A 70 years old female patient with thyroid cancer received palliative radiation therapy for neck swelling and hemoptysis. She had a cardiac pacemaker under her chest due to complete AV block since 8 years ago. We present clinical detail and review previously reported articles.
Aged ; Atrioventricular Block ; Female ; Hemoptysis ; Humans ; Neck ; Radiotherapy* ; Thorax ; Thyroid Neoplasms

BACKGROUND: A variety of therapeutic regimens has been used in the treatment of hypertrophic scars/keloids with onsatisfactory final results. Application of cryosurgery could be beneficial sinee it was reported to produce less scarring and recurrence after treatment compared with other methods. Objective This study was undertaken to evaluate the effect of the cryosurgery through objective, quantitative measurement of hypertrophic scar/keloid thickness and to assess the influence of the cryosurgery on fibroblasts. The latter was achieved through fibroblast cultures established from hypertrophic scars/keloids. METHODS: Eight patients, ageA 17 to 47 years old, with hypertrophic scars/keloids were treated with liquid nitrogen using the cantact method. One freeze-thaw cycle of 10-30 seconds per lesion was employed, and if needed, treatment was repeated every 20 to 40 days. The thicknesses of the lesions were measured objective,ly with ultrasound in five patients, before and after cryosurgery and were compared with controlled scars in other areas. In three patients, we cultured fibroblasts from the treated and the untreated lesions and exmuned the rate of fibroblast proliferation and collagen production. RESULTS: In all five patients, thicknesses of the hypertrophic scars/keloids decreased compared to those of controlled areas after treatment. Five of 6 hypertrophic scar cell lines demonsbated decreased fibroblast proliferation rates in comparison to control fibroblast lines. Collagen produced by the fibroblasts was variable. CONCLUSION: Cyosurgery was effective and safe in the treatment of hypertrophic scars/keloids.
Cell Line ; Cicatrix ; Cicatrix, Hypertrophic* ; Collagen ; Cryosurgery* ; Fibroblasts ; Humans ; Keloid* ; Middle Aged ; Nitrogen ; Recurrence ; Ultrasonography

Accurate quantification of mycobacterial load is important to evaluate disease severity and to monitor the course of treatment in tuberculosis (TB). We evaluated the quantitative capability of the AdvanSure TB/NTM real-time PCR kit (LG Life Science, Korea) to determine the cycle threshold (Ct) for mycobacterial burden. We retrospectively analyzed data from 108 patients whose respiratory specimens (sputums and bronchoalveolar lavage fluids) were positive for Mycobacterium tuberculosis complex (85 culture-positive and 23 culture-negative specimens). We compared Ct values with grades of acid-fast bacilli (AFB) staining, semi-quantitative colony count on solid medium, and time to positivity (TTP) in liquid and solid media. We also investigated the cutoff Ct value for predicting stain-positive status. Ct value showed significant reverse correlation with AFB staining grade (r(s)=-0.635, P<0.01). Ct value significantly decreased as the semi-quantitative counts on the solid medium increased (P<0.001), and the mean Ct value of each of the groups 1+, 2+, 3+, and 4+ were 29.0, 30.0, 27.1, and 25.5, respectively. A weak correlation between Ct value and TTP in liquid and solid media was observed (r(s)=0.468 and 0.365, respectively). A cutoff Ct value of <33.2 best predicted stain positivity, with a sensitivity of 95.0% and a specificity of 32.0%. Our findings suggest the potential use of AdvanSure TB/NTM real-time PCR kit for quantitatively determining bacterial burden, albeit with some enhancements.
Area Under Curve ; Bronchoalveolar Lavage Fluid/microbiology ; DNA, Bacterial/*analysis ; Humans ; Mycobacterium tuberculosis/genetics/*isolation & purification ; Phenotype ; ROC Curve ; Reagent Kits, Diagnostic ; *Real-Time Polymerase Chain Reaction ; Retrospective Studies ; Sensitivity and Specificity ; Sputum/microbiology ; Tuberculosis/diagnosis/microbiology

