We herein describe a 70-year-old woman who presented with respiratory failure due to extensive lung adenocarcinoma. Despite advanced disease, care in the intensive care unit with ventilator support was performed because she was a newly diagnosed patient and was considered to have the potential to recover after cancer treatment. Because prompt control of the cancer was needed to treat the respiratory failure, empirical treatment with an oral epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor was initiated before confirmation of EGFR-mutant adenocarcinoma, and the patient was successfully treated. Later, EGFR-mutant adenocarcinoma was confirmed.
Adenocarcinoma* ; Aged ; Female ; Humans ; Intensive Care Units ; Lung* ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Respiration, Artificial ; Respiratory Insufficiency* ; Ventilators, Mechanical ; Erlotinib Hydrochloride

BACKGROUND: Although epidermal growth factor receptor (EGFR), v-Ki-ras2 Kirsten rat sarcoma viral oncogene (KRAS), and anaplastic lymphoma kinase (ALK) mutations in non-small cell lung cancer (NSCLC) were thought to be mutually exclusive, some tumors harbor concomitant mutations. Discovering a driver mutation on the basis of morphologic features and therapeutic responses with mutation analysis can be used to understand pathogenesis and predict resistance in targeted therapy. METHODS: In 6,637 patients with NSCLC, 12 patients who had concomitant mutations were selected and clinicopathologic features were reviewed. Clinical characteristics included sex, age, smoking history, previous treatment, and targeted therapy with response and disease-free survival. Histologic features included dominant patterns, nuclear and cytoplasmic features. RESULTS: All patients were diagnosed with adenocarcinoma and had an EGFR mutation. Six patients had concomitant KRAS mutations and the other six had KRAS mutations. Five of six EGFR-KRAS mutation patients showed papillary and acinar histologic patterns with hobnail cells. Three of six received EGFR tyrosine kinase inhibitor (TKI) and showed partial response for 7-29 months. All six EGFR-ALK mutation patients showed solid or cribriform patterns and three had signet ring cells. Five of six EGFR-ALK mutation patients received EGFR TKI and/or ALK inhibitor and four showed partial response or stable disease, except for one patient who had acquired an EGFR mutation. CONCLUSIONS: EGFR and ALK mutations play an important role as driver mutations in double mutated NSCLC, and morphologic analysis can be used to predict treatment response.
Adenocarcinoma ; Animals ; Carcinoma, Non-Small-Cell Lung* ; Cytoplasm ; Disease-Free Survival ; Humans ; Lymphoma ; Oncogenes ; Phosphotransferases ; Protein-Tyrosine Kinases ; Rats ; Receptor, Epidermal Growth Factor ; Sarcoma ; Smoke ; Smoking

Bezoars are conglomerates of nondigestible matter in the gastrointestinal tract that may or may not be accompanied by gastrointestinal manifestations. Bezoars develop in patients with previous gastric surgery or in those patients with delayed gastric emptying that is due to gastroparesis caused by hypothyroidism or diabetes mellitus. Small bowel obstruction due to a gastric bezoar is rare, but it can lead to severe complications such as intestinal perforation, compression necrosis etc. A female patient came to our department complaining of upper abdominal pain and she was diagnosed as having a bezoar that was causing afferent loop syndrome and pancreatitis. We attempted to manage the patient by inserting a nasogastric tube, performing gastrofibroscopy and implementing percutaneous transhepatic biliary drainage, but the patient's condition worsened and deteriorated into a septic condition. An operation was planned, but the patient showed improvement owing to the migration of the bezoar. Herein, we report on a case of afferent loop syndrome due to bezoar and this was complicated by acute pancreatitis.
Abdominal Pain ; Afferent Loop Syndrome ; Bezoars ; Diabetes Mellitus ; Drainage ; Female ; Gastric Emptying ; Gastrointestinal Tract ; Gastroparesis ; Humans ; Hypothyroidism ; Intestinal Perforation ; Necrosis ; Pancreatitis ; Porphyrins

