Continuous quality improvement program and its results of Korean Society for Cytopathology

Since 1995, the Korean Society for Cytopathology has overseen the Continuous Quality Improvement program for cytopathology laboratories. The Committee of Quality Improvement has carried out an annual survey of cytology data for each laboratory and set standards for proficiency tests. Methods: Evaluations were conducted four times per year from 2008 to 2018 and comprised statistics regarding cytology diagnoses of previous years, proficiency tests using cytology slides provided by the committee, assessment of adequacy of gynecology (GYN) cytology slides, and submission of cytology slides for proficiency tests. Results: A total of 206 institutes participated in 2017, and the results were as follows. The number of cytology tests increased from year to year. The ratio of liquid-based cytology in GYN gradually decreased, as most of the GYN cytology had been performed at commercial laboratories. The distribution of GYN diagnoses demonstrated nearly 3.0% as atypical squamous cells. The rate for squamous cell carcinoma was less than 0.02%. The atypical squamous cell/squamous intraepithelial lesion ratio was about 3:1 and showed an upward trend. The major discordant rate of cytology-histology in GYN cytology was less than 1%. The proficiency test maintained a major discordant rate less than 2%. The rate of inappropriate specimens for GYN cytology slides gradually decreased. Conclusions: The Continuous Quality Improvement program should be included in quality assurance programs. Moreover, these data can contribute to development of national cancer examination guidelines and facilitate cancer prevention and treatment.

Single Port Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis: A Case Report

The use and application of a laparoscopic cholecystectomy has been regarded as a first-choice treatment option for benign gallbladder disease, even if patients have situs inversus totalis. Furthermore, surgical procedures in general are becoming less invasive, because of both patient and surgeon preferences for reduced trauma and improved cosmetic outcomes attributable to minimized incisions. A 37 years old man was aware of situs inversus totalis with chronic cholecystitis. The operation was successfully performed without any specific complications. Single port laparoscopic cholecystectomy, in an experienced operator, is possible even in patients with situs inversus totalis.

Risk Factors for the Development of Incisional Hernia in Mini-laparotomy Wounds Following Laparoscopic Distal Gastrectomy in Patients with Gastric Cancer

PURPOSE: To determine the incidence of incisional hernia (IH) in mini-laparotomy wounds and analyze the risk factors of IH following laparoscopic distal gastrectomy in patients with gastric cancer. MATERIALS AND METHODS: A total of 565 patients who underwent laparoscopic distal gastrectomy for gastric cancer at Dong-A University Hospital, Busan, South Korea, between June 2010 and December 2015, were enrolled. IH was diagnosed through physical examination or computed tomography imaging. Incidence rate and risk factors of IH were evaluated through a long-term follow-up. RESULTS: Of those enrolled, 16 patients (2.8%) developed IH. The median duration of follow-up was 58 months (range, 25–90 months). Of the 16 patients with IH, 15 (93.7%) were diagnosed within 12 months postoperatively. Multivariate analysis showed that female sex (odds ratio [OR], 3.869; 95% confidence interval [CI], 1.325–11.296), higher body mass index (BMI; OR, 1.229; 95% CI, 1.048–1.422), and presence of comorbidity (OR, 3.806; 95% CI, 1.212–11.948) were significant risk factors of IH. The vast majority of IH cases (15/16 patients, 93.7%) developed in the totally laparoscopic distal gastrectomy (TLDG) group. However, the type of surgery (i.e., TLDG or laparoscopy-assisted distal gastrectomy) did not significantly affect the development of IH (P=0.060). CONCLUSIONS: A median follow-up of 58 months showed that the overall incidence of IH in mini-laparotomy wounds was 2.8%. Multivariate analysis showed that female sex, higher BMI, and presence of comorbidity were significant risk factors of IH. Thus, surgeons should monitor the closure of mini-laparotomy wounds in patients with risk factors of IH undergoing laparoscopic distal gastrectomy.

Extramammary Paget's Disease Combined with Squamous Cell Carcinoma In Situ of the Vulva: A Case Report and Differential Diagnosis

No abstract available.

