Eosinophilic fasciitis (EF) is a scleroderma-like immune-allergic disorder of unknown etiology and pathogenesis. This rare disease is characterized by the progressive induration of the skin and soft tissue, and peripheral eosinophilia. Here, we report a case of EF. A 21-year-old female was referred due to edema in the upper and lower extremities for 1 month. Laboratory results were unremarkable except for severe eosinophilia. Parasite infestation, venous thrombosis, and cardiac and renal problems were excluded. Magnetic resonance imaging of both the lower extremities revealed symmetrical thickening and contrast enhancement of crural fascia with adjacent subcutaneous fat infiltration. A full-thickness biopsy at the lower extremity showed infiltration of the fascia by eosinophils, plasma cells, and lymphocytes with marked edema. Thus, this patient was confirmed to have EF and she was treated with systemic corticosteroids, resulting in a remarkable improvement in both edema and eosinophilia.

PURPOSE: A chemotherapy response assay test is performed to evaluate the degree of tumor growth inhibition by a chemotherapeutic agent. Several studies have been done on its usefulness; however, to the best of our knowledge, only a few studies concerning the relationship between chemotherapy response assay test results and breast cancer patients' prognoses have been conducted. Thus, we performed this study to analyze this relationship. METHODS: Among breast cancer patients who underwent curative surgery and neoadjuvant or adjuvant chemotherapy between August 2004 and December 2009, 102 were enrolled in this study. Chemotherapeutic regimens for patients were doxorubicin plus taxane or doxorubicin plus cyclophosphamide followed by taxane. We divided these patients into two groups (sensitive group [n=19] and resistant group [n=83]) and analyzed the relationship between chemosensitivity results and patient prognosis. RESULTS: The sensitive group was associated with poor disease-free survival (DFS) (p=0.003) and overall survival (OS) (p<0.001). No significant differences were observed in tumor histology (p=0.548), tumor size (p=0.479), number of metastatic lymph nodes (p=0.326), histologic grade (p=0.077), or nuclear grade (p=0.216) between the two groups. However, in respect to molecular subtype, the HER2-positive type and triple negative breast cancer were more frequently observed in the sensitive group (p=0.001). In a univariate and multivariate analysis for DFS, doxorubicin sensitivity was significantly associated with a poor prognosis (p<0.05). CONCLUSION: Better chemosensitivity results are associated with a poor prognosis in breast cancer patients who have undergone anthracycline- and taxane-based chemotherapy, however, examination of additional cases and the use of a longer study period are needed.
Breast ; Breast Neoplasms ; Bridged Compounds ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Disease-Free Survival ; Doxorubicin ; Humans ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Taxoids

PURPOSE: The prevalence rate of the BRAF mutation in papillary thyroid cancer (PTC) is as high as about 52 to 83% in Korea. Preoperative detection of BRAF mutation on fine needle aspiration cytology (FNAC) slides may help the surgeon make better therapeutic decisions. The present study aims to assess the feasibility of the mutant allele specific amplification (MASA) and restriction fragment length polymorphism (RFLP) method with using conventional FNAC slides and we also wanted to evaluate the clinical role of preoperatively detecting BRAF mutation. METHODS: We extracted the genomic DNA from 59 FNAC slides and performed direct sequencing (DS) for detecting BRAF mutation. We could use only 17 slides for the MASA method and 6 slides for the RFLP method due to the shortage of extracted DNA. Additionally, we retrospectively analyzed the cases for which a histological diagnosis could be made. RESULTS: Genomic DNA was extracted from 23 out of the 59 FNAC slides. The BRAF mutation status could be assessed via DS in 33 out of the 59 FNAC slides. The concordance between the MASA method and DS and the RFLP method and DS was 36.3% and 66.7% respectively. The positive and negative predictive value of the 13 indeterminate nodules was 87.5% and 20%, respectively. We could not find any association between the BRAF mutations and the alleged risk factors of PTC. CONCLUSION: We believe that the purity and the amount of the DNA template must be increased to detect BRAF mutation with using a FNAC slide. Preoperative detection of the BRAF mutation on a FNAC slide may refine the cytological diagnosis, but the application of assessing BRAF mutation as a prognostic marker is debatable.
Alleles ; Biopsy, Fine-Needle* ; Diagnosis* ; DNA ; Korea ; Methods ; Polymorphism, Restriction Fragment Length ; Prevalence ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: The patients with atopic dermatitis (AD) show a defective barrier function of the skin and symptoms such as xerosis, pruritus and erythematous lesions with increased transepidermal water loss (TEWL). The choice of topical moisturizer is very significant for AD patients because these symptoms could be relieved by a local moisturizing agent that strengthens the epidermal barrier function. OBJECTIVE: This study was performed to evaluate the effects of the moisturizer APDDR-0801, which contains physiologic lipid granules (DermaON(R)), for relieving the symptoms associated with AD. METHODS: 128 patients (17.8+/-12.1 years) who were suffering from mild to moderate AD topically applied the test moisturizer twice daily for up to 4 weeks. The treatment efficacy was evaluated by the investigator global assessment (IGA) score, the eczema area and severity index (EASI) score, the transepidermal water loss (TEWL), the visual analogue scale (VAS) for pruritus and sleep disturbance, and the level of inflammatory cytokines in the horny layer of the flexural areas. RESULTS: The test moisturizer was well-tolerated and 58.6% of the patients achieved clinical improvements (over moderate) after the application of the test moisturizer for 4 weeks. The significant relief of AD symptoms was observed from 2 week to 4 week in a time-dependent manner. Significant improvements in the signs and symptoms of AD were observed at 4 week, such as the EASI score (37.8% improvement), the TEWL (20.3% improvement in the antecubital fossa lesion), the VAS score for pruritus (26.2% improvement), and VAS score for insomnia (39.7% improvement). CONCLUSION: The moisturizer APDDR-0801 (Atobarrier Cream(R), which contains physiologic lipid granules, effectively relieved the symptoms associated with AD.
Cytokines ; Dermatitis, Atopic ; Eczema ; Humans ; Pruritus ; Research Personnel ; Skin ; Sleep Initiation and Maintenance Disorders ; Stress, Psychological ; Treatment Outcome

