A Case of Scalp Metastasis from Breast Cancer without Other Distant Metastases

Cutaneous metastases of malignant tumors are relatively rare, and breast cancer is the most common malignancy in women with cutaneous metastases. Since newly developed cutaneous lesions can be the first signs of metastases in breast cancer patients, it is crucial to rule out the possibility of malignancy. Although only a few cases have been reported, breast cancer contributes to a large portion of scalp metastases. This case report demonstrates a rare case of breast cancer metastasis only confined to the scalp. The patient was a 55-year-old woman who was diagnosed with scalp metastasis from breast cancer 10 years after the first curative surgery. The scalp lesion was palpable for 4 years and showed a sudden increase in size over a few months. The patient underwent wide excision with flap coverage. After surgery the patient received radiotherapy, but she has refused additional hormonal therapy. To date, there is no evidence of disease recurrence.

Quantitative assessment of liver fibrosis using shore durometer

PURPOSE: The purpose of the present study was to investigate whether hardness of liver surface correlated with degree of liver fibrosis, and its association with posthepatectomy liver failure (PHLF). METHODS: A shore durometer was used to measure hepatic hardness in 41 patients with hepatocellular carcinoma (HCC) and in 10 patients with normal liver. We investigated how hepatic hardness correlates with various values indicating the degree of liver fibrosis, and how it correlates with PHLF. RESULTS: In the normal liver group, the surface shore units (SU) was 15.06 ± 2.64. In the HCC group, there was a correlation between surface SU and preoperative results indicating liver fibrosis. Among patients with PHLF after resecting over 3 segments, the surface SU of patients with grade A PHLF was 21.85 ± 5.63, and the surface SU of patients with grade C PHLF was 35.75 ± 9.26. In patients with PHLF after resecting 2 or less segments, the surface SU of patients with PHLF grade A was 20.95 ± 5.18, and the surface SU of patients with PHLF grade B was 31.60 ± 5.57. In predicting PHLF, surface SU was more effective than preoperative platelet count, spleen volume, or liver fibrosis index. CONCLUSION: Hepatic hardness measured by the shore durometer was correlated with the degree of liver fibrosis. Liver surface SU was a more effective parameter for predicting PHLF, as compared to other indicators evaluated before hepatectomy. The decision to perform major hepatectomy should be reconsidered in cases with a liver surface SU of >30.

Quantitative assessment of liver fibrosis using shore durometer

PURPOSE: The purpose of the present study was to investigate whether hardness of liver surface correlated with degree of liver fibrosis, and its association with posthepatectomy liver failure (PHLF). METHODS: A shore durometer was used to measure hepatic hardness in 41 patients with hepatocellular carcinoma (HCC) and in 10 patients with normal liver. We investigated how hepatic hardness correlates with various values indicating the degree of liver fibrosis, and how it correlates with PHLF. RESULTS: In the normal liver group, the surface shore units (SU) was 15.06 ± 2.64. In the HCC group, there was a correlation between surface SU and preoperative results indicating liver fibrosis. Among patients with PHLF after resecting over 3 segments, the surface SU of patients with grade A PHLF was 21.85 ± 5.63, and the surface SU of patients with grade C PHLF was 35.75 ± 9.26. In patients with PHLF after resecting 2 or less segments, the surface SU of patients with PHLF grade A was 20.95 ± 5.18, and the surface SU of patients with PHLF grade B was 31.60 ± 5.57. In predicting PHLF, surface SU was more effective than preoperative platelet count, spleen volume, or liver fibrosis index. CONCLUSION: Hepatic hardness measured by the shore durometer was correlated with the degree of liver fibrosis. Liver surface SU was a more effective parameter for predicting PHLF, as compared to other indicators evaluated before hepatectomy. The decision to perform major hepatectomy should be reconsidered in cases with a liver surface SU of >30.

