Purpose: To investigate the value of MR textural analysis, including use of diffusionweighted imaging (DWI) to differentiate malignant from benign soft-tissue tumors on 3T MRI. Materials and Methods: We enrolled 69 patients (25 men, 44 women, ages 18 to 84 years) with pathologically confirmed soft-tissue tumors (29 benign, 40 malignant) who underwent pre-treatment 3T-MRI. We calculated MR texture, including mean, standard deviation (SD), skewness, kurtosis, mean of positive pixels (MPP), and entropy, according to different spatial-scale factors (SSF, 0, 2, 4, 6) on axial T1-and T2-weighted images (T1WI, T2WI), contrast-enhanced T1WI (CE-T1WI), high b-value DWI (800 sec/mm2 ), and apparent diffusion coefficient (ADC) map. We used the Mann-Whitney U test, logistic regression, and area under the receiver operating characteristic curve (AUC) for statistical analysis. Results: Malignant soft-tissue tumors had significantly lower mean values of DWI, ADC, T2WI and CE-T1WI, MPP of ADC, and CE-T1WI, but significantly higher kurtosis of DWI, T1WI, and CE-T1WI, and entropy of DWI, ADC, and T2WI than did benign tumors (P < 0.050). In multivariate logistic regression, the mean ADC value (SSF, 6) and kurtosis of CE-T1WI (SSF, 4) were independently associated with malignancy (P ≤ 0.009). A multivariate model of MR features worked well for diagnosis of malignant soft-tissue tumors (AUC, 0.909). Conclusion Accurate diagnosis could be obtained using MR textural analysis with DWI and CE-T1WI in differentiating benign from malignant soft-tissue tumors.

Purpose: To investigate the value of MR textural analysis, including use of diffusionweighted imaging (DWI) to differentiate malignant from benign soft-tissue tumors on 3T MRI. Materials and Methods: We enrolled 69 patients (25 men, 44 women, ages 18 to 84 years) with pathologically confirmed soft-tissue tumors (29 benign, 40 malignant) who underwent pre-treatment 3T-MRI. We calculated MR texture, including mean, standard deviation (SD), skewness, kurtosis, mean of positive pixels (MPP), and entropy, according to different spatial-scale factors (SSF, 0, 2, 4, 6) on axial T1-and T2-weighted images (T1WI, T2WI), contrast-enhanced T1WI (CE-T1WI), high b-value DWI (800 sec/mm2 ), and apparent diffusion coefficient (ADC) map. We used the Mann-Whitney U test, logistic regression, and area under the receiver operating characteristic curve (AUC) for statistical analysis. Results: Malignant soft-tissue tumors had significantly lower mean values of DWI, ADC, T2WI and CE-T1WI, MPP of ADC, and CE-T1WI, but significantly higher kurtosis of DWI, T1WI, and CE-T1WI, and entropy of DWI, ADC, and T2WI than did benign tumors (P < 0.050). In multivariate logistic regression, the mean ADC value (SSF, 6) and kurtosis of CE-T1WI (SSF, 4) were independently associated with malignancy (P ≤ 0.009). A multivariate model of MR features worked well for diagnosis of malignant soft-tissue tumors (AUC, 0.909). Conclusion Accurate diagnosis could be obtained using MR textural analysis with DWI and CE-T1WI in differentiating benign from malignant soft-tissue tumors.

Background/Aims: We evaluated the efficacy of docetaxel and epirubicin as neoadjuvant chemotherapy in locally advanced breast cancer and assessed the predictive factors for response to neoadjuvant chemotherapy and prognostic factors related to relapse-free survival. Methods: Forty patients who received docetaxel and epirubicinas neoadjuvant chemotherapy for locally advanced breast cancer were evaluated retrospectively. Neoadjuvant chemotherapy consisted of intravenous injection of 75 mg/m2 docetaxel and 60 mg/m2 epirubucin on day 1, every 21 days, and two to six cycles. Results: Twenty-five (62.5%) patients showed a partial response, and 15 (37.5%) patients showed a stable disease in the first response evaluation after two or three cycles of neoadjuvant chemotherapy. In the second response evaluation of nine patients who received six cycles of neoadjuvant chemotherapy, one patient achieved a complete response, but two patients with hormone receptor-negative, human epidermal growth factor receptor 2-positive breast cancer experienced disease progression. Twenty-five (62.5%) patients experienced downstaging after neoadjuvant chemotherapy. Patients with > 20% pretreatment Ki-67 and decrease of Ki-67 between pre- and post-neoadjuvant chemotherapy showed a trend for better response. In multivariate analysis, advanced pathological stage showed a significant negative effect on relapse-free survival. Conclusions Docetaxel and epirubicin neoadjuvant chemotherapy showed a good response in locally advanced breast cancer. Pretreatment Ki-67 and change of Ki-67 may play a role as predictive factor for response to neoadjuvant chemotherapy.

