Clinical implications of the BRAF mutation in papillary thyroid carcinoma and chronic lymphocytic thyroiditis.

BACKGROUND: The purpose of this study was to examine the possible prognostics and clinicopathologic characteristics underlying the BRAFV600E mutation and papillary thyroid carcinoma (PTC) coexisting or in absence of chronic lymphocytic thyroiditis (CLT). METHODS: This study was conducted on 172 patients who had undergone total thyroidectomy or unilateral total thyroidectomy for PTC; the patients were then examined for the BRAFV600E mutation using specimens obtained after their surgery from January 2013 to August 2015. RESULTS: BRAF mutations were found in 130 of 172 patients (75.6%). CLT was present in 27.9% of patients (48/172). The incidence of the BRAFV600E mutation was significantly increased in the group with no CLT (P = 0.001). The findings of the multivariate analysis pertaining to the coexistence of CLT and PTC showed no significant correlation other than the BRAFV600E mutation. No significant difference was noted in the clinicopathologic factors between the two groups based on the coexistence of CLT in univariate and multivariate analyses. CONCLUSIONS: The BRAFV600E mutation is less frequent in PTC coexisting with CLT presumably because CLT and the BRAFV600E mutation operate independently in the formation and progression of thyroid cancer.

Outcome of children with blunt liver or spleen injuries: Experience from a single institution in Korea.

INTRODUCTION: The aim of this study is to evaluate the demographics, injury pattern, and treatment outcomes among children hospitalized for the management of blunt liver and spleen injury at a single institution in Korea, and to document trends in treatment strategies of children with blunt torso trauma. METHODS: Children (<20 years) with blunt liver and spleen injuries, hospitalized at our center between May 2010 and February 2016, were included in the present study. Data were retrospectively analyzed for demographic and injury-related information were obtained. RESULTS: During the study period, 34 patients with blunt liver injury and 21 patients with blunt spleen injury presented at the center. The most common cause of liver and spleen injury was motor vehicle collision, followed by fall. Thirty patients (88.2%) with liver injuries and 18 patients (85.7%) with spleen injuries were managed conservatively. No cases of mortality occurred in patients with spleen injury group; one patient (2.9%) died in patients with liver injury due to uncontrolled bleeding. CONCLUSIONS: Our data demonstrated that 85.7% of patients with spleen injuries and 88.2% of patients with liver injuries were managed nonoperatively. Operative management was chosen more selectively, being applied in patients with high grade organ injury scores or abrupt changes in vital status. Our findings will contribute to the available data concerning children with traumatic injuries in Korea.

Incidentally detected breast lesions on chest CT with US correlation: a pictorial essay.

With the increasing use of computed tomography (CT), incidental breast lesions are detected more frequently. When interpreting chest CT findings, it is important for radiologists to carefully review the breast to recognize any abnormal findings that could affect patient management. The purpose of this study is to discuss incidental breast lesions on chest CT with ultrasonography correlation that may be encountered in routine clinical practice.

17 Cases of Acupuncture Related Pneumothorax and Factors Influencing Pneumothorax.

OBJECTIVES: Acupuncture is increasing in popularity as a complementary and alternative medicine. Pneumothorax is the most common and potentially serious adverse effect after acupuncture. This complication can cause fatality in the absence of rapid treatment. Here, we analyze the clinical presentation and discuss prevention of post-acupuncture pneumothorax and an approach to reducing this complication. METHODS: Patients presenting with post-acupuncture pneumothorax in our hospital center during 2011-2015 were retrospectively analyzed. Body mass index (BMI), patient's pre-acupuncture chief complaint and disease, and the characteristics associated with pneumothorax were assessed. The diagnosis of pneumothorax was based on clinical presentation and chest radiography. Conservative treatment or thoracostomy was performed. RESULTS: Seventeen patients (15 women and 2 men) with a mean age of 42 years (range: 18-73 years) were included; three were underweight (BMI < 18.5kg/m2), 11 patients had a healthy weight (BMI= 18.5-22.95kg/m2), one was overweight (BMI = 23- 24.95kg/m2), and two were obese (BMI ≥ 25 kg/m2). All but one case of bilateral pneumothorax had unilateral pneumothorax (right side: 6; left side: 10). Chest pain or dyspnea, or both. were the initial symptoms in all patients. Twelve patients underwent immediate thoracostomy. The patient with bilateral pneumothorax underwent right-side thoracostomy, and subsequently left-side thoracostomy, due to progression of the left-side pneumothorax. Five patients were successfully managed conservatively. All patients had an excellent outcome; all were asymptomatic and exhibited a normal chest X-ray at follow-up. CONCLUSION: Acupuncturists must be aware that delayed diagnosis and management of pneumothorax are life-threatening, and when symptoms of possible pneumothorax arise, patients should be advised to undergo an appropriate evaluation and intervention, particularly so in those with abnormal BMI.

