In a 8 year-old boy who had epidural hematoma in the occipital area, had an episode of dislodgement of the endotracheal tube due to improper position. After operation, there were drowsy consciousness, irregular respiration, apnea, absence of cough reflex and swallowing reflex. Then these was no improvement in spite of treatment, and because of this hypoxic encephalopathy was diagnosed. WE suspected there might be some pathologic lesion volving the respiratory center and lower cranial nerves. CT scanning was performed and the result was diagnosed with epidural hematoma and subdural hematoma in the posterior fossa. The patient was reoperated.
Apnea ; Child ; Consciousness ; Cough ; Cranial Nerves ; Deglutition ; Hematoma* ; Hematoma, Subdural ; Humans ; Hypoxia, Brain ; Male ; Reflex ; Respiration ; Respiratory Center ; Tomography, X-Ray Computed

Hyperinsullinism and the resultant hypoglycemia are hallmarks of functioning beta islet cell tumors of the pancreas. The management of one case of insulinoma during surgery for the removal of the tumor is described and the available literature on the subject reviewed. The outline of the anesthetic management for the insulinoma is as follows: 1) Anesthetists should understand the signs and the symptoms of hypoglycemia and hyperglycemia. 2) Preoprative management: a) infusion of glucose for avoiding hypoglycemia due to NPO after midnight. b) glucocorticosteroid administration with premedications. 3) Operative management: a) continuous determination of blood glucose level may be helpful. b) Maintenance of the glucose level about 50mg% above symptomatic CNS level have the advantage that exicision of the infulinoma can be immediately judged. c) The use of an agent that decreases CMRO2 and does not affect the insulin-glucose ratio is rational choice when concern about hypoglycemia exists. Thiopental-enflurane anesthesia with controlled ventilation maintaining normocarbia is recommended. d) beta-adrenergic blocker. These drugs must be avoided in the hypoglycemic state.
Adenoma, Islet Cell ; Anesthesia ; Blood Glucose ; Glucose ; Hyperglycemia ; Hypoglycemia ; Insulinoma ; Pancreas ; Premedication ; Ventilation

Targeted therapies guided by molecular diagnostics have become a standard treatment of lung cancer. Epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements are currently used as the best predictive biomarkers for EGFR tyrosine kinase inhibitors and ALK inhibitors, respectively. Besides EGFR and ALK, the list of druggable genetic alterations has been growing, including ROS1 rearrangements, RET rearrangements, and MET alterations. In this situation, pathologists should carefully manage clinical samples for molecular testing and should do their best to quickly and accurately identify patients who will benefit from precision therapeutics. Here, we grouped molecular biomarkers of lung cancers into three categories—mutations, gene rearrangements, and amplifications—and propose expanded guidelines on molecular testing of lung cancers.
Biomarkers ; Gene Rearrangement ; Humans ; Lung Neoplasms* ; Lung* ; Lymphoma ; Pathology, Molecular ; Phosphotransferases ; Precision Medicine ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor

Rearrangement of anaplastic lymphoma kinase (ALK) gene is the best predictor of response to crizotinib, an ALK tyrosine kinase inhibitor. However, the prevalence of the ALK fusion is low, so accurate patient identification is crucial for successful treatment using ALK inhibitors. Furthermore, most patients with lung cancer present with advanced-stage disease at the time of diagnosis, so it is important for pathologists to detect ALK-rearranged patients while effectively maximizing small biopsy or cytology specimens. In this review, we propose a guideline recommendation for ALK testing approved by the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists.
Biopsy ; Diagnosis ; Gene Rearrangement* ; Humans ; Lung Neoplasms* ; Lung* ; Lymphoma ; Pathology* ; Phosphotransferases ; Prevalence ; Protein-Tyrosine Kinases

Mutations of the epidermal growth factor receptor (EGFR) are the strongest predictive factor for response to EGFR tyrosine kinase inhibitors (TKIs), such as gefitinib and erlotinib. EGFR TKIs are approved in Korea as a first-line treatment for lung cancer patients with mutated EGFR. Rapid and accurate EGFR mutation testing is essential for patient selection and establishing targeted therapies with EGFR TKIs. Thus, a standard set of guideline recommendations for EGFR mutation testing suitable for the Korean medical community is necessary. In this article, we propose a set of guideline recommendations for EGFR mutation testing that was discussed and approved by the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists.
Humans ; Korea ; Lung ; Lung Neoplasms ; Patient Selection ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride

