Milk of calcium located in the breast is typically a benign entity. However, carcinoma may incidentally arise adjacent to or even within milk of calcium. Consequently, the characteristics of all observed calcific particles should be carefully analyzed. In this study, we report a case of carcinoma presented as malignant microcalcifications mixed within milk of calcium in a breast.
Breast Neoplasms/*chemistry/radiography ; Calcium Carbonate/*analysis ; Carcinoma, Ductal/*chemistry/radiography ; Female ; Humans ; Mammography ; Middle Aged

Osteomas of the middle ear are exceedingly rare benign neoplasms. To date, only 21 cases have been reported in the literature. They arise from the promontory, the pyramidal process and the ossicles, and they are usually asymptomatic or cause some conductive hearing loss. We report here the CT & pathologic findings in a 38-year-old woman with a benign osteoma of the middle ear along with chronic otitis media.
Adult ; Ear, Middle* ; Female ; Hearing Loss, Conductive ; Humans ; Osteoma* ; Otitis Media

Lymph nodes (LNs) containing echogenic deposits is a specific ultrasonographic (US) finding of pathologic LNs. Here, I reported on a case of hyperechoic cervical lymph nodes after injection of silicone into the face. US showed globally or partially hyperechoic cervical LNs with hyperechoic tapering trails. This is the first description of ultrasonographic findings and the pathologic correlation for LNs affected by migration of liquid injectable silicone into the neck.
Lymph Nodes* ; Neck ; Silicones* ; Ultrasonography

No abstract available.
Syringoma*

BACKGROUND: Asthmatic patients frequently suffer cold-weather-associated respiratory symptoms. The sensitivity, specificity, accuracy and diagnostic value of isocapnic hyperventilation of cold air(IHCA) using a multistep method was investigated in patients suspected to have asthma. METHOD: One hundred and 29 adult patients who had an IHCA performed between july 1999 and December 2000, had an methacholine bronchoprovocation test because of a clinical suspicion of asthma. RESULTS: According to strict criteria, 50 were defined as asthmatics and 79 as symptomatic nonashmatics. There were no differences in age, sex and smoking state between the asthmatic and symptomatic nonasthmatic groups. There was a significant decrease in the percentage reduction in the forced expiratory volume in 1 second(FEV1) after the IHCA between the asthmatics(-10.0±6.8%) and the symptomatic nonasthmatics(-2.3±2.5%). The factors associated with a reactivity to IHCA were FEV1/FVC, FEF25-75/FVC and FEV1(% of predicted). The accuracy was highest using a 7% fall in FEV1; the sensitivity was 76% and the specificity 96%. CONCLUSION: IHCA is a specific, although not a sensitive, test for diagnosing asthma in adult patients. Furthermore, the diagnostic cut-off value of the different methods of IHCA need to be determined.
Adult* ; Asthma* ; Forced Expiratory Volume ; Humans ; Hyperventilation* ; Methacholine Chloride ; Sensitivity and Specificity ; Smoke ; Smoking

PURPOSE: To evaluate the incidence of sacral insufficiency fracture in osteoporotic patients with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. MATERIALS AND METHODS: We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. RESULTS: Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference (p = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference (p=0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. CONCLUSION: About 10% of the patients with osteoporotic compression fracture in the T/L spine also had pelvic sacral insufficiency fracture, which was not uncommon. These findings suggest the need to consider the possibility of pelvic sacral insufficiency fracture in cases of T/L spinal MRI for patients with osteoporotic compression fracture.
Bone Marrow ; Edema ; Female ; Fractures, Compression* ; Fractures, Stress* ; Hand ; Humans ; Incidence* ; Magnetic Resonance Imaging ; Male ; Osteoporosis ; Retrospective Studies ; Sacrum ; Spine*

