Osteoporotic vertebral compression fractures have become common in aging societies and can lead to a decreased quality of life with severe back pain and neurological deficits.Traditional direct decompression and stabilization surgeries can produce sufficient decompression and provide good results. However, after surgical treatment, some elderly patients with numerous chronic diseases often experience severe postoperative complications owing to the long surgery duration and massive bleeding. Therefore, to prevent perioperative morbidity, other surgical methods that simplify the surgical process and reduce the operation time are required. Herein, we describe a case of indirect decompression using ligamentotaxis and sequential anabolic agents. To examine their effectiveness during surgery, we monitored intraoperative motor-evoked potentials. The patient’s neurological symptoms improved postoperatively. After the operation, the anabolic agent “romosozumab” was injected monthly to treat osteoporosis, prevent additional fractures, and accelerate posterolateral fusion. On serial follow-up, the anterior body height of the fractured vertebra improved significantly, demonstrating the importance of osteoporosis treatment using anabolic agents.Indirect decompression surgery may have early effects, whereas sequential anabolic agent use may consolidate the long-term effects of surgical treatment.

BACKGROUND: Usually, high-flow nasal cannula (HFNC) therapy is indicated for de novo acute hypoxemic respiratory failure (AHRF). Although only a few researches have examined the effectiveness of HFNC therapy for respiratory failure with hypercapnia, this therapy is often performed under such conditions for various reasons. We investigated the effectiveness of HFNC therapy for AHRF patients with hypercapnia compared to those without hypercapnia.METHODS: All consecutive patients receiving HFNC therapy between January 2012 and June 2018 at a university hospital were enrolled and classified into nonhypercapnic and hypercapnic groups. We compared the outcomes of both groups and adjusted the outcomes with propensity score matching.RESULTS: A total of 862 patients were enrolled, of which 202 were included in the hypercapnic group. HFNC weaning success rates were higher, and intensive care unit (ICU) and hospital mortality was lower in the hypercapnic group than in the nonhypercapnic group (all P < 0.05). However, no statistical differences in HFNC weaning success (adjusted P = 0.623, matched P = 0.593), ICU mortality (adjusted P = 0.463, matched P = 0.195), and hospital mortality (adjusted P = 0.602, matched P = 0.579) were noted from the propensity-adjusted and propensity-matched analyses. Additionally, in the propensity score-matched subgroup analysis (according to chronic lung diseases and causes of HFNC application), there was also no significant difference in outcomes between the two groups.CONCLUSION: In AHRF with underlying conditions, HFNC therapy might be helpful for patients with hypercapnia. Large prospective and randomized controlled trials are required for firm conclusions.

BACKGROUND: Usually, high-flow nasal cannula (HFNC) therapy is indicated for de novo acute hypoxemic respiratory failure (AHRF). Although only a few researches have examined the effectiveness of HFNC therapy for respiratory failure with hypercapnia, this therapy is often performed under such conditions for various reasons. We investigated the effectiveness of HFNC therapy for AHRF patients with hypercapnia compared to those without hypercapnia. METHODS: All consecutive patients receiving HFNC therapy between January 2012 and June 2018 at a university hospital were enrolled and classified into nonhypercapnic and hypercapnic groups. We compared the outcomes of both groups and adjusted the outcomes with propensity score matching. RESULTS: A total of 862 patients were enrolled, of which 202 were included in the hypercapnic group. HFNC weaning success rates were higher, and intensive care unit (ICU) and hospital mortality was lower in the hypercapnic group than in the nonhypercapnic group (all P < 0.05). However, no statistical differences in HFNC weaning success (adjusted P = 0.623, matched P = 0.593), ICU mortality (adjusted P = 0.463, matched P = 0.195), and hospital mortality (adjusted P = 0.602, matched P = 0.579) were noted from the propensity-adjusted and propensity-matched analyses. Additionally, in the propensity score-matched subgroup analysis (according to chronic lung diseases and causes of HFNC application), there was also no significant difference in outcomes between the two groups. CONCLUSION In AHRF with underlying conditions, HFNC therapy might be helpful for patients with hypercapnia. Large prospective and randomized controlled trials are required for firm conclusions.

