Florid Reactive Periostitis of the Clavicle: A Case Report

Florid reactive periostitis (FRP) is a rare benign fibro-osseous proliferation, occurring mostly in the short tubular bones of hands and rarely in the long tubular bones. We report a surgically confirmed case of FRP involving the clavicle in a 26-year-old male. On MRI scans, a soft tissue mass with T2 high signal intensity was found that originated from the periosteum of the clavicle and included surrounding a periosteal elevation and perilesional soft tissue edema. Strong contrast enhancement was noted inside the mass and along the periosteum involving more than half of the circumference of the clavicle. Serial radiographs revealed a soft tissue mass without mineralization that turned into an ossified mass with a solid periosteal reaction within a month.

The Effects of Snack Control Education and Telephone Coaching on Self-Management, Social Support, Self-Efficacy, and Blood Glucose in Diabetes Patients / 임상당뇨병

Dietary therapy for diabetes is the most basic way to manage blood glucose. Currently, the nutritional intake rate of diabetic patients in Korea is beyond the recommended rate of the Korean Diabetes Association, showing large amounts of carbohydrates in foods consumed as snacks with an additional focus on sugar. Thus, it is necessary to support healthy dietary habits through snack control. This study is a random assignment experimental study with a total of 56 participants; 28 participants were in the control group, while the remaining 28 patients had type 2 diabetes and had visited Kyung Hee University Hospital. The experimental group with snack control education and telephone coaching exhibited a higher self-management score (t = –9.494, P < 0.001), perceived social support score (t = 7.201, P < 0.001), and self-efficacy score (t = 7.185, P < 0.001) than the control group. Additionally, the experimental group showed lower levels of glycosylated hemoglobin and average blood glucose compared to the control group (t = –4.820, P < 0.001). Thus, snack control education and telephone coaching are effective in improving diabetes self-management behavior, perceived social support, self-efficacy, and reducing glycosylated hemoglobin and average blood glucose. These results confirm the usefulness of snack education materials, and I suggest snack control education as a means of arbitration to improve the self-care of diabetics.

Prognostic Value of Tumor Regression Grade on MR in Rectal Cancer: A Large-Scale, Single-Center Experience

Objective@#To determine the prognostic value of MRI-based tumor regression grading (mrTRG) in rectal cancer compared withpathological tumor regression grading (pTRG), and to assess the effect of diffusion-weighted imaging (DWI) on interobserveragreement for evaluating mrTRG. @*Materials and Methods@#Between 2007 and 2016, we retrospectively enrolled 321 patients (male:female = 208:113; meanage, 60.2 years) with rectal cancer who underwent both pre-chemoradiotherapy (CRT) and post-CRT MRI. Two radiologistsindependently determined mrTRG using a 5-point grading system with and without DWI in a one-month interval. Two pathologistsgraded pTRG using a 5-point grading system in consensus. Kaplan-Meier estimation and Cox-proportional hazard models wereused for survival analysis. Cohen’s kappa analysis was used to determine interobserver agreement. @*Results@#According to mrTRG on MRI with DWI, there were 6 mrTRG 1, 48 mrTRG 2, 109 mrTRG 3, 152 mrTRG 4, and 6 mrTRG 5.By pTRG, there were 7 pTRG 1, 59 pTRG 2, 180 pTRG 3, 73 pTRG 4, and 2 pTRG 5. A 5-year overall survival (OS) was significantlydifferent according to the 5-point grading mrTRG (p= 0.024) and pTRG (p= 0.038). The 5-year disease-free survival (DFS)was significantly different among the five mrTRG groups (p= 0.039), but not among the five pTRG groups (p= 0.072). OSand DFS were significantly different according to post-CRT MR variables: extramural venous invasion after CRT (hazard ratio= 2.259 for OS, hazard ratio = 5.011 for DFS) and extramesorectal lymph node (hazard ratio = 2.610 for DFS). For mrTRG, kvalue between the two radiologists was 0.309 (fair agreement) without DWI and slightly improved to 0.376 with DWI. @*Conclusion@#mrTRG may predict OS and DFS comparably or even better compared to pTRG. The addition of DWI on T2-weightedMRI may improve interobserver agreement on mrTRG.

