MRI-Based Stepwise Approach to Anterior Mediastinal Cystic Lesions for Diagnosis and Further Management

As the majority of incidentally detected lesions in the anterior mediastinum is small nodules with soft tissue appearance, the differential diagnosis has typically included thymic neoplasm and prevascular lymph node, with benign cyst. Overestimation or misinterpretation of these lesions can lead to unnecessary surgery for ultimately benign conditions. Diagnosing mediastinal cysts using MRI serves as a problem-solving modality in distinguishing between surgical and nonsurgical anterior mediastinal lesions. The pitfalls of MRI evaluation for anterior mediastinal cystic lesions are as follows: first, we acknowledge the limitation of T2-weighted images for evaluating benign cystic lesions. Due to variable contents within benign cystic lesions, such as hemorrhage, T2 signal intensity may be variable. Second, owing to extensive necrosis and cystic changes, the T2 shine-through effect may be seen on diffusion-weighted images (DWI), and small solid portions might be missed on enhanced images.Therefore, both enhancement and DWI with apparent diffusion coefficient values should be considered. An algorithm will be suggested for the diagnostic evaluation of anterior mediastinal cystic lesions, and finally, a management strategy based on MRI features will be suggested.

Radiologic Findings of Polyacrylamide Gel Mammoplasty and Its Complications:A Report of Four Case Series and Review of Literature

Polyacrylamide gel (PAAG) has been used for augmentation mammoplasty in certain countries, such as China or Eastern European countries. However, owing to various complications, its use is currently banned in most countries. Nevertheless, because of the migratory stream of female from these countries, we also encounter patients with PAAG mammoplasty in Korea. Owing to the various imaging features of PAAG mammoplasty, it may interfere with the identification of malignancy or other pathologic conditions. Therefore, it is important to identify the imaging findings related to PAAG mammoplasty. However, there is limited literature on the radiologic findings of complications related to PAAG mammoplasty in Korea. Herein we report four cases of PAAG mammoplasty, the complications faced, and depict various radiologic features through multimodality imaging.

CT Findings of Thymic Epidermoid Cyst in the Anterior Mediastinum: A Case Report and Literature Review

An epidermoid cyst is a benign tumor found anywhere in the body. However, the occurrence of epidermoid cysts in the thymus is extremely rare, with only six cases reported worldwide. The correct diagnosis of thymic epidermoid cysts is often difficult due to the unusual location and nonspecific imaging findings. Herein, we present a case of a thymic epidermoid cyst in a 37-year-old female with clinical information and chest CT findings. Further, we have reviewed previous literature reports describing imaging findings of thymic epidermoid cysts.

Evaluation of adjacent tooth displacement in the posterior implant restoration with proximal contact loss by superimposition of digital models

PURPOSE: This study was conducted to investigate patterns of adjacent tooth displacement in the posterior implant with interproximal contact loss (ICL) by 3-D digital superimposition method. MATERIALS AND METHODS: Posterior partially edentulous patients, restored with implant fixed partial prostheses before 2011 and suffered from food impaction of ICL between 2009 and 2011, were included. Two dental casts, at the time of delivery and at the time of food impaction in a same patient, was converted into 3-D digital models through scanning and superimposition was performed to assess chronologic changes of the dentition. Directions of tooth displacement were evaluated and the amount of ICL was calculated. Correlations between the amount of ICL and elapsed time, or between the amount of ICL and age after function, were assessed at a significance level of P.05). CONCLUSION: Natural teeth showed various directional movements to result in occlusal change in the arch. The 3-D superimposition of chronologic digital models was a helpful method to analyze the changes of dentition and individual tooth displacement adjacent to implant restoration.

