Background: Gastric-type endocervical adenocarcinoma (GEA) is unrelated to human papillomavirus (HPV) infection and is clinically aggressive compared with HPV-associated usual-type endocervical adenocarcinoma (UEA). The cytological diagnosis falls short of a definitive diagnosis of GEA and is often categorized as atypical glandular cells (AGCs). To improve cytologic recognition, cytological findings of HPV-independent GEA were analyzed and the results compared with HPV-associated UEA. Methods: Cervical Papanicolaou (Pap) smears from eight patients with a histopathologic diagnosis of GEA and 12 control cases of UEA were reviewed. All slides were conventionally prepared and/or liquid-based prepared (ThinPrep) and stained following the Pap method. A mucinous background, architectural, nuclear, and cytoplasmic features were analyzed and compared with UEA. Results: Preoperative cytologic diagnoses of the eight GEA cases were AGCs, favor neoplastic in three cases, adenocarcinoma in situ in one case, and adenocarcinoma in four cases. Cytologically, monolayered honeycomb-like sheets (p = .002) of atypical endocervical cells with vacuolar granular cytoplasm (p = .001) were extensive in GEA, and three-dimensional clusters (p = .010) were extensive in UEA. Although the differences were not statistically significant, background mucin (p = .058), vesicular nuclei (p = .057), and golden-brown intracytoplasmic mucin (p = .089) were also discriminatory findings for GEA versus UEA. Conclusions Although GEA is difficult to diagnose on cytologic screening, GEA can be recognized based on cytologic features of monolayered honeycomb sheets of atypical endocervical cells with abundant vacuolar cytoplasm and some golden-brown intracytoplasmic mucin. UEA cases are characterized by three-dimensional clusters.

Anti–glomerular basement membrane (GBM) nephritis is characterized by circulating anti-GBM antibodies and crescentic glomerulonephritis (GN) with deposition of IgG along the GBM. In a limited number of cases, glomerular immune complexes have been identified in anti-GBM nephritis. A 38-year-old female presented azotemia, hematuria, and proteinuria without any pulmonary symptoms. A renal biopsy showed crescentic GN with linear IgG deposition along the GBM and mesangial IgA deposition. The patient was diagnosed as concurrent anti-GBM nephritis and IgA nephropathy. Therapies with pulse methylprednisolone and cyclophosphamide administration were effective. Concurrent cases of both anti-GBM nephritis and IgA nephropathy are rare among cases of anti-GBM diseases with deposition of immune complexes. This rare case of concurrent anti-GBM nephritis and IgA nephropathy with literature review is noteworthy.
Adult ; Anti-Glomerular Basement Membrane Disease ; Antibodies ; Antigen-Antibody Complex ; Azotemia ; Basement Membrane ; Biopsy ; Cyclophosphamide ; Female ; Glomerulonephritis ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Methylprednisolone ; Nephritis ; Proteinuria

Gangliocytic paraganglioma is a very rare tumor that is usually located in the duodenum. It is characterized by benign behavior and favorable outcomes; however, it sometimes shows regional lymph node metastasis. The clinical management of gangliocytic paraganglioma has not yet been standardized. A 36-year-old Korean man visited Kosin University Gospel Hospital for the management of a duodenal subepithelial mass that was detected incidentally. Endoscopic mucosal resection was performed without any adverse events. Pathological examination of the resected specimen revealed gangliocytic paraganglioma. The patient has remained in good health during the 6 months of follow-up after the procedure.
Adult ; Duodenum ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Paraganglioma

BACKGROUND/AIMS: Helicobacter pylori is a distinctive pathogen that lives in the gastric mucosa and is a well known risk factor of gastric adenocarcinoma. Iron deficiency aggravates the development of H. pylori-induced premalignant and malignant lesions in a cagA-dependent manner, enhancing H. pylori virulence. The aim of this study was to identify the relationship between iron deficiency and H. pylori eradication rates. MATERIALS AND METHODS: Participants who received 7 days of first-line triple therapy with serum iron level measured in parallel were retrospectively investigated between 2005 and 2014. H. pylori eradication was confirmed by the rapid urease test or 13C-urea breath test at least 4 weeks after completion of triple therapy. Iron deficiency was defined as either a serum iron level less than 50 µg/dL or a serum ferritin level less than 12 ng/mL. RESULTS: A total of 194 patients received 7 days of first-line triple therapy along with parallel serum iron level measurements over the 10-year period. The mean average age was 53.3 years (range, 21~86 years), and 135 patients (69.6%) were male. The overall H. pylori eradication rate was 83.5%. Proportions of eradication success with ferritin level less than 12 ng/mL and iron less than 50 µg/dL were 90.5% and 88.6%, respectively. However, there was no statistical difference in eradication rates according to iron deficiency. CONCLUSIONS: Iron deficiency might not be related with H. pylori eradication rates in this study. Further large-scale studies are needed to confirm this result.
Adenocarcinoma ; Breath Tests ; Disease Eradication ; Ferritins ; Gastric Mucosa ; Helicobacter pylori* ; Helicobacter* ; Humans ; Iron* ; Male ; Retrospective Studies ; Risk Factors ; Urease ; Virulence

