Purpose: Factors associated with invasive recurrence (REC) of ductal carcinoma in situ (DCIS) are less known. This study was aimed at identifying better biomarkers to predict the prognosis of DCIS. Methods: RNA extracted from formalin-fixed paraffin-embedded blocks of twenty-four pure DCIS cases was subjected to differential gene expression analysis. The DCIS cases were selected by matching age and estrogen receptor status. Sixteen REC-free and 8 invasive-REC cases with disease-free interval of > 5 years were analyzed. Immunohistochemistry (IHC) staining was used to validate sixty-one independent pure DCIS cases, including invasive-REC (n = 16) and REC-free (n = 45) cases. Results: Eight differentially expressed genes (DEGs) were statistically significant (log 2-fold change [FC] < –1 or > 1 and p < 0.001). Less than ½ fold expression of CUL1, androgen receptor (AR), RPS27A, CTNNB1, MAP3K1, PRKACA, GNG12, MGMT genes was observed in the REC group compared to the no evidence of disease group. AR and histone deacetylase 1 (HDAC1) genes were selected for external validation (AR: log 2-FC − 1.35, p < 0.001, and HDAC1: log 2-FC − 0.774, p < 0.001). External validation showed that the absence of AR and high HDAC1 expression were independent risk factors for invasive REC (hazard ratio [HR], 5.04; 95% confidence interval [CI], 1.24–20.4; p = 0.023 and HR, 3.07; 95% CI, 1.04–9.04; p = 0.042). High nuclear grade 3 was also associated with long-term invasive REC. Conclusion Comparative gene expression analysis of pure DCIS revealed 8 DEGs among recurring cases. External validation with IHC suggested that the absence of AR and overexpression of HDAC1 are associated with a greater risk of long-term invasive REC of pure DCIS.

Androgen insensitivity syndrome (AIS) is a rare genetic disease caused by various abnormalities in the androgen receptor (AR). The AR is an essential steroid hormone receptor that plays a critical role in male sexual differentiation and development and preservation of the male phenotype. Mutations in the AR gene on the X chromosome cause malfunction of the AR so that a 46,XY karyotype male has some physical characteristics of a woman or a full female phenotype. Depending on the phenotype, AIS can be classified as complete, partial or mild. Here, we report 2 cases of complete AIS in young children who showed complete sex reversal from male to female as a result of AR mutations. They had palpable inguinal masses and normal female external genitalia, a blind-end vagina and absent Müllerian duct derivatives. They were both 46,XY karyotype and AR gene analysis demonstrated pathologic mutations in both. Because AIS is inherited in an X-linked recessive manner, we performed genetic analysis of the female family members of each patient and found the same mutation in the mothers of both patients and in the female sibling of case 2. Gonadectomy was performed in both patients to avoid the risk of malignancy in the undescended testicles, and estrogen replacement therapy is planned for their adolescence. Individuals with complete AIS are usually raised as females and need appropriate care.
Adolescent ; Androgen-Insensitivity Syndrome* ; Child ; Disorders of Sex Development ; Estrogen Replacement Therapy ; Female* ; Genitalia ; Humans ; Karyotype ; Male ; Mothers ; Phenotype ; Receptors, Androgen ; Sex Differentiation ; Siblings ; Testis ; Vagina ; X Chromosome

BACKGROUND: The purpose of this study was to determine the prognostic significance of chest computed tomographic (CT) parameters in acute submassive pulmonary embolism (PE). METHODS: Between January 2006 and December 2009, 268 consecutive patients with acute submassive PE that was confirmed by chest CT with pulmonary angiography in emergency room were studied. One experienced radiologist measured CT parameters and judged the presence of right ventricular dysfunction. CT parameters were analyzed to determine their ability to predict a major adverse event (MAE). RESULTS: There were 220 patients included and 61 (27.7%) had MAE. Left ventricular and right ventricular maximum minor axis (36.4+/-8.0 vs. 41.7+/-7.4, p<0.01; 45.7+/-9.4 vs. 41.5+/-7.6, p<0.01), superior vena cava diameter (19.2+/-3.4 vs. 18.0+/-3.4, p=0.02), azygos vein diameter (10.0+/-2.2 vs. 9.2+/-2.3, p=0.02), septal displacement (19 vs. 18, p<0.01) were significantly higher in MAE group than in no MAE group. Patients with MAE had high right ventricular/left ventricular dimension ratio (RV/LV ratio) compared to patients without MAE (1.34+/-0.48 vs. 1.03+/-0.28, p<0.01). The most useful cut-off value of RV/LV ratio for MAE was 1.3 and the area under the curve was 0.71 (0.62~0.79). CONCLUSION: RV/LV ratio on chest CT was a significant predictor of submassive PE related shock, intubation, in-hospital mortality, thrombolysis, thrombectomy within 30 days.
Angiography ; Axis, Cervical Vertebra ; Azygos Vein ; Displacement (Psychology) ; Emergencies ; Hospital Mortality ; Humans ; Intubation ; Prognosis ; Pulmonary Embolism ; Shock ; Thorax ; Thrombectomy ; Vena Cava, Superior ; Ventricular Dysfunction, Right