The Prevalence of Sarcopenia in Korean Hospitalized Elderly

BACKGROUND: Sarcopenia is a syndrome characterized by the progressive loss of skeletal muscle mass and muscle strength. Although data exist on the prevalence of sarcopenia among the community-dwelling elderly, there is no systematic research on hospitalized elderly patients in Korea, in accordance with the newly developed criteria. METHODS: A cross-sectional study was conducted at the Daejin Medical Center, Bundang Jesaeng Hospital, Korea, from May 2013 to March 2015. In this study, we evaluated the levels of hemoglobin, total cholesterol, serum albumin, serum prealbumin, and serum zinc. Handgrip strength was measured with a hand grip dynamometer (FT-7110). Furthermore, the skeletal muscle mass was measured by bioelectrical impedance analysis (BIA). Sarcopenia was defined by skeletal muscle mass as measured with BIA, according to the Asian Working Group for Sarcopenia. RESULTS: Of the hospitalized elderly subjects, 40 (46.5%) had a definite diagnosis of sarcopenia and 46 (53.5%) had no sarcopenia. The prevalence of sarcopenia of the subjects was higher in males than females (males, 46.9% vs. females, 46.3%). The correlation analysis showed that the score of skeletal muscle index (SMI) was negatively correlated with age; whereas, it was positively correlated with the BMI, body weight, and serum prealbumin level. CONCLUSION: The results of the study showed that sarcopenia was associated with several factors, including age, BMI, serum prealbumin level, among the study subjects. Sarcopenia can be used as a sensitive predictive marker for prognosis of the hospitalized elderly.

Measurement of antioxidant capacity using the biological antioxidant potential test and its role as a predictive marker of metabolic syndrome

BACKGROUND/AIMS: Oxidative stress increases the risk of cardiovascular complications of metabolic syndrome (MetS). This study was conducted to examine the difference in antioxidant capacity according to the presence of MetS, and to characterize the association between antioxidant capacity and MetS-related factors. METHODS: We used the biological antioxidant potential (BAP) test to estimate antioxidant capacity. The BAP test has recently been used as an indicator of antioxidant capacity. We measured BAP levels in 45 patients with MetS (mean age, 44.6 +/- 1.1 years) and 47 age- and sex-matched controls (mean age, 42.7 +/- 1.1 years). To evaluate the association between antioxidant capacity and MetS, adiponectin, high-sensitivity C-reactive protein (hs-CRP), interleukin-6, tumor necrosis factor-alpha, and homeostatic model assessment for insulin resistance (HOMA-IR), linear regression and logistic analyses were performed. RESULTS: The mean BAP of the MetS group (1,937.3 +/- 36.5 micromol/L) was significantly lower than that of the non-MetS group (2,101.7 +/- 29.5 micromol/L). Also, the mean BAP was low in persons having low high density lipoprotein and high triglyceride. Reduced antioxidant capacity was significantly associated with adiponectin, HOMA-IR and hs-CRP after adjusting for age and sex. The odds ratios for MetS with BAP, log adiponectin, log HOMA-IR, and log hs-CRP were 0.63 (95% confidence interval [CI], 0.49 to 0.82), 0.22 (0.10 to 0.51), 14.24 (4.35 to 46.58), and 1.93 (1.36 to 2.75), respectively. CONCLUSIONS: Persons with MetS showed reduced antioxidant capacity. We identified relationships between antioxidant capacity measured by BAP test and MetS, as well as MetS-related factors, such as insulin resistance, hs-CRP, and adiponectin.

Effect of Intravenous High-Dose Selenium Supplementation in Patients with Systemic Inflammatory Response Syndrome: A Pilot Study / 대한내과학회지

BACKGROUND/AIMS: Systemic inflammatory response syndrome (SIRS) can induce occurrence of oxidative stress. Several reports have evaluated selenium supplementation in SIRS patients with encouraging results. Therefore, we evaluated the effect of intravenous high-dose selenium supplementation in patients with SIRS. METHODS: Patients were randomly assigned to one of two groups: the selenium group (800 microg/day of selenoic acid by intravenous bolus injection for 7 days) or the placebo group. Physical and biochemical measurements were used to assay acute phase reactants, severity of illness index and serum selenium concentration. RESULTS: A total of 23 patients classified as mild-to-moderate severity of illness index were enrolled between March 2010 and October 2011. Serum selenium concentration increased in the selenium group after intervention, but there was no significant change in the placebo group. In the selenium group, the white blood cell (WBC) count, serum level of c-reactive protein (CRP), Acute Physiology and Chronic Health Evaluation II (APACHEII) score and Sequential Organ Failure Assessment (SOFA) score improved significantly by days 7 and 14 compared with day 0. In the placebo group, only the serum CRP level at day 14 and APACHE II score at days 7 and 14 improved significantly compared to day 0. CONCLUSIONS: Intravenous supplementation with high-dose selenium improved acute phase reactants and the severity of illness index in patients with SIRS. However, larger prospective clinical trials are required to determine the efficacy of selenium supplementation in SIRS patients.