Cost Comparison between Surgical Treatments and Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer in Korea

BACKGROUND/AIMS: This study was conducted to evaluate whether medical costs can be reduced using endoscopic submucosal dissection (ESD) instead of conventional surgeries in patients with early gastric cancer (EGC). METHODS: Patients who underwent open gastrectomy (OG), laparoscopy-assisted gastrectomy (LAG), and ESD for EGC were recruited from three medical institutions in 2009. For macro-costing, the medical costs for each patient were derived from the expenses incurred during the patient's hospital stay and 1-year follow-up. The overall costs in micro-costing were determined by multiplying the unit cost with the resources used during the patients' hospitalization. RESULTS: A total of 194 patients were included in this study. The hospital stay for ESD was 5 to 8 days and was significantly shorter than the 12-day hospital stay for OG or the 11- to 17-day stay for LAG. Using macro-costing, the average medical costs for ESD during the hospital stay ranged from 2.1 to 3.4 million Korean Won (KRW) per patient, and the medical costs for conventional surgeries were estimated to be between 5.1 million and 8.2 million KRW. There were no significant differences in the 1-year follow-up costs between ESD and conventional surgeries. CONCLUSIONS: ESD patients had lower medical costs than those patients who had conventional surgeries for EGC with conservative indications.

Cost Comparison between Surgical Treatments and Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer in Korea

BACKGROUND/AIMS: This study was conducted to evaluate whether medical costs can be reduced using endoscopic submucosal dissection (ESD) instead of conventional surgeries in patients with early gastric cancer (EGC). METHODS: Patients who underwent open gastrectomy (OG), laparoscopy-assisted gastrectomy (LAG), and ESD for EGC were recruited from three medical institutions in 2009. For macro-costing, the medical costs for each patient were derived from the expenses incurred during the patient's hospital stay and 1-year follow-up. The overall costs in micro-costing were determined by multiplying the unit cost with the resources used during the patients' hospitalization. RESULTS: A total of 194 patients were included in this study. The hospital stay for ESD was 5 to 8 days and was significantly shorter than the 12-day hospital stay for OG or the 11- to 17-day stay for LAG. Using macro-costing, the average medical costs for ESD during the hospital stay ranged from 2.1 to 3.4 million Korean Won (KRW) per patient, and the medical costs for conventional surgeries were estimated to be between 5.1 million and 8.2 million KRW. There were no significant differences in the 1-year follow-up costs between ESD and conventional surgeries. CONCLUSIONS: ESD patients had lower medical costs than those patients who had conventional surgeries for EGC with conservative indications.

Severe Pneumonia Caused by 2009 Pandemic Influenza A (H1N1) Virus in Children and Corticosteroid Treatment / 소아감염

PURPOSE: The effect of corticosteroid on severe pneumonia caused by 2009 pandemic influenza (H1N1) A virus is controversial. This study was aimed to present the effects of early, short-term corticosteroid treatment for severe pneumonia with this virus infection. METHODS: A retrospective analysis was performed on severe pneumonia patients (37 patients) who had severe respiratory distress at presentation requiring oxygen therapy and received intravenous methylprednisolone (MP, 8-10 mg/kg, divided in 4 doses/day for 2-3 days) with oseltamivir. The clinical and laboratory characteristics of the patients were evaluated through the medical records and chest radiographic findings. RESULTS: The mean age and male-to-female ratio of the patients were 6.5+/-2.9 years of age, and 3.4:1 (male 29 patients), respectively. The 5-9 aged group was predominant among the age groups (25 patients, 67.6%). Duration of fever prior to admission was 1.4+/-0.6 days and dyspnea developed within 24 h after beginning of respiratory symptoms in all patients. All patients were previously healthy and received oseltamivir within 48 h. Thirteen patients (35.1%) developed dyspnea during oseltamivir treatment. Following MP infusion, all 37 patients including 13 progressive pneumonia patients during oseltamivir treatment showed an immediate halt in the progression of pneumonic infiltration with rapid clinical improvement. There were no side-effects following steroid use. CONCLUSION: For severe pneumonia patients, early corticosteroid treatment halted clinical exacerbation, and possibly prevented progression to acute respiratory distress syndrome. Further controlled clinical studies are needed for the role of corticosteroids and antivirals on severely affected patients with influenza virus infections.