Is It Contralateral Axillary Metastasis or Occult Breast Cancer?: A Confusing Case Report.

We report the case of a 43-year-old woman with primary left breast cancer presenting metastatic lymphadenopathy in the contralateral axilla. This patient represents a diagnostic and therapeutic challenge because primary breast cancer, occult contralateral breast cancer, and extra-mammary primary lesion can all be the source of the contralateral axillary metastasis. Left breast-conserving surgery, left sentinel lymph node biopsy, right breast mass excision, and right axillary lymph node dissection were performed. Immunohistochemical analysis revealed that the left breast cancer specimen was positive for estrogen receptor (ER) and progesterone receptor (PR), but negative for human epidermal growth factor receptor 2 (HER2). In contrast, the right axillary lymphadenopathy specimen was negative for ER and PR, but positive for HER2. Further investigation revealed no evidence of occult primary cancers or extra-mammary tumors. After surgical intervention, the patient was treated with adjuvant chemotherapy, adjuvant radiation therapy, and targeted therapy with trastuzumab. Two years after diagnosis, she is free of disease and presently being treated with tamoxifen.

Comparison of Hepatic Resection and Radiofrequency Ablation for the Treatment of Colorectal Liver Metastasis.

The liver is the major site of metastasis of primary colorectal cancer. Hepatic resection (HR) is considered the standard treatment for colorectal liver metastasis. In high-risk cases, radiofrequency ablation (RFA) can be attempted as an alternative treatment. This study compared the clinical profiles and overall and disease-free survival rates of patients with colorectal liver metastasis undergoing HR and RFA. From 1995 to 2009, we retrospectively analyzed clinical experiences of 43 and 17 patients who had undergone HR and RFA for primary colorectal cancer, respectively. To compare outcomes, we investigated the 3-year overall and disease-free survival rates. The 3-year overall survival rates of patients treated with HR and RFA were 53.5 and 47.1 %, respectively (p = 0.285); the disease-free survival rates were 35.0 and 26.9 %, respectively (p = 0.211). In the HR and RFA groups, 30 (60.2 %) and 13 (76.5 %) patients developed recurrence, respectively (p = 0.604). In the HR group, 1 patient died from postoperative liver failure, and 9 (20.9 %) developed postoperative complications, including wound infection, biliary leakage, intra-abdominal abscess, and pneumonia. In the RFA group, 1 patient (5.9 %) required prolonged inpatient care because of a procedure-related liver abscess. Although HR should be considered the first option for colorectal liver metastasis, RFA can be regarded as a primary treatment modality depending on the patient's characteristics, especially when a patient refuses surgery or has comorbidities.

Fibromatosis associated with silicone breast implant: ultrasonography and MR imaging findings.

Desmoid type fibromatosis is an uncommon benign disease entity of which its etiology is currently unknown. It constitutes 0.3% of all solid neoplasms, but it is rarely seen in the breast and even more scarcely reported to develop in association with breast implant. We present ultrasonography and magnetic resonance imaging findings of a 29-year-old female patient with fibromatosis after breast implant surgery. Knowledge of imaging findings of breast fibromatosis associated with implant will be helpful for accurate diagnosis and appropriate management.

Acute acalculous cholecystitis after laparoscopic appendectomy in a young healthy patient: report of a case.

Acute acalculous cholecystitis (AAC) is defined as acute inflammation of the gallbladder in the absence of gallstones. AAC occurs in patients after major surgery and in the presence of serious co-morbidities such as severe trauma, burns, sepsis, prolonged intravenous hyperalimentation and hemodynamic instability. AAC is rare in patients with none of the established risk factors. We present a case of a 38-year-old woman who developed AAC after laparoscopic appendectomy.