Background: The main cause of death in pulmonary embolism (PE) is right-heart failure due to acute pressure overload. In this sense, extracorporeal membrane oxygenation (ECMO) might be useful in maintaining hemodynamic stability and improving organ perfusion. Some previous studies have reported ECMO as a bridge to reperfusion therapy of PE. However, little is known about the patients that benefit from ECMO. Methods: Patients who underwent ECMO due to pulmonary thromboembolism at a single university-affiliated hospital between January 2010 and December 2018 were retrospectively reviewed. Results: During the study period, nine patients received ECMO in high-risk PE. The median age of the patients was 60 years (range, 22–76 years), and six (66.7%) were male. All nine patients had cardiac arrests, of which three occurred outside the hospital. All the patients received mechanical support with veno-arterial ECMO, and the median ECMO duration was 1.1 days (range, 0.2–14.0 days). ECMO with anticoagulation alone was performed in six (66.7%), and ECMO with reperfusion therapy was done in three (33.3%). The 30-day mortality rate was 77.8%. The median time taken from the first cardiac arrest to initiation of ECMO was 31 minutes (range, 30–32 minutes) in survivors (n=2) and 65 minutes (range, 33–482 minutes) in non-survivors (n=7). Conclusion High-risk PE with cardiac arrest has a high mortality rate despite aggressive management with ECMO and reperfusion therapy. Early decision to start ECMO and its rapid initiation might help save those with cardiac arrest in high-risk PE.

Drug-induced immune hemolytic anemia is a rare disease that occurs in 1 in 1 million individuals of the general population. Rifampin-induced immune hemolytic anemia is caused by drug-dependent antibodies and this can be treated without complication by drug cessation. Herein, we present a case of rifampin-induced immune hemolytic anemia in a patient with primary Sjogren's syndrome (pSS) which occurred during treatment of pulmonary tuberculosis. At admission, the patient's laboratory tests revealed hemolytic anemia and positive direct antiglobulin test result. Since the incidence of autoimmune hemolytic anemia (AIHA) in pSS is reported to be 3 percent, which is higher than that of the general population, differential diagnosis between AIHA and rifampin-induced immune hemolytic anemia was required for planning future anti-tuberculous treatment. We identified rifampin-dependent antibody by drug-induced immune complex test and diagnosed rifampin-induced immune hemolytic anemia. Based on this experience, if rifampin administration is considered in patients with systemic autoimmune disease such as pSS, which has a high incidence of AIHA, we suggest evaluating the presence and the cause of hemolytic anemia at baseline by testing serum lactate dehydrogenase, haptoglobin, and direct and indirect antiglobulin tests before drug administration to promptly identify the cause of hemolysis if hemolytic anemia develops.

PURPOSE: The purpose of this study is to evaluate imaging and histopathologic findings including the immunohistochemical characteristics of invasive micropapillary carcinoma (IMPC) of the breast. METHODS: Twenty-nine patients diagnosed with IMPC were included in the present study. Mammographic, sonographic, and magnetic resonance imaging (MRI) findings were analyzed retrospectively according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings were also evaluated. Microscopic slides of surgical specimens were reviewed in consensus by two pathologists with a specialty in breast pathology. RESULTS: Most IMPCs presented as a high density irregular mass with a non-circumscribed margin associated with microcalcifications on mammography, as an irregular hypoechoic mass with a spiculated margin on ultrasound, and as irregular spiculated masses with washout patterns on MRI. PET-CT showed a high maximum standardized uptake value (SUVmax) (mean, 11.2). Axillary nodal metastases were identified in 65.5% of the patients. Immunohistochemical studies showed high positivities for estrogen receptor and c-erbB-2 (93.1% and 51.7micro, respectively). CONCLUSION: Even though the imaging characteristics of IMPCs are not distinguishable from typical invasive ductal carcinomas, this tumor type frequently results in nodal metastases and high positivities for both estrogen receptor and c-erbB-2. The high SUVmax value that is apparent on PET-CT might be helpful in the diagnosis of IMPC.
Breast ; Carcinoma, Ductal ; Consensus ; Electrons ; Estrogens ; Humans ; Information Systems ; Magnetic Resonance Imaging ; Mammography ; Neoplasm Metastasis ; Retrospective Studies

