Maffuccis syndrome was first reported by Maffucci, in 1881. This syndrome is manifested by multiple enchondromas and hemangiomas, characterized by non-hereditary mesenchymal neoplasia that has a propensity for malignant transformation. Involvement of long bones, particularly the bones of the hands and feet, is most common. The most important complication of this syndrome is the high frequency of chondr osarcomatous metaplasia. We report a case of Maffuccis syndrome in a 56-year-old woman with multiple hemangioma on both the hands and forearms, left foot and enchondromas of multiple bones. The disease started at the age of 8 and was associated with deformity, but malignant transformation was not found.
Chondroma ; Congenital Abnormalities ; Enchondromatosis ; Female ; Foot ; Forearm ; Hand ; Hemangioma ; Humans ; Metaplasia ; Middle Aged

PURPOSE: Barriers to cardiopulmonary resuscitation (CPR) education are magnified by relative cost and course availability. E-learning has emerged as a viable solution for continuous, on-demand training and organizational learning. We assessed the hypothesis that E-learning is a viable strategy for CPR training of the general public and sought to evaluate its effects on CPR quality compared to traditional classroom-based methods. METHODS: The E-learning program was specifically designed to teach basic life support skills, and consisted of 50 minutes internet lectures and simulation videos. The training session was freely available to twenty two officers in rural South Korea. The trainees were able to practice with a mannequin and an automated external defibrillator (AED) trainer at their place of employment over the course of 3 days. The control group was trained at a hospital by certified instructors using the same equipment during a 2 hour period. At the end of the course, the participant's skills were evaluated using a checklist and a skill performance test. RESULTS: Forty two subjects were enrolled finally with 19 and 23 belonging to the E-learning and the control groups, respectively. One E-learning trainee was excluded because he was absent from the skills test. The mean time to learn CPR and AED techniques was 29.0+/-24.5 minutes in the elearning group. The mean age of the E-learning group was significantly older than that of the control group (32.4+/-4.0 vs. 26.0+/-1.5, p<0.001). However, we did not find any significant differences in their weight, height or CPR educational status. Before the education sessions, the willingness to perform CPR and their confidence in performing CPR were not significantly different among the two groups. Regarding skill performance, there were no significant differences between the groups except the volume of ventilation. The control group showed a higher volume of ventilation than the elearning group (1,031.7+/-521.6 vs. 548.8+/-303.3, p=0.004). CONCLUSION: E-learning accompanied with appropriate practice can be a helpful tool for public CPR training. The demand for E-learning will increase, and this study shows that e-learning programs can be successful, yielding similar results as traditional, classroom-based training.
Cardiopulmonary Resuscitation ; Checklist ; Defibrillators ; Education, Distance ; Educational Status ; Employment ; Hypogonadism ; Internet ; Learning ; Lectures ; Life Support Care ; Manikins ; Mitochondrial Diseases ; Ophthalmoplegia ; Republic of Korea ; Ventilation

