No abstract available.
Glomerulonephritis, IGA* ; Immunoglobulin A* ; Nephritis* ; Purpura, Schoenlein-Henoch*

Duret hemorrhage is characterized by an upper brainstem hemorrhage due to increased intracranial pressure by mass effect such as subdural hematoma or a brain tumor. The anteroposterior elongation and downward displacement of the upper brainstem by transtentorial herniation results in the compression and tearing of the paramedian perforating vessels that feed the upper brainstem tegmentum. The consequent hemorrhage that involves the upper brainstem renders recovery to be almost impossible. Following a tricuspid valve replacement surgery, a 56-year-old woman developed a left fronto-temporo-parietal nontraumatic subdural hematoma resulting in transtentorial herniation of the left mesial temporal lobe. A successful surgical evacuation of the hematoma was done with clinical improvement. Two days later, she was referred to neurology with an aggravated right side weakness, dysarthria, and a newly developed extraocular movement disturbance. A brain CT and MRI showed a pontine hemorrhage. We report a case of pontine hemorrhage, a Duret hemorrhage, after the surgical evacuation of nontraumatic subdural hematoma.
Brain ; Brain Neoplasms ; Brain Stem ; Dysarthria ; Female ; Hematoma ; Hematoma, Subdural* ; Hemorrhage* ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Middle Aged ; Neurology ; Temporal Lobe ; Tricuspid Valve

There had been a continuous evolution of lymphoma classification and recently a Revised European-American Lymphoma Classification was proposed by the International Lymphoma Study Group. This new classification often requires information on immunophenotypic and molecular biologic markers in addition to the usual histologic findings. Recent advances in the production of commercially available monoclonal antibodies reactive on formalin-fixed paraffin-embedded tissues provide us a great help to classify the non-Hodgkin's lymphoma. We have analyzed 31 low grade B-cell lymphomas by the schemes proposed by the International Lymphoma Study Group using antibodies to CD3, CD5, CD20, CD23, CD43, cyclin D1, and bcl-2 protein, and have analyzed the immunophenotypic features. Among 31 low grade B-cell lymphomas, 8 small lymphocytic lymphomas, 5 mantle cell lymphomas, 7 follicle center lymphomas (2 grade I, 3 grade II, and 2 grade III), and 11 marginal zone B-cell lymphomas (all of which were extranodal) were identified. Among 8 small lymphocytic lymphomas, 5 cases were positive for CD5; 6 cases were positive for CD23; 7 cases were positive for CD43; all 8 cases were negative for cyclin D1; and 7 cases were positive for bcl-2. Among 5 mantle cell lymphomas, 4 cases were positive for CD5 and CD43; all five cases were negative for CD23; 4 cases were positive for cyclin D1 and bcl-2. All 7 follicle center lymphomas were negative for CD5, CD43 and cyclin D1 and 2 cases were positive for CD23; and 6 cases were positive for bcl-2. All marginal zone B-cell lymphomas were negative for CD5, CD23 and cyclin D1; 3 cases were positive for CD43 and 9 cases were positive for bcl-2. Diagnostic utility for CD5 antigen detection on paraffin embedded tissue has a limitation due to weak antigen expression in tumor cells of B-cell lymphomas; however, still be useful in differentiating small lymphocytic lymphoma and mantle cell lymphoma from other B-cell lymphomas when applied in conjunction with CD43. CD23, CD43, and cyclin D1 appear to be of great help in differentiating subgroups of low grade B-cell lymphomas. Bcl-2, as known, is found to be useful to rule out reactive follicular hyperplasia.
Antibodies ; Antibodies, Monoclonal ; Antigens, CD5 ; B-Lymphocytes* ; Biomarkers ; Classification ; Cyclin D1 ; Hyperplasia ; Immunohistochemistry* ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Mantle-Cell ; Lymphoma, Non-Hodgkin ; Paraffin*