BACKGROUND: Procalcitonin is a well known marker in infection that plays a role in distinguishing between bacterial and viral infections in screening. The aim of the present study was to evaluate the role of procalcitonin in differentiating between 2009 H1N1 influenza pneumonia and community acquired pneumonia of bacterial origin, or mixed bacterial origin and 2009 H1N1 influenza infection. METHODS: A retrospective observational study was performed over the 6-month winter period during the 2009 H1N1 influenza pandemic. Ninety-six patient-subjects were enrolled, all of whom had been diagnosed with community acquired pneumonia in emergency department during the study period. On admission, laboratory studies were performed, which included 2009 H1N1 influenza real-time polymerase chain reaction of nasal secretions and procalcitonin on serum; the laboratory values were compared between the study groups. Receiver operating characteristic curve analyses were performed on the resulting data. RESULTS: Compared to those with bacterial or mixed infections (n=62) and bacterial pneumonia with confirmed organisms (n=30), patients with 2009 H1N1 pneumonia (n=34) were significantly more likely to have low procalcitonin levels (p=0.008, 0.001). Using cutoff of value >0.3 ng/mL, the sensitivity and specificity of procalcitonin for detection of patients with confirmed bacterial pneumonia were 76.2% and 60.6%, respectively. A significant difference in procalcitonin was found between 2009 H1N1 pneumonia and pneumonia caused by mixed influenza viral and bacterial infections (0.15 [0.05~0.84] vs. 10.3 [0.05~22.87] ng/mL, p=0.045). CONCLUSION: Serum procalcitonin measurement may assist in the discrimination between pneumonia of bacterial and of 2009 H1N1 influenza origin. High values of procalcitonin suggest that bacterial infection or mixed infection of bacteria and 2009 H1N1 influenza is more likely.
Bacteria ; Bacterial Infections ; Calcitonin ; Coinfection ; Discrimination (Psychology) ; Emergencies ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Mass Screening ; Pandemics ; Pneumonia ; Pneumonia, Bacterial ; Protein Precursors ; Real-Time Polymerase Chain Reaction ; Retrospective Studies ; ROC Curve

Inferior sinus venosus type atrial septal defect (ASD) is a rare congenital cardiac deformity that occurs between the inferior vena cava and right atrium. Inferior sinus venosus defect is difficult to diagnose through transthoracic echocardiography because of its location which is infero-posterior to the fossa ovalis. Increasing pulmonary arterial pressure and pulmonary vascular resistance in patients with sinus venosus defect usually occur earlier than other types of ASD. We report a case of 19-year-old man who presented exertional dyspnea due to inferior sinus venous type ASD with mild pulmonary hypertension. In this case, we found clues from slight diastolic flattening of interventricular septum and shortened acceleration time of right ventricular outflow tract on initial transthoracic echocardiography, leading right heart catheterization and transesophageal echocardiography to reveal this rare type of ASD.
Acceleration ; Arterial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Congenital Abnormalities ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria ; Heart Septal Defects, Atrial ; Humans ; Hypertension, Pulmonary ; Vascular Resistance ; Vena Cava, Inferior ; Young Adult