BACKGROUND: The microtubule-associated protein Tau binds to both inner and outer surfaces of microtubules, leading to tubulin assembly and microtubule stabilization. The aim of this study was to evaluate the significance of Tau, alpha-tubulin, and betaIII-tubulin expression in breast carcinoma and to assess their relationships with disease progression in the context of taxane treatment. METHODS: Immunohistochemical expressions of Tau, alpha-tubulin, and betaIII-tubulin were assessed in 183 breast cancer cases. Expression was correlated with clinicopathologic parameters, disease progression and overall survival. RESULTS: Tau expression was correlated with lymph node metastasis and estrogen receptor (ER) positivity (p=.003 and p<.001, respectively). Loss of alpha-tubulin was significantly correlated with distant metastasis (p=.034). Loss of betaIII-tubulin was correlated with lymph node metastasis and ER positivity (p=.004 and p<.001, respectively). In taxane-treated cases, Tau expression and loss of alpha-tubulin and betaIII-tubulin expression were related to disease progression (p=.001, p=.028, and p=.030, respectively). Tau expression was associated with a worse survival rate in taxane-treated patients (p=.049). CONCLUSIONS: Tau expression and loss of alpha-tubulin and betaIII-tubulin expression were correlated with aggressive behavior in taxane-treated breast cancer. Further evaluation of Tau, alpha-tubulin and betaIII-tubulin may be useful in predicting clinical behavior and seeking therapeutic measures in taxane-based chemotherapy for breast cancer.
Breast Neoplasms* ; Breast* ; Disease Progression ; Drug Therapy ; Estrogens ; Humans ; Lymph Nodes ; Microtubules ; Neoplasm Metastasis ; Survival Rate ; tau Proteins ; Taxoids ; Tubulin*

BACKGROUND: Understanding the biologic behavior of a tumor is a prerequisite for tumor registration code assignment. The aim of this report was to propose appropriate behavior codes of the International Classification of Disease Oncology 3 (ICD-O3) to rare, yet pathologically interesting hematopoietic and soft tissue tumors. METHODS: The Study Group for Hematopathology, the Bone and Soft Tissue Pathology Study Group, and the Cancer Registration Committee prepared the questionnaire containing provisional behavior codes of selected diseases. RESULTS: In situ lesions of mantle cell and follicular lymphomas, dendritic cell tumors, and neoplasms with perivascular epithelioid cell differentiation (PEComa), not otherwise specified were classified as malignant (-/3). The fibromatosis group, with the exception of lipofibromatosis, was proposed as benign (-/0). Lipofibromatosis and several diseases that belong to the PEComa group were proposed as uncertain malignant potential (-/1). For the hematologic and soft tissue tumors, 274 and 288 members of the Korean Society of Pathologists, respectively, provided opinions through questionnaire, and most responders showed agreement with the provisional behavior code proposed. CONCLUSIONS: The determination of behavior codes for the rare diseases described in this study, especially those of the PEComa group or malignant lymphoma, could be viewed as impractical and premature, but this study provides the basis for future research on this topic.
Dendritic Cells ; Epithelioid Cells ; Fibroma ; Hematologic Neoplasms ; Lymphoma ; Lymphoma, Follicular ; Perivascular Epithelioid Cell Neoplasms ; Surveys and Questionnaires ; Rare Diseases ; Soft Tissue Neoplasms

BACKGROUND: Abnormal umbilical artery Doppler velocimetry is one of the important findings of intrauterine growth restriction (IUGR) and IUGR is associated with high perinatal morbidity and mortality. In addition, this abnormal Doppler velocimetry is correlated with placental insufficiency. The aim of this study was to determine the pathologic differences in the placentas from IUGR pregnancies with and without the absent or reversed end diastolic velocity (AREDV). METHODS: Among the cases that had undergone prenatal follow-up in our institute, a retrospective slide review was conducted for 18 cases of IUGR with AREDV and 17 cases with IUGR that had normal end-diastolic flow of the umbilical artery. RESULTS: The birth weight and the other clinical parameters were not different among the two groups. Grossly, the placental weight percentiles were significantly smaller in AREDV group when they were adjusted according to gestational age. Histologically, chronic deciduitis, mural hypertrophy of the decidual arteries, an intimal fibrin cushion of the large fetal vessels, increased syncytial knots, villous agglutinations, avascular villi, villous stromal-vascular karyorrhexis, and acute atherosis were more frequently found in the AREDV group and their presence showed statistical significance. CONCLUSIONS: These findings suggest that pathologic abnormalities due to fetal and maternal vasculopathies in the placenta may be the cornerstone for inducing AREDV in the umbilical artery.
Arteries ; Birth Weight ; Fetal Growth Retardation ; Fibrin ; Follow-Up Studies ; Gestational Age ; Hypertrophy ; Placenta ; Placental Insufficiency ; Pregnancy ; Retrospective Studies ; Rheology ; Umbilical Arteries

BACKGROUND: The cytological examination of cerebrospinal fluid (CSF) using conventional cytology with a cytocentrifuge (cytospin) is an important method for evaluating the involvement of leukemia in the CNS. Liquid-based cytology (LBC) is now a widely used cytological method not only for gynecological and non-gynecological specimens, but its application to CSF for the identification of leukemic cell has not yet been reported. In this study, we tried to compare conventional cytology with using a cytospin with LBC and Papanicolaou (Pap) staining. We also examined the modified LBC with Wright staining to assess whether this modified method can be useful for diagnosing Leukemia. METHODS: We studied 30 cases of CSF that were obtained from 16 patients, including 17 cases of acute myeloid leukemia, 12 cases of acute lymphoblastic leukemia and 1 case of diffuse large B cell lymphoma. We applied conventional cytology with a cytocentrifuge (cytospin), LBC with Pap staining and modified LBC with Wright staining. RESULTS: The morphological features of the LBC with Pap staining showed difficulty for interpretation when compared with conventional cytology with a cytospin, and mainly because of cellular shrinkage. The modified LBC with Wright staining showed good morphological features. CONCLUSIONS: We suggest that modified LBC with Wright staining may be useful for examining CSF.
Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Lymphoma, B-Cell ; Precursor Cell Lymphoblastic Leukemia-Lymphoma

