No abstract available.
Funnel Chest*

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

Dimethylformamide (DMF), a widely used industrial solvent, has been reported to induce subtle to clinically overt hepatotoxicity. Liver injury due to occupational exposure through inhalation and skin contact has been sporadically reported. We report a 23-year-old male who developed intermittent abdominal pain, anorexia, nausea, vomiting, chest discomfort, and general weakness for 4 days after working in a plastic-coated-glove factory. An acute hepatitis episode occurred after working in an enclosed workplace for 3 days. Other causes of hepatitis such as viral, drug induced or alcoholic hepatitis, could be excluded or were considered to be unlikely. Based on occupational history, serological examination and serial liver function examinations, the case was compatible with DMF-induced acute toxic hepatitis. Hepatotoxicity due to occupational exposure to solvents (e.g., DMF) should be considered in any patient with unexplained hepatitis. The fast improvement of the clinical symptoms and the progressive normalization of the liver function tests once the DMF exposure has been stopped, supports the diagnosis.
Abdominal Pain ; Anorexia ; Diagnosis ; Dimethylformamide* ; Drug-Induced Liver Injury* ; Hepatitis ; Hepatitis, Alcoholic ; Humans ; Inhalation ; Liver ; Liver Function Tests ; Male ; Nausea ; Occupational Exposure ; Skin ; Solvents ; Thorax ; Vomiting ; Young Adult

PURPOSE: The aim of this study was to determine whether crossed cerebellar hyperperfusion (CCH) was helpful in discriminating mesial from lateral temporal lobe epilepsy (TLE) and what other factors were related in the development of CCH on ictal brain SPECT. MATERALS AND METHODS: We conducted retrospective analysis in 59 patients with TLE (M:41, F:18; 27.4+/-7.8 years old; mesial TLE: 51, lateral TLE: 8), which was confirmed by invasive EEG and surgical outcome (Engel class I , II). All the patients underwent ictal Tc-99m HMPAO brain SPECT and their injection time from ictal EEG onset on video EEG monitoring ranged from 11 sec to 75 sec (32.6+/-19.5 sec) in 39 patients. Multiple factors including age, TLE subtype (mesial TLE or lateral TLE), propagation pattern (hyperperfusion localized to temporal lobes, spread to adjacent lobes or contralateral hemisphere) and injection time were evaluated for their relationship with CCH using multiple logistic regression analysis RESULTS: CCH was observed in 18 among 59 patients. CCH developed in 29% (15/51) of mesial TLE patients and 38% (3/8) of lateral TLE patients. CCH was associated with propagation pattern; no CCH (0/13) in patients with hyperperfusion localized to temporal lobe, 30% (7/23) in patients with propagation to adjacent lobes, 48% (11/23) to contralateral hemisphere. Multiple logistic regression analysis revealed that propagation pattern (p=0.01) and age (p=0.02) were related to the development of CCH. CONCLUSION: Crossed cerebellar hyperperfusio ictal brain SPECT did not help differentiate mesial from lateral temporal lobe epilepsy. Crossed cerebellar hyperperfusion was associated with propagation pattern of temporal lobe epilepsy and age.
Brain* ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Logistic Models ; Retrospective Studies ; Technetium Tc 99m Exametazime* ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon*

Plasma cell neoplasms of the liver include primary extramedullary plasmacytoma and a local manifestation of multiple myeloma. Extramedullary plasmacytoma of the liver in multiple myeloma is extremely rare although extramedullary involvement frequently occur in extramedullary sites such as lymph nodes, lung, pleura, gastrointestinal tracts, nervous system and spleen. We experienced a case of multiple myeloma with multiple intrahepatic extramedullary plasmacytomas which initially presented as metastatic cancer of the liver. Intrahepatic extramedullary plasmacytoma confirmed by ultrasono-guided liver biopsy, which disclosed numerous neoplastic plasma cell infiltration.
Biopsy ; Gastrointestinal Tract ; Liver ; Liver Neoplasms ; Lung ; Lymph Nodes ; Multiple Myeloma* ; Neoplasms, Plasma Cell ; Nervous System ; Plasma Cells ; Plasmacytoma* ; Pleura ; Spleen