BACKGROUND/AIMS: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS. METHODS: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a median of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS. RESULTS: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87;HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). CONCLUSIONS: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation.
Acute Coronary Syndrome ; Biomarkers ; C-Reactive Protein ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Troponin ; Troponin I

PURPOSE: PTMC is defined as a papillary thyroid cancer smaller than 10 mm in its greatest diameter. It is the most common form of differentiated thyroid cancer and its prognosis is known to be very favorable. The aim of this study is to identify its biologic behavior and to formulate a reasonable therapeutic strategy for the treatment of PTMC. METHODS: 379 patients with papillary thyroid cancer were analyzed. Each patient was diagnosed preoperatively or postoperatively and treated between Jan. 2000 and Dec. 2007. Among these patients, 143 had been identified as having PTMC (37.7%) with a mean tumor size of 0.72 cm in diameter. RESULTS: There were no significant differences of the clinical characteristics such as gender, age, the operative methods, or multicentricity between the PTMC group and the non-PTMC group, except for LN metastases. Also, there were fewer symptoms of palpable neck mass and preoperative findings such as capsular invasion and microcalcification in the PTMC group. We performed unilateral lobectomy with or without central compartment neck node dissection for the early stage diseases, but for the later stages of disease we performed near-total or total thyroidectomy with routine central compartment neck node dissection. And for the patients with lateral node enlargement, we performed ipsilateral modified radical neck dissection (MRND). CONCLUSION: This study shows that PTMC is quite similar to conventional papillary thyroid cancer in its biological behavior, and we conclude that total thyroidectomy with central compartment neck node dissection is the proper therapeutic strategy to treat PTMC. However, further study is necessary for identifying the low-risk and high-risk patients with PTMC.
Humans ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy

PURPOSE: Although the diagnostic accuracy of thyroid cancer by fine needle aspiration cytology (FNAC) is increasing, there are some nodules for which ultrasonography and FNAC show indeterminant. The purpose of this study was to determine the usefulness of thyroid ultrasonography by the surgeon prior to operation METHODS: Forty-nine patients who underwent thyroid operations between June 2006 and January 2007 were selected for this study. Thyroid ultrasonography was performed on each patient.And we recorded and analyzed the shape and the margin of the nodule, internal echogeneiety, heterogeneiety, the presence of microcalcification, height versus width, and the presence of level VI lymph node larger than 3 mm, assigning each a score of 1, 2 or 3. RESULTS: The average score was 17.1. Assuming an average score over 14 is considered to be malignant, the sensitivity, specificity, positive predictive value, and negative predictive value were 95.6%, 88.9%, 91.7%, 94.1% respectively. Statistically significant characteristics of malignancy were the shape and the margin of the nodule, internal echogeneiety, microcalcification, taller than wide shape and the presence of enlarged VI lymph nodes. The heterogeneiety had no significant P value. CONCLUSION: When malignancy cannot be confirmed even after repeated FNAC, preoperative ultrasonograpy performed by surgeons can be a reliable test and helpful for operations.
Biopsy, Fine-Needle ; Humans ; Lymph Nodes ; Sensitivity and Specificity ; Surgeons* ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography*

In contrast to the intrinsic feedback inhibition defect of primary hyperparathyroidism (HPT), secondary HPT is caused by chronic extrinsic overstimulation of otherwise normal parathyroid glands. This condition is very common in patients with end stage renal disease (ESRD), and secondary HPT develops as a complex sequence of interactions. As the glomerular filtration rate falls, the renal production of 1,23- dihydroxy-vitamin D3 decreases. Moreover, this causes a reduction in intestinal calcium absorption, which creates the parathyroid hormone (PTH) secretion. This secretion increases serum calcium levels by mobilizing calcium from bones. Lastly, the PTH secretion is further stimulated by hyperphosphatemia (via a phosphorous-specific receptor) and a decrease in ionized calcium (from reduced solubility caused by hyperphosphatemia). Intact PTH levels of 500 to 1,500 pg/ml are common (normal: 10~65 pg/ml) in ESRD patients. Long-standing hyperphosphatemia contributes to the alteration of the parathyroid cells, which affect feedback inhibition, due to an increase in ionized calcium. Secondary HPT is mainly controlled by the restriction of phosphate, the inhibition of phosphorous absorption and the supplementation of calcitriol. Secondary HPT, which is unresponsive to medical treatment, it is well known that a total parathyroidectomy and autotransplantation has good results. This report documents our experience with secondary HPT, treated with a total parathyroidectomy and autotransplantation.
Absorption ; Accidental Falls ; Autografts ; Calcitriol ; Calcium ; Glomerular Filtration Rate ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary* ; Hyperphosphatemia ; Kidney Failure, Chronic* ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Solubility ; Transplantation, Autologous