PURPOSE: In order to provide effective hospice care, adequate length of survival (LOS) in hospice is necessary. However the reported average LOS is much shorter. Analysis of LOS in hospice has not been reported from Korea. We evaluated the duration of LOS and the factors associated with LOS at our hospice center. MATERIALS AND METHODS: We retrospectively examined 446 patients who were admitted to our hospice unit between January 2010 and December 2012. We performed univariate and multivariate analysis for analysis of factors associated with LOS. RESULTS: The median LOS was 9.5 days (range, 1 to 186 days). The LOS of 389 patients (86.8%) was< 1 month. At the time of admission to hospice, 112 patients (25.2%) were completely bedridden, 110 patients (24.8%) had mouth care only without intake, and 134 patients (30.1%) had decreased consciousness, from confusion to coma. The median time interval between the day of the last anticancer treatment and the day of hospice admission was 75 days. By analysis of the results of multivariate analysis, decreased intake and laboratory results showing increased total white blood cell (WBC), decreased platelet count, increased serum creatinine, increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) level were poor prognostic factors for survival in hospice. CONCLUSION: Before hospice admission, careful evaluation of the patient's performance, particularly the oral intake, and total WBC, platelet, creatinine, AST, ALT, and LDH level is essential, because these were strong predictors of shorter LOS. In the future, conduct of prospective controlled studies is warranted in order to confirm the relationship between potential prognostic factors and LOS in hospice.
Alanine Transaminase ; Aspartate Aminotransferases ; Blood Platelets ; Coma ; Consciousness ; Creatinine ; Hospice Care ; Hospices* ; Humans ; Korea ; L-Lactate Dehydrogenase ; Leukocytes ; Mouth ; Multivariate Analysis ; Platelet Count ; Prognosis ; Retrospective Studies ; Survival Analysis

OBJECTIVES: The aim of this study was to explore the changes of bronchoscopic features according to epidemiologic change of lung cancer. METHODS: We performed a retrospective review of the clinical characteristics of 1,139 lung cancer patient who underwent bronchoscopy at Kosin University Hospital from January 2000 to December 2010. RESULTS: The age of patients increased significantly during the last decade (P < 0.001). The most common histological type was adenocarcinoma (38.1%), followed by squamous carcinoma (35.7%) and small cell carcinoma (15.3%). There was an increasing incidence of adenocarcinoma over the time (P < 0.001). Bronchoscopic feature were divided into two classes; central type, peripheral type. The peripheral type was predominant (62.3%). The proportion of peripheral type has been increased in process of time (49.7% vs. 63.7% vs. 73.7%; P < 0.01). Among the major histopathologic type of lung cancer, adenocarcinoma (81.3%) and unclassifiable non-small-cell lung cancer (73.4%), small cell carcinoma (56.9%) were associated with preferential occurrence of peripheral type. Squamous cell carcinoma of the lung more often arised in central type (59%). However, the proportion of peripheral squamous cell carcinoma has been increased. On the subgroup analysis, the median survival time of peripheral type with adenocarcinoma and small cell carcinoma were longer than central type (P < 0.05). CONCLUSIONS: The age of the lung cancer patients at diagnosis was getting older. The most frequent histopathologic type was adenocarcinoma. The proportion of peripheral type lung cancer gradually increased over the time. The survival time of peripheral type lung cancer was longer than central type.
Adenocarcinoma ; Bronchoscopy ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Humans ; Incidence ; Lung ; Lung Neoplasms* ; Retrospective Studies

