Comparison of One- and Two-Region of Interest Strain Elastography Measurements in the Differential Diagnosis of Breast Masses

OBJECTIVE: To compare the diagnostic performance and interobserver variability of strain ratio obtained from one or two regions of interest (ROI) on breast elastography.MATERIALS AND METHODS: From April to May 2016, 140 breast masses in 140 patients who underwent conventional ultrasonography (US) with strain elastography followed by US-guided biopsy were evaluated. Three experienced breast radiologists reviewed recorded US and elastography images, measured strain ratios, and categorized them according to the American College of Radiology breast imaging reporting and data system lexicon. Strain ratio was obtained using the 1-ROI method (one ROI drawn on the target mass), and the 2-ROI method (one ROI in the target mass and another in reference fat tissue). The diagnostic performance of the three radiologists among datasets and optimal cut-off values for strain ratios were evaluated. Interobserver variability of strain ratio for each ROI method was assessed using intraclass correlation coefficient values, Bland–Altman plots, and coefficients of variation.RESULTS: Compared to US alone, US combined with the strain ratio measured using either ROI method significantly improved specificity, positive predictive value, accuracy, and area under the receiver operating characteristic curve (AUC) (all p values < 0.05). Strain ratio obtained using the 1-ROI method showed higher interobserver agreement between the three radiologists without a significant difference in AUC for differentiating breast cancer when the optimal strain ratio cut-off value was used, compared with the 2-ROI method (AUC: 0.788 vs. 0.783, 0.693 vs. 0.715, and 0.691 vs. 0.686, respectively, all p values > 0.05).CONCLUSION: Strain ratios obtained using the 1-ROI method showed higher interobserver agreement without a significant difference in AUC, compared to those obtained using the 2-ROI method. Considering that the 1-ROI method can reduce performers' efforts, it could have an important role in improving the diagnostic performance of breast US by enabling consistent management of breast lesions.

The role of rpoS, hmp, and ssrAB in Salmonella enterica Gallinarum and evaluation of a triple-deletion mutant as a live vaccine candidate in Lohmann layer chickens

Salmonella enterica Gallinarum (SG) causes fowl typhoid (FT), a septicemic disease in avian species. We constructed deletion mutants lacking the stress sigma factor RpoS, the nitric oxide (NO)-detoxifying flavohemoglobin Hmp, and the SsrA/SsrB regulator to confirm the functions of these factors in SG. All gene products were fully functional in wild-type (WT) SG whereas mutants harboring single mutations or a combination of rpoS, hmp, and ssrAB mutations showed hypersusceptibility to H2O2, loss of NO metabolism, and absence of Salmonella pathogenicity island (SPI)-2 expression, respectively. A triple-deletion mutant, SGDelta3 (SGDeltarpoSDeltahmpDeltassrAB), was evaluated for attenuated virulence and protection efficacy in two-week-old Lohmann layer chickens. The SGDelta3 mutant did not cause any mortality after inoculation with either 1 x 10(6) or 1 x 10(8) colony-forming units (CFUs) of bacteria. Significantly lower numbers of salmonellae were recovered from the liver and spleen of chickens inoculated with the SGDelta3 mutant compared to chickens inoculated with WT SG. Vaccination with the SGDelta3 mutant conferred complete protection against challenge with virulent SG on the chickens comparable to the group vaccinated with a conventional vaccine strain, SG9R. Overall, these results indicate that SGDelta3 could be a promising candidate for a live Salmonella vaccine against FT.