BACKGROUND: The purpose of this study was to determine the prognostic significance of chest computed tomographic (CT) parameters in acute submassive pulmonary embolism (PE). METHODS: Between January 2006 and December 2009, 268 consecutive patients with acute submassive PE that was confirmed by chest CT with pulmonary angiography in emergency room were studied. One experienced radiologist measured CT parameters and judged the presence of right ventricular dysfunction. CT parameters were analyzed to determine their ability to predict a major adverse event (MAE). RESULTS: There were 220 patients included and 61 (27.7%) had MAE. Left ventricular and right ventricular maximum minor axis (36.4+/-8.0 vs. 41.7+/-7.4, p<0.01; 45.7+/-9.4 vs. 41.5+/-7.6, p<0.01), superior vena cava diameter (19.2+/-3.4 vs. 18.0+/-3.4, p=0.02), azygos vein diameter (10.0+/-2.2 vs. 9.2+/-2.3, p=0.02), septal displacement (19 vs. 18, p<0.01) were significantly higher in MAE group than in no MAE group. Patients with MAE had high right ventricular/left ventricular dimension ratio (RV/LV ratio) compared to patients without MAE (1.34+/-0.48 vs. 1.03+/-0.28, p<0.01). The most useful cut-off value of RV/LV ratio for MAE was 1.3 and the area under the curve was 0.71 (0.62~0.79). CONCLUSION: RV/LV ratio on chest CT was a significant predictor of submassive PE related shock, intubation, in-hospital mortality, thrombolysis, thrombectomy within 30 days.
Angiography ; Axis, Cervical Vertebra ; Azygos Vein ; Displacement (Psychology) ; Emergencies ; Hospital Mortality ; Humans ; Intubation ; Prognosis ; Pulmonary Embolism ; Shock ; Thorax ; Thrombectomy ; Vena Cava, Superior ; Ventricular Dysfunction, Right

OBJECTIVE: The purpose of this study is to evaluate the patterns of vaginal bleeding on continuous combined hormone replacement therapy (HRT) with micronized progesterone (MP), compared with medroxyprogesterone acetate (MPA) and to find any effects of body weight, body mass index, age of menopause, and duration of postmenopausal amenorrhea on these patterns of vaginal bleedings. METHODS: In continuous combined HRT using MP, 0.625 mg conjugate equine estrogen (CEE) and 100 mg MP were daily administered orally in 100 postmenopausal women. In continuous combined HRT using MPA, 0.625 mg CEE and 2.5 mg MPA were daily administered orally in 70 postmenopausal women. And we observed the vaginal bleeding patterns for six months after initiation of therapy. RESULTS: No vaginal bleeding or only slight vaginal spotting within 3 months were in 92 women (92%) in continuous combined HRT using MP. Only 8 women (8%) showed continuous bleeding for more than three months or heavy bleeding, so they stopped HRT or changed to other regimens. These were statistically significant lower rates of frequency of vaginal bleeding (35%) and drop out (8%), compared with the group using MPA (62.9%, and 42.9%) in our previous study. There were no statistically significant differences in the means of body weight, body mass index, and age of menopause between two treatment groups, but the mean of durations of postmanopausal amenorrhea was significantly longer in MP treatment group than that of MPA treatment group. In each treatment group, there were no statistically significant differences in the means of body weight, body mass index, duration of postmanopausal amenorrhea, and age of menopause according to the frequency of vaginal bleeding. CONCLUSION: Continuous combined HRT using MP showed less bleeding and better compliance than that using MPA.
Amenorrhea ; Body Mass Index ; Body Weight ; Compliance ; Estrogens ; Female ; Hemorrhage ; Hormone Replacement Therapy* ; Humans ; Medroxyprogesterone Acetate ; Menopause ; Metrorrhagia ; Progesterone* ; Uterine Hemorrhage*