Association of Respiratory Viral Infection and Atopy with Severity of Acute Bronchiolitis in Infants / 소아알레르기및호흡기학회지

PURPOSE: We investigated the influence of respiratory virus and atopic characteristics on the severity of bronchiolitis. METHODS: Four hundred and eighteen infants <2-years-old and hospitalized at Daegu Fatima Hospital with bronchiolitis from March 2007 to February 2010 were evaluated. They were detected for specific respiratory viruses in nasopharyngeal aspirates by multiplex reverse transcription-polymerase chain reaction. Clinical severity score, based on respiratory rate, wheezing, chest retraction, and oxygen saturation was assessed at admission. According to the scores, all patients were divided into a mild to moderate bronchiolitis group and a severe group. Clinical data related to host factors, including atopic characteristics and respiratory viruses, were compared among individual groups. Multivariate logistic regression analyses were performed to identify independent risk factors for severe bronchiolitis. RESULTS: A single virus was identified in 365 infants (87%) and multiple viruses in 53 (13%). Respiratory syncytial virus (RSV) was the most common virus detected (51%). RSV and rhinovirus were the viruses most frequently identified in mixed infections in infants hospitalized with bronchiolitis. Infants with coinfections were 3.28 times (95% confidence interval, 1.36 to 7.89) more at risk for severe bronchiolitis than those with a single infection. Host factors associated with more severe bronchiolitis included male gender, younger age, prematurity, and chronic cardiorespiratory illness. Type of viruses, personal and family history of atopy, and passive smoking were not significantly associated with bronchiolitis severity. CONCLUSION: Viral coinfections and host factors, including male gender, younger age, prematurity, and chronic cardiorespiratory illness are relevant risk factors for infants with severe bronchiolitis.

The Influence of Atopic Findings on Severity of Pneumonia in Children with 2009 Pandemic Influenza A (H1N1) Infection / 소아감염

PURPOSE: Atopic findings may be associated with severity of pneumonia in 2009 pandemic influenza A (H1N1) infection, which could suggest a possible association between atopic findings and the severity of viral infections. Thus, we studied association between atopic findings and severity of disease in children with H1N1 influenza infection. METHODS: A retrospective study was performed in 74 children admitted in a single tertiary institute and confirmed as H1N1 patients by reverse transcriptase (RT) - polymerase chain reaction (PCR). They were divided into 2 groups according to the severity of pneumonia. We evaluated whether the atopic finding is risk factor between the two groups. RESULTS: Children with severe pneumonia had higher percentages of serum eosinophilia (88% vs 40%, P<0.001), asthma (65% vs 35%, P=0.011), allergic rhinitis (71% vs 40%, P=0.009), and IgE level (P=0.007). We found positive correlations between aeroallergen sensitizations and severity of pneumonia (82% vs 53%, P=0.007). CONCLUSION: Among patients with H1N1 pneumonia, asthma and atopic findings are risk factors for severity of pneumonia.

Degree of Compliance with Polypharmacy and Its Influential Factors in Rural Elderly Patients with Chronic Diseases in South Korea

BACKGROUND: This study was to verify the necessity of a control program developed to improve compliance, by conducting a research on the status of medication compliance in the elderly with chronic diseases in rural area and analyzing the related variables. METHODS: The organized questionnaire and pill-count were used to collect information on personal details, physical status, drugs taken in the elderly over 65 years old suffering from more than two chronic diseases in one rural area. RESULTS: The mean age of the subjects was 73.13+/-6.36 (65~93), and the number of the subjects in compliance group was 60 (77.9%) and the accuracy of self-report which was identified by pill-count was 0.86. Polypharmacy and visiting several clinics were the main factors that decided a low- degree of compliance, with OR of 5.92 (95% CI 1.11~31.44, P=0.037), and 4.25 (95% CI 1.03~17.53, P=0.045), respectively. CONCLUSION: Systematic efforts are necessary and plans must be established without delay to increase compliance in the elderly in the rural, expansively to manage chronic diseases in stay-at-home elders.

