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Objective@#Imaging-based survival stratification of patients with gliomas is important for their management, and the 2021 WHO classification system must be clinically tested. The aim of this study was to compare integrative imaging- and pathology-based methods for survival stratification of patients with diffuse glioma. @*Materials and Methods@#This study included diffuse glioma cases from The Cancer Genome Atlas (training set: 141 patients) and Asan Medical Center (validation set: 131 patients). Two neuroradiologists analyzed presurgical CT and MRI to assign gliomas to five imaging-based risk subgroups (1 to 5) according to well-known imaging phenotypes (e.g., T2/FLAIR mismatch) and recategorized them into three imaging-based risk groups, according to the 2021 WHO classification: group 1 (corresponding to risk subgroup 1, indicating oligodendroglioma, isocitrate dehydrogenase [IDH]-mutant, and 1p19q-codeleted), group 2 (risk subgroups 2 and 3, indicating astrocytoma, IDH-mutant), and group 3 (risk subgroups 4 and 5, indicating glioblastoma, IDHwt). The progression-free survival (PFS) and overall survival (OS) were estimated for each imaging risk group, subgroup, and pathological diagnosis. Time-dependent area-under-the receiver operating characteristic analysis (AUC) was used to compare the performance between imaging-based and pathology-based survival model. @*Results@#Both OS and PFS were stratified according to the five imaging-based risk subgroups (P < 0.001) and three imagingbased risk groups (P < 0.001). The three imaging-based groups showed high performance in predicting PFS at one-year (AUC, 0.787) and five-years (AUC, 0.823), which was similar to that of the pathology-based prediction of PFS (AUC of 0.785 and 0.837). Combined with clinical predictors, the performance of the imaging-based survival model for 1- and 3-year PFS (AUC 0.813 and 0.921) was similar to that of the pathology-based survival model (AUC 0.839 and 0.889). @*Conclusion@#Imaging-based survival stratification according to the 2021 WHO classification demonstrated a performance similar to that of pathology-based survival stratification, especially in predicting PFS.
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Purpose@#Pancreatic enzyme reflux into the biliary tract is associated with chronic inflammation and increased cellular proliferation in the biliary epithelium, leading to biliary carcinoma. We evaluated the relationship between high bile juice amylase levels and biliary microflora in patients with malignant gallbladder lesions. @*Methods@#In this retrospective study, 25 gallbladder specimens were obtained from patients with gallbladder cancer to evaluate amylase levels and perform bacterial culture. The samples were divided into high and low amylase groups and culture-positive and negative groups for analysis. Bile juice amylase 3 times higher than the normal serum amylase level (36–128 IU/L) was considered high. @*Results@#The number of positive cultures was higher in the high amylase group than in the low amylase group, but the difference was insignificant. There were no differences in other clinicopathological factors. Sixteen patients showed positive culture results; Escherichia coli and Klebsiella spp. were the most common gram-negative bacteria, whereas Enterococcus and Streptococcus spp. were the most common gram-positive bacteria. Age and bile juice amylase levels were significantly higher in the culture-positive group than in the culture-negative group. The incidence of bacterial resistance to cephalosporins was 6.25%–35.29%, and this incidence was particularly high for lower-generation cephalosporins. @*Conclusion@#Bacteria in gallbladder were identified more frequently when the amylase level was high. High amylase levels in the gallbladder can be associated with caused chronic bacterial infections with occult pancreaticobiliary reflux, potentially triggering gallbladder cancer
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Background and Objectives@#There has been a long debate on whether intraoperative parathyroid hormone (IOPTH) monitoring is mandatory or not in the excision of a single abnormal parathyroid gland. The aim of this study is to suggest a new criteron of IOPTH monitoring. Subjects and Method We retrospectively analyzed 31 patients who underwent parathyroidectomy from 2005 to 2019. Patients had IOPTH not measured and those with secondary hyperparathyroidism were excluded. IOPTH was measured preoperatively (EX00), at 10 minutes (EX10) and 20 minutes (EX20) after the excision and analyzed. We determined the surgery as a ‘successful excision of lesion (SEOUL)’ when it met the following criteria: criterion 1) the level of EX10 or EX20 decreased under the upper normal or under upper limit of parathyroid hormone (65 pg/mL); criterion 2) EX20 decreased below 50% of EX00 and less than 195 pg/ mL (3 times the upper normal limit); criterion 3) multiglandular disease. @*Results@#Twenty-five patients among 31 patients were included this study (M:F=8:17). Twenty- two patients were suspected of single lesion and three patients of multiple lesions on preoperative images (99mTc-sestamibi scan, neck CT, and PET-CT). IOPTH of EX00, EX10, and EX20 were 488.92±658.74, 121.36±134.73, and 92.44±111.55 pg/mL, respectively. Sixty-four percent patients (16/25) met the criterion 1. Six patients (24%) successfully excised a lesion meeting the criterion 2. Three patients had multiglandular disease, meeting the criterion 3. @*Conclusion@#Our new criteria suggest when we could stop the procedure. If the level of IOPTH does not meet the SEOUL criteria, it means that there might be more lesions.
