Background: Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. Methods: Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). Results: On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. Conclusions Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.

OBJECTIVES: Significant benefit of intravenous ferric carboxymaltose (FCM) for restless legs syndrome (RLS) has been demonstrated. However, clinical indicators to expect treatment response of RLS are not clarified. The aim of this study is to find out determinant factors to predict treatment outcome of FCM. METHODS: We enrolled consecutive 108 patients with RLS who visited sleep clinic and received FCM from April 2016 to November 2017. Obtained data were detailed history including international restless legs scale (IRLS) and questionnaires, comorbid diseases, medication. Complete blood cell count, serum iron, ferritin, and total iron-binding capacity were sampled before and after treatment. Treatment response was assessed about four weeks after FCM administration. Patients with more than 40% decrease on IRLS were classified into the responders. RESULTS: 99 patients (mean 54.5 y and 79 females) were included. 58 patients (58.6%) were classified to be responders. There were substantial differences in post-treatment IRLS and symptom reduction rate between responders (7.4±6.4, 77.5±18.6%) and non-responders (29.7±8.7, 7.4±10.3%). No significant differences were found in demographics, baseline IRLS, sleep, and mood status between two groups. Serum ferritin and transferrin saturation was significantly lower in responders (37.6 ng/mL, 25.0%) than non-responders (55.1 ng/mL, p=0.014 and 36.5%, p=0.001). Patients with a history of gastrectomy (n=8) showed an excellent response to FCM (83.8% of symptom reduction). Comorbid lumbosacral radiculopathy had lower response rate (29.4%). CONCLUSIONS: Peripheral iron compromised state and gastrectomy history may indicate good response to intravenous FCM in patients with RLS. Patients with lumbosacral radiculopathy tend to be poor responders to intravenous FCM.
Blood Cell Count ; Demography ; Ferritins ; Gastrectomy ; Humans ; Iron ; Radiculopathy ; Restless Legs Syndrome ; Transferrin ; Treatment Outcome

Nontuberculous mycobacteria (NTM) have been increasingly recognized as an important cause of chronic pulmonary infections. The Mycobacterium avium complex (MAC), which is composed of two species, Mycobacterium avium and Mycobacterium intracelluare, is the most commonly encountered pathogen associated with NTM lung disease. MAC pulmonary infection typically presents in a fibrocavitary form or a nodular bronchiectatic form. However, there have been atypical presentations of MAC pulmonary infections, including solitary pulmonary nodules (SPN). There have been several previous reports of SPN due to MAC infection in the United States, Japan, and Korea. In 2009, Sekine and colleagues reported a case of MAC pulmonary infection presenting with multiple nodules. To date, however, there have been no cases of NTM lung infection with multiple cavitary pulmonary nodules, and neither a fibrotic change nor nodular bronchiectasis. The present case showed a multiple cavitating nodular lung infection due to MAC, which is very rare and different from the typical presentation of MAC pulmonary infections. We also showed that percutaneous transthoracic needle aspiration can be a useful diagnostic tool to evaluate a case of multiple cavitary nodules.
Bronchiectasis ; Japan ; Korea ; Lung ; Lung Diseases ; Mycobacterium avium ; Mycobacterium avium Complex* ; Mycobacterium* ; Needles ; Nontuberculous Mycobacteria ; Solitary Pulmonary Nodule ; United States

BACKGROUND: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015. MATERIALS AND METHODS: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay. RESULTS: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death. CONCLUSION: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.
Antiviral Agents ; Aspartate Aminotransferases ; Coronavirus Infections* ; Disease Outbreaks ; Dyspnea ; Extracorporeal Membrane Oxygenation ; Fever ; Humans ; Hypotension ; Leukocytosis ; Leukopenia ; Lung Diseases ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Mortality ; Pneumonia ; Polymerase Chain Reaction ; Republic of Korea* ; Respiration, Artificial ; Thrombocytopenia