Ulcerative colitis, one of the inflammatory bowel disease, is primarily managed medically with combinations of 5-ASA and steroids. However, this chronic disease requires surgical management if symptoms persist or complications develop despite medical management. The clinical course, the indications and outcome for surgical management of pediatric ulcerative colitis patients were studied from medical records retrospectively. Twenty-one patients under the age of 15 who were endoscopically diagnosed with ulcerative colitis at the Seoul National University Children's Hospital between January, 1988 and January, 2003 were subjected to the study. Mean follow up period was 3 years and 10 months. The mean age was 10.3 years old. All patients received medical management primarily after diagnosis and 8 patients (38%) eventually required surgical management. Of 13 patients who received medical management only, 7 patients (53%) showed remission, 4 patients are still on medical management, and 2 patients expired due to congenital immune deficiency and hepatic failure owing to sclerosing cholangitis respectively. In 8 patients who received surgical management, 1 patient underwent surgery due to sigmoid colon perforation and 7 patients due to intractability of medical management. The perforated case received colon segmental resection and the other 7 patients recieved total protocolectomy with ileal pouch-anal anastomosis. One patient expired postoperatively due to pneumonia and sepsis. One patient is still on medical management because of mild persistent hematochezia after surgery. The other operated patients are showing good prognosis without any management. Pediatric ulcerative colitis patients can be surgically managed if the patient is intractable to medical management or if complications such as perforation is present. Total protocolectomy & ileal pouch-anal anastomosis is thought to be the adequate surgical method.
Child* ; Cholangitis, Sclerosing ; Chronic Disease ; Colitis, Ulcerative* ; Colon ; Colon, Sigmoid ; Diagnosis ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Liver Failure ; Medical Records ; Pneumonia ; Prognosis ; Retrospective Studies ; Seoul ; Sepsis ; Steroids ; Ulcer*

Various cancer types have been associated with cancer-related cerebral infarction. In this study, we describe the first case of cancer-related cerebral infarction in which the underlying disease was primary bone marrow lymphoma (PBML). A 79-year-old man presented with abruptly developed bilateral lower extremity weakness and confusion. Diffusion-weighted imaging on admission showed multiple cortical and subcortical embolic infarction lesions in multiple vascular territories. Diagnostic evaluations to determine the embolic source revealed no abnormalities. Laboratory testing demonstrated elevated D-dimer (2.59 μg/mL) but no other prothrombotic abnormalities. In suspicion of cancer-related stroke, we performed chest CT, abdomen CT, and FDG-PET to detect the hidden malignancy. Findings revealed no evidence of cancer; however, they did reveal signs of anemia (hemoglobin 9.0 g/dL). Bone marrow aspiration biopsy showed large atypical B cell involvement suggestive of high-grade B cell lymphoma. The patient was diagnosed with primary bone marrow diffuse large B-cell lymphoma initially presenting with ischemic stroke. Our case suggests that primary bone marrow cancer may be a candidate for the differential diagnosis of hidden malignancy in patients with suspected cancer-related stroke. Bone marrow biopsy may be essential for establishing an appropriate differential diagnosis in patients with abnormal hematologic findings.

No abstract available.
Fibroma, Desmoplastic* ; Fibula*

PURPOSE: To report a case of frosted branch angiitis (FBA) associated with Epstein-Barr virus (EBV) infection in a child. CASE SUMMARY: A 7-year-old boy presented with bilateral blurred vision. On ophthalmic examination, his best-corrected visual acuity was 20/25 in the right eye and 20/32 in the left eye. The pupils were equal, round, and reactive to light without a relative afferent pupillary defect. He had normal color vision in both eyes. Slit-lamp examination revealed no abnormalities in the anterior parts of the eyes. Fundoscopic examination revealed prominent white sheathing retinal vasculitis predominantly on the veins in all quadrants, as well as macular edema and irregular foveal reflex in both eyes. Fluorescein angiography showed normal blood flow, but late diffuse staining and leakage of the affected vessels. Spectral domain optical coherence tomography (SD-OCT) showed thickening of the vessel walls, swelling due to hyperreflective material, and hyperreflective retinal depositions. Serological tests and the serum polymerase chain reaction for EBV were positive. A diagnosis of FBA associated with EBV was made. He was treated with systemic acyclovir and steroids. The response was rapid, with improvement in visual acuity to 20/20 in both eyes by day 3. After 7 weeks, all clinical signs resolved and SD-OCT examination showed normal vessel wall thickness and the absence of hyperreflective depositions. CONCLUSIONS: EBV may present with FBA even in the absence of a systemic sign of primary EBV infection. Thus, EBV should be considered as the etiology of FBA.
Acyclovir ; Child ; Color Vision ; Diagnosis ; Epstein-Barr Virus Infections ; Fluorescein Angiography ; Herpesvirus 4, Human ; Humans ; Macular Edema ; Male ; Polymerase Chain Reaction ; Pupil ; Pupil Disorders ; Reflex ; Retinal Vasculitis ; Retinaldehyde ; Serologic Tests ; Steroids ; Tomography, Optical Coherence ; Vasculitis ; Veins ; Visual Acuity