BACKGROUND: Aberration of the cell cycle regulatory proteins has been reported to contribute to the development and progression of human malignancy. We studied the expression of G1/S cell cycle regulatory proteins to investigate the carcinogenesis in cutaneous squamous cell lesions. METHODS: We evaluated the expressions of p16, pRb, cyclin D1 and Ki-67 protein by immunonohistochemistry in cases of normal skin (n=15), seborrheic keratosis (SK; n=26), actinic keratosis (AK; n=30), Bowen's disease (BD; n=37), keratoacanthoma (KA; n=23), and squamous cell carcinoma (SCC; n=22). RESULTS: The Ki-67 expression gradually increased from SK, through AK, to BD. The expression of p16 was more increased in BD than that in AK. The decreased expressions of p16 and Rb, and the increased expression of cyclin D1 were observed to a greater degree in SCC than those in BD. The expressions of cyclin D1 and Ki-67 were higher in SCC than those in KA. CONCLUSIONS: The altered expressions of p16, Rb, and cyclin D1 were considered to be related to the carcinogenesis in the cutaneous squamous cell lesions. Therefore, immunohistochemical studies of the cell cycle regulatory proteins and a combined analysis may be helpful as an adjunct to the histomorphology in the diagnosis of cutaneous squamous cell lesions.
Bowen's Disease ; Carcinoma, Squamous Cell ; Cell Cycle ; Cell Cycle Proteins ; Cyclin D1 ; Humans ; Keratoacanthoma ; Keratosis, Actinic ; Keratosis, Seborrheic ; Skin

Although chronic myelogenous leukemia (CML) may be involved in any part of the body, infiltration of the body fluid has rarely reported in the literature. Here we report on a 35 year-old male patient who was diagnosed chronic myelogenous leukemia ten years previously and he received allogenic hematopoietic stem cell transplantation. He then presented with left knee pain eight years after the initial diagnosis. MRI revealed a soft tissue mass at the distal femur. Cytology of the joint fluid revealed myeloblasts, promyelocytes, eosinophilic myelocytes, band neutrophils, megakaryocytes and orthochromatic erythroblasts, which was all consistent with leukemic infiltration of the knee joint fluid. The immunohistochemistry was positive for CD34, CD117 and myeloperoxidase (MPO). Despite that the patient underwent radiation therapy, MRI revealed growth of the mass, and ten months later, the lymphoid blast phase of CML was confirmed after biopsy. The patient received an above knee amputation. Five months later, multiple masses were revealed on PET-CT at the left iliopsoas muscle, abdominal wall and bones. Bilateral pleural effusion occurred shortly after this. Cytologic evaluation of the pleural fluid also revealed blast-like cells, and histologic evaluation of the abdominal mass confirmed the lymphoid blast phase of CML with positivity for CD3, UCHL-1, CD34 and CD117, but negativity for MPO.
Abdominal Muscles ; Amputation ; Biopsy ; Blast Crisis ; Body Fluids ; Eosinophils ; Erythroblasts ; Femur ; Granulocyte Precursor Cells ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunohistochemistry ; Joints ; Knee ; Knee Joint ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemic Infiltration ; Male ; Megakaryocytes ; Neutrophils ; Peroxidase ; Pleural Effusion

Various types of glomerulonephritis can occur at the same time with Hodgkin lymphoma, including minimal change disease and membranous glomerulonephritis. However, the concurrence of IgA nephropathy with Hodgkin lymphoma is rare. We report here on a case of IgA nephropathy in a patient with newly diagnosed Hodgkin lymphoma: A 60-year-old man presented with weight loss and anorexia. The patient showed lymphadenopathies in the neck on physical examination, and multiple lymphadenopathies in the mediastinum and abdomen on computerized tomography. Diagnosis of Hodgkin lymphoma was made after cervical lymph nodes were excised, but during the course of the chemotherapy, laboratory findings of hematuria and an elevated creatinine level were observed and IgA nephropathy was additionally diagnosed from a renal biopsy. There were fluctuations in the creatinine level and the amounts of hematuria and proteinuria, but by the time of the eighth cycle of chemotherapy, the patients condition had rapidly deteriorated, mainly due to the newly developed adult respiratory distress syndrome. The patient died soon thereafter.
Abdomen ; Anorexia ; Biopsy ; Creatinine ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranous ; Hematuria ; Hodgkin Disease ; Humans ; Immunoglobulin A ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Mediastinum ; Middle Aged ; Neck ; Nephrosis, Lipoid ; Physical Examination ; Proteinuria ; Respiratory Distress Syndrome, Adult ; Weight Loss