We report here on a case of a recurrent left anterior neck infection and focal left suppurative thyroiditis that were associated with a congenital pyriform sinus fistula (PSF) in an 18-year-old male. Acute suppurative thyroidits is a very rare clinical condition and it is usually caused by infection that's derived from infected perithyroidal tissue or a congenital internal fistula. The PSF can lead to recurrent episodes of neck inflammation and abscess, and it is the most common cause of acute suppurative thyroiditis in young man. In this current case, the CT scan showed an air-containing tract of a PSF from the left pyriform sinus to the left thyroid gland and the perithyroidal soft tissue. The CT scan also showed a neck inflammatory infiltration or abscess along the course of the sinus tract. The focal low density of the thyroid parenchyma was seen and this was suggestive of suppurative thyroiditis. Barium esophagography demonstrated the fistulous tract in the PSF. We performed laryngoscopy, and the internal opening of the pyriform sinus fistula was successfully cauterized with AgNO3 and the post procedure course was fair. When an air-containing tract and a recurrent inflammatory infiltration or abscess are present at the left anterior neck with including the thyroid and perithyroidal soft tissue, a PSF should be strongly suspected.
Abscess ; Adolescent ; Barium ; Fistula* ; Humans ; Inflammation ; Laryngoscopy ; Male ; Neck ; Pyriform Sinus* ; Soft Tissue Infections* ; Thyroid Gland* ; Thyroiditis ; Thyroiditis, Suppurative ; Tomography, X-Ray Computed

Splenic injury during colonoscopy is a rare, but potentially life-threatening complication. We report here on the case of a 75-year-old female patient with a ruptured spleen after screening colonoscopy and we review the relevant literature.
Aged ; Colonoscopy ; Female ; Humans ; Mass Screening ; Spleen ; Splenic Rupture

BACKGROUND: To evaluate the accuracy of a portable hemoglobin photometer, the HemoCue, during surgery, hemoglobin concentrations (Hb) of HemoCue were compared with those of the SYSMEX XE-2100, in the situation of bleeding. METHODS: Hemoglobin concentrations were measured with HemoCue and by the SYSMEX XE-2100 at the same time, on 100 blood samples obtained from patients who were bleeding more than 500 ml, during surgery. The limits of agreement between the two methods were calculated from the results according to the method of Bland & Altman. The results of HemoCue were adjusted by adding the mean bias, defining the corrected values, and reevaluated the agreement with the results of the SYSMEX XE-2100. RESULTS: The differences in results between the two methods were 1.12 +/- 0.37 g/dl. The limits of agreement were 0.38-1.86 g/dl, which means disagreement between the two methods. However, the corrected values represented agreement with the values of the SYSMEX XE-2100. The limits of agreement were -0.74-0.74 g/dl. CONCLUSIONS: The corrected Hb values of HemoCue were comparable to the values of SYSMEX XE-2100. It is useful to evaluate the hemoglobin concentration using HemoCue intraoperatively.
Anemia ; Bias (Epidemiology) ; Hemoglobins ; Hemorrhage ; Humans