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Background and Objectives@#Recurrent epistaxis requiring emergency department (ED) visits results in increased morbidity in the elderly and associated with high health care costs. This study is to analyze the frequency and characteristics of epistaxis patients in the elderly and to find out the risk factors and effective treatment for recurrent epistaxis. Subjects and Method We studied retrospectively the clinical cases of 977 emergency patients and 155 patients, aged over 65, for the treatment of epistaxis during the last 10 years from January 2008 to January 2018. The group A, comprised of 95 patients (68.29%), was treated with an initial treatment. The group B, which comprised of 60 patients (38.71%), visited for re-bleeding following an initial treatment. @*Results@#Patients made 2 to 10 ED visits due to re-bleeding and 32 of the 60 patients (53.5%) visited twice. The electrocauterization was the most common (61.7%) for treatment method during rebleeding, followed by posterior packing (18.3%). The factors that increases the risk of recurrent epistaxis are anticoagulants, posterior epistaxis, anterior packing, inefficient ED packing. There was no correlation between comorbidities and rebleeding. @*Conclusion@#Accurate medical history taking of anticoagulants may enable personnel to provide more effective management of these patients. The most important factors in the failure of primary care were not being able to find the precise area of bleeding and ineffective packing during the initial treatment. Therefore, it is important that we must carefully check the areas using the endoscope to decrease the failure of initial treatment of epistaxis.
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Although the understanding of appendiceal mucinous neoplasms (AMNs) and their relationship with disseminated peritoneal mucinous disease have advanced, the diagnosis, classification, and treatment of AMNs are still confusing for pathologists and clinicians. The Gastrointestinal Pathology Study Group of the Korean Society of Pathologists (GPSG-KSP) proposed a multicenter study and held a workshop for the “Standardization of the Pathologic Diagnosis of the Appendiceal Mucinous Neoplasm” to overcome the controversy and potential conflicts. The present article is focused on the diagnostic criteria, terminologies, tumor grading, pathologic staging, biologic behavior, treatment, and prognosis of AMNs and disseminated peritoneal mucinous disease. In addition, GPSG-KSP proposes a checklist of standard data elements of appendiceal epithelial neoplasms to standardize pathologic diagnosis. We hope the present article will provide pathologists with updated knowledge on how to handle and diagnose AMNs and disseminated peritoneal mucinous disease.
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Purpose@#The purpose of this study is to objectively and systematically investigate the effect of Kinesio taping by organizing and analyzing the research results using effect size. @*Methods@#A total of 1,000 papers was searched, and 100 of them were selected the first time. Afterward, the effects of taping were analyzed and classified papers that studied balance, muscle strength, and pain, and finally 34 papers were selected. The effect size was calculated using the Effect Size Calculators (University of Colorado, USA) program. Statistical analysis was performed by using PASW Statistics software version 23.0 (IBM Co., Armonk, NY, USA). Descriptive statistics were used to obtain the effect size and confidence interval for each group. @*Results@#In a study related to balance control ability, the effect size was 1.519 in the young subjects group (20-39 years old), and the effect size in the elderly group (65 years or older) was 0.360. In a study related to muscle strength, the effect size was 0.469 in the group of young subjects and 0.250 in the middle-aged group (40-65 years old), and the effect size of the elderly group was 0.848. In the study related to pain control, the effect size was 0.469 in the young group, the effect size of the middle-aged group was 0.972, and the effect size of the elderly group was 1.040. @*Conclusion@#Kinesio taping differed in the degree of effect according to the age group of the subjects, but it was effective in balance control ability, muscle strength, and pain.
