OBJECTIVE: To determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and DCE ultrasound (DCE-US) for predicting response to neoadjuvant chemotherapy (NAC) in breast cancer patients. MATERIALS AND METHODS: This Institutional Review Board-approved prospective study was performed between 2014 and 2016. Thirty-nine women with breast cancer underwent DCE-US and DCE-MRI before the NAC, follow-up DCE-US after the first cycle of NAC, and follow-up DCE-MRI after the second cycle of NAC. DCE-MRI parameters (transfer constant [Ktrans], reverse constant [kep], and leakage space [Ve]) were assessed with histograms. From DCE-US, peak-enhancement, the area under the curve, wash-in rate, wash-out rate, time to peak, and rise time (RT) were obtained. After surgery, all the imaging parameters and their changes were compared with histopathologic response using the Miller-Payne Grading (MPG) system. Data from minor and good responders were compared using Wilcoxon rank sum test, chi-square test, or Fisher's exact test. Receiver operating characteristic curve analysis was used for assessing diagnostic performance to predict good response. RESULTS: Twelve patients (30.8%) showed a good response (MPG 4 or 5) and 27 (69.2%) showed a minor response (MPG 1–3). The mean, 25th, 50th, and 75th percentiles of Ktrans and Kep of post-NAC DCE-MRI differed between the two groups. These parameters showed fair to good diagnostic performance for the prediction of response to NAC (AUC 0.76–0.81, p ≤ 0.007). Among DCE-US parameters, the percentage change in RT showed fair prediction (AUC 0.71, p = 0.023). CONCLUSION: Quantitative analysis of DCE-MRI and DCE-US was helpful for early prediction of response to NAC.
Breast Neoplasms* ; Breast* ; Drug Therapy* ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prospective Studies ; ROC Curve ; Ultrasonography*

PURPOSE: The purpose of this study was to evaluate the B-mode sonographic and sonoelastographic features of high risk lesions of the breast. MATERIALS AND METHODS: From April 2009 to February 2010, 1390 patients with breast lesions underwent US-guided core-biopsy. Among them, 13 lesions were confirmed to be pure sclerosing adenosis by subsequent surgical excision or on imaging follow-up of more than 1 year. Two radiologists retrospectively analyzed the B-mode sonography according to the Breast Imaging Reporting and Data System classification. The sonoelastographic images were classified into 5 elasticity scores according to the Itoh classification and the strain ratio between the mass and the surrounding fat tissue was reviewed. We considered the sonoelastographic patterns to be suspicious for the case with a score of 4 and 5 and a strain ratio of more than a 2.24. RESULTS: The common B-mode sonographic features of sclerosing adenosis were an irregular shape (69.2%, 9 of 13), an indistinct margin (92.3%, 12 of 13), hypoechogenicity (76.9%, 10 of 13) and category 4A, a low suspicion of malignancy (61.5%, 8 of 13). The common sonoelastographic features were a score of 2 (42%, 6 of 13) and a strain ratio < 2.24 (69.2%, 9 of 13). CONCLUSION: Sclerosing adenosis showed suspicious B-mode sonographic findings, but it had benign sonolastographic features.
Breast ; Elasticity ; Elasticity Imaging Techniques ; Follow-Up Studies ; Humans ; Information Systems ; Retrospective Studies ; Sprains and Strains

