Asbestos exposure may cause asbestosis, pleural plaques and benign pleural disease, and may give a predisposition to malignant mesothelioma in occupationally exposed workers. This case report describes a 50-year-old man, dying from histologically confirmed, diffuse, malignant mesothelioma after asbestos exposure. As a young man, he had been exposed at the workplace to crocidolite for 2 years, but he had no other known history of occupational or environmental asbestos exposure. The patient presented with chest pain and general weakness. Computed tomography showed bilateral irregular pleural thickening along both lower lateral chest walls and a low attenuating mass in the anterior portion of the left lobe. Pathological examinations revealed that it was an epithelial type with tubulopapillary structures and it tested immunohistochemically positive for antibodies against cytokeratin, calretinin and vimentin. The patient was started on chemotherapy but he died to the disease at ten months after the first onset of the symptoms. Mesothelioma is a rare neoplasm in the general population. Nevertheless, the importance of close medical surveillance of the high-risk population is emphasized, because of increased asbestos exposure.
Antibodies ; Asbestos ; Asbestos, Crocidolite* ; Asbestosis ; Calbindin 2 ; Chest Pain ; Drug Therapy ; Humans ; Keratins ; Mesothelioma* ; Middle Aged ; Occupations ; Pleural Diseases ; Thorax ; Vimentin

Granulocytic sarcoma is a localized tumor that's composed of immature granulocytic cells and this is more common in patient with 8;21 translocation. We present here a case in a 64-year-old man who was diagnosed with acute myelogenous leukemia (erythroleukemia) that had a complex hyperdiploid karyotype. While he underwent chemotherapy, he developed nausea, vomiting, headache and dysarthria. After several diagnostic work-ups, granulocytic sarcoma in the cerebellum and leptomeningeal metastasis of his leukemia were found on the magnetic resonance imaging and the cerebrospinal fluid cytology.
Brain ; Cerebellum ; Dysarthria ; Headache ; Humans ; Karyotype ; Leukemia ; Leukemia, Erythroblastic, Acute ; Leukemia, Myeloid, Acute ; Magnetic Resonance Imaging ; Middle Aged ; Nausea ; Neoplasm Metastasis ; Sarcoma ; Sarcoma, Myeloid ; Vomiting

Objective: This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. Methods: This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. Results: The median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. Conclusion Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

Objective: This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. Methods: This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. Results: The median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. Conclusion Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

BACKGROUND: This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB).METHODS: This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy.RESULTS: For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633–5,316.628; P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915–405.786; P = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy.CONCLUSION: Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.

BACKGROUND: This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB). METHODS: This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy. RESULTS: For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633–5,316.628; P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915–405.786; P = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy. CONCLUSION Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.

BACKGROUND/AIMS: The prevalence of malignancies associated with human immunodeficiency virus (HIV) is rapidly increasing. The aim of the present study was to identify clinical features associated with malignancies in South Korean patients infected with HIV. METHODS: From January 1990 to June 2007, we reviewed an electronic database containing pathological reports obtained from HIV-infected patients and then retrospectively analyzed a total of 27 malignancy cases treated at four different institutions. RESULTS: Among 683 patients infected with HIV, malignant diseases were diagnosed in 27 cases (4.0%). Twenty-five of these patients were male, and the median age was 48 (range; 24-76). At the time of diagnosis, the median CD4+ lymphocyte count was 42/uL (range 3-339). Acquired immune deficiency syndrome (AIDS)-defining malignancies were diagnosed in 13 patients (48%) and non-AIDS-defining malignancies were diagnosed in 14 patients (52%). Two patients each were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the pre-highly active anti-retroviral therapy (HARRT) period. In contrast, 11 patients (48%) and 12 patients (52%) were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the HARRT period, respectively. Among AIDS-defining malignancies, non-Hodgkins lymphoma was the most frequently observed (9/13), followed by Kaposi's sarcoma (4/13). Among the 9 patients with non-Hodgkins lymphoma, diffuse large B-cell lymphoma was most common (5/9), followed by primary CNS lymphoma (3/9) and Burkitt's lymphoma (1/9). Gastrointestinal (GI) malignancies [i.e., gastric cancer (3/14), rectal cancer (3/14), and esophageal cancer (1/14)] and hepatocellular carcinoma (3/14) were the most commonly observed among the non-AIDS-defining malignancies. Other observed non-AIDS-defining malignancies were thyroid cancer (1/14), tonsillar cancer (1/14), angiosarcoma (1/14), and eccrine cancer (1/14). Finally, median CD4+ lymphocyte counts at the time of diagnosis were significantly different (18 vs. 114/uL, p=0.001) between AIDS-defining malignancies and non-AIDS-defining malignancies. CONCLUSIONS: Malignancies were diagnosed in 4.0% of patients infected with HIV. This study showed similar rates of incidence between AIDS-defining and non-AIDS-defining malignancies. Non-Hodgkins lymphoma was the most frequently observed malignancy, whereas GI malignancies and hepatocellular carcinoma were common among non-AIDS-defining malignancies.
Acquired Immunodeficiency Syndrome ; Burkitt Lymphoma ; Carcinoma, Hepatocellular ; Electronics ; Electrons ; Esophageal Neoplasms ; Hemangiosarcoma ; HIV ; Humans ; Incidence ; Lymphocyte Count ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Male ; Prevalence ; Rectal Neoplasms ; Retrospective Studies ; Sarcoma, Kaposi ; Stomach Neoplasms ; Thyroid Neoplasms ; Tonsillar Neoplasms

Synthetic cannabinoids (CBs) such as the JWH series have caused social problems concerning their abuse liability. Because the JWH series produces euphoric and hallucinogenic effects, they have been distributed illegally under street names such as "Spice" and "Smoke". Many countries including Korea have started to schedule some of the JWH series compounds as controlled substances, but there are a number of JWH series chemicals that remain uncontrolled by law. In this study, three synthetic CBs with different binding affinities to the CB1 receptor (JWH-073, 081, and 210) and Delta9-tetrahydrocannabinol (Delta9-THC) were evaluated for their potential for psychological dependence. The conditioned place preference test (unbiased method) and self-administration test (fixed ratio of 1) using rodents were conducted. Ki values of the three synthetic cannabinoids were calculated as supplementary data using a receptor binding assay and overexpressed CB1 protein membranes to compare dependence potential with CB1 receptor binding affinity. All mice administered JWH-073, 081, or 210 showed significantly increased time spent at unpreferred space in a dose-dependence manner in the conditioned place preference test. In contrast, all tested substances except Delta9-THC showed aversion phenomenon at high doses in the conditioned place preference test. The order of affinity to the CB1 receptor in the receptor binding assay was JWH-210 > JWH-081 >> JWH-073, which was in agreement with the results from the conditioned place preference test. However, no change in self-administration was observed. These findings suggest the possibility to predict dependence potential of synthetic CBs through a receptor binding assay at the screening level.
Animals ; Appointments and Schedules ; Cannabinoids* ; Controlled Substances ; Jurisprudence ; Korea ; Mass Screening ; Membranes ; Mice ; Receptor, Cannabinoid, CB1 ; Rodentia ; Social Problems