Expression of Cyclooxygenase-2 and Matrix Metalloproteinases in Sinonasal Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The matrix metalloproteinases (MMPs) have been associated with tumor cell invasion and metastasis by mediating the degradation of extracellular matrix components. Cyclooxygenase-2 (COX-2) plays an important role in promotion of carcinogenesis, tumor invasiveness and angiogenesis. Recently, some investigators have reported that COX-2 could promote secretion of MMP-2 and MMP-9. Therefore, an interrelation between MMPs and the associated COX-2 may play a significant role in the invasive phenotype of malignant tumors. In the present study, the authors investigated the correlation between expressions of COX-2 and MMPs. MATERIALS AND METHOD: Immunohistochemical staining of MMP-2, -3 and -9, and COX-2 were performed on paraffin-embedded tissue sections of 51 nasal cavity and paranasal sinuses tumors (27 inverted papillomas, 5 inverted papillomas with malignant transformation, and 19 squamous cell carcinomas). Co-expression of these MMPs and COX-2 was visualized with confocal laser scanning microscope. RESULTS: MMP-2, -3 and -9 were found mainly in malignant lesions in concert with COX-2. However, the co-expressions of MMP-2 and COX-2, MMP-9 and COX-2 were detected with significance. CONCLUSION: These results suggest a potentially important role for COX-2 in the regulation of MMPs, malignant transformation, and progression of squamous cell carcinoma, and it points out the potential use of COX-2 inhibitors, in the prevention and treatment of squamous cell carcinoma of nasal cavity and paranasal sinuses.

Immunohistochemical Expressions of p16 and p21 Proteins in Laryngeal Squamous Cell Carcinomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cyclin-dependent kinase inhibitor (CDKI) is known to play an important role in oncogenesis, but its clinical effect in head and neck cancer has not been reported yet. This study was designed to investigate the prognostic relevance of p16 and p21 protein expressions by evaluating the correlation between the expression pattern of p16 and p21 proteins, and tumor progress in laryngeal squamous cell carcinoma. MATERIALS AND METHODS: Paraffin-embedded tissue specimens from 54 patients, who were diagnosed with laryngeal squamous cell carcinoma between 1993 and 2002, were immunohistochemically stained for p16 and p21 proteins. The clinical features from these patients were retrospectively evaluated. The percentages of positive nuclei that stained positive for tumor were determined. RESULTS: In p16 protein, the proportion of strong expression was higher than that of weak expression in early tumor stage (T1, T2) and clinical stages (stage I, II): the proportion of weak expression was higher in the advanced tumor stage (T3, T4) and the clinical stages (stage III, IV): the correlations between the expressions of p16 protein and tumor clinical stages were significant (p0.05). In p16 and p21 protein, the proportion of weak expression was higher in nodal stage with neck metastasis than in nodal stage without neck metastasis: but the correlation between expression of p16 or p21 protein and nodal stage was not significant, respectively (p>0.05). CONCLUSION: There was a significant correlation between weak expression of p16 protein and more advanced tumor clinical stages. The expression of p16 protein may have prognostic value restrictively in laryngeal squamous cell carcinoma. Further study will be needed to understand the role of p16 and p21 protein in oncogenesis of laryngeal squamous cell carcinoma.

Diagnostic Significance of the Urine-Stick Test in Middle and High School Children in Seoul

