Purpose: The purpose of this study was to compare the accuracy of preoperative breast tumor size measured by ultrasonography (US) and magnetic resonance imaging (MRI) in patients with ductal carcinoma in situ (DCIS). Methods: Medical records of 74 patients postoperatively diagnosed with DCIS were retrospectively analyzed. Tumor size measurements obtained using the two imaging modalities were compared for accuracy with those obtained during the final pathologic examination. Patients with only microcalcification on imaging were excluded. Results: For all patients, Lin’s concordance correlation coefficient (CCC) of MRI was 0.725, which was more accurate than 0.670 of US. In subgroup analysis, CCC of US was 0.757, more accurate than 0.697 of MRI in premenopausal DCIS patients. Background parenchymal enhancement (BPE) was the only risk factor deteriorating the accuracy of US and MRI examinations. Moderate and marked BPE was associated with the inaccurate tumor size estimations in both US and MRI (odds ratio [OR]:2.23, 95% confidence interval [CI]=1.12−3.52, p=0.001 in US, OR:8.16, 95% CI=1.17−15.2, p=0.031 in MRI). Conclusion MRI was more accurate for measuring tumor size in patients with DCIS. Moderate and marked BPE was a risk factor that prevented accurate measurement of preoperative tumor size. In premenopausal patients, US would help measure tumor size accurately.

Breast metastases from small cell lung carcinoma (SCLC) are extremely rare. Although reports of breast metastases from SCLC exist, only three studies have reported solitary and synchronous breast metastases. Herein, we present a case of SCLC with solitary and synchronous breast metastases. This unusual case highlights the importance of the combined use of radiological and immunohistochemical features to accurately distinguish solitary metastatic SCLC from primary breast carcinoma or metastatic carcinoma of other types of lung cancer. It also emphasizes the importance of the differences between solitary metastatic SCLC and primary breast carcinoma or metastatic carcinoma of other types of lung cancer for the respective prognoses and development of appropriate therapeutic plans.

Objective: This systematic review and meta-analysis evaluated the accuracy of preoperative breast magnetic resonance imaging (MRI) features and tumor-to-nipple distance (TND) for diagnosing occult nipple-areolar complex (NAC) involvement in breast cancer. Materials and Methods: The MEDLINE, Embase, and Cochrane databases were searched for articles published until March 20, 2022, excluding studies of patients with clinically evident NAC involvement or those treated with neoadjuvant chemotherapy.Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Two reviewers independently evaluated studies that reported the diagnostic performance of MRI imaging features such as continuity to the NAC, unilateral NAC enhancement, non-mass enhancement (NME) type, mass size (> 20 mm), and TND. Summary estimates of the sensitivity and specificity curves and the summary receiver operating characteristic (SROC) curve of the MRI features for NAC involvement were calculated using random-effects models. We also calculated the TND cutoffs required to achieve predetermined specificity values. Results: Fifteen studies (n = 4002 breast lesions) were analyzed. The pooled sensitivity and specificity (with 95% confidence intervals) for NAC involvement diagnosis were 71% (58–81) and 94% (91–96), respectively, for continuity to the NAC; 58% (45–70) and 97% (95–99), respectively, for unilateral NAC enhancement; 55% (46–64) and 83% (75–88), respectively, for NME type; and 88% (68–96) and 58% (40–75), respectively, for mass size (> 20 mm). TND had an area under the SROC curve of 0.799 for NAC involvement. A TND of 11.5 mm achieved a predetermined specificity of 85% with a sensitivity of 64%, and a TND of 12.3 mm yielded a predetermined specificity of 83% with a sensitivity of 65%. Conclusion Continuity to the NAC and unilateral NAC enhancement may help predict occult NAC involvement in breast cancer. To achieve the desired diagnostic performance with TND, a suitable cutoff value should be considered.

In small infants or neonates, open heart surgery without transfusion can have many risks regarding inadequate oxygen delivery and coagulopathy. However, if parents refuse blood transfusion, cardiac surgery without transfusion should be considered. We report a case of bloodless cardiac surgery in a 2.89 kg neonate with Jehovah's Witness parents. Blood conserving strategies were used. Preoperatively, erythropoietin and iron were supplemented to increase the hemoglobin level. Intraoperatively, techniques for minimizing blood loss were used, such as reducing priming volume for cardiopulmonary bypass, a blood salvage system, and modified ultrafiltration. Postoperatively, pharmacologic agents were administered and blood sampling was minimized.
Blood Transfusion ; Cardiopulmonary Bypass ; Erythropoietin ; Heart ; Hemoglobins ; Humans ; Infant ; Infant, Newborn ; Iron ; Jehovah's Witnesses ; Oxygen ; Parents ; Thoracic Surgery ; Ultrafiltration ; Wit and Humor as Topic

Purpose: Here, we report a case of acute noninfectious endophthalmitis after removal of silicone oil (SO) and posterior capsulectomy in a patient with proliferative diabetic retinopathy.Case summary: SO removal and posterior capsulectomy were performed in a 61-year-old man who had undergone vitrectomy with combined cataract surgery, membrane peeling, laser photocoagulation, and SO injection to treat vitreous hemorrhage and tractional retinal detachment three months previously. The patient’s best-corrected visual acuity on the day after surgery was 20/50; it decreased to hand motion at five days after SO removal. Exudative membrane with hypopyon, anterior chamber cell (trace), and mild conjunctival injection were observed. The patient did not complain of ocular pain. Topical steroid was applied following a diagnosis of postoperative noninfectious endophthalmitis. The exudative membrane and hypopyon decreased after three days of treatment and had resolved completely after one month of treatment. The patient’s visual acuity improved to 20/50. Conclusions Noninfectious endophthalmitis can develop after removal of SO and posterior capsulectomy. Topical steroid treatment is effective in such cases.

