong independent prognostic factor for breast cancer in the subgroup aged > 50 years regardless of the molecular subtype, but not in the subgroup aged ≤ 50 years. Favorable clinicopathologic features and active treatments can explain the main causality of the superior prognosis in the high EL group.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Education* ; Educational Status ; Humans ; Mastectomy, Segmental ; Multivariate Analysis ; Prognosis ; Survival Analysis

Objective: To investigate the relationship between maximal tongue protrusion length (MTPL) and dysphagia in post-stroke patients. Methods: Free tongue length (FTL) was measured using the quick tongue-tie assessment tool and MTPL was measured using a transparent plastic ruler in 47 post-stroke patients. The MTPL-to-FTL (RMF) ratio was calculated. Swallowing function in all patients was evaluated via videofluoroscopic swallowing study (VFSS), PenetrationAspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Videofluoroscopic Dysphagia Scale (VDS). Results: The MTPL and RMF values were significantly higher in the non-aspirator group than in the aspirator group (MTPL, p=0.0049; RMF, p<0.001). MTPL and RMF showed significant correlations with PAS, FOIS and VDS scores. The cut-off value in RMF for the prediction of aspiration was 1.56, with a sensitivity of 84% and a specificity of 86%. Conclusion There is a relationship between MTPL and dysphagia in post-stroke patients. MTPL and RMF can be useful for detecting aspiration in post-stroke patients.

Correction of funding statement in ACKNOWLEDGEMENTS section.