Uterine perforation related with dilatation and curettage (D&C) is an uncommon event. Combined complications such as hemorrhage, adjacent organ injury, and omental incarceration may require an emergent surgical treatment. These are usually evident immediately or several days after the D&C, and a delayed presentation of uterine perforation are extremely rare. Herein, we report a rare case of omental incarceration presenting as a hyperechoic endometrial mass in a postmenopausal woman, diagnosed twenty-three years after the D&C. According to this case, when we encounter a hyperechoic endometrial lesion penetrating the uterine wall in women with a history of an intrauterine procedure such as D&C, we need to consider the possibility of an incarcerated omentum.

Uterine perforation related with dilatation and curettage (D&C) is an uncommon event. Combined complications such as hemorrhage, adjacent organ injury, and omental incarceration may require an emergent surgical treatment. These are usually evident immediately or several days after the D&C, and a delayed presentation of uterine perforation are extremely rare. Herein, we report a rare case of omental incarceration presenting as a hyperechoic endometrial mass in a postmenopausal woman, diagnosed twenty-three years after the D&C. According to this case, when we encounter a hyperechoic endometrial lesion penetrating the uterine wall in women with a history of an intrauterine procedure such as D&C, we need to consider the possibility of an incarcerated omentum.

PURPOSE: This study was conducted to compare the safety and effectiveness of intravenous ketamine-midazolam (KM) and ketamine-propofol (KP) combination for the lumbar puncture (LP) procedure in children. METHODS: This was a retrospective analysis of patients aged ≤18 years old who received intravenous injection of KM or KP for undergoing LP in the pediatric emergency department. To investigate the effectiveness of KM and KP, we compared the sedation success rate, induction time, procedure time and total sedation time. In addition, adverse events and complications were recorded to assess the safety of the agents. RESULTS: A total 61 patients were enrolled in study. Twenty-eight patients were given KM and 33 patients received KP. All sedations were successful in both groups. While the mean induction time in KM was shorter than in the KP group (3±4 vs. 6±5 minutes, p=0.02), the total sedation time in the KP group was significantly shorter than that in the KM group (33±26 vs. 61±43 minutes, p < 0.01). There were no adverse effects such as hypotension, bradycardia or hypoxic event. CONCLUSION: This study showed that intravenous KM and KP are hemodynamically stable and have few side effects when applied for pediatric sedation during lumbar puncture. Although KM has a shorter induction time than KP, KP has a shorter duration of sedation. Both of these materials can be considered useful agents for sedation when conducting painful procedures in children.
Bradycardia ; Child ; Conscious Sedation ; Emergency Service, Hospital ; Humans ; Hypotension ; Injections, Intravenous ; Ketamine ; Midazolam ; Propofol ; Retrospective Studies ; Spinal Puncture

PURPOSE: To introduce the history and principle mechanism of electrochemical treatment (EChT) with animal study and report two cases successfully treated breast cancer and hemangioma by EChT. METHODS: In animal study, the breast cancer tumor in nude mouse treated with EChT (100 Coulomb/cm3) were reviewed for histologic changes. In the case studies, we reported method of EChT and clinical results after EChT. Case 1: 74 yr old female with locally advanced breast cancer received 3 times EChT with 1,000 Coulomb/time, 8 Volt. Case 2: 51 yr old female with breast hemagioma received one time EChT with 80 Coulomb, 8 Volt. RESULTS: In animal study, There were destructive change including vaculated cell fragment and extensive coagulative necrosis. Case 1 showed no local recurrence during 18 monthes after EChT. Case 2 also showed no evidence of recurrence of hemangioma. CONCLUSION: The EChT is easy to use. It is effective, safe, less traumatic and makes patients recover quickly. This is a new and effective method to treat patients with tumours that are inoperable and can not receive chemotherapy or radiotherapy.
Animals ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Female ; Hemangioma ; Humans ; Mice ; Mice, Nude ; Necrosis ; Radiotherapy ; Recurrence