PURPOSE: To evaluate the magnetic resonance imaging (MRI) and clinicopathological features of triple negative breast cancer, and compare them with those of non-triple negative breast cancer. MATERIALS AND METHODS: This study included 231 pathologically confirmed breast cancers from January 2007 to May 2008. We retrospectively reviewed the MRI findings according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon: mass or non-mass type, mass shape, mass margin, non-mass distribution, and enhancement pattern. Histologic type, histologic grade, and the results for epidermal growth factor receptor, p53, and Ki 67 were reviewed. RESULTS: Of 231 patients, 43(18.6%) were triple negative breast cancer. Forty triple negative breast cancers (93.0%) were mass-type lesion on MRI. A round or oval or lobular shape (p=0.006) and rim enhancement (p=0.004) were significantly more in triple negative breast cancer than non-triple negative breast cancer. In contrast, irregular shape (p=0.006) and spiculated margins (p=0.032) were significantly more in non-triple negative breast cancer. Old age (p=0.019), high histologic grade (p<0.0001), EGFR positivity (p<0.0001), p53 overexpression (p=0.038), and Ki 67 expression (<0.0001) were significantly associated with the triple negative breast cancer. CONCLUSION: MRI finding may be helpful for differentiation between triple negative and non-triple negative breast cancer.
Breast ; Breast Neoplasms ; Humans ; Information Systems ; Magnetic Resonance Imaging ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies

The enterobiliary fistulas are mostly spontaneous and are caused by biliary disease associated with calculi. Review of many series shows that the most common variety of enterobiliary fistulas is a cholecystoduodenal fistula followed by cholecystocolic, cholecystogastric and choledochoduodenal fistula in that order. But very few cases of choledochocolonic fistulae have been reported. We report a case of choledocholithiasis combined with the absence of gallbladder leading to a choledochocolonic fistula, which was confirmed by endoscopic retrograde cholangiography and abdominal exploration in a 63- year-old male patient with complaint of right upper abdominal pain.
Abdominal Pain ; Calculi ; Cholangiography ; Choledocholithiasis ; Fistula* ; Gallbladder* ; Humans ; Intestinal Fistula ; Male

While nontuberculous mycobacterium (NTM) infections are recently on the rise, arthritis caused by NTM is hardly reported in Korea. NTM arthritis has no distinctive clinical characteristics from chronic arthritis. Tuberculosis of the joint specifically produces similar clinical and pathologic presentations to NTM arthritis, so it is not easy to distinguish between them. We report a case of Mycobacterium intracellulare in an arthritis patient after trauma and surgical repair of the injury. At the beginning, the patient was diagnosed as tuberculous tenosynovitis through pathology without microbiologic evidence. The final diagnosis was made after subsequent recurrences for several years. The misdiagnosis and delayed diagnosis led to irreversible joint destruction and functional impairment. NTM infection must be included in the differential diagnosis of chronic arthritis at the outset.
Arthritis ; Delayed Diagnosis ; Diagnosis, Differential ; Diagnostic Errors ; Humans ; Joints ; Korea ; Mycobacterium ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection ; Nontuberculous Mycobacteria ; Recurrence ; Tenosynovitis ; Tuberculosis

PURPOSE: Urine collection using a sterile adhesive bag for urinalysis has been used commonly in infants and young children. However, this method has had some drawbacks. So, this study was performed to evaluate the usage of disposable diapers as a substitute for the routine urine collection method. METHODS: 60 mL of self voided fresh urine was collected from 99 patients. Half of the urine was poured on the disposable diapers which did not contain absorbent gel beads. After 1 hr, we obtained the urine samples(extracted urine) by compressing the wet diapers using a 50 ml syringe. Routine, microscopic and biochemical analyses were performed on the other half of fresh urine and extracted urine. Then we compared each result by correlative analysis. RESULTS: 198 samples from 99 patients were evaluated. The results of routine urinalysis except WBC and biochemical urinalysis showed a significant correlation between the two groups(P<0.05). The relative coefficients of urine SG, pH, glucose, protein, blood and leukocytes between the two groups were 0.964, 0.938, 0.977, 0.956, 0.931 and 0.738, respectively. Those of urinary sodium, potassium, chloride and creatinine were 0.997, 0.998, 0.995 and 0.998, respectively. Microscopic examinations showed lower relative coefficients than the other results, 0.740 for RBC and 0.602 for WBC, but these were still significant(P<0.05). CONCLUSION: The results of the urine analysis with extracted urine from diapers correlates well with that of fresh urine. This new method is very helpful and can be used as an alternative of urine collection, especially for infants and young children.
Adhesives ; Child* ; Creatinine ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Infant* ; Leukocytes ; Potassium ; Sodium ; Syringes ; Urinalysis ; Urine Specimen Collection*