Background: Osteoporotic vertebral compression fractures (OVCFs) are often associated with delayed myelopathy. Surgical treatment of delayed myelopathy following an OVCF comprises spinal canal decompression and stable fixation of the vertebral column with an acceptable sagittal alignment. However, such surgical methods are not usually feasible because of medical comorbidities and osteoporosis. We devised a novel, simple technique to decompress the spinal canal and reconstruct the middle column by translating the fractured vertebral body anteriorly through a posterior approach and verified the validity of the new technique. Methods: We conducted a single-center, retrospective study. Patients who underwent vertebral body anterior translation (VBaT) between 2014 and 2017 due to delayed myelopathy after OVCFs were included. Through a posterior approach, discs between the fractured vertebra and the adjacent vertebrae were released. The fractured vertebra was translated anteriorly with pedicle screws and rods to realign the middle column. Radiological and functional improvement was analyzed. Results: There were 12 consecutive patients. The mean age was 70.3 ± 9.4 years. There were 8 female and 4 male patients. Follow-up period was 35.9 ± 13.1 months. Nine patients had pedicle screw augmentation with polymethyl methacrylate. The mean number of fusion segments was 3.4 (range, 2–4). There were 3 types of spinal canal invasion. Five patients had vertebral body vacuum clefts with posterior wall fractures. Five patients had vertebral body angulation with endplate protrusion. Two patients had 3 column fractures. In radiological analysis, the regional kyphotic angle was 35.1° ± 9.1° preoperatively and improved to 8.8° ± 6.8° postoperatively and 9.8° ± 6.1° at the final follow-up (p < 0.001). The anterior vertebral body height ratio was 27.6% ± 7.0% preoperatively and improved to 80.5% ± 13.7% postoperatively and 83.7% ± 12.5% at the final follow-up (p < 0.001). The spinal canal invasion ratio was 52.6% ± 9.1% preoperatively and improved to 25.2% ± 10.4% postoperatively (p < 0.001). Neurological deficit was improved in all patients by 1–3 grades according to Nurick’s grading system. Conclusions In delayed myelopathy following an OVCF, although the posterior cortex invades the spinal canal, it is usually already in the union state. Therefore, it can bear compression force as a middle column if realigned to be in line with the adjoining vertebrae. VBaT demonstrated satisfactory reduction of kyphosis and maintenance of stability until the last follow-up.

PTEN hamartoma tumor syndrome is a spectrum of disorders characterized by unique phenotypic features including multiple hamartomas caused by mutations of the tumor suppressor gene PTEN. Cowden syndrome and Bannayan–Riley–Ruvalcaba syndrome are representative diseases, and both have several common clinical features and differences. Because PTEN mutations are associated with an increased risk of malignancy including breast, thyroid, endometrial, and renal cancers, cancer surveillance is an important element of disease management. We report a germline mutation of the PTEN (c.723dupT, exon 7) identified in a young woman with a simultaneous occurrence of breast cancer, dermatofibrosarcoma protuberans, and follicular neoplasm. This case suggests that it is critical for clinicians to recognize the phenotypic features associated with these syndromes to accurately diagnose them and provide preventive care.
Breast ; Breast Neoplasms ; Dermatofibrosarcoma ; Disease Management ; Exons ; Female ; Genes, Tumor Suppressor ; Germ-Line Mutation ; Hamartoma ; Hamartoma Syndrome, Multiple ; Humans ; Kidney Neoplasms ; Thyroid Gland

BACKGROUND: Until recently, the removal of melanocytic nevi has been performed with a CO2 laser or Er:YAG laser. These lasers have been useful for removing affected spots. However, enlargement of spots or some sequelae, including depressed or hypertrophic scars, could develop as unwanted results. The Q-switched Nd:YAG laser has been used to remove deep-seated melanocytes, such as Ota nevus or tattoos. However, there have been no previous experiments performed to test the efficacy and safety of this laser treatment for melanocytic nevi. OBJECTIVE: The objective of this study was to investigate the efficacy and safety of the 1,064 nm Q-switched Nd:YAG laser for removing melanocytic nevi, including congenital nevomelanocytic and acquired nevomelanocytic nevi. METHODS: Two thousand and sixty four Korean patients with small melanocytic nevi were treated with a Q-switched Nd:YAG laser from 2005 to 2009. High-resolution photographs were taken in identical lighting and positions before and after the six weeks of treatment to observe the procedural efficacy. RESULTS: About 70% of the nevi treated using a 1,064 nm Q-switched Nd:YAG laser were completely removed after one session. The other 30% were completely treated within three sessions. The appearance of sequelae such as hollow scars noticeably decreased compared to the results seen in CO2 or Er:YAG laser treatments. CONCLUSION: Use of the 1,064 nm Q-switched Nd:YAG laser is a safe and effective treatment modality for melanocytic nevi.
Cicatrix ; Cicatrix, Hypertrophic ; Humans ; Lasers, Gas ; Light ; Lighting ; Melanocytes ; Nevus ; Nevus of Ota ; Nevus, Pigmented