The spleen is one of the largest organ in the reticuloendothelial system and plays an important role in theac-tivation of immune response. It is the organ most commonly injured after blunt abdominal trauma, and malig-nantlesions such as lymphoma, or these due to metastasis, occur not infrequently. Even so, it is ignored even inabdominal ultrasonography. Some benign splenic lesions, however can cause severe symptoms and result in high mortality, and their accurate diagnosis is therefore essential. This study describes the imaging findings andhistopathologic features of various nontraumatic benign splenic lesions.
Diagnosis ; Lymphoma ; Mononuclear Phagocyte System ; Mortality ; Neoplasm Metastasis ; Spleen ; Ultrasonography

BACKGROUND: Since cigarette smoking is an important risk factor for respiratory infections and alters the immune response, the severity of influenza illness and the immunogenicity of influenza vaccination may differ between cigarette smokers and non-smokers. This study investigated the effect of cigarette smoke exposure on the severity of influenza illness and vaccine-induced antibody production in mice. MATERIALS AND METHODS: Cigarette smoke exposed (CE) and non-cigarette smoke exposed (NCE) mice were infected with mouse-adapted influenza A/PR8/8/34 (H1N1). Influenza virus was quantified in bronchoalveolar lavage fluid by real-time polymerase chain reaction and the lung pathology was examined to investigate the influence of smoke exposure on the severity of illness. To assess immunogenicity, hemagglutination inhibition antibodies were measured in pre- and post-influenza vaccination blood samples from CE and NCE mice. RESULTS: Influenza viral proliferation was higher and inflammatory changes such as macrophage infiltration in the alveolar space and necrotizing bronchitis were more pronounced in CE mice, compared with controls. Vaccine-induced immunogenicity was achieved in both CE and NCE mice. CONCLUSIONS: Cigarette smoke exposure enhanced influenza viral replication and the inflammatory changes associated with influenza illness, but had no significant effect on vaccine-induced immunogenicity.
Animals ; Antibodies ; Antibody Formation ; Bronchitis ; Bronchoalveolar Lavage Fluid ; Hemagglutination ; Inflammation ; Influenza, Human ; Lung ; Macrophages ; Mice ; Orthomyxoviridae ; Real-Time Polymerase Chain Reaction ; Respiratory Tract Infections ; Risk Factors ; Smoke ; Smoking ; Tobacco Products ; Vaccination

BACKGROUND: Simian virus 40 (SV40), a polyomavirus, was discovered as a contaminant of a human polio vaccine in the 1960s. It is known that malignant mesothelioma (MM) is associated with SV40, and that the virus works as a cofactor to the carcinogenetic effects of asbestos. However, the reports about the correlation between SV40 and MM have not been consistent. The purpose of this study is to identify SV40 in MM tissue in Korea through detection of SV40 protein and DNA. METHODS: We analyzed 62 cases of available paraffin-blocks enrolled through the Korean Malignant Mesothelioma Surveillance System and performed immunohistochemistry for SV40 protein and real-time polymerase chain reaction (PCR) for SV40 DNA. RESULTS: Of 62 total cases, 40 had disease involving the pleura (64.5%), and 29 (46.8%) were found to be of the epithelioid subtype. Immunostaining demonstrated that all examined tissues were negative for SV40 protein. Sufficient DNA was extracted for real-time PCR analysis from 36 cases. Quantitative PCR of these samples showed no increase in SV40 transcript compared to the negative controls. CONCLUSIONS: SV40 is not associated with the development of MM in Korea.
Asbestos ; DNA ; Humans ; Immunohistochemistry ; Korea ; Mesothelioma ; Pleura ; Poliomyelitis ; Polymerase Chain Reaction ; Polyomavirus ; Real-Time Polymerase Chain Reaction ; Simian virus 40 ; Viruses

Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.

Artificial intelligence (AI) in medicine has gained a lot of momentum in the last decades and has been applied to various fields of medicine. Advances in computer science, medical informatics, robotics, and the need for personalized medicine have facilitated the role of AI in modern healthcare. Similarly, as in other fields, AI applications, such as machine learning, artificial neural networks, and deep learning, have shown great potential in andrology and reproductive medicine. AI-based tools are poised to become valuable assets with abilities to support and aid in diagnosing and treating male infertility, and in improving the accuracy of patient care. These automated, AI-based predictions may offer consistency and efficiency in terms of time and cost in infertility research and clinical management. In andrology and reproductive medicine, AI has been used for objective sperm, oocyte, and embryo selection, prediction of surgical outcomes, cost-effective assessment, development of robotic surgery, and clinical decision-making systems. In the future, better integration and implementation of AI into medicine will undoubtedly lead to pioneering evidence-based breakthroughs and the reshaping of andrology and reproductive medicine.