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Malignant nodular hidradenoma (MNH) is an infrequent, highly malignant tumor derived from eccrine sweat glands. MNH usually occurs on the scalp, trunk, and proximal extremities, and rarely on the hand. A 55-year-old male patient visited clinics with a gradually enlarging painless mass at fingertip. It begins a year ago. Recently, it has grown rapidly and starts ulceration, and bleeding over the past 3 weeks. According to the biopsy report, it has focal necrosis, atypia, atypical mitoses, and nuclear pleomorphism suggested that the mass was MNH. After histological diagnosis, tiny bone erosion was observed in the re-read radiographic finding. For the oncologic evaluation, the patient was transferred to the cancer center. Radical amputation was performed to the residual tumor that might remain based on re-reading of radiographs. MNH of the finger is especially difficult to the diagnosis given its rarity and variable histology. When ulcerative skin lesion and radiographic bone erosion are observed, one should suspect malignancy and makes out a proper therapeutic plan after histologic biopsy.

While it is the most frequently observed subtype of all cutaneous soft tissue sarcomas, dermatofibrosarcoma protuberans is still uncommon, with a high local recurrence rate. Although surgical resection could be a simple curative procedure, surgeons can encounter difficulties when dissecting or closing the wound, depending on the location and the size of the tumor. We present a case report of direct repair of soft tissue defect with intraoperative tissue expansion after sarcoma resection. A 62-year-old male visited our clinic with an approximately 1.5×1.5 cm-sized mass on his lower leg. We excised the mass, which a pathologic study confirmed as dermatofibrosarcoma protuberans. The authors planned a wide excision of the lesion as soon as possible. The excised lesion was not large; however, the soft tissue defect could not be closed by direct approximation. We eventually closed the tumor resection wound using a Foley catheter as a tissue expander. The patient’s wound healed well, albeit leaving a minimal scar. This case suggests that a Foley catheter could be an effective and versatile tool that is readily available in any medical setting, including after a small tumor resection in outpatient surgery.

Background/aim Previous reports have indicated that increased expression of Jagged-1 (JAG1) may predict chemotherapy response and poor prognosis for patients with recurrent or metastatic colorectal cancer (CRC). This study aimed to investigate the clinical impact of JAG1 expression level in patients with CRC, including recurrence, especially in those diagnosed with lymph node-positive stage III CRC who underwent complete resection and appropriate adjuvant chemotherapy. Patients and methods All patients were enrolled through a retrospective chart review, and only those for whom the clinical course and all clinical information were adequately determined according to the inclusion criteria were selected for retrospective review through medical records. Immunohistochemical staining of JAG1 was performed using paraffin-embedded tissue. JAG1 expression was determined by scoring for staining intensity and percentage of positively stained cells; the final JAG1 score was determined as the sum of both scores. Results Sixteen patients who experienced relapse and 15 without (for over 3 years) were selected. The protein expression level of JAG1 showed a tendency for being lower in the group without recurrence, although not statistically significantly (p=0.083); however, the mean JAG1 expression score was significantly lower in the group without recurrence (1.53 vs. 3.19; p=0.004). The patients were divided into two groups with low and high JAG1 expression. The results showed that high JAG1 expression was significantly associated with recurrence of stage III CRC (p=0.029). Conclusion The expression of JAG1 may be a potential novel biomarker for predicting CRC recurrence.

BACKGROUND Arsenic trioxide (ATO) is recommended for patients who do not achieve molecular remission or who have molecular or morphologic relapse. However, there are no guidelines for adjusting ATO dosage in patients with severe renal failure or on dialysis. Herein, we report the successful treatment of relapsed acute promyelocytic leukemia (APL) in a patient on hemodialysis with ATO single agent and review the cases in literature. CASE SUMMARY A 46-year-old woman who has been on hemodialysis to chronic glomerulone-phritis for 15 years visited our hospital for pancytopenia. She had been seen for pancytopenia 3 years ago and had been diagnosed with APL. She also received chemotherapy for APL but unfortunately was lost to follow-up after her second consolidation chemotherapy. She was noted to have pancytopenia by her nephrologist during hemodialysis 1 mo ago. Bone marrow biopsy and reverse transcriptase-polymerase chain reaction (RT-PCR) tests revealed a diagnosis of relapsed APL. Treatment for relapsed APL with ATO single agent was started and she achieved molecular remission after administering 24 doses of ATO. Thus far, four consolidation therapies have been performed with the ATO single agent, and, to date, the molecular remission has been maintained as negative promyelocytic leukemia/retinoic acid receptor-α fusion gene as confirmed by RT-PCR testing for two years. CONCLUSION This is a rare case of relapsed APL successfully treated with the single agent ATO in a patient on hemodialysis.

