Malignant fibrous histiocytoma (MFH) of the liver is uncommon, representing less than 1% of the primary malignant lesions of the liver. We report primary MFH of the liver in a 59-year-old woman. The tumor, measuring 9.0 9.0 6.0 cm, was located in the left lobe of the liver. It showed multiple areas of hemorrhage and necrosis. Microscopically, the tumor consisted of plump spindle cells haphazardly arranged in short fascicle and focal storiform pattern. Multiple bizarre giant cells were also noted. Immunohistochemically, many of the tumor cells were positive for vimentin and alpha1-antitrypsin but negative for epithelial markers. Ultrastructurally, the tumor cells showed fibroblastic and histiocytic features.
Female ; Fibroblasts ; Giant Cells ; Hemorrhage ; Histiocytoma, Malignant Fibrous* ; Humans ; Liver* ; Microscopy, Electron ; Middle Aged ; Necrosis ; Vimentin

No abstract available.
Hemorrhage*

Recently developed new classifications (Holland, Van Nuys, modified Lagios) of ductal carcinoma in situ (DCIS) linked to outcome have emphasized the importance of nuclear morphology rather than architecture. We have evaluated these three classifications in ductal carcinomas composed of in situ and invasive carcinomas. The reproducibility of three classifications was assessed (n=49), and the histological grade of the DCIS was compared with the histologic differentiation (modified Bloom & Richardson method) and nuclear grade (modified Black method) of the coexisting invasive ductal carcinoma (n=45). According to Holland classification, the DCIS component was poorly differentiated in 51.0%, intermediately differentiated in 40.8%, and well differentiated in 8.2%. Using the Van Nuys classification, the DCIS component was group 3 (high grade with or without necrosis) in 44.9%, group 2 (non-high grade with necrosis) in 28.6%, and group 1 (non-high grade without necrosis) in 26.5%. According to the modified Lagios classification, the DCIS component was high-grade in 42.8%, intermediate-grade in 32.7%, and low-grade in 24.5%. The histologic grades of the three classifications revealed significant correlations between Holland and Van Nuys classification (p<0.0001) and between Holland and modified Lagios classification (p<0.0001), especially in poorly differentiated/group 3/high-grade DCIS. The reproducibility of classification of the DCIS was 71.4% in the Holland, 61.2% in the Van Nuys, and 55.1% in the modified Lagios classifications. The grade of the DCIS showed significant correlation with the grade of coexisting invasive ductal carcinoma (p<0.0001), especially in poorly differentiated/group 3/high-grade DCIS. In conclusion, DCIS grade, determined by the Holland, Van Nuys or modified Lagios classifications, is closely correlated with the histologic grade of the invasive ductal component in tumors composed of in situ and invasive ductal carcinoma, and may be a useful factor to estimate clinical behavior of DCIS. In our experience the Holland classification is recommended for DCIS classification due to its high reproducibility.
Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Classification* ; Netherlands

BACKGROUND: Ischemic heart disease is the most common type of heart disease and an important cause of death in Korea. Among marketed anti-anginal medications, molsidomine, nicorandil, and trimetazidine are approved in Korea with unique mechanism of actions. As these drugs are not approved by the US Food and Drug Administration, the access to the up-to-dated and comprehensive safety-related information has been less than optimal from drug information resources used by Korean pharmacists. METHODS: A systematic review was conducted using Embase and Korean manuscripts to compile safety updates for these medications. Out of 418 articles from keyword searches, 52 studies were reviewed in full to compare adverse effects (AEs) with the approved package inserts (PI). RESULTS: Molsidomine related adverse effects were mostly mild or moderate, but anxiety, palpitation, epigastric pain, and sexual potency reduction were additional AEs found from the review not listed in PI. Although PI has included ulceration in oral cavity and gastrointestinal tracts including anus by nicorandil, the Korea FDA recently recommended adding corneal, genital, and skin ulcers to the approved PI. Trimetazidine induced Parkinsonism, worsening of the symptoms for patients diagnosed with Parkinson's disease, gastrointestinal burning, and muscle cramps were additionally identified AEs not listed in PI for trimetazidine. CONCLUSION: Continuous evaluations of the safety profile of these agents are needed to balance the risks and benefits to provide evidence-based safety counseling to the patients. In addition, more focused efforts on spontaneous reporting are warranted by healthcare professionals to safeguard patients against AEs.
Anal Canal ; Anxiety ; Burns ; Cause of Death ; Counseling ; Delivery of Health Care ; Gastrointestinal Tract ; Heart Diseases ; Humans ; Korea ; Molsidomine* ; Mouth ; Muscle Cramp ; Myocardial Ischemia ; Nicorandil* ; Parkinson Disease ; Parkinsonian Disorders ; Pharmacists ; Product Labeling ; Risk Assessment ; Skin Ulcer ; Trimetazidine* ; Ulcer ; United States Food and Drug Administration