PURPOSE: Barriers to cardiopulmonary resuscitation (CPR) education are magnified by relative cost and course availability. E-learning has emerged as a viable solution for continuous, on-demand training and organizational learning. We assessed the hypothesis that E-learning is a viable strategy for CPR training of the general public and sought to evaluate its effects on CPR quality compared to traditional classroom-based methods. METHODS: The E-learning program was specifically designed to teach basic life support skills, and consisted of 50 minutes internet lectures and simulation videos. The training session was freely available to twenty two officers in rural South Korea. The trainees were able to practice with a mannequin and an automated external defibrillator (AED) trainer at their place of employment over the course of 3 days. The control group was trained at a hospital by certified instructors using the same equipment during a 2 hour period. At the end of the course, the participant's skills were evaluated using a checklist and a skill performance test. RESULTS: Forty two subjects were enrolled finally with 19 and 23 belonging to the E-learning and the control groups, respectively. One E-learning trainee was excluded because he was absent from the skills test. The mean time to learn CPR and AED techniques was 29.0+/-24.5 minutes in the elearning group. The mean age of the E-learning group was significantly older than that of the control group (32.4+/-4.0 vs. 26.0+/-1.5, p<0.001). However, we did not find any significant differences in their weight, height or CPR educational status. Before the education sessions, the willingness to perform CPR and their confidence in performing CPR were not significantly different among the two groups. Regarding skill performance, there were no significant differences between the groups except the volume of ventilation. The control group showed a higher volume of ventilation than the elearning group (1,031.7+/-521.6 vs. 548.8+/-303.3, p=0.004). CONCLUSION: E-learning accompanied with appropriate practice can be a helpful tool for public CPR training. The demand for E-learning will increase, and this study shows that e-learning programs can be successful, yielding similar results as traditional, classroom-based training.
Cardiopulmonary Resuscitation ; Checklist ; Defibrillators ; Education, Distance ; Educational Status ; Employment ; Hypogonadism ; Internet ; Learning ; Lectures ; Life Support Care ; Manikins ; Mitochondrial Diseases ; Ophthalmoplegia ; Republic of Korea ; Ventilation

Botryomycosis is a rare, chronic and suppurative di- sease that is often mistaken clinically and histologically for a fungal infection, because the histologic feature shows a cluster of bacteria found within an eosinophilic matrix or capsule, giving the appearance of granules mimicking the sulfur granules of actinomycosis. Staphy- lococcus aureus is the most common organism cultured from lesions of botryomycosis, but other bacteria have also been isolated and implicated, including Psudomonas aeruginosa, E. coli, Proteus spp., Bacillus spp.. In some case, multiple pathogenic bacteria were found on cul ture. This disease has two patterns of organ involve ment. The more common type is cutaneous type, which involves the skin, subcutaneous soft tissue, muscle and bone. The other is visceral type which involves the lungs, liver, tongue, orbit, bowel, brain, kidney or pros tate. We report a case of brain and pulmonary botry omycosis in a 60 year-old man, who have early lung cancer. Botryomycosis was diagnosed by brain mass removal, PCNA and bronchoscopy, and lung cancer was detected incidentally by bronchoscope. The patient was treated with the Penicillin G after operation of brain mass, and right pneumonectomy was done.
Actinomycosis ; Bacillus ; Bacteria ; Brain ; Bronchoscopes ; Bronchoscopy ; Eosinophils ; Humans ; Kidney ; Liver ; Lung Neoplasms* ; Lung* ; Middle Aged ; Oceans and Seas ; Orbit ; Penicillin G ; Pneumonectomy ; Proliferating Cell Nuclear Antigen ; Proteus ; Skin ; Sulfur ; Tongue

Background: Cadherin-11, a cell-to-cell adhesion molecule, is associated with higher tumor grade and decreased patient survival. The purpose of this study was to investigate the clinical significance of cadherin-11 expression in the progression and prognosis of a newly diagnosed primary glioblastoma (GBL). Methods: Between 2007 and 2016, 52 out of 178 patients diagnosed with a GBL and satisfied the following criteria: 1) a new primary GBL, 2) gross-total resection, 3) immunohistochemically-available tissue, and 4) standardized adjuvant treatment. Results: In terms of staining intensity, the low-intensity cadherin-11 group showed longer progression-free survival (PFS) than the high-intensity cadherin-11 group (median PFS, 12.0 months [95% CI, 11.1-12.9] vs. median PFS, 6.0 months [95% CI, 3.7-8.3]; p<0.001). The low-intensity cadherin-11 group revealed longer overall survival (OS) than the high-intensity cadherin-11 group (median OS, 20.0 months [95% CI, 11.8-16.6] vs. median OS, 15.0 months [95% CI, 11.8-18.2]; p=0.003). The staining intensity of cadherin-11 was a statistically significant factor in PFS and OS in terms of univariate and multivariate analyses (univariate analysis: p<0.001 and p=0.005; multivariate analysis: p<0.001 and p=0.005). Conclusion Our clinical study demonstrates high cadherin-11 expression may be associated with poor PFS and OS for a newly diagnosed primary GBL.

