Gynandroblastoma is an extremely rare sex cord-stromal tumor with both female (granulosa cell tumor) and male (Sertoli-Leydig cell tumor) elements. Juvenile granulosa cell tumors are also very rare and are so named because they usually occur in children and adolescents. A 71-year-old woman with right upper quadrant abdominal pain visited our hospital. Pelvic computed tomography showed a large multilocular cystic mass, suspected to be of ovarian origin. We performed a total abdominal hysterectomy (total abdominal hysterectomy was performed) with bilateral salpingo-oophorectomy. A 13-cm multilocular cystic mass with serous fluid was observed in her right ovary. Upon microscopic examination, the solid component of the mass showed both Sertoli-Leydig cell and juvenile granulosa cell differentiation, which we diagnosed as gynandroblastoma. Gynandroblastoma with a juvenile granulosa cell tumor component is extremely rare and, until now, only six cases have been reported in the English literature. We report the first gynandroblastoma with a juvenile granulosa cell tumor component diagnosed in an elderly patient, along with a literature review.
Abdominal Pain ; Adolescent ; Aged ; Child ; Female ; Granulosa Cell Tumor ; Granulosa Cells ; Humans ; Hysterectomy ; Male ; Ovary ; Postmenopause ; Sex Cord-Gonadal Stromal Tumors

PURPOSE: We designed the aft-multiple-slit (AMS) system to reduce scatter in cone-beam computed tomography (CBCT). As a preliminary study, we performed a Monte Carlo N-Particle Transport Code (MCNP) simulation to verify the effectiveness of this system. MATERIALS AND METHODS: The MCNPX code was used to build the AMS geometry. An AMS is an equi-angled arc to consider beam divergence. The scatter-reduced projection images were compared with the primary images only and the primary plus scatter radiation images with and without AMS to evaluate the effectiveness of scatter reduction. To obtain the full 2 dimensional (2D) projection image, the whole AMS system was moved to obtain closed septa of the AMS after the first image acquisition. RESULTS: The primary radiation with and without AMS is identical to all the slit widths, but the profiles of the primary plus scattered radiation varied according to the slit widths in the 2D projection image. The average scatter reduction factors were 29%, 15%, 9%, and 8% when the slit widths were 5 mm, 10 mm, 15 mm, and 20 mm, respectively. CONCLUSION: We have evaluated the scatter reduction effect of the AMS in CBCT imaging using the Monte Carlo (MC) simulations. A preliminary study based on the MCNP simulations showed a mount of scatter reduction with the proposed system.
Cone-Beam Computed Tomography

PURPOSE: Endoscopic thyroidectomy has brought lots of advantages to the patients since its first introduction. The aim of this study is to evaluate the functional and cosmetic satisfaction of patients receiving endoscopic thyroidectomy with patients receiving conventional thyroidectomy. METHODS: From October 2009 to January 2010, 98 patients underwent with conventional (n=69) or endoscopic (n=22) thyroidectomy. Of these patients 91 who had responded to a questionnaire distributed during the visit outpatient clinic visit. The questionnaire responses were analyzed to compare the satisfaction and postoperative results of these patients. RESULTS: The patient mean age was 45.5±10.1 years and the male to female ratio was 1:8.1. Perceived cosmetic satisfaction was significantly greater in patients who received conventional thyroidectomy than in those who received endoscopic thyroidectomy (P=0.03). Otherwise, there were no significant differences concerning functional problems. The conventional surgery was significantly longer than the endoscopic surgery (P=0.001). However, there were no significant differences in estimated blood loss, postoperative hospital stayand complication rates (P>0.05). CONCLUSION: Endoscopic thyroidectomy might bring satisfactory cosmetic result compared to conventional thyroidectomy. However, further studies are necessary.
Ambulatory Care Facilities ; Female ; Humans ; Male ; Patient Satisfaction* ; Postoperative Hemorrhage ; Thyroidectomy*