ABSTRACT
Although the understanding of appendiceal mucinous neoplasms (AMNs) and their relationship with disseminated peritoneal mucinous disease have advanced, the diagnosis, classification, and treatment of AMNs are still confusing for pathologists and clinicians. The Gastrointestinal Pathology Study Group of the Korean Society of Pathologists (GPSG-KSP) proposed a multicenter study and held a workshop for the “Standardization of the Pathologic Diagnosis of the Appendiceal Mucinous Neoplasm” to overcome the controversy and potential conflicts. The present article is focused on the diagnostic criteria, terminologies, tumor grading, pathologic staging, biologic behavior, treatment, and prognosis of AMNs and disseminated peritoneal mucinous disease. In addition, GPSG-KSP proposes a checklist of standard data elements of appendiceal epithelial neoplasms to standardize pathologic diagnosis. We hope the present article will provide pathologists with updated knowledge on how to handle and diagnose AMNs and disseminated peritoneal mucinous disease.
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Purpose@#The purpose of this study is to objectively and systematically investigate the effect of Kinesio taping by organizing and analyzing the research results using effect size. @*Methods@#A total of 1,000 papers was searched, and 100 of them were selected the first time. Afterward, the effects of taping were analyzed and classified papers that studied balance, muscle strength, and pain, and finally 34 papers were selected. The effect size was calculated using the Effect Size Calculators (University of Colorado, USA) program. Statistical analysis was performed by using PASW Statistics software version 23.0 (IBM Co., Armonk, NY, USA). Descriptive statistics were used to obtain the effect size and confidence interval for each group. @*Results@#In a study related to balance control ability, the effect size was 1.519 in the young subjects group (20-39 years old), and the effect size in the elderly group (65 years or older) was 0.360. In a study related to muscle strength, the effect size was 0.469 in the group of young subjects and 0.250 in the middle-aged group (40-65 years old), and the effect size of the elderly group was 0.848. In the study related to pain control, the effect size was 0.469 in the young group, the effect size of the middle-aged group was 0.972, and the effect size of the elderly group was 1.040. @*Conclusion@#Kinesio taping differed in the degree of effect according to the age group of the subjects, but it was effective in balance control ability, muscle strength, and pain.
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Objective@#Hip fracture is a major problem for elderly patients and is expected to become more common as society ages. Transthoracic echocardiography (TTE) is still widely performed for cardiac risk assessment, while routine echocardiography is not recommended in patients undergoing non-cardiac surgery. Thus, we evaluated the relationship between TTE-related variables and postoperative outcomes in elderly patients with hip fracture. @*Methods@#This study consisted of a single-center, retrospective medical record review including a total of 356 patients. The study population included patients 65 years of age and older who underwent TTE for preoperative assessment within 1 month before the scheduled hip fracture surgery between January 2013 and October 2016. @*Results@#In total, 356 patients were included. Seven patients died within 30 days after surgery. Advanced age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1–1.3; P @*Conclusion@#In elderly patients undergoing hip fracture surgery, preoperative TTE is not a useful predictive factor for postoperative mortality.
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Antimicrobial filters that prevent cross-contamination through anesthesia equipment are commonly used in operating rooms. Occlusion of this filter leads to the patient’s airway obstruction, which may lead to fatal outcomes. We report a case of the airway obstruction by antimicrobial filter occlusion during general anesthesia, and symptoms recovered immediately after removal of the filter.
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Retroperitoneal hemorrhage is a potentially lethal complication in patients on anticoagulant therapy and can be caused by ovarian artery bleeding, regardless of the patients’ age and obstetric history. This case illustrates the clinical presentation of ovarian artery bleeding in a postmenopausal female on anticoagulant therapy, the diagnostic utility of transcatheter angiography, and successful embolization.