Purpose: The purpose of this study was to investigate the effects of anxiety and smartphone dependency on sleep quality in pregnant women with preterm labor. Methods: The participants of this study were 111 pregnant women who were between 20 and 37 weeks of gestation and experienced preterm labor. The data were collected from October 1, 2018 to October 25, 2019. The collected data were analyzed using descriptive statistics (frequency, percentage, and standard deviation), as well as the t-test, Pearson correlation coefficients, and hierarchical multiple regression. Results: Significant negative correlations were found between anxiety and sleep quality and between smartphone dependency and sleep quality. Participants’ history of preterm birth, pregnancy method, bowel movements, anxiety, and smartphone dependency significantly affected sleep quality, with an explanatory power of 18%.Conclusion: In order to improve the quality of sleep, which is an important health-related factor for pregnant women experiencing preterm labor, it will be necessary to identify a history of premature birth, pregnancies achieved using artificial reproductive technology, bowel problems, and smartphone dependency in advance and to provide nursing interventions accordingly.

Background/aim We investigated the clinical role of the molecular targets, APEX1 and Jagged-1, and the Apex1 - Jagged-1 cascade in gastric cancer cells. Materials and methods We used 6 human gastric cancer cell lines (SNU-1, SNU-5, SNU-16, NCI-N87, KATO- III and AGS), and demonstrated the chemosensitivity of APEX1 and Jagged-1 through the MTT assay and immunoblotting. Tumor growth was assayed following cisplatin and 5-FU treatment using a xenograft model injected with KATO-III cells. Moreover, gastric tumor samples from 9 patients, divided in 2 groups according to chemotherapy response, were examined by immunocytochemical (IHC) staining, and protein expression levels were scored. Results Following APEX1 knockdown, the MTT assay revealed that the IC50 of cisplatin and 5-FU in AGS cells was decreased approximately 7% and 15%, respectively, however, their decrease in chemoresistant KATO-III cells was decreased by approximately 21% and 67% for cisplatin and 5-FU, respectively. The tumor volume of KATO-III/sicontrol mice treated with cisplatin and 5-FU was affected less, compared with KATO-III/siAPEX1 mice treated with cisplatin and 5-FU. Also, the expression levels of APEX1, Jagged-1 and CD133, assayed by IHC staining, were higher in the chemorefractory group than in the chemoresponsive group. Conclusion Jagged-1-activated signaling by APEX1 plays a role in advanced gastric cancer.

BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of solid organ transplantation or allogenic hematopoietic stem cell transplantation that is associated with immunosuppressive therapy. Potential manifestations are diverse, ranging from reactive lymphoid hyperplasia to high-grade lymphoma. PTLD is usually of B-cell origin and associated with Epstein-Barr virus (EBV) infection. Herein, we describe a case of PTLD involving the peritoneal omentum. There has been only case of PTLD as a diffuse large B-cell lymphoma (DLBCL) in the peritoneum. CASE SUMMARY The patient was a 62-year-old man who had been receiving immunosuppressive therapy with tacrolimus since undergoing a liver transplant 15 years prior. He reported that he had experienced abdominal discomfort and anorexia 1 month prior to the current admission. Abdominal pelvic computed tomography (CT) revealed peritoneal and omental mass-like lesions without bowel obstruction. Ultrasonography-guided biopsy was performed, and he was histologically diagnosed with EBV-negative DLBCL. Positron emission tomography (PET)-CT depicted peritoneum and omentum involvement only, without any lymphadenopathy or organ masses, including in the gastrointestinal tract. Six cycles of chemotherapy with a “R-CHOP“ regimen (rituximab-cyclophosphamide, doxorubicin, vincristine, prednisolone) were administered, and PET-CT performed thereafter indicated complete remission. CONCLUSION This is the first report of isolated peritoneal lymphomatosis defined as PTLD in a liver transplant recipient.