PURPOSE: Coiling or infusion of embolic materials into a wide necked aneurysm can be performed with stenting. The purpose of our study is to assess the technical feasibility of aneurysm treatment with glue embolization after stenting. MATERIALS AND METHODS: We used four Wallstents for surgically repairing eight canine carotid aneurysms. After confirmation of the aneurysms on the angiogram, we introduced a 6-7 F guiding catheter in order to deploy the stents. After stenting, we passed a microcatheter into the aneurysm lumen through the stent mesh. 28% glue was slowly injected until the glue cast completely filled the lumen. We evaluated the passage of a microcatheter through the stent meshwork, formation of the glue cast and the stents' ability to protection for any leakage of glue. The follow-up angiogram was obtained for two dogs, one to three times until 8 weeks, and then we sacrificed the dogs and performed pathologic examinations. RESULTS: Stenting was successful in all cases except one in which the vessel was occluded because the stent was not completely expanded within the lumen. The microcatheter could not pass through the stent mesh in one aneurysm. The two week follow-up angiogram showed complete occlusion of the aneurysm and a patent carotid lumen in a case after successful stenting and glue embolization without distal migration of glue. Tungsten in the glue was noted to migrate out of aneurysm into the soft tissue of the neck. Histopathologic examination showed successful obliteration and stable organization of the aneurysmal lumen with ingrowth of fibroblasts and a foreign body reaction. In contrast, the aneurysms without the glue embolization being performed showed partially thrombosed aneurysmal lumens that became smaller and indistinct on the 8 week follow-up angiograms. Histopathologic examination showed a disorganized thrombus with numerous recanalizations. CONCLUSION: Glue embolization after stenting could be performed for aneurysm without distal migration of the glue or gluing of the catheter. This concept appears to be useful for applications to the further research and the treatment of aneurysm.
Adhesives* ; Aneurysm* ; Animals ; Carotid Arteries* ; Catheters ; Dogs ; Fibroblasts ; Follow-Up Studies ; Foreign-Body Reaction ; Intracranial Aneurysm ; Neck ; Stents* ; Thrombosis ; Tungsten

OBJECTIVE: To determine the incidence of HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome and assess the relationship between the maternal-fetal complications and the severity of HELLP syndrome, classified based on platelet count nadir. METHODS: We reviewed the maternal and neonatal charts of ten pregnancies complicated by HELLP syndrome, managed at Dankook University Hospital between January, 1995 and December, 2002. Women were divided into 2 groups as class I HELLP which had a maternal platelet nadir 50,000 and 100,000/mm3. We compared the maternal and fetal complications between class I and class II HELLP syndrome. But we did not analyze statistically due to small number of patients. RESULTS: There were four cases of class I HELLP and six cases of class II HELLP syndrome. The incidence of HELLP syndrome was 0.10% (10/10,238) in total deliveries and was 2.26% (10/443) in women with severe pre-eclampsia or eclampsia. The mean level of platelet counts nadir was 41,500/mm3 in class I and 64,000/mm3 in class II HELLP. The mean platelet recovery days (more than 100,000/mm3) were 6.0 and 4.2 days in each class. The mean values of the maximal aspartate aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT) and uric acid might show no differences, but there might be difference in lactate dehydrogenase (LDH) levels which were 5854 and 1388 IU/L in each class. All patients with class I HELLP syndrome showed maternal complications, but only one patient with class II HELLP showed maternal complications. There might be no differences in the mean gestational ages and birth weights. The neonatal complications were similar in each class. CONCLUSION: Our data suggest that patients with class I HELLP syndrome may be at increased risk for serious maternal complications, but the neonatal complications may be associated with gestational ages.
Alanine Transaminase ; Aspartate Aminotransferases ; Birth Weight ; Blood Platelets* ; Eclampsia ; Female ; Gestational Age ; HELLP Syndrome* ; Humans ; Incidence ; L-Lactate Dehydrogenase ; Liver ; Platelet Count* ; Pre-Eclampsia ; Pregnancy ; Uric Acid

OBJECTIVE: The purpose of our study was to describe acute necrotizing encephalopathy in Korean infants and children, and we sought to evaluate the prognostic factors. MATERIALS AND METHODS: Acute necrotizing encephalopathy was diagnosed in 14 Korean infants and children. We retrospectively analyzed the neuroimaging findings including the follow-up changes. The clinical course of the disease was graded, and we evaluated prognostic factors including age, serum level of the aminotransferase, hemorrhage, and localized atrophy of the brain. RESULTS: This encephalopathy predominantly affected the bilateral thalami (n=14), pons (n=12), and midbrain (n=10) in a symmetrical pattern. Hemorrhage was observed in eight patients (57%). On the follow-up images (n=12), the brain lesions were reduced in extent for all patients, and generalized atrophy was seen in six patients. Localized tissue loss was observed in five patients and a complete resolution occurred for one patient. All the patients survived and two recovered completely; mild (n=6) to severe (n=6) neurological deficits persisted in the remaining 12 patients. The significant prognostic factors identified in this study were the presence of hemorrhage (p = 0.009) and localized atrophy (p = 0.015). CONCLUSION: Acute necrotizing encephalopathy in Korean patients showed the characteristic patterns of the post-infectious encephalopathy as described in the literature. The high survival rate and the relatively favorable clinical course observed for the present study suggest a more diverse spectrum of disease severity than was previously described. The presence of hemorrhage and localized tissue loss on MR images may suggest a poor prognosis.
Brain/pathology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Korea ; Leukoencephalitis, Acute Hemorrhagic/complications/*pathology ; *Magnetic Resonance Imaging ; Male ; Prognosis ; Retrospective Studies