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The latissimus dorsi musculocutaneous flap (LDMCF) is widely used for breast reconstruction. However, it has the disadvantage of frequent seroma formation at the donor site, and late seroma has also been reported. The authors report histological findings after the surgical treatment of a late, repeatedly recurrent seroma at 10 years after breast reconstruction with LDMCF. In 2008, a 66-year-old female patient underwent immediate breast reconstruction with LDMCF. In 2015, a late seroma was found at the donor site. After aspiration and drainage, the seroma recurred again in 2018. Total surgical excision of the seroma was performed and bloody-appearing fluid was identified in the capsule. The excised tissue was biopsied. Histological examination revealed no evidence of blood in the fluid, and multinucleated giant cells with amorphous eosinophilic proteinaceous material were identified. The cyst was suggestive of chronic granulomatous inflammation. There was no recurrence at 8 months postoperatively. The patient described herein underwent surgical treatment of late seroma that recurred after immediate breast reconstruction with LDMCF, and histological findings were identified. These results may be helpful for other future studies regarding late seroma after breast reconstruction with LDMCF.
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Purpose@#Intrahepatic recurrence has a significant effect on the survival of hepatocellular carcinoma (HCC) patients. We aimed to determine if there are useful indicators in predicting the recurrence of liver cancer after a hepatic resection. @*Methods@#We retrospectively reviewed medical records of 210 HCC patients who underwent hepatectomy between January 2009 and December 2015. We examined clinic-pathological variables comparing 2 groups of HCC patients, either intrahepatic recurrence or not. @*Results@#We divided 184 patients into 2 groups; 94 patients (51.1%) with intrahepatic recurrence and 90 patients (48.9%) without intrahepatic recurrence. Multivariate analysis showed operation type, preoperative α-FP, postoperative protein induced by vitamin K absence-II (PIVKA-II) elevation, and multiple tumor number were closely associated with intrahepatic recurrence. The preoperative PIVKA-II level was not statistically significant in postoperative intrahepatic recurrence rate. The recurrence rate was 46.2% in 132 of 184 cases of α-FP 200 ng/mL was 38 of 184 cases, 21 of which recurred (55.3%). According to the multivariate analysis, OR ratio was 8.003 (95% confidence interval [CI], 1.549–41.353) in the α-FP 100–200 ng/mL group and 1.867 (95% CI, 0.784–4.444) in α-FP 200 ng/mL or higher group (P = 0.013). Three-year survival rate of intrahepatic recurrence patients was 80.7%, 3-year survival rate of no intrahepatic recurrence patients was 95.0%. @*Conclusion@#The intrahepatic recurrence rates were high in the group preop α-FP over 100 ng/mL. Close observation is needed. Prospective study for α-FP genes of HCC patients should be planned for predicting intrahepatic recurrence after hepatectomy.
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BACKGROUND@#Respiratory mucosa defects result in airway obstruction and infection, requiring subsequent functionalrecovery of the respiratory epithelium. Because site-specific extracellular matrix (ECM) facilitates restoration of organfunction by promoting cellular migration and engraftment, previous studies considered decellularized trachea an idealECM; however, incomplete cell removal from cartilage and mucosal-architecture destruction are frequently reported. Here,we developed a decellularization protocol and applied it to the respiratory mucosa of separated porcine tracheas. @*METHODS@#The trachea was divided into groups according to decellularization protocol: native mucosa, freezing–thawing (FT), FT followed by the use of Perasafe-based chemical agents before mucosal separation (wFTP), after mucosalseparation (mFTP), and followed by DNase decellularization (mFTD). Decellularization efficacy was evaluated by DNAquantification and hematoxylin and eosin staining, and ECM content of the scaffold was evaluated by histologic analysisand glycosaminoglycan and collagen assays. Biocompatibility was assessed by cell-viability assay and in vivotransplantation. @*RESULTS@#The mFTP mucosa showed low antigenicity and maintained the ECM to form a proper microstructure.Additionally, tonsil-derived stem cells remained viable when cultured with or seeded onto mFTP mucosa, and the in vivohost response showed a constructive pattern following implantation of the mFTP scaffolds. @*CONCLUSION@#These results demonstrated that xenogenic acellular respiratory mucosa matrix displayed suitable biocompatibilityas a scaffold material for respiratory mucosa engineering.