BACKGROUND Bronchobiliary fistula (BBF) is a rare disease characterized by an abnormal connection between the biliary system and bronchi. Traditional causes of BBF include trauma and infections, and more recent causes include malignancies and certain cancer treatments. Ramucirumab is an antivascular endothelial growth factor receptor 2 monoclonal antibody, currently used as a second-line treatment for gastric cancer. CASE SUMMARY A 43-year-old man visited our hospital with the complaint of jaundice. He was diagnosed with inoperable advanced gastric cancer owing to invasion of the hepatic hilum by the tumor. After percutaneous transhepatic biliary drainage (PTBD) and stent placement, capecitabine and oxaliplatin were administered as first-line palliative chemotherapy. The tumor progressed, and paclitaxel and ramucirumab were administered as second-line chemotherapy. However, on the first day of the second cycle, the patient suddenly developed dyspnea and pneumonia. BBF was diagnosed on the basis of the presence of bilious sputum and the results of computed tomography, and PTBD was repeated. CONCLUSION This is the first report of BBF after administration of the new antiangiogenic agent ramucirumab.

Warty carcinoma (WC), known as condylomatous carcinoma, generally derives from genito-urethral area. Its symbolic lesion is the exophytic and verruciform mass associated with human papillomavirus infection. A 90-year-old female presented with growing cauliflower-like mass in her back. A wide excision was performed for two masses. It was finally confirmed as WC throughout histopathological findings—arborescent papillomatosis, hyperkeratosis and acanthosis. The patient was an ordinary housewife and there was no recurrence and any postoperative complication 6 month after the surgery. Accordingly, careful physical examination and history-taking as well as wide-excision securing safety margin are essential, especially for senile patients.

Increasing rates of coronavirus disease 2019 (COVID-19) vaccination coverage will result in more vaccine-related side effects, including acute myocarditis. In Korea, we present a 24-year-old male with acute myocarditis following COVID-19 vaccination (BNT162b2). His chest pain developed the day after vaccination and cardiac biomarkers were elevated. Echocardiography showed minimal pericardial effusion but normal myocardial contractility. Electrocardiography revealed diffuse ST elevation in lead II, and V2-5. Cardiac magnetic resonance images showed the high signal intensity of T2- short tau inversion recovery image, the high value of T2 mapping sequence, and late gadolinium enhancement in basal inferior and inferolateral wall. It was presumed that COVID-19 mRNA vaccination was probably responsible for acute myocarditis. Clinical course of the patient was favorable and he was discharged without any adverse event., Graphical Abstract

This retrospective study aimed to evaluate the levels of coagulation factors and presence of disseminated intravascular coagulation (DIC) in patients with scrub typhus. We included patients confirmed to have scrub typhus at the Chosun University Hospital between September 2004 and December 2009. The DIC scores were evaluated in 365 patients and 36 healthy controls. The median concentrations of fibrinogen, d-dimer, and fibrin/fibrinogen degradation products (FDP) were compared between patients and healthy controls (p