Correlation between Intraocular Pressure and Bottle Heights during Vitrectomy

PURPOSE: To determine the correlation between intraocular pressure (IOP) and the bottle heights during vitrectomy using TONO-PEN(R)XL applanation tonometer and Icare(R) PRO rebound tonometer. METHODS: Twenty-four eyes of 24 patients who underwent 23-gauge sutureless vitrectomy were evaluated. After complete vitrectomy, the IOP was gradually increased by lifting the irrigation bottle height from the trocar insertion site by 40 cm, 45 cm, 50 cm, and 55 cm. The distance between the floor and patient's eye was consistent in all cases (105.5 cm). Before the removal of 23-gauge microcannulas, IOP was measured five times using each of the two methods, Tono-Pen(R)XL and Icare(R) PRO. RESULTS: The mean IOPs were 8.25 +/- 0.35 mm Hg for TONO-PEN(R)XL and 8.96 +/- 0.32 mm Hg for Icare(R) PRO at 40 cm bottle height. As the bottle height increased, the differences in IOP was also increased, 10.71 +/- 0.37 mm Hg at 45 cm, 14.18 +/- 0.39 mm Hg at 50 cm and 17.93 +/- 0.40 mm Hg at 55 cm for TONO-PEN(R)XL and 11.48 +/- 0.31 mm Hg at 45 cm, 14.64 +/- 0.31 mm Hg at 50 cm and 18.13 +/- 0.38 mm Hg at 55 cm for Icare(R) PRO. In TONO-PEN(R)XL, the linear equation was Y = 0.65 X - 18.108 (R2 = 0.794, p = 0.000) and the quadratic equation was Y = 0.013 X2 - 0.569 X + 10.446 (R2 = 0.801, p = 0.000). In Icare(R) PRO, the linear equation was Y = 0.614 X - 15.842 (R2 = 0.820, p = 0.000) and the quadratic equation was Y = 0.010 X2 - 0.306 X + 5.688 (R2 = 0.825, p = 0.000). The results show correlation of the quadratic equation was stronger than the linear equation in both tonometers. CONCLUSIONS: The differences of IOP were positively correlated with bottle heights in the form of a curve during vitrectomy. Therefore, the patients who are susceptible to retina or optic nerve damage during vitrectomy should be closely monitored.

Intravitreal Anti-vascular Endothelial Growth Factor versus Observation in Acute Central Serous Chorioretinopathy: One-year Results

PURPOSE: To evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) compared with observation for treating acute central serous chorioretinopathy (CSC). METHODS: A retrospective study of 36 patients with acute CSC, including 21 patients treated with anti-VEGF (anti-VEGF group) and 15 patients with observation (observation group). Patients in the anti-VEGF group received a single dose of bevacizumab or ranibizumab at baseline. Best-corrected visual acuity (BCVA), central foveal thickness (CFT) and resolution of subretinal fluid (SRF) on optical coherence tomography (OCT) were assessed. The integrity of the foveal inner segment/outer segment (IS/OS) line at 12 months was also analyzed. RESULTS: Resolution of SRF was achieved in 20 of 21 eyes in the anti-VEGF group and in 12 of 15 eyes in the observation group (p = 0.151). Mean BCVA and CFT were not different between the two groups at 12 months (p > 0.05). The amount of change in BCVA, however, differed significantly between the groups (p = 0.044). Final OCT more frequently detected the foveal IS/OS line in the anti-VEGF group than in the observation group (p = 0.012). CONCLUSIONS: In terms of BCVA, anti-VEGF and observation only had similar therapeutic effects in acute CSC patients. In some patients, however, the rapid resolution of SRF by anti-VEGF might reduce the risk of photoreceptor degeneration and improve long-term visual acuity.

Assessment of Breast Volume Change after Transverse Rectus Abdominis Myocutaneous Flap

BACKGROUND: The evaluation of a breast after breast reconstruction depends on a surgeon's subjective criteria. We used computed tomography (CT) scans to obtain an objective evaluation of the postoperative results by measuring the breast volume of patients who had undergone breast reconstruction using pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. This research will help in the objective postoperative evaluation of reconstructed breasts, and also in the preoperative flap size designs. METHODS: A total of 27 patients underwent breast reconstruction using pedicled TRAM flaps after mastectomy from September 2007 to July 2010. Of these, 10 patients who were followed up and underwent CT scans 2 or more times during the follow-up period were included in this study. We evaluated the change in breast volume over time using CT scans, and the interval breast volume change between CT scans. RESULTS: All of the 10 patients' reconstructed breasts showed a volume decrease over time. The breast volume changes in the intervals between CT scans were as follows: 5.65% decrease between the first CT and second CT scan, 2.3% decrease between the second CT and third CT scan, (statistically significant) and 1.89% decrease between the third CT and forth CT scan. (not statistically significant). CONCLUSIONS: This research shows the possibility of objectively evaluating the postoperative breast volume changes. The findings will be helpful in designing the size of TRAM flaps to use on defects after mastectomy. Based on these results, we should also closely observe the reconstructed breast volume for at least 2 years.

