Evaluation of Interferon-gamma Release Assay in Children with Confirmed Tuberculosis

Purpose@#This study aimed to evaluate the diagnostic value of the QuantiFERON-TB Gold InTube (QFT-GIT) in children with confirmed tuberculosis (TB). @*Methods@#We retrospectively reviewed the medical records of children aged ≤18 years who underwent both QFT-GIT and Mycobacterium tuberculosis culture between 2006 and 2017.Confirmed TB was defined as the presence of at least one positive specimen for M. tuberculosis on culture or a nucleic acid amplification test. @*Results@#Of the 582 patients included in the analysis, 48 were confirmed to have TB. The sensitivity and specificity of QFT-GIT for the diagnosis of confirmed TB were 85.4% and 95.5%, respectively. Among children with confirmed TB, the proportion in the immunocompromised state was higher in the QFT-GIT negative group than in the QFT-GIT positive group (50.0% vs. 5.7%, P=0.010). The median age at sampling was lower in the QFTGIT indeterminate group than in the QFT-GIT positive group (7 years vs. 17 years, P=0.008), and the proportion of immunosuppression was higher in the QFT-GIT indeterminate group than in the QFT-GIT positive group (42.9% vs. 5.7%, P=0.017). The interferon gamma response to mitogen control was significantly higher in the 10–18 years group than in the 0–9 years group (P<0.001), and was significantly higher in the immunocompetent group than in the immunocompromised group (P=0.001). @*Conclusion@#The QFT-GIT results should be interpreted carefully in immunocompromised or younger children suspected of having TB.

Evaluation of Interferon-gamma Release Assay in Children with Confirmed Tuberculosis

Purpose@#This study aimed to evaluate the diagnostic value of the QuantiFERON-TB Gold InTube (QFT-GIT) in children with confirmed tuberculosis (TB). @*Methods@#We retrospectively reviewed the medical records of children aged ≤18 years who underwent both QFT-GIT and Mycobacterium tuberculosis culture between 2006 and 2017.Confirmed TB was defined as the presence of at least one positive specimen for M. tuberculosis on culture or a nucleic acid amplification test. @*Results@#Of the 582 patients included in the analysis, 48 were confirmed to have TB. The sensitivity and specificity of QFT-GIT for the diagnosis of confirmed TB were 85.4% and 95.5%, respectively. Among children with confirmed TB, the proportion in the immunocompromised state was higher in the QFT-GIT negative group than in the QFT-GIT positive group (50.0% vs. 5.7%, P=0.010). The median age at sampling was lower in the QFTGIT indeterminate group than in the QFT-GIT positive group (7 years vs. 17 years, P=0.008), and the proportion of immunosuppression was higher in the QFT-GIT indeterminate group than in the QFT-GIT positive group (42.9% vs. 5.7%, P=0.017). The interferon gamma response to mitogen control was significantly higher in the 10–18 years group than in the 0–9 years group (P<0.001), and was significantly higher in the immunocompetent group than in the immunocompromised group (P=0.001). @*Conclusion@#The QFT-GIT results should be interpreted carefully in immunocompromised or younger children suspected of having TB.

The Clinicopathological Significance of Epithelial Mesenchymal Transition Associated Protein Expression in Head and Neck Squamous Cell Carcinoma

BACKGROUND: Epithelial mesenchymal transition (EMT) has an important role in invasion and metastasis of tumor cells. The purpose of this study was to evaluate the roles of EMT-associated proteins on progression and metastasis as a prognostic/predictive factor in curatively-resected (R0) head and neck squamous cell carcinoma (HNSCC). METHODS: A total of 118 patients who received curative surgery for HNSCC at Inha University Hospital between January 1996 and December 2011 were included. We used protein immunohistochemistry to evaluate the expression of E-cadherin, vimentin, and EZH2 on tissue microarrays. Also, we reviewed all medical records and analyzed the relationship between the expression of EMT-associated proteins and prognosis. RESULTS: The E-cadherin-negative group showed more moderate/poor differentiation of cancer cell type than the higher E-cadherin-expressing group (p=.016) and high EZH2 expression was significantly correlated with nodal metastasis (p=.012). Our results demonstrate a significant association between high expression of EZH2 and vimentin and presence of distant progression (p=.026). However, expression of E-cadherin, vimentin, and EZH2 was not significantly associated with overall survival. CONCLUSIONS: These findings suggest that an EMT-associated protein expression profile is correlated with aggressiveness of disease and prognosis, and could be a useful marker for determination of additional treatment in curatively-resected HNSCC patients.

