Primary rectal syphilis is a rare disease that can be misdiagnosed as lymphoma or other rectal cancers on sigmoidoscopy or CT. Here, we report a case of primary rectal syphilis mimicking rectal malignancy in a 23-year-old male who presented with a rectal mass and multiple lymphadenopathies. In this case report and literature review, we focused on the CT findings and endoscopic observations of primary rectal syphilis. Infectious diseases, such as rectal syphilis, should be considered in the differential diagnosis of young patients with unusual rectal lesions and disproportionately extensive lymphadenopathies.

Primary rectal syphilis is a rare disease that can be misdiagnosed as lymphoma or other rectal cancers on sigmoidoscopy or CT. Here, we report a case of primary rectal syphilis mimicking rectal malignancy in a 23-year-old male who presented with a rectal mass and multiple lymphadenopathies. In this case report and literature review, we focused on the CT findings and endoscopic observations of primary rectal syphilis. Infectious diseases, such as rectal syphilis, should be considered in the differential diagnosis of young patients with unusual rectal lesions and disproportionately extensive lymphadenopathies.

Primary rectal syphilis is a rare disease that can be misdiagnosed as lymphoma or other rectal cancers on sigmoidoscopy or CT. Here, we report a case of primary rectal syphilis mimicking rectal malignancy in a 23-year-old male who presented with a rectal mass and multiple lymphadenopathies. In this case report and literature review, we focused on the CT findings and endoscopic observations of primary rectal syphilis. Infectious diseases, such as rectal syphilis, should be considered in the differential diagnosis of young patients with unusual rectal lesions and disproportionately extensive lymphadenopathies.

Purpose: We aimed to analyze the occurrence of lymphedema as a side effect in patients who underwent regional nodal irradiation (RNI) following surgery for breast cancer. Methods: This retrospective study was conducted on patients with breast cancer who underwent surgery from July 2014 to October 2020 at Inje University Busan Paik Hospital. The analysis included 113 cT1-3N1-3M0 breast cancer patients who underwent RNI as part of radiotherapy (RT). Mostly, surgeries were performed using breast-conserving surgery (n = 99, 87.6%), except for 14 patients with modified radical mastectomy. The total RT dose for RNI was 45–60 Gy, and the fraction size was 1.8–2.0 Gy. Most patients underwent chemotherapy (n = 98, 86.7%), including taxanes (n = 92, 81.4%). Results: The median follow-up was 61.1 months (range, 5.0–110.5 months). Lymphedema occurred in 54 patients (47.8%) after surgery. Twenty of them (17.7%) developed a new onset of lymphedema after RT, while 34 (30.1%) detected lymphedema before the completion of RT. Over the follow-up, 16 patients (14.2%) experienced recurrence. High radiation dose (>50.4 Gy) for RNI (P = 0.003) and taxane use (P = 0.038) were related to lymphedema occurrence after RT. Moreover, lymphedema occurrence after RT was also related to recurrence after surgical resection (P = 0.026). Breast-conserving surgery was related to early-onset lymphedema before the completion of RT (P = 0.047). Furthermore, the degree of lymph node dissection (≤4) was related to the overall occurrence of lymphedema (P = 0.045). Conclusion Considering a reduction in RNI dose may be beneficial in mitigating the incidence of lymphedema after RT in patients with breast cancer.

Background: This study aimed to evaluate the effectiveness of conservative treatment in selected patients with atraumatic medial sesamoid pain (MSP) that developed during sports activities. The secondary aim was to determine the detailed underlying pathology in patients who did not respond to conservative treatment using magnetic resonance imaging (MRI). Methods: From March 2015 to August 2022, we prospectively followed 27 patients who presented to our outpatient clinic with atraumatic sports-related MSP. The conservative treatment protocol for MSP included the use of oral analgesics, activity restriction, insole modification, local corticosteroid injections, and boot walker application with crutches. MRI was performed for all patients who experienced persistent pain despite the completion of conservative treatment. Results: After the completion of the conservative treatment protocol, 48.1% of the patients reported a reduction in pain. Patients with younger age at pain onset (p = 0.001), higher body mass index (p = 0.001), and a bipartite medial sesamoid (p = 0.010) were more likely to experience persistent pain after conservative treatment. The type of sports activity was also a factor since runningand dancing-related MSP tended to respond better to conservative treatment compared to MSP originating from golf, futsal, and weightlifting with squatting. On MRI, 42.8% of patients showed no specific abnormal findings, with signal changes in soft tissues such as the subcutaneous fat and bursa being the most common, followed by intraosseous signal changes of the medial sesamoid bone and chondral or subchondral lesions of the medial sesamoid metatarsal joint (28.6% each). Conclusions Conservative treatment was successful in less than half of the patients who experienced MSP due to sports activity. Practitioners should be aware of the numerous possible causes of conservative treatment failure, such as bursitis, medial sesamoiditis, stress fracture, or chondral lesions between the medial sesamoid and metatarsal. MRI evaluation may be helpful in MSP patients who do not respond to conservative treatment.

