Genetic Features of Lung Adenocarcinoma with GroundGlass Opacity: What Causes the Invasiveness of Lung Adenocarcinoma?

Background@#Lung adenocarcinoma (LUAD) with ground-glass opacity (GGO) can become aggravated, but the reasons for this aggravation are not fully understood. The goal of this study was to analyze the genetic features and causes of progression of GGO LUAD. @*Methods@#LUAD tumor samples and normal tissues were analyzed using an Illumina HiSeq 4000 system. After the tumor mutational burden (TMB) was calculated, the identified mutations were classified as those found only in GGO LUAD, those present only in nonGGO LUAD, and those common to both tissue types. Ten high-frequency genes were selected from each domain, after which protein interaction network analysis was conducted. @*Results@#Overall, 227 mutations in GGO LUAD, 212 in non-GGO LUAD, and 48 that were common to both tumor types were found. The TMB was 8.8 in GGO and 7.8 in non-GGO samples. In GGO LUAD, mutations of FCGBP and SFTPA1 were identified. FOXQ1, IRF5, and MAGEC1 mutations were common to both types, and CDC27 and NOTCH4 mutations were identified in the non-GGO LUAD. Protein interaction network analysis indicated that IRF5 (common to both tissue types) and CDC27 (found in the non-GGO LUAD) had significant biological functions related to the cell cycle and proliferation. @*Conclusion@#In conclusion, GGO LUAD exhibited a higher TMB than non-GGO LUAD. No clinically meaningful mutations were found to be specific to GGO LUAD, but mutations involved in the epithelial-mesenchymal transition or cell cycle were found in both tumor types and in non-GGO tissue alone. These findings could explain the non-invasiveness of GGO-type LUAD.

The Optimal Pyloric Procedure: A Collective Review

Vagal damage and subsequent pyloric denervation inevitably occur during esophagectomy,potentially leading to delayed gastric emptying (DGE). The choice of an optimal pyloricprocedure to overcome DGE is important, as such procedures can lead to prolonged surgery,shortening of the conduit, disruption of the blood supply, and gastric dumping/bilereflux. This study investigated various pyloric methods and analyzed comparative studiesin order to determine the optimal pyloric procedure. Surgical procedures for the pylorusinclude pyloromyotomy, pyloroplasty, or digital fracture. Botulinum toxin injection, endoscopicballoon dilatation, and erythromycin are non-surgical procedures. The scope, technique,and effects of these procedures are changing due to advances in minimally invasivesurgery and postoperative interventions. Some comparative studies have shown that pyloricprocedures are helpful for DGE, while others have argued that it is difficult to reach anobjective conclusion because of the variety of definitions of DGE and evaluation methods.In conclusion, recent advances in interventional technology and minimally invasive surgeryhave led to questions regarding the practice of pyloric procedures. However, manyclinicians still perform them and they are at least somewhat effective. To provide guidanceon the optimal pyloric procedure, DGE should first be defined clearly, and a large-scalestudy with an objective evaluation method will then be required.

Ipsilateral Hyperhidrosis: Atypical Symptom of Small Lung Adenocarcinoma Evaluated by ¹⁸F-FDG PET-CT / 대한핵의학회잡지

A 45-year-old male visited our clinic due to right palmar anhidrosis and contralateral hyperhidrosis. Chest computed tomography (CT) showed a solitary pulmonary nodule with mediastinal lymph node enlargement, but a cause for atypical palmar anhidrosis was not identified. Subsequent fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed (PET/CT) revealed a localized pleural metastasis at the right apex with direct invasion of the paravertebral sympathetic chain. The pleural metastasis, which was not seen on chest CT, evoked ipsilateral anhidrosis independent of a mass effect or direct invasion by the primary lung tumor. 18F-FDG PET/CT can be helpful in identifying the cause of atypical symptoms in patient with small sized lung cancer.

Ipsilateral Hyperhidrosis: Atypical Symptom of Small Lung Adenocarcinoma Evaluated by ¹⁸F-FDG PET-CT / 대한핵의학회잡지

A 45-year-old male visited our clinic due to right palmar anhidrosis and contralateral hyperhidrosis. Chest computed tomography (CT) showed a solitary pulmonary nodule with mediastinal lymph node enlargement, but a cause for atypical palmar anhidrosis was not identified. Subsequent fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed (PET/CT) revealed a localized pleural metastasis at the right apex with direct invasion of the paravertebral sympathetic chain. The pleural metastasis, which was not seen on chest CT, evoked ipsilateral anhidrosis independent of a mass effect or direct invasion by the primary lung tumor. 18F-FDG PET/CT can be helpful in identifying the cause of atypical symptoms in patient with small sized lung cancer.