Cytological Findings of the Micropapillary Variant of Urothelial Carcinoma: A Comparison with Typical High-Grade Urothelial Carcinoma

BACKGROUND: Micropapillary variant of urothelial carcinoma (MPUC) showed distinct pathologic features and aggressive behavior. The cytologic findings of MPUC are still indistinct. In this study, we evaluated the cytological findings of MPUC compared with those of high-grade urothelial carcinoma (HGUC). METHODS: The voided urine cytology of 8 cases of MPUC and 8 cases of HGUC was reviewed. Following cytological parameters were evaluated: cellularity, background, number of small, tight papillary clusters, small acinar structure, scattered single cells, cytoplasmic features, nuclear-to-cytoplasmic ratio, nuclear pleomorphism, nuclear membrane irregularity, hyperchromasia, chromatin pattern and nucleoli. RESULTS: Compared to that of HGUC, cytology of MPUC showed large numbers of small, tight papillary clusters, small acinar structure, few numbers of single cells, and hyperchromatic nuclei. Other parameters were similar between the two groups; both groups showed similar cellularity, dense or vacuolated cytoplasm, moderate to severe nuclear pleomorphism, irregular nuclear membrane, coarse granular chromatin, and small and prominent nucleoli. CONCLUSIONS: The urine cytology of MPUCs showed smaller and tighter papillary cell clusters, more small acinar structures, fewer numbers of scattered single cells, and more hyperchromatic nuclei than that of HGUC. These features can help to distinguish MPUC and HGUC and offer an early cytological diagnosis of MPUC.

In-house Manual Construction of High-Density and High-Quality Tissue Microarrays by Using Homemade Recipient Agarose-Paraffin Blocks

BACKGROUND: Self-made tissue punches can be effectively used to punch holes in blank recipient paraffin blocks and extract tissue cores from the donor paraffin blocks for the low-cost construction of tissue microarrays (TMAs). However, variable degrees of section distortion and loss of the tissue cores can occurs during cutting of the TMAs, posing technical problems for in-house manual construction of high-density TMAs. We aimed to update the method for in-house manual TMA construction to improve the quality of high-density TMAs. METHODS: Blocks of agarose gel were subjected to the standard tissue processing and embedding procedure to prepare recipient agarose-paraffin blocks. The self-made tissue punches and recipient agarose-paraffin blocks were used to construct TMAs, which were completely melted and re-embedded in paraffin to make finished TMA blocks. RESULTS: The donor tissue cores were completely integrated into the surrounding paraffin of the recipient blocks. This method enabled us to construct high-density TMAs with significantly less section distortion or loss of tissue cores during microtomy. CONCLUSIONS: Simple and inexpensive construction of high-density and high-quality TMAs can be warranted by using paraffinized agarose gels as recipient blocks.

Construction of High-Density Tissue Microarrays at Low Cost by Using Self-Made Manual Microarray Kits and Recipient Paraffin Blocks

BACKGROUND: Advances of tissue microarray (TMA) technology have enabled simultaneous in situ analysis of biomarker expression in a large number of archived pathology specimens. However, the relatively high cost of TMA construction may hamper many researchers from using this essential tool of modern pathology research. We discuss methods for making TMA kits and recipient blocks for manual construction of high-density TMAs at low cost. METHODS: Ordinary cannula piercing needles, hypodermic needles, bone marrow biopsy needles, metallic ink cartridges of ballpoint pens, and disposable skin biopsy punches were used to construct self-made manual TMA kits. The recipient blocks were manufactured by boring holes in the conventional bare paraffin blocks. A mini electric hand drill and a microcompound table assembled on a drill stand were used to maximize the capacity of the recipient blocks. RESULTS: By using TMA kits made from cannula piercing needles (16- and 18-gauge), it was possible to construct TMAs with 1 mmx140 cores, 0.6 mmx320 cores, 2 mmx70 cores, 3 mmx35 cores, and 5 mmx12 cores. The capacity of the recipient blocks could be dramatically increased by drilling holes. CONCLUSIONS: Construction of TMAs using self-made TMA kits is an inexpensive alternative to construction of TMAs using commercial devices.