Stanford Type A Aortic Dissection Secondary to Infectious Aortitis: A Case Report

Nowadays, infectious aortitis has become a rare disease thanks to antibiotics, but remains life-threatening. We present a case of a patient with acupuncture-induced infectious aortitis leading to aortic dissection. Chest computed-tomogram scan revealed Stanford type A dissection with pericardial effusion. Under the impression of an impending rupture, emergent surgery was performed. During surgery, infectious aortitis was identified incidentally, so she underwent resection of the infected aorta including surrounding tissues. Then the ascending aorta and hemi-arch were replaced with a prosthetic graft as an in situ fashion. The resected tissue and blood cultures revealed Staphylococcus aureus, so prolonged antibiotherapy was prescribed.

Granular Cell Tumor of Thyroid Gland That Was Concomitant with Papillary Thyroid Carcinoma: A Case Report / 대한내분비외과학회지

Granular cell tumor (GCT) of the thyroid is rare and histogenesis of the carcinoma still remains poorly understood. Here in this study, we report a case of perithyroidal granular cell tumor in a 44-year-old woman, diagnosed as medullary carcinoma upon the interoperative frozen diagnosis. The tumor was comprised of white, solid mass with infiltrating margin in isthmus. Microscopically, the tumor revealed abundant eosinophilic cytoplasm, elongated nucleus and eosinophilic amyloid-like materials. It was composed of diffuse sheets of polygonal cells with abundant eosinophilic cytoplasm and cytologically bland nucleus on permanent section. On immunohistochemical staining, S-100 and CD68 are diffusely positive. Determining the progression and the behavior of the tumor is critical for providing long-term management and preventing aggressive treatment.

Eradication of Helicobacter pylori Increases Ghrelin mRNA Expression in the Gastric Mucosa

It has been suggested that Helicobacter pylori eradication may influence production of some peptides in the stomach, which can affect appetite. This hypothesis is controversial. To verify the hypothesis, we conducted this randomized controlled trial using H. pylori infected subjects without any gastrointestinal symptoms. The treatment group received triple H. pylori eradication therapy for 7 days and the control group received no medication. We measured ghrelin, obestatin and the tumor necrosis factor-alpha (TNF-alpha) mRNA levels in endoscopic biopsy specimens and the changes from baseline to follow-up. The plasma active n-octanoyl ghrelin and obestatin levels were measured in both groups. The ghrelin/obestatin ratios in plasma and gastric mRNA expression were calculated at baseline and follow-up. Ghrelin mRNA expression in the fundic mucosa after H. pylori eradication increased significantly compared to the control group (4.47+/-2.14 vs. 1.79+/-0.96, P=0.009), independent of inflammatory changes. However, obestatin mRNA expression decreased in the antral mucosa (-0.57+/-1.06 vs. 0.41+/-0.72, P=0.028). The treatment group showed a marginal increase (P=0.060) in plasma ghrelin/obestatin ratio. The TNF-alpha mRNA expression also decreased significantly with treatment. This randomized controlled trial demonstrates that H. pylori eradication increases ghrelin mRNA expression, independent of inflammatory cell changes.

Gastric Outlet Obstruction due to Submucosal Neurofibromatous Proliferation of Duodenal Bulb in Neurofibromatosis Type 1 Patient

Neurofibromatosis type 1 (NF1; also known as von Recklinghausen's neurofibromatosis) is inherited in an autosomal dominant fashion, although it can also arise due to spontaneous mutation. Gastrointestinal involvement of NF1 is seen in 10% to 25% and causes symptoms in fewer than 5%. Histologically, the gastro intestinal (GI) manifestation of NF1 occurs in three forms: hyperplasia of the gut neural tissue, stromal tumors, and duodenal or periampullary endocrine tumors. A 31-year-old female, diagnosed with NF1, presented with poor oral intake and vomiting for 10 days prior to admission. Preoperative gastrofiberscopic finding was gastric outlet obstructing polypoid duodenal bulb lesion. The patient underwent hemigastrectomy with antecolic gastrojejunostomy due to gastric outlet obstruction. The final pathologic report was submucosal neurofibromatous proliferation with Brunner's gland hyperplasia located at the duodenal bulb in the NF1 patient. We report this case with a review of literatures.