Operative Timing in Patients with Traumatic Acute Subdural Hematomas

PURPOSE: Acute traumatic subdural hematoma (SDH) increases after severe traumatic brain injury (TBI) and leads to high mortality. The time to operation is a correctable prognostic factor in TBI, but the timing of hematoma evacuation still remains controversial. We assessed the correlation between operative timing and mortality in traumatic acute SDH. METHODS: We conducted a retrospective study over an 8-year period in 163 surgical patients with acute traumatic SDH. Information was obtained about demographic, clinical, and radiological findings, surgical management, and mortality at discharge. RESULTS: Overall, 85 patients (52.1%) died, and 47 patients (28.8%) showed good recovery. The patients who underwent earlier surgery were more likely to have severe head injury. The time to operation in patients that died was shorter than patients with good recovery. The mean time for evacuation [Ed-Is this the same as time to surgery, or is this specifically when the hematoma was removed? Please clarify.] was 351.7+/-220.5 minutes in patients who died and 395.5+/-363.3 minutes in patients with good recovery. Patients undergoing surgery within 4 hours of injury had a mortality rate of 54.4% versus 50.9% receiving surgery after 4 hours. But the risk ratio for time spent to surgery increased until 240 minutes and then decreased. Logistic regression on patients with 240 minutes until surgery showed that the probability of death increased with time to surgery. CONCLUSION: Patients who undergo surgery within 180 minutes after injury have a lower probability of death than those with delayed surgery.

The Review of Cervical Conization For Twelve Years / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to evaluate the role of cold knife conization in the diagnosis and management of cervical neoplasia. METHODS: Cold knife conization was performed in total 163 patients from January 1992 to December 2003. The results of PAP smear and colposcopy-directed biopsy were compared with the pathologic diagnosis of conization. And we evaluated the rate of positive margin and the presence of residual lesion. And then, we reviewed the pregnancy outcome after conization. RESULTS: The rate of agreement between PAP cytology and conization was 45.4%, and the rate of agreement between colposcopy-directed biopsy and conization was 65.6%. Hysterectomy was done in 102 patients (62.6%). The positive rate of resection margin was 19.6%. The incidence of residual lesion after conization was 31.2% in margin (+) and 1.4% in margin (-). We evaluated 7 cases of pregnancy after conization. CONCLUSION: Cervical conization as surgical treatment was effective in cervical neoplasia patients, especially young patients, with continuous follow-up.

One case of monoamniotic twin pregnancy without cord entanglement and both fetus survival / 대한산부인과학회지

Monoamniotic twin pregnancies are relatively rare, occuring in 1 percentage. But perinatal mortality is 50-60 percentage. The high mortality rate has been attributed to preterm delivery, cord entanglement, twin-to-twin transfusion syndrome, intrauterine growth retardation and congenital anomalies. However, the desirable management plan of the monoamniotic twin pregnancies is still not established and there are controversies regarding the proper antepartum care of monoamniotic twins and the optimal timing and mode of delivery. We have experienced one case of monoamniotic twin without cord entanglement and both fetuses survival by cesarean section at 36+3 weeks, is reported with a brief review of the literatures.

Prenatal sonographic diagnosis of fetal hepatic hemangioma / 대한산부인과학회지

Infantile hepatic hemangioma is benign vascular tumor and the most common liver tumor in infants. Small hepatic hemangioma is usually asymptomatic and seldom require therapy. Giant hepatic hemangioma, defined as more than 4 cm in diameter, is rare, but can lead to life-threatening complications such as consumptive coagulopathy, anemia, hemorrhage after tumor rupture and congestive heart failure due to arteriovenous shunting. Neonatal mortality rate is about 70-90%. The differential diagnosis of a fetal liver mass includes hemangioma, hepatoblastoma, and mesenchymal harmatoma. Although hepatic hemangioma represents the most common tumor of the liver in infant, the prenatal diagnosis of this condition has been rarely reported in the literature. we experienced a case of fetal hepatic hemangioma by prenatal sonography and report our case with a brief review of literature.

A Case of Tetrasomy 12p Diagnosed Prenatally / 대한산부인과학회잡지

Tetrasomy for the short arm of chromosome 12 (Pallister-Killian syndrome) is an uncommon mosaic aneuploidy, which may present in the prenatal period with an ultrasonographically detected fetal abnormalities or following karyotyping for maternal age and other causes. In this syndrome the chromosome abnormalities, isochromosome is present in amniocyte with a much greater percentage than fetal lymphocyte. The most consistent reported prenatal ultrasound findings for tetrasomy 12p include polyhydramnios with short femurs and a diaphragmatic hernia. We report a case identified by prenatal karyotyping diagnosis.