Hafnia Alvei Keratitis after Using a Therapeutic Contact Lens in a Patient with Graft-Versus-Host Disease

PURPOSE: To report a case of bacterial keratitis caused by Hafnia alvei after using a contact lens in a patient with graft-versus-host disease. CASE SUMMARY: A 47-year-old male patient presented with a corneal ulcer. The patient had been wearing a therapeutic contact lens for a month because of severe dry eye syndrome and filament removal due to filamentary keratitis. The patient had been taking moxifloxacin to prevent infection, but had not for the previous 7 days. The corneal ulcer occurred at the 11 o'clock direction in the peripheral cornea accompanied by corneal epithelial defect and stromal infiltration. The corneal scraping and culture yielded Hafnia alvei, which is susceptible to ceftazidime, levofloxacin and moxifloxacin. There was no systemic signs or symptoms to suspect systemic infection. After treatment with a topical antibiotic agent, the patient's eye condition improved with only mild corneal opacity remaining. CONCLUSIONS: Hafnia alvei infection rarely occurs in humans but should be considered as a potential causal pathogen in immunosuppressed patients.

Wound Healing Effect of Bacterial Synthesized Cellulose on Full Thickness Skin Defect in the Rat

PURPOSE: Cellulose is a natural substance from plants or bacteria. It is known that bacterial synthesized cellulose has an effect of wound healing. The aim of this study is to show the effect of bacterial synthesized cellulose from citrus on wound healing. METHODS: Three full-thickness skin defects were made on the back of Sprague-Dawley rats. Three wounds were treated by vaseline gauze(Group V), Algisite M(R)(Group A) and bacterial synthesized cellulose from citrus(Group C) was used for dressing on skin defect on rats. We analyzed the gross, histological and biochemistry finding. RESULTS: Group C showed more decrease of wound size compared to Group V(33% versus 7.2#) after 14 days. The histologic findings revealed Group C and Group A preceed the process of wound healing rather than Group V(More rapid collagen deposition and neovascularization and reduced inflammation). Also, the expressions of vascular endothelial growth factor(VEGF) and transforming growth factor(TGF)-beta1 were increased in the Group C and Group A compared with the Group V in 7 days. VEGF and TGF-beta1 expression were decreased in the Group C and Group A in 14 days, however Group V was not decreased at 14 day because of delayed wound healing process. CONCLUSION: Bacterial synthesized cellulose from citrus affects wound healing by reducing the inflammatory stage. And stimulates wound contracture by the deposition of extracellular matrix, thus preventing the formation of chronic wounds.

A Case of Jejunogastric Intussusception that was Diagnosed by Gastroscopy in a Patient who had Undergone Subtotal Gastrectomy / 대한소화기내시경학회지

Jejunogastric intussusception is a rare, but potentially lethal complication after gastrectomy or gastrojejunostomy. In the acute condition, early diagnosis and prompt surgical treatment are mandatory to reduce the incidence of mortality. We present here a case of jejunogastric intussusception that was diagnosed by gastroscopy in a patient with a history of subtotal gastrectomy, and she had experienced increasing epigastric pain and vomiting for 1 day.

