Predictive Factors for Upgrading Patients with Benign Breast Papillary Lesions Using a Core Needle Biopsy / 한국유방암학회지

PURPOSE: Intraductal papilloma (IDP) is a benign breast disease with malignant potential, for which complete surgical excision is usually recommended. The aim of the present study was to investigate predictive factors for upgrading patients with a benign papillary lesion (BPL). METHODS: This study was an observational study using a prospectively collected cohort. In total, 13,049 patients who underwent a core needle biopsy (CNB) for a breast lesion between January 2009 and May 2015 were enrolled. We reviewed all patients with pathologically confirmed BPL from a CNB. RESULTS: Surgical treatment was performed for 363 out of a total of 592 lesions. According to the pathological differences, the lowest upgrade rate was shown in IDP without atypia (without atypia, 6.0%; with atypia, 26.8%; papillary neoplasm, 31.5%; p54 years and lesion size >1 cm were significantly associated with upgrade to malignancy (odds ratio [OR]=4.351, p=0.005 and OR=4.236, p=0.001, respectively). CONCLUSION: The indications for surgical treatment can be defined as age >54 years and mass size >1 cm, even in IDP without atypia in the CNB results; this also includes cases of IDP with atypia or papillary neoplasm. Therefore, we suggest that close observation without surgery is sufficient for younger women with a small IDP without atypia.

Hyperbilirubinemia Is a Significant Indicator for the Severity of Acute Appendicitis

PURPOSE: This study aims to reveal more effective clinical or laboratory markers for the diagnosis of acute appendicitis and to score the severity based on a sufficiently large number of patients with acute appendicitis. METHODS: We identified 1,195 patients with acute appendicitis after excluding those with other causes of hyperbilirubinemia among the 1,271 patients that underwent a laparoscopic or an open appendectomy between 2009 and 2010. A retrospective chart review of the medical records, including laboratory and histologic results, was conducted. We then analyzed the data using univariate and multivariate analyses. RESULTS: Among the 1,195 patients, a laparoscopic appendectomy was performed in 685 cases (57.32%), and an open appendectomy was performed in 510 cases (42.68%). The univariate analysis demonstrated significant differences for white blood cell count (P < 0.0001), segmented neutrophils (P = 0.0035), total bilirubin (P < 0.0001), and systemic inflammatory response syndrome (SIRS) score between groups (P < 0.0001). The multivariate analysis demonstrated that total bilirubin (odds ratio, 1.772; 95% confidence interval, 1.320 to 2.379; P = 0.0001) and SIRS score (odds ratio, 1.583; 95% confidence interval, 1.313 to 1.908; P < 0.0001) have statistically significant diagnostic value for perforated appendicitis. CONCLUSION: Hyperbilirubinemia is a statistically significant diagnostic marker for acute appendicitis and the likelihood of perforation.

Superior Lumbar Hernia

Lumbar hernia is an uncommon pathological defect of the abdominal wall. It presents difficulties in diagnosis and treatment because of the depth of the sac and the surrounding layers of muscle, fascia, and bone. It is an extrusion of intraperitoneal or extraperitoneal organs of the abdomen through a defect of the transversalis fascia. Inferior lumbar hernias are bordered by the iliac crest representing its base, limited by the external oblique muscle laterally, the latissimus dorsi medially, and the internal oblique muscle as its floor. Superior lumbar hernias are bordered by the 12th rib superiorly, quadratus lumborum muscle medially, and the internal oblique muscle laterally underneath the latissimus dorsi muscle. Diagnosis depends largely on the capacity for clinical suspicion, and confirmation is based on imaging tests. We report a case of an acquired primary lumbar hernia diagnosed by computed tomography, which was treated successfully at our institution.

A roentgenocephalometric study of craniofacial skeletal characteristics of Korean normal occlusion by Moyers' analysis / 대한치과교정학회지

This study was performed to establish the cephalometric standards and to observe the nature of anatomic fit in the internal structural relationship of the craniofaciodental complex of the normal Korean by means of Moyers' method. Lateral cephalograms of 143 males and 144 females with normal occlusion and acceptable profile from 6 to 25 years of age, which were consisted of 5 groups that were 6 year-, 9 year-, 12 year-, 15 year- and adult-group were obtained. Data were gathered by traced digitizing the cephalograms and were statistically analyzed. The findings can be summerized as follows. 1. Norms of Korean males, females and both sexes in each group were established. 2. There was little significant sexual dimorphism in the form of craniofacial skeleton of all age groups. 3. The height and length of craniofacial skeleton was alike in each sexes in the 6 year-, 9 year- and 12 year-group, whereas it was larger in male than in female in the 15 year- and adult-group. 4. There were no significant sexual differences in the internal structural relationship of the craniofacial skeleton in all age groups.