Hypernatremia develops commonly in critically ill patients during hospitalization, and is associated with adverse outcomes. However, community acquired hypernatremia (CAH) has been rarely studied. We conducted a study in patients who presented to an urban referral hospital, and were admitted with CAH. We retrospectively analyzed patients admitted to an urban tertiary care hospital from January 1, 2012 to December 31, 2014. CAH is defined as more than 147 mEq/L at admission in patients not transferred from other hospitals. Severity of hypernatremia is categorized as mild (148-150 mEq/L), moderate (151-154 mEq/L) or severe (≥155 mEq/L). All data were extracted from electronic medical records and the major outcome is hospital mortality. During the study period, 79,998 patients were admitted to the hospital. Of them, 178 patients (0.2%) had hypernatremia at the time of admission. 121 (68.0%) had mild hypernatremia, 33 (18.5%) had moderate hypernatremia, and 24 (13.5%) had severe hypernatremia at admission. During the hospital stay, 91 (51.1%) developed mild hypernatremia, 31 (17.4%) developed moderate hypernatremia and 56 (31.5%) developed severe hypernatremia. Mean duration of hypernatremia was 2.3 ± 2.0 days. The length of hospital stay was 7 (interquartile range 3-23) days and hospital mortality was 24.3%. Multivariate analysis shows that a peak sodium level that qualified as moderate [OR = 11.50, 95% CI (2.67-49.42)] or severe hypernatremia [OR = 5.18, 95% CI (1.43-18.79)] is an independent risk factor for hospital mortality compared to mild hypernatremia. Admission from the emergency department (ED), oral intake restriction, mean arterial pressure (MAP) and respiratory rate (RR) at admission time are also independently associated with hospital mortality. Maximum sodium level in CAH is independently associated with hospital mortality.

악성 빈혈은 위점막의 위축 혹은 위벽세포의 자가면역성손상으로 내인자가 결핍되며 비타민 B12의 흡수 장애가 일어나 거대적혈모구빈혈이 발생한 것을 의미한다. 악성 빈혈의 치료는 비타민 B12 근육주사나 스테로이드의 투여이나, 저자들은 악성 빈혈로 진단된 후 특별한 치료 없이 자연적으로 호전된 악성 빈혈의 증례를 경험하였기에 이를 보고하는 바이다.

Background/aim Colorectal cancer (CRC) is one of the most common in the world and its prevalence is rapidly increasing. Jagged-1-activated Notch signaling by apurinic/apyrimidinic endodeoxyribonuclease 1 (APEX1) promotes CRC, and high expression of Jagged-1 is associated with poor prognosis. However, its clinical implication is unknown. The aim of this study was to investigate the clinical role of Jagged-1-activated Notch signaling by APEX1. Materials and methods The 5-dimethylthiazol-2-yl) 2, 5-diphenyltetrazolium bromide (MTT) assay was used to evaluate the anti-cancer efficacy of 5-fluorouracil (5-FU), oxaliplatin, and irinotecan. Tissue from CRC patients was analyzed to assess the clinical specificity of Jagged-1 activated by APEX1. Results The half-maximal inhibitory concentration (IC50) in cells co-expressing APEX1 and Jagged-1 cells was higher than that in cells expressing only APEX1. These results indicated that the simultaneous expression of APEX1 and Jagged-1 might be associated with chemoresistance toward 5-FU, oxaliplatin, and irinotecan. Analysis of tissue from CRC patients revealed that high expression of Jagged-1 was associated with a statistically significantly low response to chemotherapy. Conclusion Overexpression of Jagged-1 by APEX1 might serve as a predictor of response to chemotherapy and of poor prognosis, and moreover may be a therapeutic target for chemotherapy of advanced CRC.

Aims: Hepatic fibrosis results from chronic liver injury and inflammatory responses. Sestrin 2 (Sesn2), an evolutionarily conserved antioxidant enzyme, reduces the severities of acute hepa...

Background: It is expected that artificial intelligence (AI) will be used extensively in the medical field in the future. Objective: The purpose of this study is to investigate the awareness of AI among Korean doctors and to assess physicians’ attitudes toward the medical application of AI. Methods: We conducted an online survey composed of 11 closed-ended questions using Google Forms. The survey consisted of questions regarding the recognition of and attitudes toward AI, the development direction of AI in medicine, and the possible risks of using AI in the medical field. Results: A total of 669 participants completed the survey. Only 40 (5.9%) answered that they had good familiarity with AI. However, most participants considered AI useful in the medical field (558/669, 83.4% agreement). The advantage of using AI was seen as the ability to analyze vast amounts of high-quality, clinically relevant data in real time. Respondents agreed that the area of medicine in which AI would be most useful is disease diagnosis (558/669, 83.4% agreement). One possible problem cited by the participants was that AI would not be able to assist in unexpected situations owing to inadequate information (196/669, 29.3%). Less than half of the participants(294/669, 43.9%) agreed that AI is diagnostically superior to human doctors. Only 237 (35.4%) answered that they agreed that AI could replace them in their jobs. Conclusions: This study suggests that Korean doctors and medical students have favorable attitudes toward AI in the medical field. The majority of physicians surveyed believed that AI will not replace their roles in the future.