Background/Aims: Early studies on direct oral anticoagulants (DOACs) reported a higher risk of gastrointestinal bleeding (GIB) compared with warfarin; however, recent studies have reported a reduced risk. Therefore, this study was designed to evaluate the risk of GIB in users of DOAC and warfarin. Methods: Using a common data model, we investigated the comparative risk of GIB in subjects from eight hospitals who were newly prescribed DOACs or warfarin. We excluded subjects who had a prior history of GIB or had been prescribed both medications. After propensity score matching, we analyzed 3,347 matched pairs of new DOAC and new warfarin users. Results: The risk of GIB in new DOAC users was comparable to that in new warfarin users (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.65 to 1.40; p=0.808). New DOAC users had a similar risk of GIB to new warfarin users among older patients >65 years (HR, 1.00; 95% CI, 0.69 to 1.52; p=0.997) and in older patients >75 years (HR, 1.21; 95% CI, 0.68 to 2.10; p=0.509). In addition, the risk of GIB was not significantly different between two groups according to sex. We also found that the risk of GIB in DOAC users was 26% lower in edoxaban or apixaban subgroups compared to rivaroxaban or dabigatran subgroups (HR, 0.74; 95% CI, 0.69 to 1.00; p=0.049). Conclusions In real-world practice, the risk of GIB in new DOAC users is comparable to that in new warfarin users. In DOAC users, the risk of GIB was lower in edoxaban or apixaban subgroups than rivaroxaban or dabigatran subgroups.

Background/Aims: Early studies on direct oral anticoagulants (DOACs) reported a higher risk of gastrointestinal bleeding (GIB) compared with warfarin; however, recent studies have reported a reduced risk. Therefore, this study was designed to evaluate the risk of GIB in users of DOAC and warfarin. Methods: Using a common data model, we investigated the comparative risk of GIB in subjects from eight hospitals who were newly prescribed DOACs or warfarin. We excluded subjects who had a prior history of GIB or had been prescribed both medications. After propensity score matching, we analyzed 3,347 matched pairs of new DOAC and new warfarin users. Results: The risk of GIB in new DOAC users was comparable to that in new warfarin users (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.65 to 1.40; p=0.808). New DOAC users had a similar risk of GIB to new warfarin users among older patients >65 years (HR, 1.00; 95% CI, 0.69 to 1.52; p=0.997) and in older patients >75 years (HR, 1.21; 95% CI, 0.68 to 2.10; p=0.509). In addition, the risk of GIB was not significantly different between two groups according to sex. We also found that the risk of GIB in DOAC users was 26% lower in edoxaban or apixaban subgroups compared to rivaroxaban or dabigatran subgroups (HR, 0.74; 95% CI, 0.69 to 1.00; p=0.049). Conclusions In real-world practice, the risk of GIB in new DOAC users is comparable to that in new warfarin users. In DOAC users, the risk of GIB was lower in edoxaban or apixaban subgroups than rivaroxaban or dabigatran subgroups.