Background: DNA prevalence and type distribution of human papillomavirus (HPV) varies geographically. We investigated HPV prevalence and type distribution in Korean women using the MyHPV DNA chip testing. Methods: A total of 2,368 women from five regions of the country underwent Pap smear examination and MyHPV chip testing. Results: Overall HPV positivity was 15.8% and 78.4% in women with normal and abnormal cytology, respectively. High-risk HPV infection was strongly correlated with cytological atypia. In women with abnormal cytology, the five most common HPV types were 16, 58, 18, 52, and 56/53, and HPV16 was significantly the most common type in most geographical regions. After HPV16, HPV58, and 52 were the next most frequently detected types. Women with normal cytology, in contrast, showed heterogeneity in HPV type distribution. High-grade intraepithelial lesions infected with HPV16, 18, 31 or 45 are more likely to progress to carcinoma. Conclusions: The HPV chip test can provide useful data regarding HPV positivity and type. The most common HPV type in Korean women with abnormal cytology is HPV16, with HPV58 and 52 being frequently present. Our data may have important implications for vaccination programs and the development of cervical screening.
Cervix Uteri ; DNA ; Female ; Genotype ; Humans ; Mass Screening ; Oligonucleotide Array Sequence Analysis ; Population Characteristics ; Prevalence ; Republic of Korea ; Vaccination ; Vaginal Smears

We present a case of recurrent follicular lymphoma with an extensive plasma cell component involving infra-auricular lymph nodes in a 64 year-old woman. Immunohistochemical staining showed a strongly positive reaction of the follicles with CD20, bcl-2, bcl-6, CD10 and CD21 on the first biopsy specimen. The intrafollicular and interfollicular plasma cells showed monoclonality for IgG heavy chain and lambda light chain. The histological and immunohistochemical findings in the recurrent tumor were identical with those of the original. Discussion is focused on the importance of the differential diagnosis between reactive lymphoid hyperplasia and other lymphomas having plasmacytic differentiation.
Biopsy ; Diagnosis, Differential ; Female ; Granuloma, Plasma Cell ; Humans ; Immunoglobulin G ; Lymph Nodes ; Lymphoma ; Lymphoma, Follicular* ; Middle Aged ; Plasma Cells* ; Plasma* ; Pseudolymphoma ; Stomach

Continuous renal replacement therapy (CRRT) has been used increasingly for the management of renal failure in hemodynamically unstable and critically ill patients. CRRT requires anticoagulation, usually with heparin, to prevent clotting in the extracorporeal circuit. Systemic heparinization is associated with a high rate of bleeding when used during CRRT in critically ill patients. We applied regional citrate anticoagulation for CRRT to two critically ill patients with high bleeding risk using calcium containing commercial solutions. We conclude that regional citrate anticoagulation with commercial calcium containing solution can be used alternative to heparin for CRRT in patients with high bleeding risk.
Calcium ; Citric Acid* ; Critical Illness ; Hemodiafiltration* ; Hemorrhage ; Heparin ; Humans ; Renal Insufficiency ; Renal Replacement Therapy

BACKGROUND: This study was to evaluate a nationwide nosocomial infection rate and antimicrobial resistance in intensive care units(ICUs) in Korea. METHODS: The study was carried out at 16 university-affiliated teaching hospitals from July through October 2004. We performed a prospective multicenter study to investigate nosocomial infection rates, device-associated infection rated, and causative pathogens and their antimicrobial resistance. RESULTS: The urinary tract was the most commonly involved site. Nosocomial infection rate was 12.48 in medical. ICU (MICU), 9.59 in medical surgical ICU (MSICU), 14.76 in surgical ICU (MSICU), and 11.60 in other lCU. Device-associated infection rates were as follow: 1) rates of urinary catheter-associated urinary tract infection were 4.26 in MICU, 3.17 in SICU, 4.88 in MSICU, and 5.87 in other ICU; 2) rates of central line-associated bloodstream infection were 3.24 in MICU, 1.56 in SlCU, 2.36 in MSICU, and 1.78 in other ICU; 3) rates of ventilator-associated pneumonia were 3.61 in MlCU, 13.05 in SICU, 1.68 in MSICU, and 4.84 in other lCU. Staphylococcus aureus was the most frequently identified microorganism in this study; 93% of S. aurues were resistant to methicillin; 17% of Pseudomonas aeruginosa isolated were resistant to imipenem; 11% of Enterococcus faecium and 18% of Enterococcus faecalis showed resistance to vancomycin. Over a half of Acinetobacter spp, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Escherichia coli showed resistant to fluoroquinolone. Conclusion: This study shows the seriousness of antimicrobial resistance and the importance of infection control in the lCU in Korea. This study should provide a theoretical strategy to enforce the infection control.
Acinetobacter ; Cross Infection* ; Enterococcus faecalis ; Enterococcus faecium ; Escherichia coli ; Hospitals, Teaching ; Hospitals, University* ; Imipenem ; Infection Control ; Intensive Care Units* ; Critical Care* ; Klebsiella pneumoniae ; Korea* ; Methicillin ; Pneumonia, Ventilator-Associated ; Prospective Studies ; Pseudomonas aeruginosa ; Staphylococcus aureus ; Stenotrophomonas maltophilia ; Urinary Tract ; Urinary Tract Infections ; Vancomycin