BACKGROUND: We evaluated the reliability and accuracy of the combined use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) bacterial identification and Vitek 2 antimicrobial susceptibility testing (AST) for bacteria from positive blood culture bottles. METHODS: Direct identification and AST were performed in parallel to the standard methods in monomicrobial positive blood culture bottles. In total, 254 isolates grown on aerobic and/or anaerobic bottles were identified with MALDI-TOF Vitek MS (bioMerieux, France), and 1,978 microorganism/antimicrobial agent combinations were assessed. For isolates from anaerobic bottles, an aliquot of the culture broth was centrifuged, washed, and filtered through a nylon mesh. For isolates from aerobic/pediatric bottles, a lysis step using 9.26% ammonium chloride solution and 2% saponin solution was included. RESULTS: The overall correct identification rate was 81.8% (208/254) and that for gram-positive/gram-negative isolates was 73.9%/92.6%, respectively, and it was 81.8%, 87.6%, and 57.9% for isolates from aerobic, anaerobic, and pediatric bottles, respectively. Identification was not possible in 45 cases, and most of these isolates were streptococci (N=14) and coagulase-negative staphylococci (N=11). Misidentification occurred only in one case. Compared with standard methods, direct AST showed 97.9% (1,936/1,978) agreement with very major error of 0.25%, major error of 0.05%, and minor error of 1.8%. CONCLUSIONS: This simple and cost-effective sample preparation method gives reliable results for the direct identification and AST of bacteria. For the identification of streptococci and coagulase-negative staphylococci, the method should be further improved.
Adult ; Ammonium Chloride/chemistry ; Anti-Infective Agents/*pharmacology ; Child ; Gram-Negative Bacteria/drug effects/*isolation & purification/metabolism ; Gram-Positive Bacteria/drug effects/*isolation & purification/metabolism ; Humans ; Reagent Kits, Diagnostic ; Saponins/chemistry ; *Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

No abstract available.
Immunocompromised Host* ; Mycoplasma hominis* ; Mycoplasma* ; Skin* ; Soft Tissue Infections*

OBJECTIVE: Cystoscopy has been included as diagnostic procedure for pretreatment evaluation of cervical cancer by FIGO. However, its invasiveness brings up a question regarding the necessity of inclusion in staging work up of cervical cancer. We performed this study to evaluate the clinical implication of cystoscopy in cervical cancer staging. METHODS: 128 patients with invasive cervical cancer patients who were histologically diagnosed from Jan 1995 to Dec 1999 were retrospectively reviewed. Physical examination, computed tomography (CT), cystoscopy were performed in all patients. The distribution of FIGO stage was Ib 48.4%, II 35.2%, III 8.6%, and IV 7.8%. Bladder invasion was evaluated in CT and histopathologic examination was performed on cystoscopy when invasion was suspected. McNemar test was used to compare the finding in CT and cystoscopy for matched patients. P-value of 0.05 was regarded as statistically significant. RESULTS: Among seven patients whose bladder was suspected to be invaded by cervical cancer in CT scan, three patients had actual bladder invasion confirmed by cystoscopy (positive predictive rate = 42.9%). CT was statistically comparable to cystoscopy (P = 0.375, McNemar test; contingency coefficient = 0.481). CONCLUSION: Cystoscopy, which is an invasive procedure, may not be necessary and might be substituted by CT scan for pretreatment evaluation in some subset of cervical cancer patients.
Cystoscopy* ; Humans ; Physical Examination ; Retrospective Studies ; Tomography, X-Ray Computed ; Urinary Bladder ; Uterine Cervical Neoplasms*

BACKGROUND: Three chromogenic media using direct inoculation were compared with enriched enterococcosel broth for vancomycin-resistant Enterococcus faecium and/or Enterococcus faecalis (VRE) surveillance. METHODS: A total of 174 rectal swabs were included for VRE surveillance. The specimens were transferred in enterococcosel broth (EB). An aliquot of the broth was inoculated onto Brilliance VRE, chromID VRE, and VRESelect media and incubated for up to 48 h. We examined each media and EB after 24 h and 48 h of incubation. When appropriately colored colonies were observed, identification was confirmed using the VITEK-2 system and/or VITEK MS. Vancomycin susceptibility was confirmed by disk diffusion test. The presence of resistance genes was confirmed using Anyplex VanR Real-time Detection (Seegene, Korea). RESULTS: Of the 174 rectal swab specimens, 73 VRE were isolated. For enterococcosel broth, Brilliance VRE, chromID VRE, and VRESelect, the sensitivity at 24 h was 79.2%, 83.3%, 79.2%, and 79.2%, respectively. The sensitivity at 48 h was 91.7%, 93.1%, 91.4%, and 90.3%, respectively. The specificity at 24 h was 85.3%, 97.1%, 98.0%, and 98.0%, while that at 48 h was 79.4%, 85.3%, 95.2%, and 95.1%, respectively. The specificity of chromogenic media at 24 h and 48 h was significantly higher than that of EB. Furthermore, the specificity at 48 h was significantly higher for chromID VRE and VRESelect than Brilliance VRE, although color distinction was easier with VRESelect. CONCLUSION: Based on our results, use of chromID VRE or VRESelect is more reliable and convenient for screening of VRE. In addition, five vanA-positive Enterococcus gallinarum, Enterococcus avium and Enterococcus durans were isolated, and two of them (one E. avium and one E. durans) were detected only on VRESelect.
Diffusion ; Enterococcus ; Enterococcus faecalis ; Enterococcus faecium ; Mass Screening ; Sensitivity and Specificity ; Vancomycin