Detection of JC Virus T-Ag in Early Gastric Cancer

BACKGROUND: JC virus (JCV) is a polyomavirus that commonly infects humans and can cause progressive multifocal leukoencephalopathy in immunocompromised patients. Recently, many reports have documented detection of JCV in gastrointestinal tract cancers. We investigated the presence of JCV in gastric adenocarcinoma, adenoma, and non-neoplastic gastric mucosa. METHODS: We selected paraffin-embedded tissue from endoscopic mucosal resections performed from January 2007 to September 2008. DNA was extracted from the paraffin-embedded specimens of 30 adenocarcinomas, 20 adenomas of the stomach, and 20 non-neoplastic gastric mucosa. Polymerase chain reaction amplifications were performed using gene-specific primers to detect the JCV gene sequences, and immunohistochemical staining was performed to detect the T-antigen (T-Ag) protein. RESULTS: The T-Ag sequence was detected in nine of 30 gastric cancers (30%), two of 20 adenomas (10%), and eight of 20 non-neoplastic gastric mucosa specimens (40%). T-Ag protein expression was found in five of 30 gastric cancers (16.7%) and one of 20 non-neoplastic gastric mucosa specimens (5%), whereas no expression was observed in any of the adenomas. CONCLUSIONS: Although we could not detect a correlation between JCV and gastric cancer, we demonstrated the presence of JCV T-Ag expression in human gastric cancers. These findings suggest a possible role for JCV in gastric carcinogenesis.

Associations between Nonalcoholic Fatty Liver Disease and Colorectal Adenoma in Health Screen Examinees / 대한소화기내시경학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) and colorectal cancer share several risk factors. However the relationship between NAFLD and colorectal adenoma is unclear. Therefore, we investigated the possibility of an association between NAFLD and colorectal adenoma. METHODS: We reviewed the records of 3,106 subjects who had undergone colonoscopy and abdominal ultrasonography between April 2007 and August 2009. RESULTS: The sex ratio (male/female) was 4.94:1 and the mean age was 50.6+/-9.7 years in patients with colorectal adenoma; the corresponding numbers were 2.23: 1 and 45.0+/-9.2 years in patients without colorectal adenoma (p<0.001). The prevalence of NAFLD was 26.0% in the adenoma group and 21.4% in the control group (p=0.013). Additionally, there were positive associations between colorectal adenoma and BMI and lipid profile. Among the risk factors selected by univariate analysis, older age (OR 2.592; 95% CI 2.087~3.219), and being male (OR 2.470; 95% CI 1.878~3.247) were independent risk factors for colorectal adenoma. Patients with NAFLD had more colorectal adenomas (p=0.005) and their adenomas were located more in the proximal colon (p=0.009). CONCLUSIONS: NAFLD is not associated with increased risk for colorectal adenoma. However, among patients with NAFLD, colorectal adenomas were likely to be increased in number and they were likely to be located in the proximal colon.

A Case of Recurrent Pneumatosis Cystoides Intestinalis Associated with Recurrent Pneumoperitoneum / 대한소화기학회지

Pneumatosis cystoides intestinalis is an uncommon condition of unknown etiology, characterized by the presence of multiple gas filled cysts in the gastrointestinal tract. Many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical, pulmonary, and bacterial causes. Approximately 85% of cases are thought to be secondary to coexisting disorders of the gastrointestinal tract or the respiratory system. The condition has been associated with the therapeutic uses of lactulose, steroids, and various cancer chemotherapeutic regimens. Lactitol is a disaccharide analogue of lactulose which is available as a pure crystalline powder. There are three previous case reports suggestive of lactulose causing pnumatosis intestinalis. We report a case of recurrent pneumatosis cystoides intestinalis associated with benign recurrent pneumoperitoneum developed probably secondary to lactitol therapy.

A case of diastasis of the symphysis pubis accompanying gait disturbance developed before labor pain / 대한산부인과학회지

We experienced a case of diastasis of the symphysis pubis accompanying severe pubic pain and serious gait disturbance, which was developed at 34 weeks gestation before labor pain in 36-year-old primiparous woman, who has experienced previous cesarean section at her first pregnancy due to pelvic pain before onset of labor, so we report a case with a review of the literature.