Background: Recently, deep learning techniques have been used in medical imaging studies. We present an algorithm that measures radiologic parameters of distal radius fractures using a deep learning technique and compares the predicted parameters with those measured by an orthopedic hand surgeon. Methods: We collected anteroposterior (AP) and lateral X-ray images of 634 wrists in 624 patients with distal radius fractures treated conservatively with a follow-up of at least 2 months. We allocated 507 AP and 507 lateral images to the training set (80% of the images were used to train the model, and 20% were utilized for validation) and 127 AP and 127 lateral images to the test set. The margins of the radius and ulna were annotated for ground truth, and the scaphoid in the lateral views was annotated in the box configuration to determine the volar side of the images. Radius segmentation was performed using attention U-Net, and the volar/dorsal side was identified using a detection and classification model based on RetinaNet. The proposed algorithm measures the radial inclination, dorsal or volar tilt, and radial height by index axes and points from the segmented radius and ulna. Results: The segmentation model for the radius exhibited an accuracy of 99.98% and a Dice similarity coefficient (DSC) of 98.07% for AP images, and an accuracy of 99.75% and a DSC of 94.84% for lateral images. The segmentation model for the ulna showed an accuracy of 99.84% and a DSC of 96.48%. Based on the comparison of the radial inclinations measured by the algorithm and the manual method, the Pearson correlation coefficient was 0.952, and the intraclass correlation coefficient was 0.975. For dorsal/ volar tilt, the correlation coefficient was 0.940, and the intraclass correlation coefficient was 0.968. For radial height, it was 0.768 and 0.868, respectively. Conclusions The deep learning-based algorithm demonstrated excellent segmentation of the distal radius and ulna in AP and lateral radiographs of the wrist with distal radius fractures and afforded automatic measurements of radiologic parameters.

Background/Aims: We used next-generation sequencing (NGS) to analyze resistance-associated substitutions (RASs) and retreatment outcomes in patients with chronic hepatitis C virus (HCV) infection who failed direct-acting antiviral agent (DAA) treatment in South Korea. Methods: Using prospectively collected data from the Korean HCV cohort study, we recruited 36 patients who failed DAA treatment in 10 centers between 2007 and 2020; 29 blood samples were available from 24 patients. RASs were analyzed using NGS. Results: RASs were analyzed for 13 patients with genotype 1b, 10 with genotype 2, and one with genotype 3a. The unsuccessful DAA regimens were daclatasvir+asunaprevir (n=11), sofosbuvir+ribavirin (n=9), ledipasvir/sofosbuvir (n=3), and glecaprevir/pibrentasvir (n=1). In the patients with genotype 1b, NS3, NS5A, and NS5B RASs were detected in eight, seven, and seven of 10 patients at baseline and in four, six, and two of six patients after DAA failure, respectively. Among the 10 patients with genotype 2, the only baseline RAS was NS3 Y56F, which was detected in one patient. NS5A F28C was detected after DAA failure in a patient with genotype 2 infection who was erroneously treated with daclatasvir+asunaprevir. After retreatment, 16 patients had a 100% sustained virological response rate. Conclusions NS3 and NS5A RASs were commonly present at baseline, and there was an increasing trend of NS5A RASs after failed DAA treatment in genotype 1b. However, RASs were rarely present in patients with genotype 2 who were treated with sofosbuvir+ribavirin. Despite baseline or treatment-emergent RASs, retreatment with pan-genotypic DAA was highly successful in Korea, so we encourage active retreatment after unsuccessful DAA treatment.