Purpose We report the case of a patient with IgG4-related disease with multiple organ involvement, especially myocardium, that was successfully treated with prednisone. Methods We performed several serological tests, electrocardiogram, echocardiography, computed tomography and inguinal lymph node biopsy. Results We diagnosed the patient with IgG4-related disease by the elevated serum IgG4 level and histological lymph node findings. Conclusions This is the first reported case of IgG4-related disease with dilated cardiomyopathy.

Multiple enchondromas are well described in the literature, however, the associated spectrum of MR imaging findings remains unclear. Secondary chondrosarcoma of the hand and feet associated with multiple enchondromas is extremely rare. Herein, we reported a case of multiple enchondromas of intramedullary, intracortical, and periosteal location with associated low-grade chondrosarcomas in the lower extremities on MR imaging in a 57-year-old woman.

Two major genetic mutations in non-small cell lung carcinomas (NSCLCs), epidermal growth factor receptor (EGFR) and KRAS, have been well studied. Since 2007 when Soda et al. [1] discovered rearrangements of anaplastic lymphoma kinase (ALK) in NSCLC, the ALK gene has received attention as being responsible for another molecular subtype of lung cancer, accounting for about 3% to 6% of NSCLCs [1,2]. It is important that the presence of ALK gene rearrangement can be an indication for targeted therapy, like EGFR-tyrosine kinase inhibitor (ex. gefitinib) as first-line therapy in patients with advanced pulmonary adenocarcinoma. Moreover, studies have shown that the ALK-targeted inhibitor ‘crizotinib’ produces a notable positive effect in patients harboring the EML4/ALK translocation [3]. For the most effective use of ALK inhibitor, an accurate method to detect ALK gene rearrangement should be performed. To date, fluorescence in situ hybridization (FISH) is the universally accepted standard method for detecting ALK rearrangement, with immunohistochemistry (IHC) used as a screening method for identifying ALK rearrangement [4,5]. However, there is a need for a more rapid method to detect ALK rearrangement due to the highly time-consuming nature of FISH. We encountered a patient who showed a dramatic response to crizotinib treatment before confirming ALK rearrangement by FISH based only IHC-positive results for ALK and suspicious histological findings from a biopsy. Therefore, we were curious whether the combination of IHC and suspicious histological findings can improve upon the shortcomings of FISH. Additionally, limited specimen obtained by biopsy is common and often results in lack of remaining tissue for ALK study after the two major mutation tests (EGFR and KRAS) for lung cancer. If the histologic finding is more suggestive of ALK mutation [6], priority can be given to the ALK mutation test because EGFR, KRAS, and ALK are known to be virtually mutually exclusive. Our study aimed to investigate the characteristic histologic features of ALK-positive pulmonary adenocarcinoma, in order to identify important histologic findings in small biopsied specimens whose architecture is difficult to assess and to evaluate whether the combination of these morphologic features and IHC results can overcome the shortcomings of FISH.