Trend Analysis for the Choice and Cost of Lung Cancer Treatment in South Korea, 2003-2013 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Our study aimed to report the annual changes in lung cancer statistics and analyze trends in sociodemographic, medical, and financial factors from 2003 to 2013 in the national database from the Korean National Health Insurance (KNHI). MATERIALS AND METHODS: Among 7,489 patients with code C34 in KNHI database, only lung cancer patients newly diagnosed after 2003 were included in the study population, for a total of 4,582 patients. Descriptive statistics were used to characterize treatment patterns and medical costs according to sociodemographic factors. RESULTS: Approximately 70% of subjects were male, and the mean age was 67 years. Around 46% of patients were over 70 years old, and 12% were over 80 years old. The medical costs were highest for patients younger than 60 and lowest for those over 80 years old. Surgery was more common in younger patients, while “no treatment” increased greatly with age. In trend analysis, the proportions of aging (p for trend < 0.001), female (p for trend=0.003), metropolitan/urban (p for trend=0.041), and lowest or highest-income patients (p for trend=0.004) increased over time, along with the prevalence of surgery as the primary treatment (p for trend < 0.001). There was also a trend with regard to change in medical costs (p for trend < 0.001), in that those of surgery and radiotherapy increased. CONCLUSION: Surgery as a curative treatment has increased over the past decade. However, the elderly, suburban/rural residents, and low-income patients were more likely to be untreated. Therefore, active measures are required for these increasingly vulnerable groups.

Psychological Problems of Pneumothorax According to Resilience, Stress, and Post-Traumatic Stress

OBJECTIVE: The aims of the study were to investigate psychological distress in pneumothorax patients. METHODS: A cohort study was performed in 101 patients with spontaneous pneumothorax. They were divided into three groups: (A) under 19 years old, (B) those of an intermediate age, and (C) over 45 years old. General well-being [Psychological Wellbeing Index-Short Form (PWI-SF)], traumatic event [Impact of Event Scale (IES)], and resilience [Life Orientation Test-Revised (LOT-R)] were assessed. RESULTS: There were 35 patients in Group A, 51 in B, and 15 in C. The mean length of hospital stay was five days in all patients. The overall recurrence rate after surgery was 8%. All patients were under severe stress and reported an average PWI-SF score of 39. The IES score was 27, which did not meet the criteria for post-traumatic stress disorder but was higher in Group C than in the other groups (p=0.02). Age and operation were significant factors for a high IES, but age was the only significant factor according to multivariate analysis. CONCLUSION: Pneumothorax patients may be at high risk for severe stress. Moreover, post-traumatic stress was higher in elderly patients. Actions to reduce the psychological problems in these patients are required.

Diaphragmatic Hernia after Transhiatal Esophagectomy for Esophageal Cancer

Diaphragmatic hernia was found in a patient who had undergone transhiatal esophagectomy for early esophageal cancer. Chest X-ray was not helpful, but abdominal or chest computed tomography was useful for accurate diagnosis. Primary repair through thoracotomy was performed and was found to be feasible and effective. However, long-term follow-up is required because hernia recurrence is common.

Primary Pulmonary Amyloidosis with Mediastinal Lymphadenopathy

We report a case of inadvertent hoarseness after surgery for primary pulmonary amyloidosis. A 55-year-old male was transferred to our facility due to a lung mass. Chest computed tomography revealed a solitary pulmonary nodule. Positron emission tomography-computed tomography showed fluorodeoxyglucose uptake in the main mass and in the mediastinal lymph nodes. To confirm the pathology of the mass, wedge resection and thorough lymph node dissection were performed via video-assisted thoracic surgery (VATS). No complications except for hoarseness were observed; hoarseness developed soon after surgery and lasted for 3 months. The main mass was diagnosed as amyloidosis, but this was not found in the lymph nodes. In conclusion, VATS wedge resection for peripheral amyloidosis is a feasible and safe procedure. However, mediastinal lymph node dissection is not recommended unless there is evidence of a clear benefit.

A Case of Erythema Nodosum Migrans / 대한피부과학회지

No abstract available.

Acute Aortic Dissection in Pregnancy with the Marfan Syndrome

Acute aortic dissection (AAD) during pregnancy can be fatal to both the pregnant mother and the baby, particularly in patients with the Marfan syndrome. We report a case of the modified Bentall procedure in surgery for AAD in a 31-year-old pregnant woman at 24 weeks of gestation with the Marfan syndrome. The patient recovered well after the operation, but unfortunately, the fetus could not be saved.

Facial Flushing and Persistent Erythema of Rosacea Improved by Carvedilol / 대한피부과학회지

No abstract available.