Objective: This study aimed to evaluate the diagnostic value of combining the quantitative parameters of shear waveelastography (SWE) and superb microvascular imaging (SMI) to breast ultrasound (US) to differentiate between benign andmalignant breast masses. Materials and Methods: A total of 200 pathologically confirmed breast lesions in 192 patients were retrospectively reviewedusing breast US with B-mode imaging, SWE, and SMI. Breast masses were assessed based on the breast imaging reporting anddata system (BI-RADS) and quantitative parameters using the maximum elasticity (Emax) and ratio (Eratio) in SWE and thevascular index in SMI (SMIVI). The area under the receiver operating characteristic curve (AUC) value, sensitivity, specificity,accuracy, negative predictive value, and positive predictive value of B-mode alone versus the combination of B-mode US withSWE or SMI of both parameters in differentiating between benign and malignant breast masses was compared, respectively.Hypothetical performances of selective downgrading of BI-RADS category 4a (set 1) and both upgrading of category 3 anddowngrading of category 4a (set 2) were calculated. Results: Emax with a cutoff value of 86.45 kPa had the highest AUC value compared to Eratio of 3.57 or SMIVI of 3.35%. Inset 1, the combination of B-mode with Emax or SMIVI had a significantly higher AUC value (0.829 and 0.778, respectively)than B-mode alone (0.719) (p< 0.001 and p= 0.047, respectively). B-mode US with the addition of Emax, Eratio, and SMIVIhad the best diagnostic performance of AUC value (0.849). The accuracy and specificity increased significantly from 68.0%to 84.0% (p< 0.001) and from 46.1% to 79.1% (p< 0.001), respectively, and the sensitivity decreased from 97.6% to 90.6%without statistical loss (p= 0.199). Conclusion Combining all quantitative values of SWE and SMI with B-mode US improved the diagnostic performance indifferentiating between benign and malignant breast lesions.

Objectives: This study aims to assess dental hygienists’ level of digital literacy and its effect on occupational self-efficacy and organizational commitment. Methods: The online survey results, obtained from 307 respondents, were statistically analyzed using frequency analysis, t-test, one-way ANOVA, and multiple regression analysis with the IBM SPSS 20.0 software. Results: The factors affecting the technology portion of digital literacy included age (P＜0.001), years in career (P＜0.001), number of personnel in workplace (P=0.009), level of education (P=0.001), region of workplace (P=0.002), and form of workplace (P=0.021). The factors affecting the application portion of digital literacy included age (P＜0.001), years in career (P=0.009), and number of personnel in the workplace (P=0.008). The level of occupational self-efficacy positively affected the technology portion of digital literacy, while organizational commitment positively affected the technology portion and negatively affected the application portion of digital literacy. Conclusions Although this study has limitations, it carries significance as a survey of dental hygienists’ digital literacy standing. To adapt to and function in the current society of digital informatics, ongoing education and research on digital literacy are warranted.

BACKGROUND: Microalbuminuria in type 2 diabetes is a predictor of development of clinical nephropathy and cardiovascular disease. But, it has been reported that reduced glomerular filtration rate (GFR) may occur in some normoalbuminuric diabetic patients. The aim of this study was to identify whether decreased GFR without microalbuminuria is to predict diabetic vascular complications. METHODS: Between January 1998 and February 2001, 73 patients with type 2 diabetes who visited Yeungnam university medical center were divided into 5 groups according to initial GFR ranges: group 1 (GFR < 30 mL/min), group 2 (30 < or = GFR < 60 mL/min), group 3 (60 < or = GFR < 90 mL/min), group 4 (90 < or = GFR < 125 mL/min), group 5 (125 mL/min < or = GFR). They were examined for microvascular and macrovascular complications initially and after 4 years. RESULTS: Decreased GFR had a negative correlation with age (r = -0.472, P = 0.001). Decreased GFR without microalbuminuria had a significant correlation with development of diabetic nephropathy (P = 0.016) after 4 years. There were no significant correlation with the prevalence of diabetic retinopathy, peripheral neuropathy, and macrovacular disease. But, our study showed that coronary artery disease had an increasing tendency with decreased GFR without statistical significance (P = 0.085). CONCLUSIONS: Our data suggest that reduced GFR, independent of albuminuria, may be an important predictor of diabetic nephropathy and coronary artery disease to some extent. So we recommend that not only the microalbuminuria, but also the decrease in GFR should be evaluated at the follow-up of patients with type 2 diabetes.
Academic Medical Centers ; Albuminuria ; Cardiovascular Diseases ; Coronary Artery Disease ; Diabetic Nephropathies ; Diabetic Retinopathy ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Peripheral Nervous System Diseases ; Prevalence