PURPOSE: The purpose of this study is to evaluate imaging and histopathologic findings including the immunohistochemical characteristics of invasive micropapillary carcinoma (IMPC) of the breast. METHODS: Twenty-nine patients diagnosed with IMPC were included in the present study. Mammographic, sonographic, and magnetic resonance imaging (MRI) findings were analyzed retrospectively according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) findings were also evaluated. Microscopic slides of surgical specimens were reviewed in consensus by two pathologists with a specialty in breast pathology. RESULTS: Most IMPCs presented as a high density irregular mass with a non-circumscribed margin associated with microcalcifications on mammography, as an irregular hypoechoic mass with a spiculated margin on ultrasound, and as irregular spiculated masses with washout patterns on MRI. PET-CT showed a high maximum standardized uptake value (SUVmax) (mean, 11.2). Axillary nodal metastases were identified in 65.5% of the patients. Immunohistochemical studies showed high positivities for estrogen receptor and c-erbB-2 (93.1% and 51.7micro, respectively). CONCLUSION: Even though the imaging characteristics of IMPCs are not distinguishable from typical invasive ductal carcinomas, this tumor type frequently results in nodal metastases and high positivities for both estrogen receptor and c-erbB-2. The high SUVmax value that is apparent on PET-CT might be helpful in the diagnosis of IMPC.
Breast ; Carcinoma, Ductal ; Consensus ; Electrons ; Estrogens ; Humans ; Information Systems ; Magnetic Resonance Imaging ; Mammography ; Neoplasm Metastasis ; Retrospective Studies

PURPOSE: We evaluated the usefulness of intracranial stent implantation for treating patients with atherosclerotic stenosis and with recurrent, ischemic, neurological symptoms despite having undergone medical therapy. MATERIALS AND METHODS: Between March 2004 and April 2010, we attempted intracranial, stent-assisted angioplasty in 77 patients with 85 lesions (anterior circulation 73 cases, posterior circulation 12 cases) and who had ischemic neurological symptoms with more than 50% major cerebral artery stenosis. We analyzed the results regarding the technical success rate, complication rate, and restenosis rate during the mean 29.4 month follow-up period. RESULTS: Intracranial stent implantation was successfully performed in 74 cases (87.1%). In nine cases among the 11, failed cases, stent implantation failure was due to the tortuosity of the target vessel. One patient experienced middle cerebral artery rupture during the procedure, and we embolized the vessel using a microcoil. Five patients developed cerebral infarction in three weeks after the procedure, three of whom improved using conservative management, although the other, two patients expired. The mean number of residual stenoses decreased from 72.3% to 14.7%. Three patients demonstrated significant in-stent restenosis, i.e. more than 50%, during the follow-up period. CONCLUSION: As stent-assisted angioplasty in intracranial, atherosclerotic stenosis is effective and relatively safe, it can be considered as an alternative treatment for patients with recurrent, ischemic, neurologic symptoms despite having undergone medical therapy.
Angioplasty ; Cerebral Arteries ; Cerebral Infarction ; Constriction, Pathologic ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Intracranial Arteriosclerosis ; Middle Cerebral Artery ; Neurologic Manifestations ; Rupture ; Stents

Palisaded encapsulated neuroma (PEN) is a benign cutaneous neural tumor. It usually presents in adults as a solitary asymptomatic skin-colored papule that is almost always on the face. We report here on an uncommon case of plexiform PEN that developed on the penis of a 43-year-old man. It was 6 mm-sized skin colored papule. Histologically, there is an encapsulated nodule with a plexiform growth pattern in the dermis and a palisading arrangement of nuclei. On immunohistochemical staining, the tumor cells of the nodule were positive for S-100 and neurofilament.
Adult ; Dermis ; Humans ; Male ; Neuroma ; Penis ; Skin

PURPOSE: The purpose of the study was to identify effects of the BeHaS program on self esteem, fatigue and anxiety in postoperative care patients with breast cancer who had surgery with, chemotherapy, radiotherapy, with or without current hormone therapy. METHODS: This study was a 2-group quasi-experimental research study with a pre and post test design. Fifty-four patients with breast cancer were assigned to the experimental (n=29) or control group (n=25). The BeHaS program which strengthens self esteem through support over a 90-minute period, consists of theme activity (30 minutes), education (15 minutes), group support (15 minutes) and exercise (30 minutes). The experimental group participated in the program once a week for 10 weeks, but the control group was not involved. Data were gathered from October to December, 2008 using a questionnaire with measures of self esteem, fatigue and anxiety. Data were analyzed using t-test with SPSS Win 12.0 to identify differences between the groups. RESULTS: Self esteem was significantly increased (p= .001) and fatigue significantly decreased (p= .013) in the experimental group. But there was no significant difference in anxiety (p= .868). CONCLUSION: These results suggest that the BeHaS program for patients with breast cancer had beneficial effects on self esteem and fatigue.
Anxiety ; Breast ; Breast Neoplasms ; Fatigue ; Humans ; Postoperative Care ; Surveys and Questionnaires ; Self Concept