PURPOSE: This study was performed to assess the diagnostic significance of the urine-stick test in detecting Diabetes Mellitus (DM) and to assess the clinical characteristics of adolescent diabetes. MEHTODS: A total of 926,208 middle and high school children participated. The urine-stick test was performed and those who showed glycosuria and, further studies such as evaluations of plasma glucose, triglyceride, cholesterol and C-peptide level done. We compared the clinical characteristics between the diabetes group and non-diabetes group. RESULTS: Among 926,208 students, 1,020 (0.11%) showed glycosuria. Among the 1,020 glycosuria positive subjects, 339 (33.2%) had further laboratory tests. Two hundred and sixty-eight cases (79.1%) were normal, 52 cases (15.3%) were newly diagnosed as DM, 9 cases (2.7%) were already diagnosed DM, 10 cases (2.9%) had an impaired glucose tolerance. The 52 newly diagnosed DM cases, whose postprandial 2 hour glucose level was more than 200m/dL, showed different fasting glucose levels. Thirty cases (57.7%) had a level of more than 140mg/dL, 11 cases (21.1%) were between 110 and 140mg/dL and 11 cases (21.1%) were at a level of less than 110mg/dL. Polydipsia, polyuria and polyphagia were frequent symptoms exibited by the DM group while weight loss and fatigue showed no significant difference between the DM and non-diabetes groups. Six cases were type 1 DM and 44 cases were type 2 DM. Being female, having a family history of DM and a higher BMI and higher diastolic blood pressure were significant risk factors for DM. CONCLUSION: The positive rate of glycosuria by the urine-stick test was 0.11%. Among glycosuria positive subjects 15.3% were newly diagnosed as DM. For the high risk group, an annual urine-stick test and a postprandial blood glucose test should be performed and a systematic referral system is necessary.

Diagnostic Significance of the Urine-Stick Test in Middle and High School Children in Seoul

PURPOSE: This study was performed to assess the diagnostic significance of the urine-stick test in detecting Diabetes Mellitus (DM) and to assess the clinical characteristics of adolescent diabetes. MEHTODS: A total of 926,208 middle and high school children participated. The urine-stick test was performed and those who showed glycosuria and, further studies such as evaluations of plasma glucose, triglyceride, cholesterol and C-peptide level done. We compared the clinical characteristics between the diabetes group and non-diabetes group. RESULTS: Among 926,208 students, 1,020 (0.11%) showed glycosuria. Among the 1,020 glycosuria positive subjects, 339 (33.2%) had further laboratory tests. Two hundred and sixty-eight cases (79.1%) were normal, 52 cases (15.3%) were newly diagnosed as DM, 9 cases (2.7%) were already diagnosed DM, 10 cases (2.9%) had an impaired glucose tolerance. The 52 newly diagnosed DM cases, whose postprandial 2 hour glucose level was more than 200m/dL, showed different fasting glucose levels. Thirty cases (57.7%) had a level of more than 140mg/dL, 11 cases (21.1%) were between 110 and 140mg/dL and 11 cases (21.1%) were at a level of less than 110mg/dL. Polydipsia, polyuria and polyphagia were frequent symptoms exibited by the DM group while weight loss and fatigue showed no significant difference between the DM and non-diabetes groups. Six cases were type 1 DM and 44 cases were type 2 DM. Being female, having a family history of DM and a higher BMI and higher diastolic blood pressure were significant risk factors for DM. CONCLUSION: The positive rate of glycosuria by the urine-stick test was 0.11%. Among glycosuria positive subjects 15.3% were newly diagnosed as DM. For the high risk group, an annual urine-stick test and a postprandial blood glucose test should be performed and a systematic referral system is necessary.

Clinical Experience of Mismatched blood Transfusion, resulted in acute Renal Failure / 대한정형외과학회잡지

A case report on the ABO-type imcompatible transfusion has been made. The case was O-type, 51 year old male who has been transfused 1,000ml of A-type whole blood during and after the intramedullary nailing of the left femur. He had fall in acute hemoglobinuric renal failure immediately after the transfusion. He has been received peritoneal dialysis (P.D.) at eighth day after mismatched transfusion, to correct the uremic condition. His pre-P.D. labaratory findings were Hb. 4.5gm%, BUN 85mg%, creatinine 12. 2mg% and K 7.0mEq/1. He was well recovering after the P.D. but worse again in 16th day after mismatched transfusion with BUN 114mg%, creatinine 12.4mg% and pulmonary edema. An-other P.D. was performed at 16th day and recovered gradually since then. He had marked maximum amount of urine was 9, 100ml at 36 th day after mismatch transfusion. Following the second P.D. his conditions improved gradually and electrolyte imbalance was controlled caused from polyuric state properly. His renal condition was recovered completely at the ten weeks after the mismatch transfusion.