PURPOSE: This study is directed to evaluate standardized developmental test performances of infants and children who, as fetuses, had mild isolated cerebral ventriculomegaly diagnosed by ultrasound. METHODS: All prenatal sonographic findings from 2001 to 2002 were evaluated. Live isolated mild ventriculomegaly (IMVM) of 10-15 mm were observed in 95 cases (1.1 percent). Standardized developmental testing of 40 cases of IMVM and 36 cases in a comparison group were offered to parents Both groups of children were adjusted to normal antepatum subjects with respect to sex, race, indication for ultrasound and gestational age at the time of ultrasound. Test of cognitive and motor development (Bayley Scales of Infant Development, Second Edition; BSID-II) were administered by developmental examiners. RESULTS: Forty cases and 34 comparison sujects completed the testing. The IMVM and comparison groups were similar with respect to parental age, gestational age, birth weight, familial socioeconomic status. The IMVM subjects scored lower than the comparison group on both the BSID-II, but there was not statistically significant. differences; metal development index (MDI) (92.7+/-12.9 vs 94.7+/-14.1, P=0.47) and psychomotor development index (PDI) (100.3+/-14.1 vs 101.3+/-10.7, P=0.75). Eleven cases (27.5 percent) of IMVM group and five cases (14.7 percent) of the comparison group were developmentally delayed, but most cases in both groups showed mild delays. Resolution or lack of progression, lateral ventricle diameter < or= 12 mm and females were associated with better scores, but there were not statistically significant. Polarity, and head circumference were not related to later development. CONCLUSION: This study show children with MIVM did not delay performance in the developmental test, but we might suggest a tendency to increase the risk of mild developmental delay.
Birth Weight ; Child ; Child Development ; Continental Population Groups ; Female ; Fetus ; Gestational Age ; Head ; Humans ; Hydrocephalus ; Infant ; Lateral Ventricles ; Parents ; Social Class ; Ultrasonography ; Weights and Measures

BACKGROUND: Patients with lymph node-negative breast cancer show a 10-year recurrence rate of approximately 20%. In node-negative breast cancer, the prognostic factors are age, menopause, tumor size, hormone receptors, p53, DNA ploidy, Ki-67 index (Ki-67) and c-erbB2. Of these, ErbB2 (the protein of the c-erbB2 gene) is a member of the receptor tyrosine kinase family. Overexpression of ErbB2 is known to regulate cell proliferation, differentiation, growth and apoptosis via the ErbB2/Phosphoinositol 3-Kinase (PI 3-K)/Akt signaling pathway. Therefore, it is important to identify high- risk patients that would benefit from adjuvant therapies related with ErB2. For this purpose, the prognostic relevance of the ErbB2/PI 3-K/Akt pathway was examined in node-negative breast cancer. METHODS: A retrospective analysis was performed on the hospital records of all 72 patients diagnosed with breast cancer, and who underwent surgical treatment between January 1996 and December 2003. Clinicopathological data were compared with the results of immunohistochemical staining using the phospho-specific antibody for the expression of Akt. RESULTS: The mean age of the patient's was 48.6 years. Phospho-Akt (pAkt) was expressed in 24 cases (33.3%), but there was no statistical relationship between pAkt expression and the known prognostic factors of breast cancer. There was no statistical significance in the survival rates between the pAkt positive and negative expression groups (P=0.123). In the ErbB2 positive patients, the expression of pAkt was associated with a shorter disease-free survival (P=0.045), and the disease-free survival was shorter in patients whose tumors expressed pAkt and had a high level of Ki-67 (P=0.040). CONCLUSION: The co-expression of ErbB2 and pAkt positivity implied a poor prognosis in node-negative breast cancer patients, and the co-expression of high Ki-67 and pAkt positivity also revealed a poor prognosis in these patients. These results show that the expression of pAkt could be considered a prognostic marker of node-negative breast cancer with ErbB2 positive expression and high levels of Ki-67.
Apoptosis ; Breast Neoplasms* ; Breast* ; Cell Proliferation ; Disease-Free Survival ; DNA ; Female ; Hospital Records ; Humans ; Menopause ; Ploidies ; Prognosis ; Protein-Tyrosine Kinases ; Recurrence ; Retrospective Studies ; Survival Rate