Transforming growth factor-beta promoted vascular endothelial growth factor release by human lung fibroblasts / 소아과

PURPOSE: The human lung fibroblast may act as an immunomodulatory cell by providing pro-inflammatory cytokines and chemokines, which are important in airway remodeling. Vascular endothelial growth factor (VEGF) induces mucosal edema and angiogenesis. Thymus and activation regulated chemokine (TARC) induces selective migration of T helper 2 cells. We investigated whether human lung fibroblasts produced VEGF and TARC, and the effects were augmented with the co-culture of fibroblasts and human bronchial smooth muscle cells (HBSMC), and whether dexamethasone can inhibit the proliferation and the release of VEGF in lung fibroblasts. METHODS: Human lung fibroblasts were cultured with and without HBSMC, growth-arrested in serum-deprived medium, and pretreated with dexamethasone for 16 hours. After 24-hour stimulation with platelet derived growth factor-BB (PDGF-BB) and/or transforming growth factor-beta (TGF-beta), culture supernatant was harvested for assays of VEGF and TARC. Cell proliferation was assayed using BrdU cell proliferation ELISA kit. RESULTS: 1) The release of VEGF was significantly increased after stimulation with TGF-beta, and its release was augmented when co-stimulated with PDGF and TGF-beta. 2) VEGF release induced by PDGF or TGF-beta was inhibited by dexamethasone. 3) There was no synergistic effect on the release of VEGF when human lung fibroblasts were co-cultured with HBSMC. 4) Dexamethasone did not suppress human lung fibroblasts proliferations. 5) Neither TGF-beta nor PDGF induced TARC release from lung fibroblasts. CONCLUSION: Human lung fibroblasts may modulate airway remodeling by release of VEGF, but they have no synergistic effects when co-cultured with HBSMC. Dexamethasone suppresses VEGF release, not proliferation of lung fibroblast.

Natural Course of Primary Headache in Children

PURPOSE: Headache is a notable problem in clinical practice and a frequent symptom in children, but a systemic evaluation of the clinical course in affected patients is uncommon. The main aim of the present study is to investigate the natural course of primary headache in children after two years of diagnosis. METHODS: Based on the international classification of headache disorder(2nd edition), 51 children were diagnosed as migraine or tension-type headache from September, 2003 to October, 2005. They did not received prophylactic treatment. Their symptoms were reassessed in 42 out of 51 children 2 years after the initial diagnosis. We evaluated the condition of the patients with headache by a telephone interview with their parents. RESULTS: The diagnosed group consisted of 25 patients(59.5%) with migraine and 17 patients(40.5%) with tension-type headache. Regarding the location of the headache, the incidence of temporal area was higher in the migraine(52.0%) group than in the tension-type headache(11.8%) group. In the migraine group, 15 cases(60%) had pulsating headache, which was higher than in the tension-type headache group. At the 2-year follow up, headache-free or improvement was observed in 80.0%(20 cases) of the migraine group and 82.3%(14 cases) of the tension-type headache group. Among 14 children with positive headache family history, 12 patients(85.7%) were headache-free or improved. But there was not significant relationship between headache family history and prognosis. CONCLUSION: Primary headache had a high tendency to improve without long-term management by a 2-year follow-up in this study. Therefore, it is the way of reducing the unnecessary treatment to decide prophylactic treatment after investigating the severity or frequency of the headache using the headache diary or questionnaire.

A case of idiopathic renal hypouricemia / 소아과

Idiopathic renal hypouricemia is a disorder characterized by impaired urate handling in the renal tubules. This disease usually produces no symptoms, but hematuria, uric acid nephrolithiasis or acute renal failure may develop. A defect in the SLC22A12 gene, which encodes the human urate transporter, is the known major cause of this disorder. We describe a 10-month-old boy with idiopathic renal hypouricemia. He was diagnosed with transient pseudohypoaldosteronism at admission, but hypouricemia was accidentally found through follow-up study. By gene analysis, his diagnosis was confirmed to idiopathic renal hypouricemia. In addition, we report a mutation in the human urate transporter 1 (hURAT1) gene identified in his family.

The Ictal Electroencephalographic Findings in a Neonate with Hypocalcemia Seizure

Seizures in neonates can occur due to the problems of delivery at birth such as anoxia and cerebral hemorrhage. Other events, such as hypocalcemia, hypoglycemia, hyponatremia, hypernatremia, hypomagnesemia, infection and central nervous system malformations, can cause sezures. Hypocalcemia occurs most commonly in neonates, which is one of the important causes of neonatal seizures over the post few decades. The electroencephalogram (EEG) in neonatal hypocalcemia may show abnormal spikes, specifically focal, rhythmic, high-voltage, and frontocentral discharges that rapidly generalize. We report the ictal EEG findings in a neonate with hypocalcemic seizures.