This study investigated the effect of switching normal diet to vegetarian diet rich in vegetables and fruits for school foodservice and home meal on the nutritional status, bowel habit improvement and stress reduction of teachers and adolescents. A total of 40 research subjects (26 students, 14 teachers) from one middle school voluntarily participated in the research. Questionnaire surveys and blood analysis were conducted before and after a 12-week vegetarian diet period. The participants were asked on their dietary habit, bowel habit and stress measurement. After 12 weeks, reduction of BMI (kg/m2) in the students (p < 0.05) and reduction of TC (mg/dL) in both teachers and students (p < 0.05) were observed. Also reduction of LDL-C (mg/dL) was observed in the teachers (p < 0.05) whereas serum calcium and Vitamin B12 was increased in the students and teachers (p < 0.005). The teacher's stress level was reduced (p < 0.05) after the 12-week vegetarian diet. As for the changes in bowel habit, the number of the students and teachers classified as experiencing functional constipation was decreased respectively from 10 to 7, from 7 to 5. Based on the result, it is considered that the vegetarian diet rich in fruits and vegetables improved general health status of study subjects suggesting that such a dietary habit would substantially contribute to improving nutritional status and bowel habit.
Adolescent ; Calcium ; Constipation ; Diet ; Diet, Vegetarian* ; Food Habits ; Fruit ; Humans ; Meals ; Nutritional Status* ; Research Subjects ; Vegetables ; Vitamin B 12

PURPOSE: The relatively low incidence of breast cancer in Asian countries with cultures which traditionally eat a large amount of soy is worth noticing in research fields. Genistein is a isoflavone phytoestrogen found in soy and its consumption may have a role in cancer etiology. We have established a hypothesis that a diet high in soy consumption is related to a low incidence of breast cancer. Fatty acid synthase (FAS) is a multi-protein enzyme responsible for de novo biosynthesis of fatty acids. Recent studies have demonstrated that high levels of FAS occurs in a subset of human cancers, such as breast cancer, ovarian cancer, and prostate cancer. High level of FAS are associated with a poor prognosis. Sterol regulatory element binding proteins (SREBPs) are a family of transcription factors that regulate genes involved in lipid metabolism, including FAS. Recent studies show that expression of SREBP1c is correlates with FAS expression. The aim of this study is to investigate the effect of genistein on the expression of FAS in breast cancer cells. METHODS: We performed immunofluorescent staining to examine the expression of FAS under different concentration of genistein. RT-PCR was also performed to investigate the mRNA expression of FAS and SREBP1c in different conditioned breast cancer cells treated with different concentration of FAS inhibitor and genistein. RESULTS: By immunofluorescent staining, the FAS expression after treatment with the FAS inhibitor, C75, decreased at a micron10 M concentration. However the expression of FAS decreased at all concentrations of genistein (0.5, 1, 5, 10 micronM). The mRNA levels of FAS and SREBP1c after treatment with C75 decreased constantly according to time and concentration. However the effect was noted only after 12 hr. The mRNA level of FAS and SREBP1c following treatment with genistein decreased at only a 10 micronM concentration (p<0.005). CONCLUSION: Genistein may down regulate FAS expression in breast cancer cells through modulation of SREBP-1c. This finding may account for the relatively low incidence of breast cancer in Asians who consume a large amount of soy in their diet.
Asian Continental Ancestry Group ; Breast Neoplasms* ; Breast* ; Diet ; Fatty Acids ; Genistein* ; Humans ; Incidence ; Lipid Metabolism ; Ovarian Neoplasms ; Phytoestrogens ; Prognosis ; Prostatic Neoplasms ; RNA, Messenger ; Sterol Regulatory Element Binding Protein 1 ; Sterol Regulatory Element Binding Proteins ; Transcription Factors

PURPOSE: Of the many carcinogenic mechanisms, DNA methylation is a strong factor in various cancers, including cancer of the breast. The genes related to breast cancer include 14.3.3 sigma, Cyclin D2, RARbeta, Twist, Ras association domain family 1A gene (BASSF1A), HIN-1, p16, and Adenomatous polyposis coli (APC). Of these, hypermethylation of the APC and RASSF1A genes is, found in breast cancer patients, and especially in those with a poor prognosis. This study investigated whether hypermethylation of the APC and RASSF1A genes is related with breast cancer metastasis. METHODS: Of the 110 patients who received surgical operation at our hospital's department of surgery from January 2001 to December 2003, 16 patients with metastatic lesion found during the follow-up period were selected. Seventeen patients without metastasis selected as the tissue group after considering their age, cancer stage, and physical state. Forty seven patients were selected as the serum group, including 6 patients with metastasis, and they were evaluated for metastasis and methylation. Serum and tissue were collected and after being processed by the methylation specific PCR (MSP), and the methylation of the APC and RASSF1A genes was observed. RESULTS: In the tissue study group, the APC gene methylation ratio of the patients whose stages are between the stage 2 and 3 was 50:94%, and that of RASSF1A gene methylation was 68.7:65% respectively. Methylation rates of both genes was found in 42.9% of the stage 2 recurrent patients (non-recurrent patients: 22%) and in 77.8% (non-recurrent patients: 50%) in stage 3 recurrent patients. In the serum study group, a statistical correlation was shown (p=0.013) between methylation of RASSF1A and recurrence, where 5 of the 16 patients with methylation showed recurrences and only 1 patient of the 31 nonmethylated patients showed recurrence. CONCLUSION: We determined the correlation between APC and RASSF1A methylation and recurrence of breast cancer. Further studies with large sample populations and more advanced method are needed to confirm our findings.
Adenomatous Polyposis Coli* ; Breast Neoplasms* ; Breast* ; Cyclin D2 ; DNA Methylation ; Follow-Up Studies ; Genes, APC ; Humans ; Methylation* ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Prognosis ; Recurrence