Clinicopathologic and Molecular Characteristics of Lung Adenocarcinoma Arising in Young Patients

Lung cancer rarely occurs in young patients. Recent studies have demonstrated that epidemiologic data are closely correlated to some molecular characteristics. We investigated the clinicopathologic characteristics of lung adenocarcinoma in young patients and evaluated immunohistochemically detected epidermal growth factor receptor (EGFR) mutation status and anaplastic lymphoma kinase (ALK) positivity. Among lung adenocarcinoma patients, 31 cases were of the 50 yr-old group. Young patients were more likely to be females (67.7% vs 40.2%), and nonsmokers (58.1% vs 45.2%) and more often had high TNM stage (stage IV was 80.6% vs 52.1%) and had a high rate of distant metastasis (51.6% vs 28.0%) compared with older patients. The signet ring cell feature was more common (25.8% vs 11.5%) and lepidic growth pattern was rarely present (3.2% vs 16.5%) in the adenocarcinoma of young patients. There was no significant survival difference between the two age groups. The rate of EGFR mutation status and ALK positivity did not show a statistical difference between two groups. In conclusion, lung adenocarcinoma of young patients demonstrates distinct pathologic features with frequent presence of a signet ring cell feature and rare occurrence of lepidic growth pattern. Further investigation for other genetic abnormalities would be needed.

Cytologic Findings of Clear Cell Adenocarcinoma of the Urethra: A Case Report

Clear cell adenocarcinoma of the urethra is a rare disease entity with an uncertain histogenesis. Here, we present a case of primary clear cell adenocarcinoma of the female urethra with its cytological findings. A 54-year-old woman presented with a painless gross hematuria lasting 3 months. On vaginal sonography, there was a sausage-like, elongated mass in the urethra, measuring 3.8x4.3 cm. The voided urine cytology revealed small clusters of rounded or papillary cells. The necrotic debris and inflammatory cells were present within some clusters of tumor cells. These tumor cells were enlarged and had abundant clear or granular cytoplasm with cytoplasmic vacuoles. The nucleus was granular and contained vesicular chromatin with prominent nucleoli. The hobnail cells and hyaline globules were also present as in a histologic section. The histologic findings were compatible with clear cell adenocarcinoma. The tumor showed distinctive cytological features. Cytologically, however, it is necessary to make a differential diagnosis from other adenocarcinoma or high-grade urothelial carcinoma.

Adenocarcinoma with Intraductal Papillary Mucinous Neoplasm Arising in Jejunal Heterotopic Pancreas

A 74-year-old man suffered from jejunal perforation and adhesion to sigmoid colon due to adenocarcinoma associated with intraductal papillary mucinous neoplasm (IPMN) arising in a jejunal heterotopic pancreas. The jejunal lesion showed direct extension to the sigmoid colon, which was mistaken as sigmoid colon cancer by surgeons. Malignant transformation is a rare complication of a heterotopic pancreas. About half of malignancies in reported cases were ductal adenocarcinoma arising in the stomach, and the jejunal location is extremely rare. Furthermore, IPMN is also uncommon finding in a heterotopic pancreas.

Granular Cell Astrocytoma: Report of a Case

We report here a rare case of granular cell astrocytoma. A 75-year-old man was admitted to Inha University Hospital with a three-month history of language deterioration. In a magnetic resonance imaging, a 6.5 cm-sized heterogeneous enhancing mass was seen in both the frontal lobes and the anterior genu of the corpus callosum. A stereotactic biopsy was performed. The tumor was composed of large and small round cells with abundant intracytoplasmic granules. The nuclei were bland, round to oval, and often eccentrically located. The cytoplasm of the tumor cells was positive for glial fibrillary acidic protein and S-100 protein.