Primary Cardiac Hemangioendothelioma in an Infant: A Case Report / 임상소아혈액종양

Primary cardiac tumors are rare, with a prevalence of 0.001–0.2%. Among such tumors, cardiac hemangioendotheliomas are some of the most uncommon. In Korea, there have been no reports of hemangioendothelioma occurring in the heart of infants. We herein report a case of an infant that was admitted to our medical center and presented with cough and a runny nose. The initial diagnosis was acute bronchiolitis. Cardiomegaly was observed on chest radiography. Echocardiography revealed a tumor measuring 3.5×4.0 cm in the right atrium. The infant was transferred to a tertiary medical center for tumor excision. The excised lesion was 3.8×3×3.2 cm in size, and biopsy confirmed a diagnosis of hemangioendothelioma. In this case report, we describe our experience with a rare case involving cardiac tumor in an infant with an upper respiratory tract infection.

CpG Island Methylation in Sessile Serrated Adenoma/Polyp of the Colorectum: Implications for Differential Diagnosis of Molecularly High-Risk Lesions among Non-dysplastic Sessile Serrated Adenomas/Polyps

BACKGROUND: Although colorectal sessile serrated adenomas/polyps (SSA/Ps) with morphologic dysplasia are regarded as definite high-risk premalignant lesions, no reliable grading or risk-stratifying system exists for non-dysplastic SSA/Ps. The accumulation of CpG island methylation is a molecular hallmark of progression of SSA/Ps. Thus, we decided to classify non-dysplastic SSA/Ps into risk subgroups based on the extent of CpG island methylation. METHODS: The CpG island methylator phenotype (CIMP) status of 132 non-dysplastic SSA/Ps was determined using eight CIMP-specific promoter markers. SSA/Ps with CIMP-high and/or MLH1 promoter methylation were regarded as a high-risk subgroup. RESULTS: Based on the CIMP analysis results, methylation frequency of each CIMP marker suggested a sequential pattern of CpG island methylation during progression of SSA/P, indicating MLH1 as a late-methylated marker. Among the 132 non-dysplastic SSA/Ps, 34 (26%) were determined to be high-risk lesions (33 CIMP-high and 8 MLH1-methylated cases; seven cases overlapped). All 34 high-risk SSA/Ps were located exclusively in the proximal colon (100%, p = .001) and were significantly associated with older age (≥ 50 years, 100%; p = .003) and a larger histologically measured lesion size (> 5 mm, 100%; p = .004). In addition, the high-risk SSA/Ps were characterized by a relatively higher number of typical base-dilated serrated crypts. CONCLUSIONS: Both CIMP-high and MLH1 methylation are late-step molecular events during progression of SSA/Ps and rarely occur in SSA/Ps of young patients. Comprehensive consideration of age (≥ 50), location (proximal colon), and histologic size (> 5 mm) may be important for the prediction of high-risk lesions among non-dysplastic SSA/Ps.

Multiplicity of Advanced T Category–Tumors Is a Risk Factor for Survival in Patients with Colorectal Carcinoma

BACKGROUND: Previous studies on synchronous colorectal carcinoma (SCRC) have reported inconsistent results about its clinicopathologic and molecular features and prognostic significance. METHODS: Forty-six patients with multiple advanced tumors (T2 or higher category) who did not receive neoadjuvant chemotherapy and/or radiotherapy and who are not associated with familial adenomatous polyposis were selected and 99 tumors from them were subjected to clinicopathologic and molecular analysis. Ninety-two cases of solitary colorectal carcinoma (CRC) were selected as a control considering the distributions of types of surgeries performed on patients with SCRC and T categories of individual tumors from SCRC. RESULTS: SCRC with multiple advanced tumors was significantly associated with more frequent nodal metastasis (p = .003) and distant metastasis (p = .001) than solitary CRC. KRAS mutation, microsatellite instability, and CpG island methylator phenotype statuses were not different between SCRC and solitary CRC groups. In univariate survival analysis, overall and recurrence-free survival were significantly lower in patients with SCRC than in patients with solitary CRC, even after adjusting for the extensiveness of surgical procedure, adjuvant chemotherapy, or staging. Multivariate Cox regression analysis revealed that tumor multiplicity was an independent prognostic factor for overall survival (hazard ratio, 4.618; 95% confidence interval, 2.126 to 10.030; p < .001), but not for recurrence-free survival (p = .151). CONCLUSIONS: Findings suggested that multiplicity of advanced T category–tumors might be associated with an increased risk of nodal metastasis and a risk factor for poor survival, which raises a concern about the guideline of American Joint Committee on Cancer's tumor-node-metastasis staging that T staging of an index tumor determines T staging of SCRC.

