Sparganosis of the Unilateral Breast: A Case Report

Sparganosis is a parasitic infection caused by the sparganum, the plercercoid of the genus Spirometra. The preoperative diagnosis of breast sparganosis is difficult in most cases because it is a rare parasitic infection less than 2% of all cases. We report a 62-year-old woman case of breast sparganosis that were confirmed by surgical removal of worms from the right breast. The radiologic images of the patient also revealed characteristic features of breast sparganosis. The patient described the migrating palpable breast mass, which strongly suggested the possibility of breast sparganosis. The treatment of choice and confirmative diagnosis for sparganosis are complete surgical extraction of the sparganum irrespective of infected site. Inspection of the mass site with detailed medical history and radiological examinations are important for preoperative diagnosis of sparganosis patients.

Improved Model for Predicting Axillary Response to Neoadjuvant Chemotherapy in Patients with Clinically Node-Positive Breast Cancer / 한국유방암학회지

PURPOSE: Pathological complete response (pCR) of axillary lymph node (LN) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC). Treatment of the axilla after NAC is not well established and the value of sentinel LN biopsy following NAC remains unclear. This study investigated the predictive value of axillary response following NAC and evaluated the predictive value of a model based on axillary response. METHODS: Data prospectively collected on 201 patients with clinically node-positive breast cancer who were treated with NAC and underwent axillary LN dissection (ALND) were retrieved. A model predictive of axillary pCR was developed based on clinicopathologic variables. The overall predictive ability between models was compared by receiver operating characteristic (ROC) curve analysis. RESULTS: Of 201 patients who underwent ALND after NAC, 68 (33.8%) achieved axillary pCR. Multivariate analysis using axillary LN pCR after NAC as the dependent variable showed that higher histologic grade (p=0.031; odds ratio [OR], 2.537; 95% confidence interval [CI], 1.087–5.925) and tumor response rate ≥47.1% (p=0.001; OR, 3.212; 95% CI, 1.584–6.515) were significantly associated with an increased probability of achieving axillary pCR. The area under the ROC curve for estimating axillary pCR was significantly higher in the model that included tumor response rate than in the model that excluded this rate (0.732 vs. 0.649, p=0.022). CONCLUSION: Tumor response rate was the most significant independent predictor of axillary pCR in response to NAC. The model that included tumor response rate was a significantly better predictor of axillary pCR than the model that excluded tumor response rate.

Significance of Contrast Enema in One-stage Transanal Endorectal Pull-through Operation for Hirschsprung Disease

In one-stage transanal endorectal pull-through operation (TERPT) for Hirschsprung disease, preoperative evaluation by contrast enema (CE) is important tool in aspect of planning of surgical procedure as well as diagnosis. This study was to evaluate the significance of CE for identifying the extent of aganglionic bowel. A retrospective analysis was performed in 40 patients who underwent TERPT between 2003 and 2011. The authors reviewed the CE studies and their correlation with pathologic extent of aganglionosis. Total 66 contrast enemas were performed in 40 patients. Twenty patients underwent single CE, but 20 patients required multiple CEs. In single CE group, 17 had clear radiographic transition zone, but 3 had less definite transition zone. In multiple CE group, 17 patients who had equivocal finding in first or second CE had definite radiographic transition zone, but 3 patients of this group had less definite radiographic transition zones. Overall, 34 patients (85%) had clear radiographic transition zone by single or repeated CE. One (2.9%) out of 34 patients with clear radiographic transition zone had discordance between radiographic and pathologic transition zone. In contrast 4 (66.7%) out of 6 patients with equivocal radiographic transition zone had discordance between radiographic and pathologic transition zone. Observation of clear radiographic transition zone is important in preparation of TERPT, and repeated CE is helpful to reduce the discordance between radiographic and pathologic transition zone. Awareness of the possibility of discordance is also important if radiographic transitional zone is not clear.

The Effects of Olanzapine in the Treatment of Inpatients with Schizophrenia and Other Psychotic Disorders: Efficacy, Safety and Quality of Life / 대한정신약물학회지

OBJECTIVE: This multicenter, open trial with olanzapine was primarily designed to evaluate effects of olanzapine on profiles of efficacy, safety, and subjective quality of life (QoL) in hospitalized patients with schizophrenia or other psychotic disorders. Secondarily, associations of changes in QoL measures with baseline characteristics and changes in efficacy and safety measures were examined. Finally, the optimal dose of olanzapine was investigated with respect to efficacy, safety and QoL profiles. METHODS: A total of 94 inpatients at nine centers in Chungchung and Honam areas of Korea was recruited. The administered dosage of olazapine varied between 5 to 20 mg/day according to each patient's clinical status. Information on socio-demographic and clinical characteristics was collected. A variety of measures on efficacy, safety and QoL was administered at baseline (admission) and at endpoint (discharge). RESULTS: Seventy-three (78%) patients completed the study. Their mean (SD) admission period was 42 (21) days. Olanzapine was effective for reducing overall psychotic symptoms including negative and depressive symptoms. It was safe and generally well tolerated, particularly in extrapyramidal symptoms, although weight gain was substantial (2.6 kg during admission period). Furthermore, it was beneficial for improving QoL. Changes in QoL measures were independently associated with improvement of nighttime sleep. The most favorable dosages of olanzapine were 17.5 or 20 mg/day in terms of efficacy, while were 7.5 or 10 mg/day with respect to safety and QoL. CONCLUSION: Olanzapine was effective and well tolerated in the treatment of inpatients with schizophrenia and other psychotic disorders. Different optimal dosages of olanzapine might be recommended according to the target or goal of treatments.