Differentiating Uterine Sarcoma From Atypical Leiomyoma on Preoperative Magnetic Resonance Imaging Using Logistic Regression Classifier: Added Value of Diffusion-Weighted Imaging-Based Quantitative Parameters

Objective@#To evaluate the added value of diffusion-weighted imaging (DWI)-based quantitative parameters to distinguish uterine sarcomas from atypical leiomyomas on preoperative magnetic resonance imaging (MRI). @*Materials and Methods@#A total of 138 patients (age, 43.7 ± 10.3 years) with uterine sarcoma (n = 44) and atypical leiomyoma (n = 94) were retrospectively collected from four institutions. The cohort was randomly divided into training (84/138, 60.0%) and validation (54/138, 40.0%) sets. Two independent readers evaluated six qualitative MRI features and two DWI-based quantitative parameters for each index tumor. Multivariable logistic regression was used to identify the relevant qualitative MRI features. Diagnostic classifiers based on qualitative MRI features alone and in combination with DWI-based quantitative parameters were developed using a logistic regression algorithm. The diagnostic performance of the classifiers was evaluated using a cross-table analysis and calculation of the area under the receiver operating characteristic curve (AUC). @*Results@#Mean apparent diffusion coefficient value of uterine sarcoma was lower than that of atypical leiomyoma (mean ± standard deviation, 0.94 ± 0.30 10-3 mm2 /s vs. 1.23 ± 0.25 10-3 mm2 /s; P < 0.001), and the relative contrast ratio was higher in the uterine sarcoma (8.16 ± 2.94 vs. 4.19 ± 2.66; P < 0.001). Selected qualitative MRI features included ill-defined margin (adjusted odds ratio [aOR], 17.9; 95% confidence interval [CI], 1.41–503, P = 0.040), intratumoral hemorrhage (aOR, 27.3; 95% CI, 3.74–596, P = 0.006), and absence of T2 dark area (aOR, 83.5; 95% CI, 12.4–1916, P < 0.001). The classifier that combined qualitative MRI features and DWI-based quantitative parameters showed significantly better performance than without DWI-based parameters in the validation set (AUC, 0.92 vs. 0.78; P < 0.001). @*Conclusion@#The addition of DWI-based quantitative parameters to qualitative MRI features improved the diagnostic performance of the logistic regression classifier in differentiating uterine sarcomas from atypical leiomyomas on preoperative MRI.

Pulmonary Cryptococcosis in a Patient with Ankylosing Spondylitis treated with Etanercept

Ankylosing spondylitis (AS) is a chronic inflammatory disorder, commonly characterized by inflammation of axial skeleton and development of enthesopathies. Tumor necrosis factor inhibitors (TNFi) shows good therapeutic responses in AS patients without good response to non-steroidal anti-inflammatory drugs. Although TNFi are relatively safe for AS patients, serious opportunistic infections, including tuberculosis and fungal infection, could develop. Here, according to our knowledge, we report a first Korean case of pulmonary cryptococcosis in a patient with AS treated with etanercept. A 64 year-old man with AS visited due to a newly appeared pulmonary nodule on a routine chest radiography. He had been administered etanercept for 5 months. Histologic findings of the lung nodule showed characteristic features of cryptococcosis. Etanercept was discontinued and oral fluconazole was administrated, as there was no evidence of central nervous system involvement. After 7 months of treatment, chest CT showed an improvement of the pulmonary lesion.

Muscle Weakness in a Patient with History of Poliomyelitis: A Differential Diagnosis for Post-polio Syndrome (PPS) and Dermatomyositis

Dermatomyositis (DM) is an idiopathic inflammatory myopathy, characterized by inflammation of the proximal skeletal muscles and typical skin manifestations, which results in symmetric muscle weakness. A 43-year-old man was presented with skin rash and left leg weakness, and he had a history of poliomyelitis. Initially, he was diagnosed as having post-polio syndrome (PPS) due to unilateral muscle weakness and a result of an the electromyography (EMG), which had shown patterns of PPS. After 4 months with conservative therapy for PPS, weakness of bilateral upper arms had developed and skin rashes on his entire body had aggravated and progressed. He was diagnosed as having dermatomyositis, based on elevated muscle enzyme levels, typical skin rashes, and typical EMG findings, which indicated muscle disease. When a patient with previous poliomyelitis has a newly developed muscle weakness or pain, we should consider various possible causes other than PPS.