Background/Aims: Early studies on direct oral anticoagulants (DOACs) reported a higher risk of gastrointestinal bleeding (GIB) compared with warfarin; however, recent studies have reported a reduced risk. Therefore, this study was designed to evaluate the risk of GIB in users of DOAC and warfarin. Methods: Using a common data model, we investigated the comparative risk of GIB in subjects from eight hospitals who were newly prescribed DOACs or warfarin. We excluded subjects who had a prior history of GIB or had been prescribed both medications. After propensity score matching, we analyzed 3,347 matched pairs of new DOAC and new warfarin users. Results: The risk of GIB in new DOAC users was comparable to that in new warfarin users (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.65 to 1.40; p=0.808). New DOAC users had a similar risk of GIB to new warfarin users among older patients >65 years (HR, 1.00; 95% CI, 0.69 to 1.52; p=0.997) and in older patients >75 years (HR, 1.21; 95% CI, 0.68 to 2.10; p=0.509). In addition, the risk of GIB was not significantly different between two groups according to sex. We also found that the risk of GIB in DOAC users was 26% lower in edoxaban or apixaban subgroups compared to rivaroxaban or dabigatran subgroups (HR, 0.74; 95% CI, 0.69 to 1.00; p=0.049). Conclusions In real-world practice, the risk of GIB in new DOAC users is comparable to that in new warfarin users. In DOAC users, the risk of GIB was lower in edoxaban or apixaban subgroups than rivaroxaban or dabigatran subgroups.

Background/Aims: Early studies on direct oral anticoagulants (DOACs) reported a higher risk of gastrointestinal bleeding (GIB) compared with warfarin; however, recent studies have reported a reduced risk. Therefore, this study was designed to evaluate the risk of GIB in users of DOAC and warfarin. Methods: Using a common data model, we investigated the comparative risk of GIB in subjects from eight hospitals who were newly prescribed DOACs or warfarin. We excluded subjects who had a prior history of GIB or had been prescribed both medications. After propensity score matching, we analyzed 3,347 matched pairs of new DOAC and new warfarin users. Results: The risk of GIB in new DOAC users was comparable to that in new warfarin users (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.65 to 1.40; p=0.808). New DOAC users had a similar risk of GIB to new warfarin users among older patients >65 years (HR, 1.00; 95% CI, 0.69 to 1.52; p=0.997) and in older patients >75 years (HR, 1.21; 95% CI, 0.68 to 2.10; p=0.509). In addition, the risk of GIB was not significantly different between two groups according to sex. We also found that the risk of GIB in DOAC users was 26% lower in edoxaban or apixaban subgroups compared to rivaroxaban or dabigatran subgroups (HR, 0.74; 95% CI, 0.69 to 1.00; p=0.049). Conclusions In real-world practice, the risk of GIB in new DOAC users is comparable to that in new warfarin users. In DOAC users, the risk of GIB was lower in edoxaban or apixaban subgroups than rivaroxaban or dabigatran subgroups.

Lateral neck node metastasis is an important prognostic factor in thyroid carcinoma. We developed a scoring system for use in prediction of lateral neck node metastasis from papillary thyroid cancer. In this study, 161 consecutive patients were included in the training data set. This scoring system, named the Yonsei Estimated Value (YEV) for lymph node metastasis in papillary thyroid cancer, was developed on the basis of results from multivariate logistic regression analysis of preoperative clinical and radiologic data. Sixty eight consecutive patients were included for testing of the validity of the scoring system. The equation for prediction of lateral neck node metastasis was follows: YEV (Yonsei Estimated Value) = 1/(1+X) X = Exp (5.333-[0.902 x sex]+[0.036 x age]-[1.020 x tumor size]-[0.177 x lymph node size]-[0.032 x lymph node density]) When the YEV was 0.3 or more, the probability of lateral neck node metastasis was 79.0%, with sensitivity of 76.3%, specificity of 69.8%, positive predictive value of 56.7%, and negative predictive value of 85.1% in the training set. When fine needle aspiration biopsy for suspicious lateral neck nodes is not possible, or the results are inadequate, our scoring system for prediction of lateral neck node metastasis can be helpful in optimization of the surgical extent for each patient.
Adolescent ; Adult ; Aged ; Algorithms ; Female ; Head and Neck Neoplasms/*diagnosis/secondary ; Humans ; Logistic Models ; Lymphatic Metastasis/*diagnosis ; Male ; Middle Aged ; *Predictive Value of Tests ; Thyroid Neoplasms/*pathology/radiography ; Tomography, X-Ray Computed