PURPOSE: The purpose of this study is to evaluate anal sphincter preservation rates, survival rates, and prognostic factors in patients with rectal cancer treated with preoperative chemoradiotherapy. MATERIALS AND METHODS: One hundred fifty patients with pathologic confirmed rectal cancer and treated by preoperative chemoradiotherapy between January 1999 and June 2007. Of the 150 patients, the 82 who completed the scheduled chemoradiotherapy, received definitive surgery at our hospital, and did not have distant metastasis upon initial diagnosis were enrolled in this study. The radiation dose delivered to the whole pelvis ranged from 41.4 to 46.0 Gy (median 44.0 Gy) using daily fractions of 1.8~2.0 Gy at 5 days per week and a boost dose to the primary tumor and high risk area up to a total of 43.2~54 Gy (median 50.4 Gy). Sixty patients (80.5%) received 5-fluorouracil, leucovorin, and cisplatin, while 16 patients (19.5%) were administered 5-fluorouracil and leucovorin every 4 weeks concurrently during radiotherapy. Surgery was performed for 3 to 45 weeks (median 7 weeks) after completion of chemoradiotherapy. RESULTS: The sphincter preservation rates for all patients were 73.2% (60/82). Of the 48 patients whose tumor was located at less than 5 cm away from the anal verge, 31 (64.6%) underwent sphincter-saving surgery. Moreover, of the 34 patients whose tumor was located at greater than or equal to 5 cm away from the anal verge, 29 (85.3%) were able to preserve their anal sphincter. A pathologic complete response was achieved in 14.6% (12/82) of all patients. The downstaging rates were 42.7% (35/82) for the T stage, 75.5% (37/49) for the N stage, and 67.1% (55/82) for the overall stages. The median follow-up period was 38 months (range 11~107 months). The overall 5-year survival, disease-free survival, and locoregional control rates were 67.4%, 58.9% and 84.4%, respectively. The 5-year overall survival rates based on the pathologic stage were 100% for stage 0 (n=12), 59.1% for stage I (n=16), 78.6% for stage II (n=30), 36.9% for stage III (n=23), and one patient with pathologic stage IV was alive for 43 months (p=0.02). The 5-year disease-free survival rates were 77.8% for stage 0, 63.6% for stage I, 58.9% for stage II, 51.1% for stage III, and 0% for stage IV (p<0.001). The 5-year locoregional control rates were 88.9% for stage 0, 93.8% for stage I, 91.1% for stage II, 68.2% for stage III, and one patient with pathologic stage IV was alive without local recurrence (p=0.01). The results of a multivariate analysis with age (< or =55 vs. >55), clinical stage (I+II vs. III), radiotherapy to surgery interval (< or =6 weeks vs. >6 weeks), operation type (sphincter preservation vs. no preservation), pathologic T stage, pathologic N stage, pathologic overall stage (0 vs. I+II vs. III+IV), and pathologic response (complete vs. non-CR), only age and pathologic N stage were significant predictors of overall survival, pathologic overall stage for disease-free survival, and pathologic N stage for locoregional control rates, respectively. Recurrence was observed in 25 patients (local recurrence in 10 patients, distant metastasis in 13 patients, and both in 2 patients). Acute hematologic toxicity (> or =grade 3) during chemoradiotherapy was observed in 2 patients, while skin toxicity was observed in 1 patient. Complications developing within 60 days after surgery and required admission or surgical intervention, were observed in 11 patients: anastomotic leakage in 5 patients, pelvic abscess in 2 patients, and others in 4 patients. CONCLUSION: Preoperative chemoradiotherapy was an effective modality to achieve downstaging and sphincter preservation in rectal cancer cases with a relatively low toxicity. Pathologic N stage was a statistically significant prognostic factor for survival and locoregional control and so, more intensified postoperative adjuvant chemotherapy should be considered in these patients.
Chemoradiotherapy ; Neoplasm Metastasis ; Rectal Neoplasms

The web of the common bile duct is an extremely rare condition and is attributed to obstructive jaundice. Most cases have been found incidentally during a surgical procedure, since no specific preoperative clinical manifestations exist. Typically, the web of the biliary tree appears as a slit- or shelf-like radiolucent narrowing on a cholangiography. We experienced a case of the web of the common bile duct with obstructive jaundice in a 62 year- old female who complained of right upper quadrant pain. The patient was diagnosed via an endoscopic retrograde cholangiopancreaticography, and treated by way of a cholecystectomy, membranectomy and T-tube insertion. Four months after the surgical procedure, the patient had a recurrence of the web-like structure in the common bile duct and was subsequently treated successfully using a retrievable covered metallic stent insertion.
Biliary Tract ; Cholangiography ; Cholecystectomy ; Common Bile Duct ; Female ; Humans ; Jaundice, Obstructive ; Recurrence ; Stents

Gastric lymphoepithelioma-like carcinoma (LELC) is a rare neoplasm of the stomach that features undifferentiated carcinoma mixed with lymphoid stroma, and it invariably has a good prognosis. Most gastric LELCs have been linked to Epstein-Barr virus (EBV) infection. We experienced a case of a patient with gastric LELC. A 57 years old female patient was found to have shallow irregular ulcerative lesion on the gastric antrum. Although repetitive endoscopic biopsy didn't yield any cancer, early gastric cancer (EGC) was strongly suspected. Endoscopic submucosal dissection (ESD) was performed for establishing the correct diagnosis and curatively resecting the lesion. The pathology revealed gastric LELC with vertical invasion to the submucosa. No remnant cancer and no lymph node metastasis were noted after surgery following ESD. Here, we are reporting on a case of gastric ELEC along with reviewing the relevant literature. We believe this is the first case of gastric ELEC that was successfully diagnosed and managed by ESD.
Biopsy ; Carcinoma ; Female ; Herpesvirus 4, Human ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Pyloric Antrum ; Stomach ; Stomach Neoplasms ; Ulcer

Uterus didelphys with unilateral obstructed hemivagina is indeed a very rare congenital anomaly. Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis usually presents after menarche with progressive abdominal pain during menses secondary to hematocolpos. The method of choice for diagnosis is magnetic resonance imaging (MRI). MRI can do much for the early diagnosis and the prevention against further complications of this condition because it can demonstrate the mullerian duct anomaly complicated with obstructed hemivagina in detail and even ipsilateral renal agenesis. A greater awareness of the syndrome of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis should lead to its prompt diagnosis, allowing for early and appropriate surgical intervention as well as decreased long-term morbidity. Early accurate diagnosis after menarche followed by excision and marsupialization of the blind hemivagina offers complete relief of symptoms and preserves reproductive potential. We report a case of uterine didelphys with obstructed hemivagina and ipsilateral renal agensis with a brief review of the literature.
Abdominal Pain ; Diagnosis ; Early Diagnosis ; Female ; Hematocolpos ; Magnetic Resonance Imaging* ; Menarche ; Uterus*