BACKGROUND: Acute myelod leukemia (AML) is a hematologic malignant disease characterized by uncontrolled proliferation of myeloid cells in marrow and arrest in their maturation. It accounts for 70~80% of chromosomal abnormalities and t (8;21) has been found in 40% of AML-M2. Because cytogenetic studies can help classifying the disease, providing the clues of disease progression and monitoring remission after chemotherapy, we have performed cytogenetic studies to identify the incidence of t (8;21) and other chromosomal abnormalities and to assure their prognostic significance in patients with AML-M2. METHODS: From August 1998 to July 2000, 38 patients with AML-M2 were treated with ara-C and idarubicin in order to induce complete remission. We evaluated chromosomal abnormalities by high resolution banding technique. We divided patients into 3 groups. Patients having normal and intermediate risk karyotype belonged to group A, t (8;21) to group B and, unfavorable and undetermined prognostic karyotype to group C. RESULTS: The incidence of chromosomal abnormalities was 71% (27/38), and the proportion of A, B, and C group were 40%, 30% and 30%, respectively. The median follow up duration of evaluable patients was 381 (55~1,295) days. The complete remission (CR) rate accounted for 79% (30/38). The CR rate in A, B and C group were 88% (14/16), 91% (10/ 11) and 55% (6/11), respectively (P=0.06). The median remission duration had not been reached yet. The median remission duration of group A and B had not been reached yet, but that of group C was 337 days (P=0.60). The overall median survival duration was 567 days, and the median survival duration of group B had not been reached yet, otherwise those that of group A and C were 432 days and 364 days, respectively (P=0.02). CONCLUSION: The incidence of chromosomal abnormalities was observed 71% in patients with AML-M2. The patients with t (8;21) showed higher complete remission rate and tendency to have longer remission duration and survival duration.
Bone Marrow ; Chromosome Aberrations* ; Cytarabine ; Cytogenetics ; Disease Progression ; Drug Therapy ; Follow-Up Studies ; Humans ; Idarubicin ; Incidence ; Karyotype ; Leukemia ; Leukemia, Myeloid, Acute* ; Myeloid Cells

PURPOSE: We evaluated the clinical role of rapid next-generation sequencing (NGS) for identifying BRCA1/2 mutations compared to traditional Sanger sequencing. METHODS: Twenty-four paired samples from 12 patients were analyzed in this prospective study to compare the performance of NGS to the Sanger method. Both NGS and Sanger sequencing were performed in 2 different laboratories using blood samples from patients with breast cancer. We then analyzed the accuracy of NGS in terms of variant calling and determining concordance rates of BRCA1/2 mutation detection. RESULTS: The overall concordance rate of BRCA1/2 mutation identification was 100%. Variants of unknown significance (VUS) were reported in two cases of BRCA1 and 3 cases of BRCA2 after Sanger sequencing, whereas NGS reported only 1 case of BRCA1 VUS, likely due to differences in reference databases used for mutation identification. The median turnaround time of Sanger sequencing was 22 days (range, 14–26 days), while the median time of NGS was only 6 days (range, 3–21 days). CONCLUSION: NGS yielded comparably accurate results to Sanger sequencing and in a much shorter time with respect to BRCA1/2 mutation identification. The shorter turnaround time and higher accuracy of NGS may help clinicians make more timely and informed decisions regarding surgery or neoadjuvant chemotherapy in patients with breast cancer.
Breast Neoplasms* ; Breast* ; Clinical Decision-Making* ; Drug Therapy ; High-Throughput Nucleotide Sequencing ; Humans ; Methods ; Prospective Studies