A study of support-therapeutic effect and reducing side effect for high-dose vitamin C use of gynecological cancer patients with chemotherapy / 부인종양

OBJECTIVE: The high-dose vitamin C is useful in the cancer. Consequently its use should have become how many help even from gynecological cancer patient who is in chemotherapy. METHODS: The study was performed prospective on 57 patients who is diagnosed initially the gynecological cancer during chemotherapy at Gospel Hospital of Kosin University between January 2005 and October 2006. The study was divided to its use 29 (cervix cancer: 17, ovarian cancer 12) and no high-dose vitamin C use 28 (cervix cancer: 11, ovarian cancer 17). The cervix cancer was treated by FP chemotherapy for all stage and the ovarian cancer was treated by CC chemotherapy for stage 1, CT or PT chemotherapy for advanced stage for 6 times respectively regarding a treatment in tumor marker change aspect and the side effect researched GOG classifications. RESULTS: It evaluated the nausea and vomiting significantly in ovarian cancer (p<0.05). It evaluated for liver enzyme, Hb, WBC, platelet serum creatinine, sensory, motor nervous system and tumor marker with the high-dose vitamin C group does not have the difference from the control group statistically. CONCLUSION: The high-dose vitamin C is a possibility of reducing nausea and vomiting in the ovarian cancer chemotherapy without other side effect. The regarding a tumor marker change it was not significantly but when it analyzed a recurrence a survival rate with more patient and follow up in long period, its use of should have become how many help in gynecological cancer treatment.

Comparative study between natural cycles and programmed cycles using exogenous steroid hormones for endometrial preparation in cryopreserved-thawed blastocyst transfer / 대한산부인과학회지

OBJECTIVE: The objective of this study was to compare the outcomes of cryopreserved-thawed blastocyst transfer (CT-BT) in natural or programmed cycles using exogenous steroid hormones. METHODS: A total of 221 CT-BT cycles were included and divided into two groups according to endometrial preparation protocols. In natural cycle group (n=116), monitoring was performed by transvaginal ultrasonography to detect ovulation. In programmed cycle group (n=105), oral estradiol valerate, 6 mg/day, was started on the third day of the menstrual cycle and administered continuously, and progesterone in oil 100 mg i.m. daily injection was started on cycle day 15. CT-BTs were performed on five days after ovulation in natural cycles and five days after the initiation of progesterone administration in programmed cycles. Pregnancy rates, implantation rates, and other clinical characteristics of the two groups were compared. RESULTS: Clinical characteristics of study subjects did not differ between the two groups. Post-thaw survival rates, number of transferred blastocysts, and number of good-quality blastocysts were not different. There were no statistically significant differences in implantation rates (21.1% vs. 19.4%), clinical pregnancy rates (36.2% vs. 36.2%), and ongoing pregnancy rates (28.4% vs. 27.6%) between the two groups. CONCLUSIONS: No statistically significant differences were found in pregnancy rates and implantation rates between the two protocols. Our results suggest that both protocols are equally effective for endometrial preparation in CT-BT cycles.