PURPOSE: The aim of this study was to investigate the prognostic significance of the expression of p53 gene product in operable invasive breast cancer by performing immunohistochemical analysis. MATERIALS AND METHODS: Between January 1993 and December 2001, 440 operable invasive breast cancer patients underwent immunohistochemical staining for p53, and we retrospectively analyzed these results together with the clinical outcomes. RESULTS: The overexpression of p53 was detected in 51.6% of the cases. The overexpression of p53 was inversely correlated with lymph node metastasis (p=0.005). The tumor size, tumor histology, histologic grade, hormonal receptor status and tumor stage were not related to the overexpression of p53. Multivariate Cox regression analysis indicate that lymph node metastasis, tumor size and the p53 expression were the significant prognostic factors for overall survival; lymph node metastasis, the estrogen receptor status and the p53 expression were the significant prognostic factors for relapse free survival. On the subgroup analysis, the p53 non-expressors showed better 7-year overall survival (92.7% vs. 76.7%, respectively, p=0.011) and relapse free survival (74.9% vs. 57.8%, respectively, p=0.032) than did the p53 overexpressors for the patients with lymph node metastasis. However, for the patients without lymph node metastasis, the survival rates were not different for both the p53 non-expressors and the p53 overexpressors. CONCLUSION: Immunohistochemical staining of the p53 gene product was an independent prognostic factor for predicting survival of the lymph node positive invasive breast cancer patients.
Breast Neoplasms* ; Breast* ; Estrogens ; Genes, p53* ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: The purpose of this study was to know whether ultrasonography is proper diagnostic tool for decision of treatment method or not, as compared the efficacy of US in allowing identifying fracture patterns of nasal bone with that of CT. MATERIALS AND METHODS: Fifty patients with nasal trauma were investigated prospectively by CT and US. According to CT and ultrasonographic findings, each case of nasal bone injury were rated as grade 1 (nasal injury but not fracture), grade 2 (simple fracture without displacement), grade 3 (unilateral simple fracture with displacement), grade 4 (bilateral simple fractures with displacement), and grade 5 (bilateral comminuted fractures with depression). Assessment for ultrasonographic method were defined as overestimations or underestimation according to whether the nasal fracture had been assigned a higher or lower grade at the review of the findings of CT. The correlation between the results of CT and ultrasonography were measured. RESULTS: In ultrasonographic estimation of grade of 50 cases of nasal bone injuries, there were correctly graded in 42 cases, overestimated in 5 cases, underestimated in 3 cases. In allowing accurate grading of nasal bone injury, images of nasal ultrasonography correlated closely with those of CT (r = 0.796). CONCLUSION: Nasal ultrasonography is a reliable method that allows appropriate grading of nasal bone injury and would be a useful first line imaging method in providing the detail necessary for proper management of patients with mild simple nasal bone injury.
Fractures, Comminuted ; Humans ; Nasal Bone ; Prospective Studies

Purpose: In patients with glufosinate poisoning, severe neurological symptoms may be closely related to a poor prognosis, but their appearance may be delayed. Therefore, this study aimed to determine whether the Acute Physiology and Chronic Health Evaluation II (APACHE II) score could predict the neurological prognosis in patients with glufosinate poisoning who present to the emergency room with alert mental status. Methods: This study was conducted retrospectively through a chart review for patients over 18 years who presented to a single emergency medical center from January 2018 to December 2022 due to glufosinate poisoning. Patients were divided into groups with a good neurological prognosis (Cerebral Performance Category [CPC] Scale 1 or 2) and a poor prognosis (CPC Scale 3, 4, or 5) to identify whether any variables showed significant differences between the two groups. Results: There were 66 patients (67.3%) with good neurological prognoses and 32 (32.8%) with poor prognoses. In the multivariate logistic analysis, the APACHE II score, serum amylase, and co-ingestion of alcohol showed significant results, with odds ratios of 1.387 (95% confidence interval [CI], 1.027–1.844), 1.017 (95% CI, 1.002–1.032), and 0.196 (95% CI, 0.040–0.948), respectively. With an APACHE II score cutoff of 6.5, the AUC was 0.826 (95% CI, 0.746–0.912). The cutoff of serum amylase was 75.5 U/L, with an AUC was 0.761 (95% CI, 0.652–0.844), and the AUC of no co-ingestion with alcohol was 0.629 (95% CI, 0.527–0.722). Conclusion The APACHE II score could be a useful indicator for predicting the neurological prognosis of patients with glufosinate poisoning who have alert mental status.