Purpose: We report bilateral, diffuse, uveal melanocytic proliferation caused by a stomach adenocarcinoma.Case summary: A 78-year-old male complained of visual impairment 3 months in duration. He had diabetes and had undergone cataract surgery on both eyes 4 years prior. His best-corrected visual acuity was counting fingers in the right eye and 20/160 in the left eye. Both intraocular pressures were normal. The anterior segments yielded no specific findings. The maculae exhibited multiple, round, patchy, pigmented or depigmented lesions with exudative retinal detachment. Fluorescein angiography revealed multiple hyperfluorescent lesions. Optical coherence tomography revealed that the hyper-reflective exudates lay between the neurosensory retina and the retinal pigment epithelium. We diagnosed bilateral, diffuse, uveal melanocytic proliferation and performed a systemic evaluation. Computed tomography revealed several mass lesions in the lung, stomach, and lymph nodes; these appeared to be malignant. An esophagogastroduodenoscopic biopsy confirmed that the lesions were adenocarcinomas. Conclusions A bilateral, diffuse, uveal melanocytic proliferation induced by a primary malignant tumor exhibited multiple, pigmented subretinal exudates associated with exudative macular retinal detachment. In patients with such findings, it is necessary to evaluate the malignant tumor status of remote organs.

PURPOSE: The purpose of this study is to analyze medical audit of screening digital mammography at a tertiary hospital and to review changes of medical audit according to newly revised standard. MATERIALS AND METHODS: We analyzed 7764 asymptomatic women who underwent screening mammogram at our hospital from January, 2013 to December, 2014. The family or past history of breast, gynecologic and other cancers was reviewed retrospectively. Analysis 1 defined category 3 as positive result and analysis 2 defined category 3 as negative. RESULTS: The overall cancer detection rate was 4.6 per 1000 cases. The cancer detection rate in patients with non-gynecological and non-thyroid cancer (n = 391, 51.2) was the highest compared to patients with family history of breast cancer (n = 691, 1.4), or gynecological cancer (n = 311, 12.9). In analysis 1, positive predictive value 1 decreased 1.3% (6.0% vs. 7.3%) and recall rate increased 1.3% (7.3% vs. 6.0%) compared with analysis 2. The results were appropriate for newly revised target. CONCLUSION The results of screening digital mammography in the tertiary medical institution showed excellent results even if category 3 was regarded as positive. In addition, screening tests for secondary cancer are needed in the tertiary hospital.

BACKGROUND: Patients showed a different response following intravenous midazolam injection. Some children showed irritability or were not sedated by midazolam. We hypothesized that there may be genetic variations of the MDR1 gene, based on the response to midazolam. METHODS: One hundred and ninety-three pediatric patients were recruited in this study. Midazolam (0.1 mg/kg) was injected intravenously before surgery. Anxiety score (activity, vocalizations, emotional expressivity, state of apparent arousal) was checked before and 5 minutes after midazolam injection. In addition, other manifestations after midazolam injection were recorded. After anesthesia, 2 ml of blood was sampled. Children were genotyped MDR1. Haplotype was analyzed using the software package PHASE, version 2.0. RESULTS: The observed frequencies of MDR1 haplotype of TTT, TGC, CAC, CGC were 0.334, 0.205, 0.182 and 0.225, respectively. There was no significant correlation between the response of midazolam and the MDR1 haplotype of TTT, TGC, CAC or CGC (P = 0.98). CONCLUSIONS: Genotyping of MDR1 may not be related to the response of midazolam in children.
Anesthesia ; Anxiety ; Child ; DNA ; Genetic Variation ; Haplotypes ; Humans ; Midazolam ; Polymorphism, Genetic

Tough ectopic male breast cancer is extremely rare, non-axillary ectopic male breast cancer is even rare. To date, the natural course and prognosis of this disease are not fully understood.Consequently, the appropriate treatment for this disease has not been established. We report on a patient with ectopic male breast cancer in the suprapubic area that relapsed with hematogenous metastasis 3 years after complete surgical resection and adjuvant treatment despite an early diagnosis. This unusual case highlights the need for new prognostic factors such as genomic profiling to predict whether ectopic male breast cancer is aggressive and to guide on the duration between follow-ups and the appropriate method for conducting them.

Tough ectopic male breast cancer is extremely rare, non-axillary ectopic male breast cancer is even rare. To date, the natural course and prognosis of this disease are not fully understood.Consequently, the appropriate treatment for this disease has not been established. We report on a patient with ectopic male breast cancer in the suprapubic area that relapsed with hematogenous metastasis 3 years after complete surgical resection and adjuvant treatment despite an early diagnosis. This unusual case highlights the need for new prognostic factors such as genomic profiling to predict whether ectopic male breast cancer is aggressive and to guide on the duration between follow-ups and the appropriate method for conducting them.