A Case of Non-Hodgkin Lymphoma during Pregnancy / 대한산부인과학회지

The occurrence of Non-Hodgkin's lymphoma (NHL) during pregnancy is very rare and this malignancy is most commonly associated with aggressive histology and dissemination. Treatment in pregnant women with low-grade lymphoma may be delayed until after delivery but women with an aggressive lymphoma must have a immediate initiation of standard chemotherapy whether to have a therapeutic abortion or not. A-32-year-old woman with NHL stage IIb complicating pregnancy is presented. The diagnosis was made aggressive lymphoma. The baby weighting 1,830 gm was delivered by normal spontaneous vaginal delivery. Following delivery, the patient received combination chemotherapy with cyclophosphamide, adriamycin, vincristine, prednisone regimen but magnetic resonance imaging undertaken during follow-up showed leptomeningeal involvement, indicating poor prognosis. She wanted discharge ten months later from disseminated disease. We experienced a case of rapid growing Non-Hodgkin's lymphoma developed on anterior mediastineum that diagnosed during pregnancy and treated following delivery. We report this case with a brief review of literature.

The Effects of Combined Estrogen and Fluocalcic Effervescent Therapy on the Bone Metabolism in Surgically Menopausal Women with Osteopenia / 대한산부인과학회지

OBJECTIVE: To evaluate the effects of combined estrogen and fluocalcic therapy on the bone metabolism in the surgicalyl menopausal women with osteopenia. METHODS: This prospective randomized clinical trial examined the effects of conjugated equine estrogen and fluocalcic in combination and separately, on BMD in 200 women with low bone mass. Treatment included 0.3 mg conjugated equine estrogen (CEE) (Group I), 0.625 mg CEE (Group II), 0.3 mg CEE plus fluocalcic (Group III), and 0.625 mg CEE plus fluocalcic (Group IV) for 12 months. Biochemical markers of bone turnover were also measured every six months. RESULTS: Urinary deoxypyridinoline in Group III and Group IV decreased signifiantly at 12 months of treatment (p<0.005). Serum osteocalcin and total alkaline phosphatase decreased slightly during the treatment in all groups but statistical significance was not foundsignificantly. CONCLUSION: The combined treatment with conjugated equine estrogen and fluocalcic is more effective in surgically menopausal women with osteopenia by decreasing bone biochemical marker.

A Case of Intracranial Cavernous Hemangioma Diagnosed in Pregnancy / 대한산부인과학회지

The cavernous hamangioma is a relatively rare intracranial vascular malformation and generally asymptomatic, Seizure is the most common clinical presentation and the hemorrhage is the second. Because reproductive females have the hormonal and hemodynamic changes, the first symptoms might develope in the gestational period. As we experienced a case of intracranial cavernous hemangioma initially diagnosed in pregnancy with new-onset seizures, we report this case with a brief review of literature.

Normal Reference Range for Cervical Length in Twin Pregnancy using transvaginal ultrasound / 대한산부인과학회지

OBJECTIVE: We performed prospective longitudinal study to establish reference range for cervical length and evaluate the change in cervix throughout pregnancy in twin pregnancy. METHODS: Fifty-four women of twin pregnancy without history of preterm labor, preterm delivery, cervix cerclage, that delivered at or after 36 weeks were included in this study. Serial measurements of cervical lengths by transvaginal ultrasound exam were performed at 20 weeks of gestation and every 4 weeks (until 28 weeks), every two weeks (until 36 weeks) and every week until delivery. Linear regression analysis was done for statistical analysis. RESULTS: The reference range for cervical length in twin pregnancy was presented as mean, standard deviation and 95% confidence interval of the mean. Cervical length gradually decreased as the gestational age progressed. There was a significant correlation between cervical length measurements and gestational age (Y=71.361-1.336X, r2=0.384, p<0.05). CONCLUSION: We presented the reference range for cervical length in twin pregnancy and evaluated the association between gestational age and cervical length. These results can be used as reference guideline in consecutive assessments of cervical lengths during twin pregnancy.

A Case of Adenoid cystic Carcinoma in the Uterine Cervix / 대한산부인과학회지

Adenoid cystic carcinoma is an uncommon adenocarcinoma type which affects mainly the salivary gland and respiratory system. In the female reproductive tract it occurs more commonly in Bartholin's gland and than in uterine cervix. Almost patients are postmenopausal women. The main presenting complaint is vaginal spotting having an abnormal pap smear. It has been diagnostically confused with adenoid basal carcinoma which has a somewhat different clinical course and pathology. The treatment should be individualized to the patients by local recurrence or distant metastasis. It shows relatively unfavorable survival. Recently we experienced a case of adenoid cystic carcinoma arising in the cervix after menopause, so we report this case with a brief review of literature.