BACKGROUND: The new type of diabetes treatment, SGLT2 inhibitors, has been approved for monotherapy and combination therapy, but medical insurance is only allowed in combination therapy with metformin, which is the first choice for type 2 diabetes treatment. METHODS: The SGLT2 inhibitors prescribed in Korea are dapagliflozin, empagliflozin and ipragliflozin. A review was conducted using Pubmed to evaluate efficacy and safety for these medications with metformin combination therapy. 10 studies were selected by searching for keywords and related references and were reviewed in full. The mechanism of action, pharmacokinetics, and the economics of treatment with SGLT2 inhibitors were examined. RESULTS: SGLT2 inhibitors had moderate glycemic control when added to the treatment of patients with type 2 diabetes who were not being regulated by metformin monotherapy. They also showed positive effects such as weight loss, as well as the lowering of blood pressure. Hypotension and serious side effects were relatively low. However, the risk of genital infection was increased. CONCLUSION: The SGLT2 inhibitors are a new class of drugs that promote glucose excretion in the urine. They are a good choice for combination therapy with metformin for the treatment of type 2 diabetes, with weight loss and very low risk of serious side effects.
Blood Pressure ; Glucose ; Humans ; Hypotension ; Insurance ; Korea ; Metformin* ; Pharmacokinetics ; Weight Loss

Purpose: The purpose of this program is to develop an educational program to improve the nursing management competency of middle-level nursing managers. Methods: The program outline is based on the results of the Importance Performance Analysis (IPA) and Systematic Review (SR). Also performed the content validity accordingly. Results: The result of the concepts are derived from 6 competencies for planning process, 4 competencies for organizing process, 4 competencies for staffing process, 26 competencies for directing process, and 12 competencies for controlling process by integrating IPA and SR. This outline of the program was constructed according to the derived integrated concept and both content validity and structured outline were interpreted as valid. Conclusion This suggests that middle-level managers need a systematic program and support to effectively lead the organization by recognizing the importance rather than performance.

BACKGROUND: Depression is the leading cause of lowering the quality of life of cancer patients and lung cancer is the most likely to cause depression. It is necessary to find out depression-related factors in lung cancer patients. METHODS: The study was a retrospective cohort study using medical records, and was a non-equivalent comparison group design. It involved patients diagnosed of lung cancer at the Konkuk University Medical Center from January to December 2012. Between antidepressants prescription group and non prescription group, socio-demographic factors, clinical factors, treatment-related factors and other factors were analyzed statistically. RESULTS: Antidepressant prescription group consisted of 23 people and non-prescription group of 206 people. Prescription rate of quetiapine was the highest 47.8% (11/23), followed by escitalopram (43.5%, 10/23), amitryptyline and trazodone (30.4%, 7/23). The prescription group was prescribed with an average of 1.9 antidepressants. Antidepressants were prescribed after average of 248 days from lung cancer diagnosis and prescription period per patient was average 177.5 days. According to the result of univariate logistic regression analysis between 2 groups, factors such as number of outpatient visit, number of admission, days of hospitalization, sleep disorder, and comorbidity were found to be statistically significant (p < 0.05). However, According multivariate logistic regression analysis showed that number of admission, days of hospitalization and sleep disorder were statistically significant (p < 0.05) excluding comorbidity. CONCLUSION: About 10% of lung cancer patients had received a prescription for antidepressants after lung cancer diagnosis. A sleep disorder, number of hospitalization and length of stay were identified as factors influencing the prescribing antidepressants.
Academic Medical Centers ; Antidepressive Agents* ; Citalopram ; Cohort Studies ; Comorbidity ; Depression ; Diagnosis ; Hospitalization ; Humans ; Length of Stay ; Logistic Models ; Lung Neoplasms* ; Lung* ; Medical Records ; Outpatients ; Prescriptions ; Quality of Life ; Quetiapine Fumarate ; Retrospective Studies ; Sleep Wake Disorders ; Trazodone

