A Rare Case of Phyllodes Tumor Metastasis to the Stomach Presenting as Anemia / Journal of the Korean Cancer Association, 대한암학회지

Metastasis of a phyllodes tumor to the stomach is an extremely rare condition with important clinical implications. A 44-year-old woman was initially diagnosed with a phyllodes tumor in her right breast in 2008, and subsequently presented to an out-patient clinic with dizziness on December 16, 2013. We found that she had severe anemia (hemoglobin levels, 6.7 g/dL), and we quickly performed esophagogastroduodenoscopy to identify the cause. This procedure revealed large ulcerofungating masses with active bleeding in the stomach. Histopathological examination revealed that the masses were consistent with phyllodes tumor metastases. In patients with a metastatic phyllodes tumor presenting as anemia, gastric metastasis should be considered as one of the differential diagnoses because overlooking the possibility might have dire consequences if cytotoxic chemotherapy were administered.

A Rare Case of Phyllodes Tumor Metastasis to the Stomach Presenting as Anemia / Journal of the Korean Cancer Association, 대한암학회지

Metastasis of a phyllodes tumor to the stomach is an extremely rare condition with important clinical implications. A 44-year-old woman was initially diagnosed with a phyllodes tumor in her right breast in 2008, and subsequently presented to an out-patient clinic with dizziness on December 16, 2013. We found that she had severe anemia (hemoglobin levels, 6.7 g/dL), and we quickly performed esophagogastroduodenoscopy to identify the cause. This procedure revealed large ulcerofungating masses with active bleeding in the stomach. Histopathological examination revealed that the masses were consistent with phyllodes tumor metastases. In patients with a metastatic phyllodes tumor presenting as anemia, gastric metastasis should be considered as one of the differential diagnoses because overlooking the possibility might have dire consequences if cytotoxic chemotherapy were administered.

Intractable in Stent Thrombosis in Malignant Superior Vena Cava Syndrome / 계명의대학술지

Endovascular treatment (EVT) including angioplasty and stenting is an effective treatment for superior vena cava (SVC) syndrome. Recurrence of SVC syndrome is mainly caused by tumor progression and occurs in around 20% after EVT, but sometimes venous thrombosis within stent accounts for recurrence of SVC syndrome. Anticoagulation after EVT is still a controversial issue. In our case, a 73-year-old man with SVC syndrome caused by mediastinal metastasis from non-small cell lung cancer underwent endovascular stent followed by anticoagulation with low molecular weight heparin (LMWH), but symptomatic progression due to in-stent thrombosis necessitated the second procedure after two weeks. A total of 4 sessions of endovascular stent and anticoagulation with LMWH, warfarin and rivaroxaban did not induce durable resolution of in-stent thrombosis. Our case suggests refractory in-stent thrombosis could develop despite of anticoagulation after endovascular stent for SVC syndrome.

Improved Algorithms for the Identification of Yeast Proteins and Significant Transcription Factor and Motif Analysis

With the rapid development of MS technologiesy, the demands for a more sophisticated MS interpretation algorithm haves grown as well. We have developed a new protein fingerprinting method using a binomial distribution, (fBIND). With the fBIND, we improved the performance accuracy of protein fingerprinting up to the maximum 49% (more than MOWSE) and 2% than(at a previous binomial distribution approach studied by of Wool et al.) as compared to the established algorithms. Moreover, we also suggest a the statistical approach to define the significance of transcription factors and motifs in the identified proteins based on the Gene Ontology (GO).

Clinically Meaningful Reduction in Pain Severity by Using a Unidimensional Scale and Verbal Categorical Rating of Pain

PURPOSE: The visual analogue scale (VAS) pain score is widely and frequently used to evaluate the severity of pain. However, statistically significant differences in the VAS scores may not always mean differences in pain severity. This study is to determine clinically meaningful reductions in pain severity as measured by the VAS and by a verbal categorical rating of pain. METHODS: Three hundred adult patients presenting to the emergency department (ED) with acute pain resulting from trauma or non-traumatic diseases were enrolled in this prospective, descriptive study. A 100-mm non-hatched, horizontal visual analogue scale was used to measure pain severity. The VAS measurements were obtained two times 1 minute apart at admission, 30 minutes after admission, and 1 hour after treatment. At each VAS measurements, patients also gave verbal ratings of their pain as "more pain,""the same pain," or "less pain." Data from the groups reporting "the same pain" or "less pain" were compared with their preceding descriptions and yielded a VAS difference. The mean VAS change was calculated, from which a grand means and 95% confidence intervals (95% CI) were determined. RESULTS: At 30 minutes after admission and 1 hour after treatment, 256 and 31 patients, respectively described their pain as "the same pain,"and 33 and 269 patients described it as "less pain." The mean reduction in VAS for the group reporting that pain was "the same pain" was 13 to 16 mm (95% CI, 8 to 20 mm) instead of 'zero.'For the group reporting that pain was "less pain," the mean reductions in VAS score were 24 mm (95% CI, 20 to 28 mm) at 30 minutes after admission and 44 mm (95% CI, 42 to 46 mm) at 1 hour after treatment. CONCLUSION: When evaluating management for acute pain in the ED, a difference in VAS score of less than 20 mm without regard to the presence or absence of treatment is unlikely to signify a clinically meaningful reduction in pain severity. This study provides guidance to those who design and interpret clinical studies of the acute pain experience in the ED.

Aconitine Intoxication Following Ingestion of Folk Recipes Containing Aconitum Species

PURPOSE: Preparations of Aconitum roots in Chinese and Korean medicine are carefully prescribe for analgesic, antirheumatic and neurologic indications. However, in Korean folk medicine, a crude medical herb prepared from Aconitum is still used as form of a decoction or an unrefined tablet. Potential hazards of these medicinal herbs are poisoning and occasional fatalities due to low margins of safety. This study was conducted to document the adverse effects related to the use of these folk recipes that resulted in the emergency department (ED) admission. METHODS: A retrospective survey was conducted of 30 patients presented to the ED of a tertiary University Hospital with suspected adverse effects from folk recipes containing Aconitum over a three-year period from 1999 to 2001. The patients was analyzed according to sex, age, intention of use, residential area, vital signs on ED presentation, time to presentation, time to discharge or ECG normalization, frequency of chief complaints, and ECG abnormalities. RESULTS: The patients' mean age was around 67 years old. The patients were predominantly female (22 patients) and from rural areas (21 patients). The drug effects of Aconitum were not appreciated by almost all the patients. Of the chief complaints, nausea or vomiting was most common (76.7%). Time to presentation in the ED varied (30 ~ 930 minutes), which suggests that the occurrence of symptoms is directly related to the amount of aconitine in folk recipes containing Aconitum. Upon the arrival, most of the patients were hypotensive (MAP: 62 mmHg), but heart rates were normal or tachycardic. The ECG findings were variable, and, except for one case, normal sinus rhythm was restored within 24 hours without pharmacological intervention. CONCLUSION: This research demonstrates the need to emphasize public announcement to deter the injudicious use of folk recipes containing Aconitum species.