PURPOSE: This study compared the survival outcomes of different treatment methods for the ipsilateral breast of occult breast cancer (OBC) patients with axillary lymph node metastasis. METHODS: A retrospective study was conducted in which forty OBC patients with axillary lymph node metastasis were identified out of 15,029 patients who had been diagnosed with a primary breast cancer at between 1992 and 2010. The patients were categorized into three treatment groups based on ipsilateral breast management: breast-conserving surgery (BCS) (n=17), mastectomy (n=12), and nonsurgical intervention with or without radiation therapy (No surgery with or without radiation therapy [No Op+/-RT]) (n=11). All patients underwent axillary lymph node dissection. Cases were evaluated based on treatment and potential prognostic factors with respect to overall survival (OS) and disease-free survival (DFS). RESULTS: During the follow-up period (median follow-up of 71.5 months), the overall OS and DFS were 76.9% and 74.9%, respectively. The 5-year treatment-specific OS was 72.0% for the BCS group, 74.0% for the mastectomy group, and 87.5% for the No Op+/-RT group (log-rank p=0.49). The 5-year DFS was 70.6% for the BCS group, 66.7% for the mastectomy group, and 90.9% for the No Op+/-RT group (log-rank p=0.36). Recurrence rates for the BCS and No Op+/-RT groups were 5.9% and 18.2%, respectively. Histologic grade and lymph node status were inversely correlated with DFS (log-rank p=0.04 and p<0.01, respectively). CONCLUSION: There was no difference in survival outcomes between the three treatment methods for the ipsilateral breast (mastectomy, BCS, and No Op+/-RT) of OBC patients with axillary lymph node metastasis. A large-scale multicenter study is needed to validate the results from this small retrospective study.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Mastectomy ; Mastectomy, Segmental ; Methods* ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies

Background: Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. Methods: A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. Results: A total of 86 severe COVID-19 patients were evaluated including 48 remdesivirtreated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). Conclusion The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.

Background: Remdesivir is widely used for the treatment of coronavirus disease 2019 (COVID-19), but controversies regarding its efficacy still remain. Methods: A retrospective cohort study was conducted to evaluate the effect of remdesivir on clinical and virologic outcomes of severe COVID-19 patients from June to July 2020. Primary clinical endpoints included clinical recovery, additional mechanical ventilator (MV) support, and duration of oxygen or MV support. Viral load reduction by hospital day (HD) 15 was evaluated by calculating changes in cycle threshold (Ct) values. Results: A total of 86 severe COVID-19 patients were evaluated including 48 remdesivirtreated patients. Baseline characteristics were not significantly different between the two groups. Remdesivir was administered an average of 7.42 days from symptom onset. The proportions of clinical recovery of the remdesivir and supportive care group at HD 14 (56.3% and 39.5%) and HD 28 (87.5% and 78.9%) were not statistically different. The proportion of patients requiring MV support by HD 28 was significantly lower in the remdesivir group than in the supportive care group (22.9% vs. 44.7%, P = 0.032), and MV duration was significantly shorter in the remdesivir group (average, 1.97 vs. 5.37 days; P = 0.017). Analysis of upper respiratory tract specimens demonstrated that increases of Ct value from HD 1–5 to 11–15 were significantly greater in the remdesivir group than the supportive care group (average, 10.19 vs. 5.36; P = 0.007), and the slope of the Ct value increase was also significantly steeper in the remdesivir group (average, 5.10 vs. 2.68; P = 0.007). Conclusion The remdesivir group showed clinical and virologic benefit in terms of MV requirement and viral load reduction, supporting remdesivir treatment for severe COVID-19.