A Case of Microscopic Polyangiitis with Ischemic Colitis / 대한신장학회잡지

Microscopic polyangiitis (MPA) is a systemic small vessel vasculitis, which is frequently complicated with rapidly progressive necrotizing glomerulonephritis. Patients with MPA often have demonstrable perinuclear antineutrophil cytoplasm antibodies (p-ANCA) in serum. The most common age of onset is 40 to 60 years and is more common in men. Gastrointestinal (GI) tract involvement is present in about 30-40%. Small bowel involvement is more common and ischemic colitis in the rectum is rare. We have experienced a case of microscopic polyangiitis with ischemic colitis in the rectum, p-ANCA positive and cresent formation on renal biopsy. A 72-year-old woman was admitted with two weeks history of abdominal pain. Total colonoscopy revealed colon obstruction with severe mucosal edema. Urine study showed hematuria and proteinuria. Serum creatinine was elevated progressively. Serume p-ANCA was positive. The titer of p-ANCA was decreased and colon obstruction was recovered after steroid and cyclophosphamide therapy.

A Case of Duodenal Gastrointestinal Stromal Tumor Presenting with Gastrointestinal Bleeding / 대한소화기내시경학회지

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial tumor of the gastrointestinal tract. GISTs are most common in the stomach, followed by small intestine, colon and rectum, and esophagus. We report a case of duodenal GIST presenting with gastrointestinal bleeding in a 53-year-old male. Upper gastrointestinal endoscopy revealed a protruded mass with central ulceration on the second portion of the duodenum. Spontaneous spurting blood was encountered from the central ulcer of the mass. Abdominal computed tomography scan and celiac angiography revealed hypervascular tumor, located in the second portion of the duodenum. Laparotomy with wedge resection was performed. Histological and immunohistochemical studies on resected specimen revealed a duodenal GIST of a combined smooth muscle and neural type.

The Usefulness of MR Imaging of the Temporal Bone in the Evaluation of Patients with Facial and Audiovestibular Dysfunction

OBJECTIVE: To evaluate the clinical utility of MR imaging of the temporal bone in patients with facial and audiovestibular dysfunction with particular emphasis on the importance of contrast enhancement. MATERIALS AND METHODS: We retrospectively reviewed the MR images of 179 patients [72 men, 107 women; average age, 44 (range, 1-77) years] who presented with peripheral facial palsy (n=15), audiometrically proven sensorineural hearing loss (n=104), vertigo (n=109), or tinnitus (n=92). Positive MR imaging findings possibly responsible for the patients' clinical manifestations were categorized according to the anatomic sites and presumed etiologies of the lesions. We also assessed the utility of contrast-enhanced MR imaging by analyzing its contribution to the demonstration of lesions which would otherwise not have been apparent. All MR images were interpreted by two neuroradiologists, who reached their conclusions by consensus. RESULTS: MR images demonstrated positive findings, thought to account for the presenting symptoms, in 78 (44%) of 179 patients, including 15 (100%) of 15 with peripheral facial palsy, 43 (41%) of 104 with sensorineural hearing loss, 40 (37%) of 109 with vertigo, and 39 (42%) of 92 with tinnitus. Thirty (38%) of those 78 patients had lesions that could be confidently recognized only at contrastenhanced MR imaging. CONCLUSION: Even though its use led to positive findings in less than half of these patients, MR imaging of the temporal bone is a useful diagnostic procedure in the evaluation of those with facial and audiovestibular dysfunction. Because it was only at contrast-enhanced MR imaging that a significant number of patients showed positive imaging findings which explained their clinical manifestations, the use of contrast material is highly recommended.

Partial Monosomy 21 Associated with Unbalanced t(10p; 21q)

No abstract available.

G Deletion Syndrome II

We experienced a case of G deletion syndrome II in a 8 year and 1 month old boy. He showed mental retardation, microcephaly, high arched palate, low set malformed ears, epicanthal fold, thoracic deformity, tracheomegaly and two lumens of esophagus. Chromosomal study showed the deletion of long arm of chromosome 22, kariotypically he was depicted as 46, XY, 22q-. A brief review of literature was also presented.