BACKGROUND: With the progress of limited surgery and endoscopic treatment for early gastric cancer (EGC), multiple synchronous EGCs, a cause of recurrence, become more important. The objective of this study was to elucidate the characteristics of multiple synchronous EGCs with an emphasis on features of preoperatively undiagnosed lesions. METHODS: We retrospectively reviewed medical records of 496 patients who underwent a gastrectomy for EGC at our institution between January 2004 and December 2004. RESULTS: Twenty-four patients (4.8%) had multiple synchronous EGCs with 24 main and 27 accessory lesions. Multiple synchronous EGCs showed male predominance (p=0.03). Other characteristics including lymph node metastasis were the same as with single EGC. Out of 27 accessory lesions, six lesions (22%) were not detected preoperatively in six patients (25%). Macroscopically five lesions were flat and one lesion was depressed. Five lesions were located at the anterior or posterior wall of the middle and low third portion and one lesion was located at the lesser curvature side of the upper third portion of the stomach. Two lesions were 4 mm, one lesion was 8 mm, two lesions were 12 mm and one lesion was 15 mm in size (mean diameter = 9.1 mm). Histologically, four lesions were of the differentiated type and two lesions were of the undifferentiated type. CONCLUSIONS: Multiple synchronous EGCs have same clinicopathologic features as a single EGC except for male predominance. Considering the possibility of a synchronous lesion, one should examine the entire stomach precisely with special attention to the anterior, posterior wall and lesser curvature side of the same or neighboring area of a known EGC lesion before treatment.
Gastrectomy ; Humans ; Lymph Nodes ; Male ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Stomach ; Stomach Neoplasms*

BACKGROUND: Identification of antibodies recognizing extractable nuclear antigens (ENAs) is use-ful in the diagnosis and characterization of a variety of connective tissue diseases. Recently, LG ENA Immunoblot (LGCI, Seoul, Korea) was introduced for detecting various autoantibodies to ENAs simultaneously. Performance of this kit was evaluated in this study. METHODS: Sera from 108 SLE patients and 103 RA patients were tested for the presence of spe-cific autoantibodies to ENAs by LG ENA Immunoblot and DID. Concordance rates in each autoan-tibody were obtained. After discordant results were resolved by EIA (ENA ELISA TEST SYSTEM, Zeus Scientific Inc., NJ, USA) and western blot (ANA Western Blot Immunoassay, IMMCO Diag-nostics Inc., NY, USA), sensitivity and specificity of LG ENA Immunoblot were evaluated. Between-day precision was also tested. RESULTS: Concordance rates in each autoantibody in two methods were as follows: anti-RNP (88.0%, 95/108; 100%, 103/103), anti-Sm (87.0%, 94/108; 97.1%, 100/103), anti-SSA (94.4%, 102/108; 99.0%, 102/103), anti-SSB (97.2%, 105/108; 98.1%, 101/103), anti-Scl70 (99.1%, 107/108; 100%, 103/103) in SLE and RA patients, respectively. Sensitivity and specificity of Immunoblot were 92.0% and 99.6% for anti-RNP, 100% and 99.6% for anti-Sm, 100% and 98.6% for anti-SSA, 90.0% and 98.5% for anti-SSB, and 100% and 100% for anti-Scl70, respectively. Between-day precisions were 100% in all anti-ENA antibodies. CONCLUSIONS: LG ENA Immunoblot showed good concordance rates with the conventional DID method and high sensitivity (>90%) and specificity (>98.5%) in detecting all kinds of anti-ENA autoantibodies. LG Immunoblot has another merit in that it can detect several autoantibodies simul-taneously. It is suggested that LG ENA Immunoblot can replace DID for anti-ENA detection without any problem.
Antibodies ; Antigens, Nuclear* ; Autoantibodies* ; Blotting, Western ; Connective Tissue Diseases ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoassay ; Sensitivity and Specificity ; Seoul

PURPOSE: To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. MATERIALS AND METHODS: Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalculous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy: liver cirrhosis (n=2), diabetes mellitus (n=3), cardiac disease (n=3), underlying malignancy (n=2), pulmonary dysfunction (n=1), septic cholangitis (n=5), and old age (n=2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. RESULTS: All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion (n=2) and procedure failure (n=1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered: catheter dislodgment (n=3), and significant abdominal pain during the procedure (2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients (94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. CONCLUSION: Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.
Abdominal Pain ; Acalculous Cholecystitis ; Bile ; Catheters ; Cholangitis ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Cholecystostomy* ; Critical Illness ; Diabetes Mellitus ; Emergencies ; Gallbladder ; Heart Diseases ; Hospitals, Community* ; Humans ; Liver Cirrhosis ; Peritonitis ; Risk Factors ; Ultrasonography