BACKGROUND: We evaluated the coincidence rate between Vitek MS system (bioMerieux, France) and Vitek 2 in identifying uropathogens directly from urine specimens. METHODS: Urine specimens submitted to our microbiology laboratory between July and September 2013 for Gram staining and bacterial culture were analyzed. Bacterial identification was performed by using the conventional method. Urine specimens showing a single morphotype by Gram staining were processed by culturing and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Of 2,370 urine specimens, 251 showed a single morphotype on Gram staining, and among them, 202 were available for MALDI-TOF MS. RESULTS: In these 202 specimens, colony growth was observed in 189 specimens, and 145 specimens had significant growth of single-colony morphotype in culture. One hundred and ten (75.9%) of them had colony counts of > or =10(5) colony-forming units (CFU)/mL and included 71 enteric gram-negative bacteria (GNB), 5 glucose-non-fermenting GNB, 9 gram-positive cocci (GPC), and 25 yeasts. Furthermore, 70 (98.6%), 3 (60.0%), 4 (44.4%), and 5 (20.0%), respectively, of these were correctly identified by Vitek MS. Thirty-one specimens (21.4%; 11 GNB, 7 GPC, 12 yeasts, and 1 gram-positive bacillus) had colony counts of 10(4)-10(5) CFU/mL. Four specimens (2.8%) yielded colony counts of 10(3)-10(4) CFU/mL. CONCLUSIONS: Vitek MS showed high rate of accuracy for the identification of GNB in urine specimens (> or =10(5) CFU/mL). This could become a rapid and accurate diagnostic method for urinary tract infection caused by GNB. However, for the identification of GPC and yeasts, further studies on appropriate pre-treatment are warranted.
Gram-Negative Bacteria ; Gram-Positive Cocci ; Mass Spectrometry* ; Stem Cells ; Urinary Tract Infections ; Urinary Tract* ; Yeasts

One of the most frequent structural chromosomal anomaly is t(8;21)(q22;q22) that occurs in approximately 5-15% of all acute myeloid leukemia (AML). However, t(3;21)(p21;q22) and t(2;11)(q31;p15) translocations are rarely reported in AML. Here, we report a unique case of AML with two translocations, t(3;21;8)(p21;q22;q22) and t(2;11)(q31;p15). Using multiplex reverse transcription polymerase chain reaction, we identified a RUNX1-RUNX1T1 fusion gene. Following a second relapse, the patient did not respond to therapy and died 55 months following the first diagnosis. We believe that this is the first case describing concurrent chromosomal aberrations involving three-way t(3;21;8) and two-way t(2;11) translocations in de novo acute myeloid leukemia.
Chromosome Aberrations* ; Diagnosis ; Humans ; Leukemia, Myeloid, Acute* ; Polymerase Chain Reaction ; Recurrence ; Reverse Transcription

PURPOSE: To evaluate the impact of postoperative radiotherapy (PORT) on patterns of failure and survivals in uterine carcinosarcoma patients treated with radical surgery. MATERIALS AND METHODS: Between October 1998 and August 2010, 19 patients with stage I-III uterine carcinosarcoma received curative hysterectomy and bilateral salpingo-oophorectomy with or without PORT at Seoul National University Hospital. Their hospital medical records were retrospectively reviewed. PORT and non-PORT groups included 11 and 8 patients, respectively. They were followed for a mean of 22.7 months (range, 7.8 to 126.6 months). RESULTS: At 5 years, the overall survival rates were 51.9% for entire, 61.4% for PORT, and 41.7% for non-PORT groups, respectively. There was no statistical difference between PORT and non-PORT groups with regard to overall survival (p = 0.682). Seven out of 19 (36.8%) patients showed treatment failures, which all happened within 12 months. Although the predominant failures were distant metastasis in PORT group and loco-regional recurrence in non-PORT group, there was no statistically significant difference in loco-regional recurrence-free survival (LRRFS) (p = 0.362) or distant metastasis-free survival (DMFS) (p = 0.548). Lymph node metastasis was found to be a significant prognostic factor in predicting poor LRRFS (p = 0.013) and DMFS (p = 0.021), while the International Federation Gynecology and Obstetrics (FIGO) stage (p = 0.043) was associated with LRRFS. CONCLUSION: Considering that adjuvant radiotherapy after surgical resection was effective to decrease loco-regional recurrence and most treatment failures were distant metastasis, multimodal therapy including surgery, radiotherapy, and chemotherapy might be an optimal treatment for uterine carcinosarcoma patients.
Carcinosarcoma ; Gynecology ; Humans ; Hysterectomy ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Obstetrics ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Failure ; Uterus