BACKGROUND/AIMS: Clostridium difficile is the predominant cause of nosocomial diarrhea. Recently, the incidence of Clostridium difficile infection (CDI) increases in Europe and North America. A retrospective study was performed to evaluate the change of incidence and clinical features of CDI in Korea. METHODS: From January 2003 to December 2008, inpatients diagnosed with CDI in Seoul Paik hospital were enrolled. The diagnosis of CDI was made when patients complained diarrhea with any positive results in C. difficile toxin assay, stool culture, or endoscopy. The incidence, recurrence rate, and clinical features were compared between early period (2003-2005) and late period (2006-2008). RESULTS: The incidence of CDI was 21.73 cases per 10,000 admitted patients in early period group, and significantly increased to 71.71 cases per 10,000 admitted patients in late period group (p<0.01). The hospital stay duration at the time of CDI diagnosis was shorter in late period group. Cephalosporin had the highest ratio as the causative antibiotics of CDI. However, there was no difference in recurrence rate between early and late period groups. Recurrence associated clinical factor was serum albumin level. CONCLUSIONS: The incidence of CDI showed increasing tendency during recent 6 years. The awareness of increasing disease burden is the first step in control of CDI.
Aged ; Anti-Bacterial Agents/therapeutic use ; Cephalosporins/therapeutic use ; *Clostridium difficile ; Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Risk Factors ; Serum Albumin/analysis

Wilson's disease is a rare autosomal recessive metabolic disease. The ATB7B gene mutation results in a defect of biliary copper excretion and subsequent accumulation of copper in the liver, brain, and sclera. The usual clinical signs of Wilson's disease include hepatitis, liver cirrhosis, movement disorder, or a Kayser-Fleisher ring in the sclera, but patients occasionally present with hepatic failure or hemolytic anemia. Under such metabolic conditions, free copper induce chronic hemolysis with oxidative damage via free radical production, and chronic hemolysis, in turn, can cause secondary pigment bililary stone formation. Herein we report a case of Wilson's disease associated with cholelithiasis in a young female.
Anemia, Hemolytic ; Brain ; Cholelithiasis ; Copper ; Hemolysis ; Hepatitis ; Hepatolenticular Degeneration ; Humans ; Liver ; Liver Cirrhosis ; Liver Failure ; Metabolic Diseases ; Movement Disorders ; Sclera

Ultrasonography (US)-guided fine needle aspiration biopsy (FNAB) is widely considered to be the diagnostic technique of choice in the assessment of nodular disease of the thyroid gland. Although the accuracy of FNAB analysis approaches 95% where there is an adequate sample, non-diagnostic sampling occurs in 10-20% of cases. Additionally, equivocal pathological results are obtained in 10-30% of cases, and there are limitations in detecting subtypes of certain diseases, such as lymphoma. Generally, US-guided core needle biopsy (CNB) allows for the procurement of a large, grossly visible specimen and a more precise pathological diagnosis. Therefore, US-guided CNB is indicated in the following situations: 1) when an inadequate specimen is obtained by FNAB, 2) when FNAB yields indeterminate or inadequate information, 3) when targeting of the lesion is difficult because it is diffuse, and 4) when there is a discrepancy between the imaging findings and the FNAB results. In this article, we describe the situations in which US-guided CNB is useful for diagnosing thyroid lesions.
Biopsy ; Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Lymphoma ; Thyroid Gland ; Thyroid Nodule

Posttraumatic high-flow communications between the intracavernous internal carotid artery (ICA) and the cavernous sinus may give rise to two different pathological entities. A connection from the intracavernous ICA system can theoretically connect with two different structures; the vein of the plexus (CCF) or the perivascular bare spaces between the veins (pseudoaneurysm). A CCF and a pseudoaneurysm can be present in the same patient. A 24-year-old man was admitted to our hospital due to sudden mental deterioration. Carotid angiography revealed a CCF, which had occurred after a trauma 5 years earlier, associated with left visual disturbance and skull base fractures. The treatment of choice was permanent coil occlusion of the intracavernous ICA at the level of the lesion. The collateral circulation was evaluated before the endovascular treatment using a balloon test occlusion (BTO). During the BTO, adequate collateral circulation was defined as symmetric angiographic filling of both hemispheres. A continuous neurological examination was performed during the procedure. The follow-up angiography showed a persistent aneurysm occlusion. We report our experience of the successful endovascular treatment of combined lesions with a review of the relevant literature.
Aneurysm ; Aneurysm, False* ; Angiography ; Carotid Artery, Internal ; Cavernous Sinus ; Collateral Circulation ; Fistula* ; Follow-Up Studies ; Humans ; Neurologic Examination ; Skull Base ; Veins ; Young Adult