PURPOSE: To compare the clinical characteristics and laboratory finding between adenoviral and group A streptococcal (GAS) pharyngitis. METHODS: A retrospective review of medical records was performed in the patients with adenovirus infection among those who were admitted for febrile respiratory disease from January 2011 to July 2013 and GAS pharyngitis among those who visited for symptoms of scarlet fever from August 2006 to July 2013. RESULTS: 179 patients (AV1 group) were diagnosed with adenoviral pharyngitis and 37 (AV2 group) of these patients had adenovirus single infection. 26 patients (GAS group) were diagnosed with scarlet fever. Adenoviral infection (AV2 group) developed in younger patients compared to GAS group (2.8+/-2.1 years vs. 5.4+/-1.8 years, P=0.000). Total durations of fever and admission were longer in AV2 (6.3+/-2.6 days vs. 3.3+/-1.9 days, P=0.000; 4.1+/-1.2 days vs. 1.9+/-1.8 days, P=0.000, respectively). WBC counts were higher in AV2 (11,449+/-5,680 cells/mm2 vs. 6,722+/-6,941 cells/mm2, P=0.000). CRP was not significantly different between AV2 and GAS group (3.8+/-3.2 mg/dL vs. 5.2+/-5.1 mg/dL, P=0.368). No difference was found between two groups in the percentage of antibiotics use (91.9% vs. 100%, P=0.261). CONCLUSION: Clinical characteristics and measures of inflammation in the laboratory findings were similar between adenoviral and GAS pharyngitis group. It is necessary to conduct the test for respiratory virus and bacteria in early stage to differentiate in the pharyngitis patients with leukocytosis and elevation of CRP level.
Adenoviridae ; Adenoviridae Infections ; Anti-Bacterial Agents ; Bacteria ; Child* ; Fever ; Humans ; Inflammation ; Leukocytosis ; Medical Records ; Pharyngitis* ; Retrospective Studies ; Scarlet Fever

No abstract available.
Phenylketonurias*

We isolated Triton X-100 solubilized protein (TSP) antigen which may be preferentially associated with the cell wall of M. tuberculosis. In this study, the proliferative activities and cytokine mRNA expression patterns of the TSP antigen were investigated in peripheral blood mononuclear cells (PBMCs) and lymph node mononuclear cells (LNMCs) from 4 patients with tuberculous lymphadenitis. The results of the TSP antigen were compared with those of the PPD antigen, known as a major seretory protein antigen of M. tuberculosis. The peak proliferative response to the TSP by PBMCs was observed at 0.1 ug/ml, whereas that of LNMCs was at 1.0 ug/ml. All of the patients showed greater blastogenic responses for the PPD than those for the TSP. IFN-r, IL-2, and IL-2Ru mRNA production from PBMCs after stimulation with the TSP were greatly augmented after 48 hrs, whereas IL-4 and IL-10 mRNA were gradually suppressed. In addition, high levels of IL-12 p40 mRNA were detected by PBMCs to the TSP antigen at 3 hrs. Elevated IFN-r and IL-2 mRNA production were observed in freshly isolated LNMCs, whereas IL-4 mRNA production was undetectable in either freshly isolated or mycobacterial antigen-stimulated LNMCs. Furthermore, IL-10 mRNA expression from LNMCs was markedly increased by the PPD antigen, but it was considerably reduced by the TSP antigen after 18 hrs. These data suggest that the TSP antigen may be a strong inducer of cytokine mRNA such as IFN-r, IL-2, and IL-12 which are involved in Thl cell and macrophage activation, and inhibit IL-10 mRNA production in LNMCs. In conclusion, the TSP antigen can be used as a preferential Thl cell immunogen in tuberculous lymphadenitis.
Cell Wall ; Humans ; Interleukin-10 ; Interleukin-12 ; Interleukin-2 ; Interleukin-4 ; Lymph Nodes* ; Macrophage Activation ; Mycobacterium tuberculosis* ; Mycobacterium* ; Octoxynol ; RNA, Messenger* ; Tuberculosis ; Tuberculosis, Lymph Node*