Successful Rechallenge with Darbepoetin Following Immunosuppressive Therapy in a Dialysis Patient with Erythropoietin-Induced Pure Red Cell Aplasia / 대한내과학회지

Patients with erythropoiesis-stimulating agent (ESA)-induced pure red cell aplasia (PRCA) should not routinely be switched to an alternative ESA or to darbepoetin-alpha because anti-erythropoietin (anti-EPO) antibodies cross-react with all kinds of recombinant ESAs. We present a case of ESA-induced PRCA in a 69-year-old man on hemodialysis whose anemia improved with reintroduction of darbepoetin-alpha following immunosuppressive therapy. The patient developed severe anemia after 15 months of subcutaneous administration of erythropoietin-alpha. After the diagnosis of PRCA, erythropoietin-alpha was discontinued and immunosuppressive therapy with a combination of prednisolone and oral cyclophosphamide was initiated. After 4 months of immunosuppressive therapy, the anti-EPO antibody titer was markedly decreased; however, esophageal candidiasis developed. Additional therapy with cyclosporine alone instead of prednisone and cyclophosphamide was performed, and anti-EPO antibody was subsequently not detected. Darbepoetin-alpha was then reintroduced, and the patient's anemia improved without red cell transfusion. In conclusion, ESA-induced PRCA was successfully treated with reintroduction of darbepoetin-alpha following immunosuppressive therapy.

A Case of Incidentally Diagnosed Adrenal Paragonimiasis

We report here on a rare case of adrenal paragonimiasis that presented with an adrenal incidentaloma. A 52-year-old male presented with fatigue and weight loss. The laboratory findings revealed eosinophilia (8.5%) and an increased eosinophil count (910/microL). The computed tomography scan showed 6.5 x 5 cm sized multilocular cystic mass in the right adrenal gland, which was non-functioning, and cystic lesions with variable sizes were also noted in the abdominal cavity. On the surgical field, whitish patches were spread out in the peritoneum, the omentum, the dome of the liver and the diaphragm. The right adrenal gland was replaced by a cystic mass filled with mucopurulent creamy materials. The pathologic findings revealed numerous eggs of Paragonimus spp. Also, the ELISA was positive for IgG paragonimus antibody. The adrenal gland can become infected by various microbial pathogens, including parasites, although it is relatively uncommon. However, in the case of a cystic adrenal mass with accompanying eosinophilia in an endemic area, clinicians should consider the possibility of parasitic infection.

A Study on Yangsaeng for Health Promotion of Aged Women in Rural Area

PURPOSE: The purpose of this study was to explore the yangsaeng level in a health management way of an aged women in rural area, and to offer basic material for the development of community's public health service. METHODS: The subjects were 144 aged women who participated voluntarily in the questionnaire. The data were collected from January to February, 2008 with a self-administered questionnaire. Data were analyzed by SPSS 13.0 win program for finding frequency, percentage, mean, standard deviation, ANOVA and Tukey. RESULTS: The average age of workers was 72. Total yangsaeng level was 3.08+/-.33, highest yangsaeng factor was Activity & Rest Yangsaeng of 3.55+/-.46 and lowest yangsaeng factor was Season Yangsaeng of 2.43+/-.75. The total Yangsaeng level was the significant difference in monthly incomes(F=4.046, p=.047). CONCLUSION: Considering the results above, the yangsaeng level of aged women is affected by the age, education level, a monthly income etc. Therefore, for health promotion plan of aged women, consider that their age, educational level, economic level ect, and systematic education for promotion of health is necessary.

Diffuse Hepatic Hemangiomatosis without Extrahepatic Involvement in an Adult Patient

We report an extremely rare case of a diffuse hepatic hemangiomatosis without extrahepatic involvement in an adult. The imaging findings of this tumor were similar to those of a hepatic hemangioma and included contrast enhancement with a centripetal filling pattern of the entire hepatic tumor on the delayed phase of a dynamic CT and inhomogeneous diffuse uptake of the entire tumor on blood-pool images obtained five hours later on a 99mTc-labeled red blood cell scan. Despite its rarity, diffuse hepatic hemangiomatosis can be suggested in adult patients with diffusely involved hepatic tumors showing the radiological findings of a hepatic hemangioma.