Background Proton pump inhibitor use is associated with incident chronic kidney disease, chronic kidney disease progression and end-stage renal disease. However, the extent of proton pump inhibitor prescriptions to chronic kidney disease patients is still unclear. Method In a retrospective study, we enrolled patients (>18 years old) who received proton pump inhibitor in the out-patient setting from 2014 through 2015. All data was obtained from electronical medical records of Soonchunhyang Medical Center. The prescription patterns and characteristics of proton pump inhibitors were analyzed according to individual estimated glomerular filtration rate of the patients. Result During the study period 178,228 patients visited the out-patient clinic. Proton pump inhibitors were prescribed to 9,109 (5.11%) patients. In our sample, 50% were females and 9.8% were chronic kidney disease (eGFR

Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive malignancy with a poor outcome that occurs in adolescents and young adults

Beta2-adrenergic receptor (&beta, 2AR) agonists can have protective effects targeting macrophage activation, but research on human subjects has not been done. This study was designed to assess the relationship between the use of &beta, 2AR agonists and diabetic vascular complications. Using data from the Korean National Health Insurance Service, adults first diagnosed with diabetes in 2004 (n = 249,222) were followed up until 31 December 2015. Propensity score matching was performed between case and control groups (n = 5179 in each), and multivariate analysis was conducted. The &beta, 2AR agonist group was divided into quartiles according to the duration of &beta, 2AR agonist use. During the follow-up, the incidence of vascular complications gradually decreased as the duration of &beta, 2AR agonist administration increased. Multivariate analysis revealed that the hazard ratio for all composite vascular complications was 0.80 (95% CI, 0.75&ndash, 0.86, p &lt, 0.001) in the longest quartile of &beta, 2AR agonist use as compared with the control group after adjusting for confounding variables. The association between the duration of &beta, 2AR agonist use and the risk of each vascular complication including cerebrovascular, peripheral vascular, peripheral neural, renal, and ophthalmic complications was consistent, and the risks were significantly lower in the longest users than the control group. Long-term use of &beta, 2AR agonists may exert a protective effect against diabetic vascular complications.

BACKGROUND Acute promyelocytic leukemia (APL) is an acute myeloid leukemia (AML) subtype with distinctive cell morphology, molecular presentation, clinical course, and treatment. About 90% of APL patients present with hemorrhagic complications due to disseminated intravascular coagulation (DIC). When APL is suspected, all-trans retinoic acid (ATRA) treatment is recommended even before confirmation by molecular tests. Specific criteria for differentiating unconfirmed APL from other AML subtypes with DIC are currently lacking. We aimed to achieve the early diagnosis of APL from other AML types with DIC by restricting the DIC criteria. METHODS We retrospectively analyzed 29 patients newly diagnosed with AML accompanied by DIC from January 2005 to January 2013. RESULTS Fibrin degradation products (FDP) (77.7 µg/mL vs. 23.7 µg/mL, p=0.026), D-dimer (7,376.2 ng/mL vs. 1,315.2 ng/mL, p=0.018), and TIBC (264.4 µg/dL vs. 206.8 µg/dL, P=0.046) were higher, while fibrinogen (133.8 mg/dL vs. 373.2 mg/dL, p

Background Mucormycosis is a rare and life-threatening invasive fungal infection. Pulmonary mucormycosis commonly occurs in patients with severe neutropenia. Typically, pulmonary mucormycosis causes tissue necrosis resulting from angioinvasion and subsequent thrombosis, so most cases can occur with necrotizing pneumonia and/or hemoptysis. Some complex cases may invade adjacent organs, such as the mediastinum, pericardium, and chest wall. However, to the best our knowledge there is little known regarding bronchoesophageal fistula due to pulmonary mucormycosis after induction chemotherapy for acute myeloid leukemia. We present a case report about this unusual presentation. Case presentation A 51-year-old Korean man was diagnosed as having acute myeloid leukemia and received induction chemotherapy. After prolonged severe neutropenia, he complained of coughing with aspiration. Imaging showed a bronchoesophageal fistula with extensive necrotizing pneumonia in the middle and lower lobes of his right lung. Bronchoscopy showed near total tissue necrosis in the middle lobe of his right lung, creating an orifice. A bronchial scope was passed through and was able to be connected with his esophagus; a bronchial wall biopsy was performed. Esophagoscopy revealed a large linear defect of his esophageal wall 30 cm from the incision that may have connected with the bronchus. A bronchial biopsy showed typical hyphae with necrotic tissue, indicating pulmonary mucormycosis. He was given amphotericin B, and a wide excision of lung and esophagus was planned. However, he suddenly died due to massive hemoptysis. Conclusion Here we present an extremely rare case of bronchoesophageal fistula with severe necrotizing pneumonia due to pulmonary mucormycosis.