The throat swabs obtained from 1,098 adults and 432 children patients with respiratory diseases were examined for Mycoplasma pneumoniae infection detected by culture and polymerase chain reaction (PCR). Antimicrobial susceptibilities of the resulting 60 M. pneumoniae isolates were evaluated by testing minimum inhibitory concentrations (MICs) of erythromycin, minocycline, tetracycline, josamycin, sparfloxacin, ofloxacin, and ciprofloxacin by a broth micro-dilution method. In a preliminary screening, the detection rate of M. pneumoniae by PCR was 29.2% (277/948) for the adults and 28.3% (90/318) for the children. In the second survey, the isolation rate of M. pneumoniae by culture was 29.3% (44/150) for the adults, and 14.0% (16/114) for the children. The PCR detection rate was 36.7% (55/150) for the adults and 23.7% (27/114) for the children. The MIC90s of the M. pneumoniae isolates were 0.015 mg/ml for erythromycin, lower than 0.03 mg/ml for josamycin, 0.06 mg/ml for sparfloxacin and minocycline, 0.12 mg/ml for tetracycline, 0.5 mg/ml for ofloxacin and CFC-222, and 1.0 mg/ml for ciprofloxacin. The isolates were susceptible to erythromycin, josamycin, sparfloxacin, minocycline, tetracycline, and ofloxacin, but the 63.3% of them was resistant to ciprofloxacin. These results indicate that the PCR method has a significant potential as a rapid and sensitive method for early detection of M. pneumoniae infection in clinical specimens as compared with the culture method, but the PCR method could not provide any information concerning the biological chracteristics of M. pneumoniae strains. Erythromycin, josamycin, sparfloxacin, minocycline, and tetracycline could be recommended as the antimicrobial agents of choice in Korea.
Adult ; Anti-Infective Agents ; Child ; Ciprofloxacin ; Erythromycin ; Humans ; Josamycin ; Korea ; Mass Screening ; Microbial Sensitivity Tests ; Minocycline ; Mycoplasma pneumoniae* ; Mycoplasma* ; Ofloxacin ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction ; Tetracycline

OBJECTIVES: Craving is the subjectively experienced motivational states inducing ongoing drug use in addicts. It also proceeds or precipitates relapse episode in drug addicts. Alcohol craving may be triggered by exposure to an object, environment, or emotion that a person has come to associate with alcohol consumption. Such stimuli are called alcohol-related cues. Among alcohol-related cues, alcohol-related visual stimuli are simple and reliable methods in inducing alcohol craving. The object of this study is to develop alcohol-related visual stimuli which induce alcohol craving reliably and to investigate the characteristics of alcohol-related visual stimuli in alcoholics. METHODS: First, the authors developed 27 alcohol and drinking color photos as candidate stimuli. Then, 3 photos which induce alcohol craving most were chosen as alcohol-related visual stimuli respectively by alcoholics, alcoholism high risk group and normal control group. The authors compared characteristics, situation and complexity of selected alcohol-related visual stimuli among three groups. RESULTS: 1) 'A glass of Soju', 'Drinking together' and 'A glass of beer, a bottle of beer and a sidedish' were chosen as alcohol-related visual stimuli which induce most craving in alcoholics, alcoholism high risk group and normal control group respectively. 2) Alcohol photo(stationary object) induced craving most in alcoholics in contrast with drinking photo(situation) in social drinkers. Alcoholics clung to alcohol per se, not to atmosphere or situation of drinking, and alcoholism high risk group felt craving by the expectation of drinking situation. Normal control group showed no consistent finding in choosing alcohol-related visual stimuli. CONCLUSION: With these results, the author suggests classical conditioning as psychopathological model of alcohol craving with alcoholics. In contrast with alcoholics, alcohol craving of alcoholism high risk group may be related to alcohol specific memory or positive expectancies about alcohol use. These finding may support different neurobiological mechanisms of alcohol craving between alcoholics and social drinkers.
Alcohol Drinking ; Alcoholics ; Alcoholism ; Atmosphere ; Beer ; Conditioning, Classical ; Cues ; Drinking ; Drug Users ; Glass ; Humans ; Memory ; Recurrence