Two Cases of Recurrent Abdominal Wall and Perihepatic Abscesses Caused by Dropped Gall Stones During a Laparoscopic Cholecystectomy

While performing a laparoscopic cholecystectomy, a surgeon may occasionally drop a patient's gall stones into the intraperitoneal cavity or perforate a patient's gallbladder. However, most of the time, the dropped stones are spontaneously absorbed by the body. In some instances, the dropped gallstones may cause late complications in the patient, such as abscesses, the formation of fistulae, or adhesion in the intra-abdominal or extra-abdomial region. We report two cases of recurrent abdominal wall and perihepatic abscesses caused by dropped gall stones during a laparoscopic cholecystectomy with late diagnosis.

A Giant Gartner Duct Cyst Originating from the Uterine Cervix and Adjacent Myometrium: A Case Report

Gartner duct cysts are relatively common congenital cysts in the anterolateral wall of the vagina. Most are small (less than 2 cm) and asymptomatic, but larger cysts may cause problems. We report a rare case of a giant Gartner duct cyst (7 cm) originating from the right lateral portion of the uterine cervix and adjacent myometrium. It appeared as an exophytic multiseptated cystic mass containing different density fluids on CT.

Spontaneous Rupture of Adrenal Metastasis from Hepatocellular Carcinoma

Rupture of adrenal tumor from various primary origins is a rather rare event. We report here on a ruptured adrenal metastasis from hepatocellular carcinoma, and this ruptured metastasis was observed at the time of the initial diagnosis.

Usefulness of Screening Ultrasound for Thyroid Gland

PURPOSE: The purpose of this study was to investigate the usefulness of the ultrasonography as a screening test for thyroid diseases. MATERIALS AND METHODS: For 7 months, thyroid ultrasonography (7.5 MHz linear array) was performed prospectively by radiologists on 1,316 subjects who do not have a history of the thyroid disease. We analyzed the morphological abnormalities of thyroid gland and these were classified as the nodulal, cystic and diffuse types in accordance with the gender and ages of the patients. We performed ultrasound-guided fine needle aspiration in 21 patients who had sonographic features that were suggestive of malignant thyroid nodules. Physical examination was performed for all subjects by clinicians before the thyroid ultrasonography, and we compared the detectability of thyroid lesions between ultrasonography and physical examination. RESULTS: Thyroidal abnormalities were detected in 94 (7.1%) of 1,316 subjects. Among the 94 patients, 72 (5.5%) showed as nodules, 18 (1.4%) showed as cysts and 4 (0.3%) showed as diffuse abnormalities. The result of the ultrasound-guided aspiration on 21 patient showed 4 malignant nodules, 16 benign nodules and 1 undetermined nodule. Physical examination detected abnormalities in only 12 patients (12.8%) of the 94 patients, which were showed as nodules, cysts and the diffuse type by ultrasonography. CONCLUSION: Thyroid disease of the general population was relatively common and the detection rate with performing physical examination for the thyroid nodule, cyst and the diffuse type was lower than that for ultrasonography. Thyroid ultrasonography is a useful screening modality for detecting thyroid diseases.

Pseudocyst in Omentum caused by Abdominal Tuberculosis: Case Report

A 25-year-old woman presented with abdominal discomfort and weight loss. Sonography demonstrated a well-defined, anechoic, cystic mass with posterior acoustic enhancement, internal thin septations, and a peripheral hypoechoic solid portion that had no increased blood flow on Doppler ultrasound. Contrast-enhanced CT revealed a cystic omental mass with internal thin septations and an enhancing solid portion which appeared as the hypoechoic solid portion on ultrasonography. A pathologic specimen demonstrated a pseudocyst containing serous fluid with gelatinous material. The solid component at the peripheral portion of the pseudocyst indicated caseous necrosis with multinucleated giant cells. This histologic finding was consistent with tuberculosis and supported the final diagnosis of omental pseudocyst caused by tuberculous peritonitis. Therefore, intraperitoneal pseudocyst with tuberculosis should be considered in the differential diagnosis of an intraperitoneal cystic mass in a young adult.