PURPOSE:This study was performed to investigate the serotype distribution of group B streptococcus (GBS) isolated from pregnant Korean women using molecular methods. METHODS:The study materials included 42 GBS isolates obtained from the vagina and anorectum of pregnant women in Seoul, Korea between 2005 and 2006. Four clinical isolates with known serotypes (Ia, Ib, III, and V) were used for validation of molecular serotyping. We used serotype-specific primers for identification of the serotypes (Ia, Ib, III, V, and VI). To determine the ambiguous serotypes by serotype-specific PCR, sequence analysis of the PCR amplicons which had been amplified with GBS-common primers was used. RESULTS:The serotypes determined by the molecular methods agreed with the previously known 4 serotypes (Ia, Ib, III, and V). The serotypes of all 42 isolates were successfully determined by molecular methods. The distribution of the GBS serotype was as follows in order of frequency: serotype III was found in 12 isolates (28.6%), serotype V was found in 11 isolates (26.2%), serotype Ia was found in 11 isolates (26.2%), serotype VI was found in 4 isolates (9.5%), serotype Ib was found in 2 isolates (4.8%), and serotype II was found in 2 isolates (4.8%). CONCLUSION:Serotypes III, V, and Ia were the most frequently identified serotypes in pregnant Korean women. Molecular serotyping is useful for surveillance of the serotype distribution of GBS in colonized pregnant women and GBS diseases of neonates.
Colon ; Female ; Humans ; Korea ; Polymerase Chain Reaction ; Pregnant Women ; Sequence Analysis ; Serotyping ; Streptococcus ; Vagina

PURPOSE: We investigated the prognostic significance of CD9 expression in tumor cells of patients with invasive lobular carcinoma (ILC). METHODS: CD9 expression was evaluated by immunohistochemistry in 113 ILC tissue samples. Correlation of CD9 expression with the patients' clinicopathological parameters and overall survival was assessed. RESULTS: CD9 expression was detected in 48 (42.5%) ILC patients. However, no significant relation could be determined between CD9 expression and the clinicopathological parameters of the patient including tumor size, lymph node metastasis, lymphovascular invasion, histologic grade, expression of hormone receptors, human epidermal growth factor receptor 2 status, and Ki-67 labeling index. Patients with CD9 expression had worse overall survival (p = 0.051) and disease-free survival (DFS, p = 0.014) compared to patients without CD9 expression. Multivariate analysis revealed that CD9 expression was an independent prognostic factor for DFS (p = 0.049). CONCLUSION: CD9 expression in tumor cells could be a significant prognostic marker in patients with ILC.
Breast Neoplasms ; Carcinoma, Lobular ; Disease-Free Survival ; Humans ; Immunohistochemistry ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Receptor, Epidermal Growth Factor

PURPOSE: Isometric handgrip exercise (IHE) is an easy and accessible form of exercise that has beneficial effects on blood pressure (BP). However, it remains unclear whether IHE is similar benefits on arterial stiffness and endothelial function compared with aerobic exercise (AE) in elderly hypertensive patients. The aim of this study was to compare the effects of IHE versus AE on arterial stiffness and endothelial function in elderly hypertensive patients.METHODS: We conducted a randomized controlled trial with a three-arm design. Fifty-four elderly hypertensive patients (15 men; mean age, 69±6 years; systolic blood pressure, 131.2±14.7; diastolic blood pressure, 80.2±7.9 mm Hg) were randomized to IHE training (n=18), AE training (n=21), or non-exercise control group (n=21) for 12 weeks. Bilateral IHE training was performed four times of 2 minutes at 30% of maximal voluntary contraction with three times per week. AE training was performed brisk walking for 30 minutes at moderate intensity with three times per week. Carotid-femoral pulse wave velocity (PWV), augmentation index heart rate corrected (AIx@75 bpm) and brachial artery flow-mediated vasodilation (FMD) as indices of arterial stiffness and endothelial function were measured at baseline and after the intervention.RESULTS: Following 12-week intervention, resting BP was significantly decreased in both IHE (p=0.001) and AE groups (p=0.002). AIx@75 bpm and FMD were unchanged in the all groups. However, PWV was significantly decreased in both IHE and AE groups (IHE, 10.9±2.3 to 9.9±2.1 m/s [p<0.001]; AE, 10.5±2.0 to 9.4±1.6 m/s [p=0.001]), without any change in the control group.CONCLUSION: These findings suggest that both IHE and AE trainings were comparable effect in improving arterial stiffness in elderly hypertensive patients.
Aged ; Blood Pressure ; Brachial Artery ; Exercise ; Heart Rate ; Humans ; Hypertension ; Isometric Contraction ; Male ; Pulse Wave Analysis ; Vascular Stiffness ; Vasodilation ; Walking