PURPOSE: Although suprapubic bladder aspiration(SBA) is the most reliable technique for identifying bacteriuria in young infant, no report has been published about the clinical manifestations of urinary tract infection(UTI) diagnosed by aspirated urine in Korea. This study was performed to examine clinical manifestations and related factors of UTI confirmed by a positive urine culture obtained by SBA in young infants. METHODS: We reviewed medical records of 159 infants younger than six months of age, who had been admitted for UTI to Korea University Ansan Hospital from January 2002 to June 2005. RESULTS: The male:female ratio was 5.1:1. The most common pathogen in urine culture was Escherichia coli(92.5 percent). Most of the gram-negative pathogens had high sensitivity to amikacin, or third generation cephalosporins and had low sensitivity to ampicillin, trimethoprim-sulfamethoxazole, or gentamicin. Hydronephrosis and vesicoureteral reflux(VUR) were present in 32.7 percent and 27.7 percent respectively. Renal cortical defects observed on DMSA scans were detected in 37.1 percent. Prolonged fever duration and hospital day, high erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) levels, hydronephrosis and VUR were related to the renal cortical defects(P<0.05). Rates of UTI-associated bacteremia and aseptic meningitis were 8.3 percent and 6.6 percent. CONCLUSION: Early differential diagnosis is very important in infants younger than 6 months of age with UTI because the clinical findings are non-specific and UTI-associated bacteremia and aseptic meningitis are concomitantly found. Because prolonged fever and higher ESR and CRP levels are risk factors of the renal cortical defects, radiologic evaluations and nephrologic follow-up were needed in identifying the predisposing congenital abnormalities and chronic renal scarring.
Amikacin ; Ampicillin ; Bacteremia ; Bacteriuria ; Blood Sedimentation ; Cephalosporins ; Cicatrix ; Congenital Abnormalities ; Diagnosis, Differential ; Escherichia ; Fever ; Gentamicins ; Gyeonggi-do ; Humans ; Hydronephrosis ; Infant* ; Korea ; Medical Records ; Meningitis ; Meningitis, Aseptic ; Pyelonephritis ; Risk Factors ; Succimer ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Bladder ; Urinary Tract Infections* ; Urinary Tract*

Bordetella (B) bronchiseptica is a common veterinary pathogen, but has rarely been implicated in human infections. Most patients with B. bronchiseptica infections are compromised clinically such as in patients with a malignancy, AIDS, malnutrition, or chronic renal failure. We experienced a case of relapsing peritonitis caused by B. bronchiseptica associated with continuous ambulatory peritoneal dialysis (CAPD). A 56-yr-old male, treated with CAPD due to end stage renal disease (ESRD), was admitted with complaints of abdominal pain and a turbid peritoneal dialysate. The culture of peritoneal dialysate identified B. bronchiseptica. The patient was treated with a combination of intraperitoneal antibiotics. There were two further episodes of relapsing peritonitis, although the organism was sensitive to the used antibiotics. Finally, the indwelling CAPD catheter was removed and the patient was started on hemodialysis. This is the first report of a B. bronchiseptica human infection in the Korean literature.
Anti-Bacterial Agents/pharmacology/therapeutic use ; Bordetella Infections/*diagnosis/microbiology ; Bordetella bronchiseptica/*metabolism ; Fibrosis ; Humans ; Kidney Failure/microbiology ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/*methods ; Peritoneum/pathology ; Peritonitis/*microbiology ; Recurrence