Recent Trends of Citation Status and Suggestions for Improved the Academic Authority of the Journal of the Korean Radiological Society during 2000-2005: Analysis of All Citations using KoMCI

PURPOSE: We wanted to analyze the citation trend and to find a way to improve the impact factor (IF) of the Journal of the Korean Radiological Society (JKRS). MATERIALS AND METHODS: The number of articles and references, the total citations and self-citations, the IF and the IF excluding self-citations (ZIF) were described by an analysis of Korean Medical Citation Index (KoMCI) during 2000-2005. The total and self citations of the JKRS were compared to that of the Top 5 journals. RESULTS: There was a 57% decrease of papers for 6 years. The Korean references/paper ranged from 0.98-0.85. The number of total citations received steadily decreased from 394 in 2000 to 180 in 2005. The IF (ZIF) of the JKRS has been gradually lowered from 0.142 (0.049) in 2000 to 0.063 (0.059) in 2005. Although the total citations that cited all papers published/the annual number of papers was 55% of that of the top 5 journals, the total citations citing papers published within the recent two years was only 24% of that of the top 5 journals. CONCLUSION: The citation status of the JKRS hassteadily decreased for the recent 6 years, and the IF of the JKRS was very low among all the Korean medical journals. To improve the IF, active advertising for the journal members of the importance of the IF is needed to encourage citing JKRS papers that have been published within the recent two years.

A Study of the Burden of Preceptors / 기본간호학회지

PURPOSE: This study investigated the burden of preceptors in order to improve preceptorship in nursing practice. METHOD: The participants were 170 preceptors at three hospitals in Pusan. The data were collected using questionnaires completed between July and September 2002, which included items to measure burden and opinions to reflect the demands of preceptors. They were analyzed using mean score, frequencies, and content analysis. RESULT: 1) The preceptors had an average of 6.3 years of clinical experience, while the practical career of a preceptor averaged 1.9 years. The average period of new nurse education was 5.5 weeks. Each year, 1.9 new nurses were trained per preceptor. 2) Of the preceptors 54.7% had received compensation without formal rules. but 54.1% did not want to serve further as preceptors because of overwork, lack of educational preparation, and lack of compensation. They were looking for solutions for existing problems. 3) Preceptors indicated that the major burden was having to repeat explanations to each preceptee, they were too busy to serve as preceptors, and their colleagues' had excessive expectations. CONCLUSION: We recommend practical management, including supplementary manpower, an education program, and compensation provided by the hospital administration with cooperation from colleges.

Mucosal Surface Nodularity on Upper Gastrointestinal Series (UGIS): Prospective Analysis of Its Primary Cause and Prevalence of Gastric Malignancy

PURPOSE: Mucosal surface nodularity was defined as present at UGIS when multiple nodular defects larger than 5 mm were scattered in the gastric mucosa in an area greater than 5x5 cm. The purpose of this study was to determine the primary causes of this radiographic finding and to assess the incidence of gastric malignancy in these patients. MATERIALS AND METHODS: During a one-year period we prospectively collected among patients who underwent UGIS, data for 51 [aged 30-78(mean, 51) years] above who met the criteria of mucosal surface nodularity. Whether or not this was present was decided by two radiologists who in reaching a consensus excluded the possibility of erosive gastritis, indicated by central barium collection in the nodular defects. The primary causes of mucosal nodularity and associated gastric pathologies were determined by the histopathological results obtained from the specimens after surgery (n=18) or endoscopic biopsy (n=33). RESULTS: Pathological examinations revealed that the primary causes of the mucosal nodularity in these 51 patients were intestinal metaplasia in 28 (54.9%), MALT lymphoma in seven (13.7%), early gastric cancer in six (11.8%), chronic gastritis in five (9.8%), low grade dysplasia in four (7.8%), and gastritis cystica profunda in one (2%). Gastric malignancy was present either in or outside the area of mucosal nodularity in 34 (66.7%) of the 51 (27 carcinomas and 7 MALT lymphomas). No different patterns of mucosal surface nodularity were noted between the groups of each disease entity. CONCLUSION: Mucosal surface nodularity is observed at UGIS in various gastric pathologies. Because of the high incidence of gastric malignancy in these patients, close follow-up or gastrofiberscopic biopsy is mandatory.

Kimura's Disease: CT Features of Abdominal Involement in a Case

Kimura's disease is a benign chronic inflammatory condition with good prognosis, commonly involving the headand neck area. With regard to abdominal manifestat ions, howeve r, the information contained in the literature islimited. Diagnosis on the basis of imaging is difficult, especially in abdominal cases manifesting aslymphadenopathy. The purpose of this report is to illustrate and discuss an abdominal case of the diseasemanifesting as lymphadenopathy.