Pseudomyxoma peritonei is a very rare condition, and even rarer in patients with history of cancer. A 70-year old woman with a history of breast cancer was admitted with abdominal pain and distention. Abdominal computed tomography revealed ascites collection, diffuse engorgement and infiltration of the mesenteric vessel, suggesting peritonitis or peritoneal carcinomatosis. Diagnostic paracentesis was attempted several times, but a sufficient specimen could not be collected due to the thick and gelatinous nature of the ascites. Therefore, the patient underwent diagnostic laparoscopy for tissue biopsy of the peritoneum, which indicated pseudomyxoma peritonei. However, the origin of the pseudomyxoma peritonei could not be identified intraoperatively due to adhesions and large amount of mucoceles. Systemic chemotherapy was performed using Fluorouracil, producing some symptomatic relief. After discharge, abdominal pain and distention gradually worsened, so at 18 months after initial diagnosis the patient received palliative surgery based on massive mucinous ascites and palpable mass at the omentum. The patient expired after surgery due to massive bleeding. (Korean J Gastroenterol 2016;67:153-157)

Tenofovir disoproxil fumarate (TDF) is widely used to treat patients with hepatitis B virus (HBV) infection. We investigated the effect of TDF on renal insufficiency in patients with chronic hepatitis B (CHB). A consecutive cohort analysis was applied to CHB patients taking prescribed TDF from January 2012 to May 2016 at Soonchunhyang University Seoul Hospital. Alterations over time in corrected calcium, phosphate, creatinine, and estimated glomerular filtration rate (eGFR) were analyzed using the generalized estimating equation method. The percentage increase in creatinine from baseline to the maximum creatinine level (delta creatinine) was compared according to the underlying disease using the Mann–Whitney U test. Cox proportional hazard regression model was used to determine risk factors associated with renal insufficiency. The baseline creatinine, eGFR, corrected calcium, and phosphate levels were 0.72 ± 0.01 mg/dL (mean ± SD), 106.37 ± 1.06 mL/min/1.73 m2, 8.82 ± 0.04 mg/dL, and 3.42 ± 0.05 mg/dL, respectively. The creatinine level had increased significantly at 12, 24, 48, 72, and 96 weeks, while the eGFR level had decreased significantly at these 5 time points. Multivariate analysis confirmed that age ≥60 years and the baseline bilirubin level were independently associated with the risk of renal insufficiency. Delta creatinine was significantly higher in patients with diabetes mellitus (DM) than in patients without DM. Renal function was decreased from baseline in CHB patients receiving TDF therapy, which indicates that the renal function of patients undergoing treatment with TDF should be monitored regularly. Old age, DM, and serum bilirubin were risk factors for the development of renal insufficiency in CHB patients receiving TDF therapy.

Blue-white reflective cholesteric liquid crystal display was prepared by a unique method of single liquid crystal layer, the combination of yellow color liquid crystal and blue color backplane. The dopant and host combination of chlolesteric liquid crystal affects the color spectrum. The CIE chromaticity coordinates of blue and white are (0.10, 0.16) and (0.29, 0.30), respectively. The relatively low driving voltages of 32 V for blue-white display are obtained.

We have improved the electro‐optical properties of a bistable cholesteric liquid crystal display (Ch‐LCD) that is driven by a 3+2 dynamic driving scheme (3+2 DDS). The best contrast ratio is achieved at the selection period of 1.2–1.5 ms/line and the temperature range 26–30°C. The suitable preparation period and evolution period for contrast ratio are 40 times and 20 times the selection time, respectively. In the 3+2 DDS, rubbing the homeotropic alignment layer increases reflectivity of the ON state and keeps the reflectivity of the OFF state at the same level, so reflectivity and contrast ratio alike increase as a result. However, in a delayed homeotropic reset driving method, when the homeotropic alignment layer is rubbed, the reflectivity of both the ON and OFF states increases, thus the contrast ratio decreases. The combination of driving method and aligned surface morphology influences the relaxation mechanism in the cholesteric texture. By optimizing panel condition, we have demonstrated an 8.4″ fol...