OBJECTIVES: Endobronchial foreign body impaction is a medical emergency because of the air way obstruction. Therefore, immediate foreign body removal is crucial in such situations. Recently, there have been several reports about cryoprobe use as a tool for removal of foreign bodies. In this study, we determined the efficacy and complications of foreign body removal using a cryoprobe during flexible bronchoscopy. METHODS: This is a retrospective review of 27 patients who visited Kosin University Gospel Hospital from August 2007 to August 2010 with respiratory symptoms due to a foreign body in the airway. There were 17 males and 10 females, aged from 7 to 78 years. The foreign bodies were more frequently located (55%) in the right bronchus. The cryoprobe was inserted through the forceps channel of the flexible bronchoscope under local anesthesia. The lesion was quickly frozen for 5 seconds at -80degrees C, and the bronchoscope was removed with the probe after crystal formation on the contacted area. RESULTS: The success rate of removal of foreign bodies was 85% (23/27) using the cryoprobe. One case of broncholith did not undergo attempted removal because of the possibility of excessive hemorrhage by the tight bronchus impaction, and three cases (plastic,silicon,and implant) failed due to limited crystal formation. There were no severe hemorrhages, arrhythmias, or casualties during the procedure. CONCLUSIONS: The removal of foreign body using a cryoprobe during flexible bronchoscopy was shown to be safe and effective. The nature of the material should be attempted before removing a foreign body.
Anesthesia, Local ; Arrhythmias, Cardiac ; Bronchi ; Bronchoscopes ; Bronchoscopy* ; Emergencies ; Female ; Foreign Bodies* ; Hemorrhage ; Humans ; Male ; Retrospective Studies ; Surgical Instruments

OBJECTIVES: The aim of this retrospective study was whether serum Tg predicts malignancy in follicular or Hurthle-cell neoplasms on fine needle aspiration. METHODS: A chart review of 111 patients (90 females, 21 males; mean age 46.8 +/- 11.9 years) with follicular or Hurthle-cell neoplasms on fine needle aspiration, who were surgically treated between Sep. 2001 and Sep. 2011, was performed. Predictive factors for malignancy were identified by the chi-squared test and multivariate logistic regression. RESULTS: There were no differences between 41 malignant and 70 benign lesions in serum Tg or any of the normalized indexes. Receiver-operator characteristic analysis revealed no cut-off value. Lesions with serum Tg levels greater than 500 g/L had no significant difference. And also there were no independent predictors of malignancy by multivariate logistic regression. CONCLUSIONS: In this study, the author found that serum Tg has poor accuracy for predicting malignancy in follicular or Hurthle cell neoplasms on fine needle aspiration.
Biopsy, Fine-Needle ; Diagnosis* ; Female ; Humans ; Logistic Models ; Male ; Retrospective Studies ; Thyroglobulin* ; Thyroid Gland* ; Thyroid Neoplasms

Ischemic colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia. Other possible causes include medications such as NSAIDs(non-steroidal antiinflammatory drugs), oral contraceptives, diuretics and others. In recent years, many of NSAID use in young age can cause ischemic lesions, but it is not common. Here we report a case of ischemic colitis in a 31-year-old man who had no specific medical history except taking 200mg of ibuprofen three times a day for seven days. It suggests the importance of precise history taking, including medications usage such as NSAIDs and other risk factors.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal ; Colitis, Ischemic* ; Contraceptives, Oral ; Diuretics ; Humans ; Ibuprofen* ; Inflammation ; Intestine, Large ; Ischemia ; Risk Factors

Therapeutic high-dose radiation can induce atherosclerotic changes of affected arteries. Radiation-associated atherosclerotic diseases of coronary, carotid and subclavian arteries have been demonstrated for years in cancer survivors, but peripheral arterial disease (PAD) associated with radiation is rarely reported. PAD is one of the major macrovascular complications of diabetes and is associated with morbidity and increased mortality. We experienced a case of PAD associated with radiation therapy in a 65-year-old diabetic female patient who had undergone cervical cancer treatment 19 years prior. Computed tomographic angiogram showed occlusion and stenosis from common iliac arteries to superficial femoral arteries. However, both infrapopliteal arteries that are commonly involved in diabetes associated PAD were preserved. She was successfully treated with percutaneous angioplasty combined with femoro-femoral bypass operation. Based on the extent and severity of arterial stenosis in this non-smoking diabetic woman who had a history of high-dose radiation to her pelvis, we concluded that atherosclerotic lesions in this patient were caused by high-dose pelvic irradiation and then exacerbated by diabetes. Therefore, special attention should be given to diabetic patients with history of pelvic irradiation with regard to development of atherosclerosis of peripheral arteries, especially in the pelvic area.
Aged ; Angioplasty ; Arteries ; Atherosclerosis ; Constriction, Pathologic ; Diabetes Mellitus ; Diabetic Foot* ; Female ; Femoral Artery ; Humans ; Iliac Artery ; Mortality ; Pelvis ; Peripheral Arterial Disease* ; Subclavian Artery ; Survivors ; Uterine Cervical Neoplasms