Undifferentiated sarcoma is one of the rare primary malignant tumor of the liver typically occur ring in later childhood. It has also been referred to embryonal sarcoma or malignant mesenchymoma. In Korea, three child and two adult cases have been reported to date in liter ature. We experienced a case of undifferentiated sarcoma in a 65- year- old female who presented with abdominal pain and right upper quadrant mass . Contrast-enhanced abdominal CT scan revealed a well demarcated mass with low at tenuation and sept ation at left lobe of the liver and the mass showed hypovas cular pattern on hepatic angiography. On cross section, the tumor was well demarcated from the adjacent liver by afibr ouspseudocapsule and showed cystic degener ation. Pathologically, the tumor was consistent with an undifferentiated sarcoma of the liver.
Abdominal Pain ; Adult* ; Angiography ; Child ; Female ; Humans ; Korea ; Liver* ; Mesenchymoma ; Sarcoma* ; Tomography, X-Ray Computed

ABSTRACT: Apoptosis of osteosarcoma cells induced by bile duct derivates, HS-1200 was investigated with relation to mitochodria. HS-1200 induced cytochrome c and Smac/DIABLO release from mitochondria which are major factors related to apoptosis. In these apoptosis processes, release of cytochrome c was not blocked by caspase inhibitor, but release of Smac/DIABLO was blocked. BKA, a kind of PTP (permeablity transition pore) inhibitor, did not block both of them. Interestingly, the alteration of MMP was not observed by means of using JC-1 dye. Although MitoTracker, DiOC-6 and Rhodamine123 were used to confirm previous results, the decrease of MMP was not observed. In order to investigate whether this phenomenon is apoptosis-specific or cell-specific process, genistein was added to cells which usually decreased MMP. After adding genistein, MMP was not decreased, suggesting this phenomenon is cell-specific process. Conclusionally, HS-1200 induced apoptosis of osteosarcoma cells via mitochondria, cytochrome c and Smac/DIABLO were released from mitochondria without decrease of MMP. The release of Smac/DIABLO was dependent of caspase.
Apoptosis* ; Bile Ducts ; Bile* ; Cytochromes c ; Genistein ; Humans* ; Mitochondria ; Osteosarcoma*

OBJECTIVES: This study aimed to investigate the 10-year risk of cardiovascular disease (CVD) by Framingham risk score (FRS) who classified as "healthy group" by Korean Occupational Safety and Health Agent (KOSHA)' s cardiovascular risk assessment. METHODS: The subjects of this study were 1,781 male workers in a large steel company. Health status was obtained periodically through medical examinations and questionnaires. We assessed cardiovascular risk using KOSHA guidelines and calculated the 10-year risk of cardiovascular disease using the Framingham risk score for those categorized to the "healthy group" by KOSHA guideline. A closer examination of cardiovascular risk factors was performed in 62 subjects paradoxically placed in the "healthy group" by KOSHA guidelines and the "high-risk group" by FRS. RESULTS: Among the "healthy group" by KOSHA's cardiovascular risk assessment, 230(15.8%) subjects had more than 3 CVD risk factors and 62(4.2%) subjects were high risk group (more than 20%) in 10-years risk of CVD by Framingham risk score. Modifiable risk factors included cigarette smoking (96.8%), high serum total cholesterol (82.3%), high serum triglyceride (66.1%), insufficient physical activity (66.1%), and obesity (58.1%). CONCLUSIONS: Among subjects with normal blood pressure, it seems that KOSHA guidelines underestimate CVD risk, identified by the Framingham risk score. For the effective prevention and management of CVD, modifiable risk factors, such as cigarette smoking, dyslipidemia, and obesity, need to be constructively controlled.
Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Dyslipidemias ; Humans ; Male ; Motor Activity ; Obesity ; Occupational Health ; Questionnaires ; Risk Assessment ; Risk Factors ; Smoking ; Steel

Cap polyposis is a rare disorder with characteristic endoscopic and histological features; its etiology is still unknown, and no specific treatment has been established. We report a case of cap polyposis that improved remarkably after infliximab infusion and had no recurrence for 3 years.
Antibodies, Monoclonal ; Recurrence ; Infliximab