The internal biliary fistula between the gallbladder or bile duct and intestinal tract is a rare disease. Because symptoms and signs of biliary fistula are not specific, these patients are commonly investigated with computed tomography, endoscopic retrograde cholangiopancreatography (ERCP) and barium study. Among them, a cholecystogastric fistula is a very rare type of biliary fistula. We recently experienced a case of cholecystogastric fistula and transmigration of the gallstone to the stomach. A 53-year-old woman was transferred with the impression of gallbladder cancer. On evaluating the cause of right upper abdominal pain and nausea, we confirmed the cholecystogastric fistula with gastroscopy, upper GI series and ERCP. Cholecystectomy and the repair of the fistula was done.
Abdominal Pain ; Barium ; Bile Ducts ; Biliary Fistula ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Female ; Fistula* ; Gallbladder ; Gallbladder Neoplasms ; Gallstones* ; Gastroscopy ; Humans ; Middle Aged ; Nausea ; Rare Diseases ; Stomach

Purpose: Setting standards is critical in health professions. However, appropriate standard setting methods do not always apply to the set cut score in performance assessment. The aim of this study was to compare the cut score when the standard setting is changed from the norm-referenced method to the borderline group method (BGM) and borderline regression method (BRM) in an objective structured clinical examination (OSCE) in medical school. Methods: This was an explorative study to model the implementation of the BGM and BRM. A total of 107 fourth-year medical students attended the OSCE at 7 stations for encountering standardized patients (SPs) and at 1 station for performing skills on a manikin on July 15th, 2021. Thirty-two physician examiners evaluated the performance by completing a checklist and global rating scales. Results: The cut score of the norm-referenced method was lower than that of the BGM (P<0.01) and BRM (P<0.02). There was no significant difference in the cut score between the BGM and BRM (P=0.40). The station with the highest standard deviation and the highest proportion of the borderline group showed the largest cut score difference in standard setting methods. Conclusion Prefixed cut scores by the norm-referenced method without considering station contents or examinee performance can vary due to station difficulty and content, affecting the appropriateness of standard setting decisions. If there is an adequate consensus on the criteria for the borderline group, standard setting with the BRM could be applied as a practical and defensible method to determine the cut score for OSCE.

Purpose: Setting standards is critical in health professions. However, appropriate standard setting methods do not always apply to the set cut score in performance assessment. The aim of this study was to compare the cut score when the standard setting is changed from the norm-referenced method to the borderline group method (BGM) and borderline regression method (BRM) in an objective structured clinical examination (OSCE) in medical school. Methods: This was an explorative study to model the implementation of the BGM and BRM. A total of 107 fourth-year medical students attended the OSCE at 7 stations for encountering standardized patients (SPs) and at 1 station for performing skills on a manikin on July 15th, 2021. Thirty-two physician examiners evaluated the performance by completing a checklist and global rating scales. Results: The cut score of the norm-referenced method was lower than that of the BGM (P<0.01) and BRM (P<0.02). There was no significant difference in the cut score between the BGM and BRM (P=0.40). The station with the highest standard deviation and the highest proportion of the borderline group showed the largest cut score difference in standard setting methods. Conclusion Prefixed cut scores by the norm-referenced method without considering station contents or examinee performance can vary due to station difficulty and content, affecting the appropriateness of standard setting decisions. If there is an adequate consensus on the criteria for the borderline group, standard setting with the BRM could be applied as a practical and defensible method to determine the cut score for OSCE.

Desmoplastic fibroma is a rare benign primary bone tumor that is histologically similar to the soft tissue desmoid tumor. It most often involves the mandible, large long bone or iliac bone. Desmoplastic fibroma in a toe has been extremely rarely reported. Authors report a rare case of desmoplastic fibroma of bone occurring in the distal phalanx of a foot, with descriptions of the radiographic and MRI findings, correlation of the radiologic and pathologic findings, and discussion on the differential diagnosis of the tumor.
Adolescent ; Bone Neoplasms/*diagnosis ; Diagnosis, Differential ; Female ; Fibroma, Desmoplastic/*diagnosis ; Humans ; Magnetic Resonance Imaging ; Male ; Toes/*pathology