Disinfection Efficacy of an Automated Endoscopic Reprocessing System with Ozonated Water / 감염과화학요법

BACKGROUND: The aim of this study is to evaluate the effectiveness of automated ozonated water endoscopic reprocessing system (AORS). MATERIALS AND METHODS: Thirty cases were collected and randomly assigned to 3 groups according to the disinfection methods (Group A, AORS for 5 minutes; Group B, AORS for 10 minutes; Group C, automated disinfection with superoxidized water for 3 minutes 30 seconds). After disinfection was finished, samples were collected from the tip of scopes (Site 1, S1) and rinsing water through biopsy channel (Site 2, S2). Samples were inoculated in blood agar plate for 48 hrs, and then colony count was evaluated. RESULTS: Culture positive rate of S1 was 0% in all three groups. Culture positive rates of S2 were 70% (7/10), 70% (7/10) and 90% (9/10) in group A, group B and group C, respectively. High culture rate group (> or = 1 CFU/ml rinsing water) was 0% (0/10), 30% (3/10) and 70% (7/10) in group A, group B and group C, respectively. Disinfection efficacy between group A and C showed a significant difference in high culture rate (P<0.05). CONCLUSIONS: AORS for 5min was at least equally effective in endoscopic reprocessing compared with the conventional superoxidized water system.

Disinfection Efficacy of an Automated Endoscopic Reprocessing System with Ozonated Water / 감염과화학요법

BACKGROUND: The aim of this study is to evaluate the effectiveness of automated ozonated water endoscopic reprocessing system (AORS). MATERIALS AND METHODS: Thirty cases were collected and randomly assigned to 3 groups according to the disinfection methods (Group A, AORS for 5 minutes; Group B, AORS for 10 minutes; Group C, automated disinfection with superoxidized water for 3 minutes 30 seconds). After disinfection was finished, samples were collected from the tip of scopes (Site 1, S1) and rinsing water through biopsy channel (Site 2, S2). Samples were inoculated in blood agar plate for 48 hrs, and then colony count was evaluated. RESULTS: Culture positive rate of S1 was 0% in all three groups. Culture positive rates of S2 were 70% (7/10), 70% (7/10) and 90% (9/10) in group A, group B and group C, respectively. High culture rate group (> or = 1 CFU/ml rinsing water) was 0% (0/10), 30% (3/10) and 70% (7/10) in group A, group B and group C, respectively. Disinfection efficacy between group A and C showed a significant difference in high culture rate (P<0.05). CONCLUSIONS: AORS for 5min was at least equally effective in endoscopic reprocessing compared with the conventional superoxidized water system.

Risk of Cesarean Section Delivery after Induction of Labor at Postterm Pregnancy in Nulliparous Women / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to evaluate the risk of cesarean section in nulliparous women who undergone induction at postterm pregnancy. METHODS: The retrospective study was conducted from March, 1997 to March, 2005 by reviewing 331 nulliparous patients more than 41 weeks' gestation delivered after induction at our Hospital. The evaluated variables to assess the risk of cesarean section were maternal age, body mass index (BMI), gestational age (GA), Bishop scores (BS), fetal body weight (FBW), fetal head circumference (FHC) and fetal sex. t-test and x2-test were used to compare these categorical variables. RESULTS: The study included 331 nulliparous singleton pregnant women undergoing elective induction for postterm pregnancy: 127 (38.4%) delivered babies by cesarean section due to induction failure, progression failure and fetal distress, whereas 204 (61.6%) delivered vaginally. The mean maternal ages were 27.59+/-2.57 in cesarean delivery group and 26.99+/-2.61 in vaginal delivery group. The average values of BMI at postterm in cesarean and vaginal delivery groups were 26.70+/-2.82 and 25.75+/-2.67 kg/m2. GA was 41.36+/-0.27 weeks in cesarean delivery group, whereas 41.20+/-0.19 weeks in vaginal delivery group. The average FBW and FHC were 3460.31+/-358.22 g and 34.59+/-1.18 cm in cesarean delivery group, compared to 3363.95+/-361.22 g and 34.03+/-1.34 cm in vaginal delivery group. CONCLUSION: The BMI, FBW and FHC have linked to the risk of cesarean delivery in nulliparous women who underwent elective induction. Thus, these information would provide the useful tools to assess the risk of cesarean section in postterm nulliparous patients for planning an induction.

A Case of Foreign Body Removal Using Latex Glove and Two Endoscopes / 대한소화기내시경학회지

Foreign body ingestion is a common clinical problem. Foreign bodies are generally swallowed accidentally and most pass out spontaneously. However, if a sharp object is not eliminated early, it can penetrate the bowel wall and cause severe complications. Endoscopic techniques for removing sharp foreign bodies safely include methods using a protector hood and overtube. An overtube is uncomfortable and has limitations in its diameter. We introduced a method using a latex glove, which is easily available, comfortable, and has no limitations in diameter. In addition, two endoscopes were used to reduce the risk of complications, and the large sharp object was easily wrapped with the latex glove. We report a case of a sharp and large foreign body being removed endoscopically using a latex glove and two endoscopes without any complications.