No abstract available.
Diagnosis* ; Female ; Pregnancy ; Pregnancy, Ectopic* ; Ultrasonography*

BACKGROUND: Bokildo (Islet) has been well known as an endemic area of paragonimiasis in Korea, and still crayfishes caught from this area are used as source of intermediate host of experimental paragonimiasis. For the reason, this study was carried out to elucidate the present status of human paragonimiasis in this region and intestinal parasitoses were studied at the same time. METHODS: From June 9 to June 12, 1999 authors visited Buyong-ri and Buwhang-ri which are located in the endemic area. All possible inhabitants including nursery children, primary and middle school children were examined by intra-dermal skin test with veronal buffered saline (VBS) antigen of Paragonimus westermani and Clonorchis sinensis. Sputa were collected from 22 adults of positive reactors. Stool examination was done for the intestinal parasites, and anal swabs with adhesive tape for the pinworm were carried out simultaneously. RESULTS: Overall positive rate in skin test was 9.5% in inhabitants, and higher rate was observed in older age groups. On microscopic examination of sputa for pargonimiasis, 2 egg-positive cases from 55-year old man and woman were detected. Prevalence rate of intestinal parasites was 7.8% (26/332) and the most predominant infected parasite was Trichuris trichiura (4.2%). The pinworm infection rate was 29.7% (nursery school children 30.0%, primary school children 29.6%, respectively). CONCLUSION: Through this study human paragonimiasis was confirmed and the life cycle of Paragonimus westermani was known to be maintained continuously in this region. Meanwhile control of intestinal parasites should be performed, especially in school children.
Adhesives ; Adult ; Astacoidea ; Barbital ; Child ; Clonorchis sinensis ; Enterobius ; Female ; Humans* ; Korea* ; Life Cycle Stages ; Middle Aged ; Nurseries ; Paragonimiasis* ; Paragonimus westermani ; Parasites ; Prevalence ; Skin Tests ; Trichuris

PURPOSE: We evaluated the relationship of cancer-associated fibroblasts (CAFs) and desmoplastic reactions with cancer invasiveness and long-term outcomes in patients with colorectal cancer (CRC). METHODS: Histologic evaluation of mature CAFs and desmoplasia was performed by observing the collagen fiber structure and fibroblast cytomorphology in the intratumoral stroma and invasive front of CRC tissues. Cancer-cell invasiveness was evaluated using lymphatic invasion, vascular invasion, perineural invasion, tumor budding, and tumor growth patterns. Overall survival and systemic recurrence were analyzed. A network analysis was performed between CAF maturation, desmoplastic reaction, and cancer invasiveness. RESULTS: The proportions of mature CAFs in the intratumoral stroma and the invasive front were 57.6% and 60.3%, respectively. Epidermal growth factor receptor (EGFR) overexpression was significantly higher in the mature CAFs in the invasive front as compared to immature CAFs. Lymphatic invasion increased as the number of mature fibroblasts in the intratumoral stroma increased. Tumor budding was observed in almost half of both mature and immature stroma samples and occurred more frequently in infiltrating tumors. On network analysis, well-connected islands were identified that was associated with EGFR overexpression, CAF maturation, and infiltrating tumor growth patterns leading to tumor budding. CONCLUSION: The maturity of CAFs and desmoplastic reactions were associated with cancer invasion. However, the cytomorphologic characteristics of CAFs were insufficient as an independent prognostic factor for patients with CRC.
Collagen ; Colorectal Neoplasms ; Fibroblasts ; Humans ; Islands ; Receptor, Epidermal Growth Factor ; Recurrence ; Wound Healing

A 65-year-old woman was referred for management of chest pain and ST segment elevation on electrocardiography. Emergency coronary angiography revealed a well demarcated thrombus that near totally occluded the mid portion of the left anterior descending artery, with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 1, and a fusiform aneurysm on the left main coronary artery. No significant stenosis was observed after aspiration of the thrombus; however, complete coronary reperfusion by urgent aspiration did not improve her dyspnea and tachypnea. Echocardiography revealed a D-shaped left ventricle; thus, we performed a chest computed tomography scan and diagnosed a pulmonary embolism. The patient's coagulation studies were normal. She was prescribed chronic anticoagulation, and we carried out transthoracic echocardiography using second harmonic imaging with agitated saline. Second harmonic imaging with the Valsalva maneuver revealed no right-to-left shunt. We report here a case of concurrent coronary embolism and pulmonary embolism without right-to-left shunt.
Aged ; Aneurysm ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Aneurysm ; Coronary Angiography ; Coronary Vessels ; Dihydroergotamine ; Dyspnea ; Echocardiography ; Electrocardiography ; Embolism ; Emergencies ; Female ; Humans ; Myocardial Infarction ; Myocardial Reperfusion ; Pulmonary Embolism ; Tachypnea ; Thorax ; Thromboembolism ; Thrombosis ; Valsalva Maneuver

Myocardial involvement with clinical symptoms is a rare manifestation of systemic lupus erythematosus (SLE), despite the relatively high prevalence of myocarditis at autopsies of SLE patients. In this review, we report the case of a 19-year-old male SLE patient who initially presented with myopericarditis and was successfully treated with high dose of glucocorticoids.
Autopsy ; Glucocorticoids ; Humans ; Lupus Erythematosus, Systemic ; Male ; Myocarditis ; Pericarditis ; Prevalence ; Young Adult