OBJECTIVE: This study aims to evaluate the degree of inter- and intraobserver agreement when characterizing breast abnormalities using the Breast Imaging Reporting and Data System (BI-RADS)-ultrasound (US) lexicon, as defined by the American College of Radiology (ACR). MATERIALS AND METHODS: Two hundred ninety three female patients with 314 lesions underwent US-guided biopsies at one facility during a two-year period. Static sonographic images of each breast lesion were acquired and reviewed by four radiologists with expertise in breast imaging. Each radiologist independently evaluated all cases and described the mass according to BI-RADS-US. To assess intraobserver variability, one of the four radiologists reassessed all of the cases one month after the initial evaluation. Inter- and intraobserver variabilities were determined using Cohen's kappa (k) statistics. RESULTS: The greatest degree of reliability for a descriptor was found for mass orientation (k = 0.61) and the least concordance of fair was found for the mass margin (k = 0.32) and echo pattern (k = 0.36). Others descriptive terms: shape, lesion boundary and posterior features (k = 0.42, k = 0.55 and k = 0.53, respectively) and the final assessment (k = 0.51) demonstrated only moderate levels of agreement. A substantial degree of intraobserver agreement was found when classifying all morphologic features: shape, orientation, margin, lesion boundary, echo pattern and posterior feature (k = 0.73, k = 0.68, k = 0.64, 0.68, k = 0.65 and k = 0.64, respectively) and rendering final assessments (k = 0.65). CONCLUSION: Although BI-RADS-US was created to achieve a consensus among radiologists when describing breast abnormalities, our study shows substantial intraobserver agreement but only moderate interobserver agreement in the mass description and final assessment of breast abnormalities according to its use. A better agreement will ultimately require specialized education, as well as self-auditing practice tests.
Adenocarcinoma/classification/*diagnosis ; Adenocarcinoma, Mucinous/classification/*diagnosis ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biopsy ; Breast Neoplasms/classification/*diagnosis ; Carcinoma, Ductal, Breast/classification/*diagnosis ; Carcinoma, Intraductal, Noninfiltrating/classification/*diagnosis ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Observer Variation ; Predictive Value of Tests ; Radiology ; Reproducibility of Results ; Sensitivity and Specificity ; Societies, Medical ; Terminology as Topic ; Ultrasonography, Doppler, Color/statistics & numerical data ; Ultrasonography, Mammary/*statistics & numerical data

The immunomodulatory and antitumor effects of lactic acid bacteria (LABs) were investigated. Cytoplasmic fraction of Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium longum were tested for the antiproliferative activity in vitro to SNUC2A, SNU1, NIH/3T3 and Jurkat cell lines by crystal violet assay. All cytoplasmic fraction suppressed proliferation of tumor cells, though L. casei and B. longum were more effective. From these results, cytoplasmic fraction of L. casei and B. longum with Y400 as a control were administered as dietary supplements to Balb/c mice for 2, and 4 consecutive wks. Administration for 4 wks enhanced the number of total T cells, NK cells and MHC class II+ cells, and CD4-CD8+ T cells in flow cytometry analysis. To determine of antitumor activity of LABs preparation in vivo, F9 teratocarcinoma cells were inoculated on mice at 14th day. Body weight was decreased with increased survival rate in all groups with the cytoplasm of LABs. Our results showed that cytoplasmic fraction of LABs had direct antiproliferative effects on tumor cell lines in vitro, effects on immune cells in vivo, and antitumor effects on tumor-bearing mice with prolonged survival periods.
3T3 Cells ; Animals ; *Bifidobacterium ; Body Weight ; Cell Division/physiology ; Cytotoxicity, Immunologic ; Flow Cytometry ; Humans ; Immunophenotyping ; Jurkat Cells ; Killer Cells, Natural/immunology ; *Lactobacillus casei ; Male ; Mice ; Mice, Inbred BALB C ; Neoplasms, Experimental/immunology/*therapy ; Probiotics/*pharmacology ; Survival Analysis ; T-Lymphocytes/immunology