Comparison of the Quality of Life in Facial Burn Patients by Anxiety Trait / 신경정신의학

OBJECTIVES: This study was designed to evaluate the quality of life in facial burn patients and its relationship to anxiety. METHODS: The study subjects consisted of 36 patients in a burn center after a burn injury. The assessment of quality of life was performed using a clinical administered SF-36 scale. All participants were instructed to complete the State and Trait Anxiety Inventory of Spielberger, the Beck Depression Inventory. RESULTS: There was no correlation between the trait of anxiety and the degree of the burn. The patients who had a high score in the Trait Anxiety Inventory after the burn injury showed a low quality of life at the one year follow-up. But the patients who had a low score in the Trait Anxiety Inventory showed a better quality of life than patients who had a mild burn injury. CONCLUSION: The results of this study suggest that the patients who had severe facial burns with a high score in the Trait Anxiety Inventory showed the specific properties of a low quality of life. Therefore, they needed intensive care from the beginning of the burn injury. In this process, resilience plays a major role in adapting to acute stress, especially burns, and anxiety is one of the protective factors in resilience.

Fine Needle Aspiration Cytologic Findings of Angiosarcoma: Report of Two Cases

Angiosarcoma is a rare malignant vascular neoplasm which can arise in any part of the body. Specific recognition of this neoplasm in cytological specimens is difficult in the absence of an ancillary method. Herein, we present the cytologic findings of two cases of angiosarcomas diagnosed on fine needle aspiration cytology. One case is a recurred angiosarcoma in the left chest wall and the other case is a lymphedema-associated angiosarcoma in the left lower leg. The cytologic findings of both cases are similar. Cytologic features that identified this neoplasm as an angiosarcoma included arborizing microtissue fragments, irregular anastomosing vascular spaces lined by atypical cells, microacini, intracytoplasmic lumen, and intracellular red blood cells, marked cell discohesiveness, spindle to ovoid, irregular, hyperchromatic nuclei, and elongated cytoplasmic processes with indistinct borders. This report emphasizes that when aspiration smears show vasoformative features in a bloody background, angiosarcoma should be included in the differential diagnosis.

A survey on change of perception and satisfaction of family medicine (From patients add in one general hospital in seoul)

BACKGROUND: The author surveyed and analyzed the changes of perception and satisfaction about family medicine. So that the outcome may bring us a reference to advance family medicine more. METHODS: 247 in and out patients in one general hospital in Seoul were surveyed by the questionnaire from July 26, 2000 to June 20. The date was analyzed statistically by SAS program. RESULTS: As for the knowledge of family medicine, 61.5% of the patients answered that they knew what it is, and the most of them, 54%, via medical institution. The office workers, married , and highly educated people tend to know more about family medicine (P<0.05). As for attitude, 68% of the group answered that family medicine is necessary, because "family medicine doctors give proper advice and consult through out all fields of medicine"(58.8%). As for the preference so prirate doctor, 56.7% of the group answered that they would register for family medicine clinic, and students and office workers are fond of family medicine(P<0.05). As for the satisfaction, 34.4% were ever been to family medicine clinic, and 35.5% out of them were dissatisfied, mainly due to the lack of knowledge of physicians about their diseases(70.1%). CONCLUSION: The perception of family medicine are still scanty compared to the old studies.

Surgical Repair of Traumatic Cyclodialysis with Persistent Hypotony

Cyclodialysis is characterized by a disruption of the circumferential attachment of the fibers of the meridional ciliary muscle to the scleral spur. Cyclodialysis can lead to a marked chronic hypotony. Prolonged periods of hypotony can result in corneal edema, Descemet`s folds, shallow anterior chamber, cataract formation, chorioretinal folds that can involve the macula, and optic disc edema. The authors experienced a case of traumatic cyclodialysis with a persistent hypotony. We have treated with refixation of the detached ciliary body, by direct cyclopexy. Postoperatively, hypotony was disappeared and visual improvement was achieved.

Clinical Analysis of 100 Low Vision Patients

One-hundred patients with low vison caused by various ophthalmic pathologies were evaluated retrospectively. Ophtic atrophy was the most common etiology for low vision. For the low vision patients, hand-help magnifiers, stand magnifiers, telecopes and spectacle-mounted magnifiers were used as optical low vision aid(LVA)s. Typoscopes, visors, absorptive lenses, reading stands were used as non-optical LVAs. Closed circuit television was used as an electrical LVA. Majority of patients(82%) benefited from being prescribed low vision aids Therefore, it was suggested that all patients having low vision should receive a low vision assessment.