A survey on premenstrual syndrome / 대한산부인과학회지

OBJECTIVE: To investigate the epidemiology of premenstrual syndrome (PMS) and actual status of women with PMS seeking a medical advice. METHODS: The survey included a total of two hundred healthy women visited to Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital (n=78) or working at the same hospital (n=122) in reproductive age during March to June 2004. The subjects were asked to fill-up PMS sheet developed by our Department as giudance by one interviewer. Diagnosis to PMS was made by DSM-IV algorithms. RESULTS: PMS was noted in 8%. The major five symptoms were low abdominal discomfort or pain, easy fatigability, breast tenderness, and irritability. The following factors were not different statistically between PMS and non-PMS group; mean age, dysmenorrhea, menstrual cycle characteristics, occupation, education, marrital status, smoking or alcohol habit. In PMS group, 7 women out of 16 had a need for treatment (43.8%), in contrast, a few women had seeked a medical advice (12.5%). Moreover, a few women had experienced prescribing medications (12.5%) or non-prescribing medications (12.5%). In non-PMS group, the corresponding figures were 11.4%, 4.9%, 2.7% and 20.1%. CONCLUSION: Our results indicate that women diagnosed as PMS seldom seek a medical advice. The women with various premenstrual complaints commonly use non-prescribing medications.

A Case of Vulvar Leiomyoma / 대한산부인과학회잡지

Vulvar leiomyoma is a rare benign solid tumor of the vulva. Their incidence is not known as most reports are of a single case or small series, and their origin is not known exactly. Most cases are asymptomatic and local excision is recommended as initial therapy and also for recurrences. We have experienced vulvar leiomyoma (the labia majora and vestibule of the vagina) in a 51 years old woman and present it with a brief review of the literatures.

A Clinical Study of Ectopic Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Ectopic pregnancy is still a major health problem among women of childbearing age, causes major maternal morbidity and mortality with pregnancy loss, and its incidence is increasing worldwide. This study is an analysis of the clinical profile of ectopic pregnancy, the current status of the incidence and the management options. METHODS: One hundred and seventy six cases of ectopic pregnancies managed at the Daedong Hospital between January 1998 and December 2002 were analyzed. RESULTS: The overall incidence of ectopic pregnancy was 1 in 28 pregnanciies and the most common age group was 31-35 years of age (35%). Nullipara was 34.6% and the cases who experienced artificial abortion was 76%. Twenty four percentages of cases had a history of previous abdominal surgery and 20% of patients reported a history of pelvic inflammatory disease. Common complaints of ectopic pregnancy were fallopian tube (91%), interstitial (6.2%), ovary (0.05%) and in tubal pregnancies, the most frequent site was ampullar (74%). Laparotomy was done in 64%, pelviscopic operation was done in 32% and the most common operative procedure was salpingectomy in 76%. CONCLUSION: Early diagnosis and appropriate management of ectopic pregnancy will remain the most effective means of reducing the mortality and morbidity, increasing the fertility. Ectopic pregnancy must be excluded in a sexually active woman with a positive pregnancy test, abdominal pain and vaginal bleeding. treatment should be tailored to individual needs.

Prenatal Diagnosis of Choledochal Cyst at 23 weeks by Sonography / 대한산부인과학회잡지

In the past few years a wide variety of fetal abnormalities have been successfully prenatal diagnosed by maternal sonography. Early excision of the choledochal cyst in the newborn is considered to be the optimal treatment and may pose less risk to the patient than delayed surgical exploration. We present a new case diagnosed a choledochal cyst at 23 weeks gestation by routine ultrasound scanning. At 38 weeks gestation a female infant was born by spontaneous delivery. At 7 weeks of age the patient underwent a laparotomy performed cyst excision with Roux-en-Y hepaticojejunostomy. We experienced a case of choledochal cyst at prenatal sonography and report our case with a brief review of literature.