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Basal cell adenocarcinoma is 1 ~ 2 % of salivary gland carcinoma. It was recently classified as low grade malignancy. It is low grade malignant counterpart of basal cell adenoma. It has similar morphologic attributes with basal cell adenoma, but it has distinctive malignant potential including infiltrative growth into surrounding tissues and distant metastasis. Recently, we have experienced a case of basal cell adenocarcinoma arising from the bilateral parotid gland in a 38-year old woman who was previously operated on superficial parotidectomy due to pleomorphic adenoma. We report this rare case with a review of literature.
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Intradural schwannoma accompanied with torsion is rare. Intradural lumbar schwannoma was found in a 63-year-old man presenting with right sacral pain radiating to the lower extremity. This mass showed minimal enhancement on MRI. The tumor's location changed each time on MRI and CT-myelography. The patient underwent surgical resection and the cauda equina, linked to this schwannoma, was severely twisted.
ABSTRACT
Intradural schwannoma accompanied with torsion is rare. Intradural lumbar schwannoma was found in a 63-year-old man presenting with right sacral pain radiating to the lower extremity. This mass showed minimal enhancement on MRI. The tumor's location changed each time on MRI and CT-myelography. The patient underwent surgical resection and the cauda equina, linked to this schwannoma, was severely twisted.
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BACKGROUND@#Respiratory mucosa defects result in airway obstruction and infection, requiring subsequent functionalrecovery of the respiratory epithelium. Because site-specific extracellular matrix (ECM) facilitates restoration of organfunction by promoting cellular migration and engraftment, previous studies considered decellularized trachea an idealECM; however, incomplete cell removal from cartilage and mucosal-architecture destruction are frequently reported. Here,we developed a decellularization protocol and applied it to the respiratory mucosa of separated porcine tracheas. @*METHODS@#The trachea was divided into groups according to decellularization protocol: native mucosa, freezing–thawing (FT), FT followed by the use of Perasafe-based chemical agents before mucosal separation (wFTP), after mucosalseparation (mFTP), and followed by DNase decellularization (mFTD). Decellularization efficacy was evaluated by DNAquantification and hematoxylin and eosin staining, and ECM content of the scaffold was evaluated by histologic analysisand glycosaminoglycan and collagen assays. Biocompatibility was assessed by cell-viability assay and in vivotransplantation. @*RESULTS@#The mFTP mucosa showed low antigenicity and maintained the ECM to form a proper microstructure.Additionally, tonsil-derived stem cells remained viable when cultured with or seeded onto mFTP mucosa, and the in vivohost response showed a constructive pattern following implantation of the mFTP scaffolds. @*CONCLUSION@#These results demonstrated that xenogenic acellular respiratory mucosa matrix displayed suitable biocompatibilityas a scaffold material for respiratory mucosa engineering.
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Basal cell adenocarcinoma is 1 ~ 2 % of salivary gland carcinoma. It was recently classified as low grade malignancy. It is low grade malignant counterpart of basal cell adenoma. It has similar morphologic attributes with basal cell adenoma, but it has distinctive malignant potential including infiltrative growth into surrounding tissues and distant metastasis. Recently, we have experienced a case of basal cell adenocarcinoma arising from the bilateral parotid gland in a 38-year old woman who was previously operated on superficial parotidectomy due to pleomorphic adenoma. We report this rare case with a review of literature.
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BACKGROUND: The reversal of a neuromuscular blockade has typically been achieved with a cholinesterase inhibitor and the concomitant use of an anticholinergic agent, and this remains a popular method. Since the introduction of sugammadex in the market, its use has been increasing because of the rapid recovery from a neuromuscular blockade achieved by rocuronium. The occurrence of anaphylaxis or an anaphylactic reaction resulting from sugammadex is rare and has been reported sparsely. Thus, one may not recognize the possibility of sugammadex-induced hypersensitivity when sudden life-threatening hypotension occurs, especially without skin manifestations during the emergence of anesthesia. This may delay treatment and increase morbidity. CASE: We report a case of a sugammadex-related hypersensitivity reaction which manifested as pure cardiovascular collapse during the emergence of anesthesia. CONCLUSIONS: We emphasize that vigilance should be paid for at least five minutes following sugammadex administration in daily clinical practice.