Purpose: 17β-Estradiol (E2) supplementation suppresses MC38 tumor growth by downregulating the expression of programmed death-ligand 1 (PD-L1). This study aims to figure out the gut microbiota that respond to anti–PD-L1 and/or estrogen treatment in MC38 colon cancer model. Materials and Methods: A syngeneic colon tumor model was developed by injection of MC38 cells into C57BL/6 background male and female mice. Three days before MC38 cells injection, E2 was supplemented to male mice daily for 1 week. Male and female mice with MC38 tumors (50-100 mm3) were injected with anti–PD-L1 antibody. Fresh feces were collected 26 days after injection of MC38 cells and 16S rRNA metagenomics sequencing of DNA extracted from feces was used to assess gut microbial composition. Results: At the taxonomic family level, Muribaculaceae was enriched only in the MC38 male control group. In male mice, linear discriminant analysis effect size analysis at the species level revealed that the four microorganisms were commonly regulated in single and combination treatment with anti–PD-L1 and/or E2; a decrease in PAC001068_g_uc and PAC001070_s (family Muribaculaceae) and increase in PAC001716_s and PAC001785_s (family Ruminococcaceae). Interestingly, in the anti–PD-L1 plus E2 group, a decrease in opportunistic pathogens (Enterobacteriaceae group) and an increase in commensal bacteria (Lactobacillus murinus group and Parabacteroides goldsteinii) were observed. Furthermore, the abundance of Parabacteroides goldsteinii was increased in both males and females in the anti–PD-L1 group. Conclusion Our results suggest that gut microbial changes induced by the pretreatment of estrogen before anti–PD-L1 might contribute to treatment of MC38 colon cancer.

In this study, we developed the protopype of QA phantom for image QA including an additional component for image based radiation treatment system. The new phantom considered two main parts: Image quality and fusion accuracy. Image quality part included for daily CT number linearity and spatial resolution, and fusion accuracy part designed to simulate a simple translation-rotation setting. The CT scans of the phantom obtained from conventional CT, MVCT of Tomotherapy unit, and both image sets were satisfied the recommendation of spatial resolution. This phantom was simple and efficient for daily imaging QA, and it is important to provide a new concept of verification of image registration.

No abstract available.
Humans ; Intubation*

Chronic obstructive pulmonary disease (COPD) is a type of progressive, obstructive lung disease characterized by long-term poor airflow. The symptoms of COPD may be relieved and its progression delayed by fluticasone (FTS), salmeterol (SM), and tiotropium (TTP). The aim of this study is to investigate pharmacokinetic (PK) characteristics of inhaled FTS, SM, and TTP after co-administration. An open-label, single-arm, three-period, simple ascending dose study was conducted in 10 healthy male subjects. A single dose of FTS/SM (250/50 µg) and TTP (18 µg) were concomitantly inhaled in period 1, and the dose of each drug was escalated to two- and three-fold in periods 2 and 3, respectively, with a 2-week washout between periods. Activated charcoal was co-administered before and after inhalation to block gastrointestinal absorption. Blood samples for PK analysis were collected up to 24 hours. PK parameters were obtained by non-compartmental analysis. FTS, SM, and TTP rapidly reached maximum plasma concentration after inhalation (0.08–3.00 h, 0.03–0.10 h and 0.03–0.10 h, respectively) and were eliminated with mean half-lives of 9.29–10.44 h, 6.09–12.39 h and 0.25–47.42 h, respectively. PK assessment of the lowest dose of TTP was limited due to relatively low systemic exposure compared to the lower limit of quantification. In conclusion, PK characteristics of FTS, SM, and TTP by pulmonary absorption were evaluated after concurrent inhalation. FTS and SM showed dose-proportional PK profiles between 250–750 µg and 50–150 µg, respectively, while TTP presented dose-proportionality in the early phase exposure between 18-54 µg.
Charcoal ; Fluticasone* ; Gastrointestinal Absorption ; Humans ; Inhalation* ; Lung Diseases, Obstructive ; Male ; Pharmacokinetics ; Plasma ; Pulmonary Disease, Chronic Obstructive ; Respiratory Tract Absorption ; Salmeterol Xinafoate* ; Tiotropium Bromide*