A 17-year old female presented with a chief complaint of melena and epigastric pain. She had a family history of colon cancer, her mother having been diagnosed with hereditary nonpolyposis colorectal carcinoma (HNPCC). After close examination including double-balloon enteroscopy, the patient was diagnosed with small bowel carcinoma, in spite of her young age. Here we report this rare case of small bowel carcinoma in a young patient with a family history of HNPCC.
Adenocarcinoma/*diagnosis/pathology/surgery ; Adolescent ; Double-Balloon Enteroscopy ; Female ; Humans ; Jejunal Neoplasms/*diagnosis/pathology/surgery ; Positron-Emission Tomography ; Tomography, X-Ray Computed

BACKGROUND: Enquiry into smoking status and recommendations for smoking cessation is an essential preventive service. However, there are few studies comparing self-reported (SR) and cotinine-verified (CV) smoking statuses, using medical check-up data. The rates of discrepancy and under-reporting are unknown. METHODS: We performed a cross-sectional study using health examination data from Healthcare System Gangnam Center, Seoul National University Hospital in 2013. We analyzed SR and CV smoking statuses and discrepancies between the two in relation to sociodemographic variables. We also attempted to ascertain the factors associated with a discrepant smoking status among current smokers. RESULTS: In the sample of 3,477 men, CV smoking rate was 11.1% higher than the SR rate. About 1 in 3 participants either omitted the smoking questionnaire or gave a false reply. The ratio of CV to SR smoking rates was 1.49 (95% confidence interval [CI], 1.38-1.61). After adjusting for confounding factors, older adults (≥60 years) showed an increased adjusted odds ratio (aOR) for discrepancy between SR and CV when compared to those in their twenties and thirties (aOR, 5.43; 95% CI, 2.69-10.96). Educational levels of high school graduation or lower (aOR, 2.33; 95% CI, 1.36-4.01), repeated health check-ups (aOR, 1.45; 95% CI, 1.03-2.06), and low cotinine levels of <500 ng/mL (aOR, 2.03; 95% CI, 1.33-3.09), were also associated with discordance between SR and CV smoking status. CONCLUSION: Omissions and false responses impede the accurate assessment of smoking status in health check-up participants. In order to improve accuracy, it is suggested that researcher pay attention to participants with greater discrepancy between SR and CV smoking status, and formulate interventions to improve response rates.
Adult* ; Cotinine ; Cross-Sectional Studies ; Delivery of Health Care ; Hospitals, Private* ; Humans ; Male* ; Mass Screening ; Odds Ratio ; Self Report ; Seoul ; Smoke* ; Smoking Cessation ; Smoking* ; Surveys and Questionnaires

Primary small cell carcinoma occasionally occurs in the gastrointestinal tract; however, primary small cell carcinoma is extremely rare in common bile duct (CBD). Moreover, synchronous advanced gastric cancer has not been reported in the medical literature. We herein report on a case of synchronous primary cancer in the CBD and stomach. A 51-year-old male was admitted because of painless jaundice. Abdominal CT and ERCP showed an exophytic mass that obscured the mid-CBD and there was also intrahepatic duct dilatation. In addition, a large ulcerofungating mass was seen at the lesser curvature of the mid-body on gastrofiberscopy. The biopsy specimen obtained from ulcer was confirmed to be poorly differentiated adenocarcinoma. Explorative laparotomy was performed to remove CBD mass and gastrectomy, however, the surgery was stopped after just biopsy because of the invasion of tumor to the portal vein and difficulty in diseection. Small cell carcinoma was diagnosed from the surgical biopsy specimen by immunohistochemical stains. The tumor cells were strongly positive for neuroendocrine markers such as CD56 and synaptophysin. The patient received chemotherapy with irinotecan and cisplatin.
Adenocarcinoma ; Biopsy ; Camptothecin ; Carcinoma, Small Cell ; Cholangiopancreatography, Endoscopic Retrograde ; Coloring Agents ; Common Bile Duct ; Dilatation ; Gastrectomy ; Humans ; Jaundice ; Laparotomy ; Male ; Middle Aged ; Portal Vein ; Stomach ; Stomach Neoplasms ; Synaptophysin ; Ulcer