OBJECTIVE: Any joint disorders can present as monoarthritis initially, which makes the range of differential diagnosis of monoarthritis extensive. Synovial biopsy may play a role in the diagnosis of monoarthritis. We reviewed the synovial biopsy findings of monoarthritis patients in order to assess its diagnostic value. METHODS: Synovial pathologic findings of 39 patients who visited the rheumatology or orthopedic surgery clinic for acute or chronic monoarthritis from Feb., 2006 to Jul., 2010 were reviewed retrospectively. RESULT: Four (10.3%) of 39 patients could be diagnosed with specific arthritis after synovial biopsy (rheumatoid arthritis, tuberculous arthritis, giant cell tumor, and osteochondroma, each). CONCLUSION: The result showed that the synovial biopsy is useful for differential diagnosis of monoarthritis in a limited number of cases.
Arthritis ; Biopsy ; Diagnosis, Differential ; Giant Cell Tumors ; Humans ; Joints ; Orthopedics ; Osteochondroma ; Rheumatology ; Synovial Membrane

Background/Aims: Papillary gastric cancer (GC) is classified as differentiated adenocarcinoma, together with well-differentiated (WD) and moderately differentiated (MD) adenocarcinoma. This study evaluated the risk of lymph node metastasis (LNM) in submucosal (SM) invasive papillary GC compared with other differentiated early GC types. Methods: This retrospective study involved three tertiary hospitals and enrolled 1,798 lesions with differentiated SM invasive GC treated with curative gastrectomy between March 2001 and December 2012. All pathology slides were reviewed, and clinicopathologic findings associated with LNM, including tumor size, location, gross type, ulceration, depth and width of SM invasion, and lymphovascular invasion (LVI), were analyzed. Results: The proportion of SM papillary GC was 2.8% (n=51). SM papillary GC was associated with larger tumor size and deeper and wider SM invasion than other differentiated GC types.LNM was significantly higher in the papillary type than in the MD and WD types. LNM was found in 27.5% of SM papillary GC patients (WD: 9.0%, MD: 21.2%). LVI was the only significant risk factor for LNM in SM papillary GC. The depth or width of SM invasion was not associated with LNM in papillary GC. Lower third location or elevated gross appearance was significantly associated with LVI. Conclusions SM papillary GC had the highest LNM rate, with features different from those of other differentiated SM invasive GCs. The treatment strategy for SM papillary GC should be carefully approached, especially for lesions located in the lower third or of the elevated gross type.

BACKGROUND AND OBJECTIVES: Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea. SUBJECTS AND METHODS: We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6+/-14.3 years and 50% of the patients were female. RESULTS: Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5+/-15.7% and 26.1% of the patients had preserved systolic function (LVEF > or =50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death. CONCLUSION: We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.
Anemia ; Angiotensin Receptor Antagonists ; Angiotensins ; Female ; Heart ; Heart Failure ; Hospitalization ; Humans ; Hyponatremia ; Korea ; Multivariate Analysis ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Registries ; Risk Factors ; Stroke Volume

BACKGROUND/AIMS: This study compared the prognostic values of the Model for End-stage Liver Disease (MELD) and the hepatic venous pressure gradient (HVPG) in the prediction of death within 3 and 12 months in patients with decompensated liver cirrhosis. METHODS: We used data from 136 consecutive patients with decompensated cirrhosis who underwent HVPG between January 2006 and June 2008. Cox regression analysis was used to investigate the independent relationships with death of MELD and HVPG. The prognostic accuracies of MELD and HVPG were analyzed by calculating the area under the receiver operating characteristic curve (AUROC) for the occurrence of death within 3 and 12 months. RESULTS: Both MELD and HVPG were independent predictors of death [hazard ratio (HR)=1.11 and 1.12, respectively; 95% confidence interval (CI)=1.04~1.20 and 1.08-1.16]. Analysis of the AUROC demonstrated that the prognostic power did not differ between MELD and HVPG for predicting the 3-month survival (HR=0.76 and 0.68, respectively; 95% CI=0.62~0.89 and 0.52~0.84; P=0.22) or the 12-month survival (HR=0.72 and 0.73, 95% CI=0.61~0.83 and CI=0.61~0.84). CONCLUSIONS: Both MELD and HVPG are independent prognostic factors of death within 3 and 12 months in patients with decompensated liver cirrhosis, and their accuracies are similar. However, HVPG has a limited role in the prediction of death in decompensated cirrhosis due to its invasiveness and limited use.
Adult ; Aged ; Area Under Curve ; Cohort Studies ; Female ; Hepatic Veins/*physiopathology ; Humans ; Liver Cirrhosis/diagnosis/*mortality/physiopathology ; Liver Failure/diagnosis/*mortality/physiopathology ; Male ; Middle Aged ; Models, Biological ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Regression Analysis ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Venous Pressure

Paraplegia secondary to spinal cord infarction is a recognized complication of open thoracic and thoracoabdominal aortic aneurysm (TAA) repair. TAA is serious and unpredictable condition. Therefore, aortic repair requires thorough information on managing the potential complications will facilitate improve control the problem. We report the symptoms and management of paraplegia in a patient who underwent stent insertion as TAA.
Aortic Aneurysm, Abdominal ; Aortic Aneurysm, Thoracic ; Humans ; Infarction ; Paraplegia ; Spinal Cord ; Spinal Cord Ischemia ; Stents