Mycobacterium abscessus Lung Disease in a Patient with Kartagener Syndrome / 결핵및호흡기질환

Primary ciliary dyskinesia (PCD) is characterized by the congenital impairment of mucociliary clearance. When accompanied by situs inversus, chronic sinusitis and bronchiectasis, PCD is known as Kartagener syndrome. The main consequence of impaired ciliary function is a reduced mucus clearance from the lungs, and susceptibility to chronic respiratory infections due to opportunistic pathogens, including nontuberculous mycobacteria (NTM). There has been no report of NTM lung disease combined with Kartagener syndrome in Korea. Here, we report an adult patient with Kartagener syndrome complicated with Mycobacterium abscessus lung disease. A 37-year-old female presented to our hospital with chronic cough and sputum. She was ultimately diagnosed with M. abscessus lung disease and Kartagener syndrome. M. abscessus was repeatedly isolated from sputum specimens collected from the patient, despite prolonged antibiotic treatment. The patient's condition improved and negative sputum culture conversion was achieved after sequential bilateral pulmonary resection.

Mediastinal Paraganglioma: Complete Resection Using Video-Assisted Thoracoscopic Surgery

Mediastinal paragangliomas are very rare neuroendocrine tumors. Complete resection is the standard treatment of a paraganglioma because of the tumor's potential malignancy and poor response to chemo- or radiotherapy. However, the highly vascular nature of the tumor and its characteristic anatomic location make complete resection difficult. We report a case of an anterior mediastinal paraganglioma, which was incidentally found on a chest computed tomography scan for chronic cough work-up of a 55-year-old woman. Complete resection was accomplished using video-assisted thoracoscopic surgery, and the patient recovered without any complications.

Response Evaluation after Neoadjuvant Chemoradiation by Positron Emission Tomography-Computed Tomography for Esophageal Squamous Cell Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Parameters of positron emission tomography-computed tomography (PET-CT) were compared with the results of histopathologic examination in order to determine which can provide an objective indication of response after neoadjuvant chemoradiation for treatment of thoracic esophageal squamous cell carcinoma (SCC). MATERIALS AND METHODS: Between August 2003 and January 2010, data on 25 patients who underwent neoadjuvant chemoradiation and subsequent resection for treatment of esophageal SCC were retrospectively reviewed. Changes in maximum standardized uptake value (DeltaSUVmax), metabolic tumor volume (DeltaMTV), and total lesion glycolysis (DeltaTLG) were analyzed by comparison with the histopathologic findings. RESULTS: Pathologic complete remission (CR) for the main tumor was achieved in 11 patients. Postradiation esophagitis was observed in 10 patients. DeltaSUVmax of the main tumor was significantly greater in the CR group than in the partial response (PR) group (p=0.039), while DeltaMTV and DeltaTLG of the main tumor were not (p=0.141 and p=0.349, respectively). The cut-off DeltaSUVmax value for CR was estimated as 72.1%, indicating significantly better accuracy than visual interpretation (p=0.045). Of the 48 involved lymph nodes, DeltaSUVmax and DeltaMTV of lymph nodes were significantly greater in the CR group than in the PR group (p=0.045 and p=0.014, respectively), while DeltaTLG was not (p=0.063). The cut-off value of DeltaSUVmax for prediction of CR in lymph nodes was calculated as 50.67%. CONCLUSION: PET-CT could be used for prediction of response to neoadjuvant treatment in thoracic esophageal SCC. DeltaSUVmax may be a more significant predictor for CR after neoadjuvant chemoradiation than DeltaTLG and DeltaMTV.

A Case of Allergic Contact Dermatitis to Petrolatum / 대한피부과학회지

No abstract available.

Licorice Induced Hypokalemia / 대한신장학회잡지

A high intake of licorice can cause hypermineralocorticoidism with sodium retention and potassium loss, edema, increased blood pressure and depression of renin-angiotensin-aldosterone system. Glycyrrhizic acid, a component of licorice, produces hypermineralocorticoidism through the inhibition of 11beta-hydroxysteroid dehydrogenase. We report a 55-year-old woman with severe muscle weakness with hypokalemia(Serum K+ : 1.7 mEq/ L) due to raw licorice tea. She boiled the licorice 50 g in water and drunk intermittently for 4 months due to her foreign body sensation on her throat. In Korea there is a traditional recipe that licorice works out for the above symptom. Her serum renin activity and aldosterone level were far beyond normal range which was typical to licorice ingestion. She also had metabolic alkalosis with pH 7.55 and hypertension. After quitting the licorice, hypokalemia and muscle weakness gradually improved and her blood pressure returned to normal.