Little is known about the treatment-seeking behaviors of acne patients, especially Asian acne patients. This study was performed to obtain detailed information about the treatment-seeking behaviors in Korean acne patients. Patients who visited the dermatology departments at 17 university hospitals completed a self-administered questionnaire. Most patients obtained information about acne from doctors or the Internet. The most important criteria for selecting a treatment method or choosing a particular clinic were effectiveness and accessibility. Patients used traditional medicine, visited beauty clinics, drank more water, and used over-the-counter topical agents more frequently than they sought doctors during the worsening period. The degree of satisfaction in treatment was found to depend on the total cost of treatment, number of places visited, site affected by acne, and emotional stress. Those who had experienced a side effect tended to have been treated for longer, to have paid more for treatment, and to have an associated skin disease. Treatments prescribed by dermatology clinics had the lowest aggravating rate, although improvement rates for family medicine clinics were also fairly high. This is the first study to investigate in detail the demographic features and characteristics of the treatmentseeking behaviors of acne patients in Asia.
Acne Vulgaris/epidemiology/*psychology/therapy ; Adult ; Demography ; Female ; Health Behavior ; Health Knowledge, Attitudes, Practice ; Hospitals, University ; Humans ; Korea ; Male ; *Patient Satisfaction ; Questionnaires ; Sex Factors ; Stress, Psychological ; Young Adult

Cancer-associated rheumatic disorders are sometimes present concurrently with a tumor, but are not recognized initially. We report a case of dermatomyositis with breast cancer. A 46 year-old woman diagnosed with breast cancer with axillary lymph node metastasis had been treated by neoadjuvant chemotherapy and a lumpectomy with axillary lymph node dissection. She presented with a red rash on her face, eyelids, neck, and shoulders. A skin biopsy did not rule out dermatomyositis. Laboratory values were within normal limits, except muscle enzymes (Creatine kinase). Electromyography showed the presence of early myopathy. A PET CT-scan showed muscle uptake in left infraspinatus, r/o myositis. No abnormalities were presented in the muscle biopsy. Symptoms were improved by steroid therapy.
Biopsy ; Breast ; Breast Neoplasms ; Dermatomyositis ; Electromyography ; Exanthema ; Eyelids ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental ; Muscles ; Muscular Diseases ; Myositis ; Neck ; Neoplasm Metastasis ; Shoulder ; Skin

BACKGROUND: Ultrasonographic imaging is very useful tool to determine various neoplasms and inflammatory changes of the human body. In addition, thanks to the use of various frequencies in ultrasonography, subcutaneous and some dermal lesions can be evaluated without invasive procedures such as a biopsy. OBJECTIVE: This study was performed to evaluate the usefulness of ultrasonography in the diagnosis of subcutaneous nodules. METHODS: We reviewed the medical records of 29 patients with subcutaneous nodules and analyzed the correlation between ultrasonographic findings and final biopsy findings. The HDI-5000 ultrasonography system (Philips, Eindhoven, Netherlands) with variable probes (from 5 to 12 MHz) was used in this study. RESULTS: In 27 patients, ultrasonographic findings were matched with final biopsy findings. One pilomatricoma was misdiagnosed as a cyst and one hemangioma as lipoma. It was very interesting to find that two malignant tumors and one subcutaneous granuloma annulare were detected by ultrasonographic examination in the absence of any clinical clues. CONCLUSION: Ultrasonography is a very useful, noninvasive, easy to apply, and relatively predictive tool for the evaluation of subcutaneous nodules. Although a skin biopsy is necessary for final diagnosis, ultrasonography would be a good substitute in the diagnosis of subcutaneous nodules when the patient refuses a skin biopsy and the nodule is located in a highly cosmetic area.
Biopsy ; Diagnosis ; Granuloma Annulare ; Hemangioma ; Human Body ; Humans ; Lipoma ; Medical Records ; Pilomatrixoma ; Skin ; Ultrasonography*