Breast carcinomas are an uncommon neoplastic condition in men, accounting for only 1% of all breast cancers, and less than 1% of all malignancies in men. A 70-year-old man who presented a right breast mass was found to have infiltrating ductal carcinoma. We herein report the case with a review of the literature.

A 59-year-old man underwent abdominal CT for evaluation of weight loss and generalized weakness. A large mass protruding from the lesser curvature of the stomach suggestive of gastrointestinal stromal tumor was demonstrated. F-FDG PET/CT showed hypermetabolic activity in the gastric mass. Mass excision and wedge resection were performed, and the diagnosis of inflammatory myofibroblastic tumor was confirmed.

BACKGROUND Human papillomavirus (HPV) prophylactic vaccines, bivalent types for HPV-16/18 with 70% prophylactic expectation, have been developed based on the genotypes found prevalent in the western countries, but little is known for those in Korea. Using a DNA chip test, we evaluated the clinical efficacy of HPV genotype based on cervical abnormalities. METHODS As the initial diagnostic tests, HPV DNA chip tests and Papanicolaou smear (PAP) were used for 1,211 subjects. Cervical colposcopy directed biopsies were performed for 626 among the 1,211 subjects within one month. RESULTS The most frequently found genotypes in all HPV-positive specimens (n=445) were HPV-16 (22.0%), 58 (13.9%), 52 (11.0%), 51 (9.0%), 56 (8.5%), and 18 (7.2%). HPV prevalence was significantly higher in specimens where PAP and biopsy results were closer to malignancy. The HPV genotype distribution of the histologically confirmed cervical high-grade squamous intraepithelial lesions (HSIL) or carcinoma cases showed HPV-16, 58, 52, 18, and 33, in descending order. The HPV DNA chip sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the detection of cervical HSIL or carcinoma were 76.9%, 70.1%, 72.1%, and 75.8%, respectively, Of these, the sensitivity and NPV were higher than those of PAP. PPV and NPV of HPV-16 were 90.5% and 60.7%, respectively, being the highest among the genotypes. CONCLUSIONS We confirmed that HPV-16 genotype was also very important for the diagnosis of HSIL and cervical carcinoma in Korea. However, contrary to the findings in the western countries, the prevalence of HPV-58 was higher than that of HPV-18. Moreover, as the other HPV genotype reports were rare in Korea, further studies are required with the HPV DNA chip test before the nationwide adoption of the vaccines.

We have experienced three cases of extramammary Paget's disease (EMPD) of the vulva that received radiation therapy (RT). Here, we analyze the efficacy of RT and include a literature survey. Three patients with EMPD of the vulva were treated with curative RT between 1993 and 1998. One of the patients had associated underlying adenocarcinoma of the vulva. The total doses of radiation administered were 54~78 Gy/6~8 weeks. Radiation fields encompassed 2 to 3 cm outer margins free from all visible disease including or not including the inguinal area using a 9 MeV electron or a 6 MV photon beam. Follow-up durations after radiotherapy were 0.6~11 years. Complete response was obtained in all three patients. Marginal failure occurred in one patient, and another patient with underlying adenocarcinoma treated by vulvectomy with bilateral inguinal lymph node dissection followed by external RT showed no relapse. Radiation induced side effects were transient acute confluent wet desquamation in the treated area resulting in mild late atrophic skin changes. Although surgery is currently considered the preferred primary treatment for EMPD, it has a high relapse rate due to the multifocal nature of the disease. We conclude that RT is of benefit in some selected cases of EMPD.

Castleman's disease (CD) is a rare lymphoproliferative disorder of unknown etiology. Clinically, it occurs as a localized (unicentric) disease or as a systemic (multicentric) disease. Unicentric Castleman's disease (UCD) presents as a solitary mass and primarily affects the mediastinal, retroperitoneal, and cervical lymph nodes. In contrast to multicentric CD, which involves peripheral lymphadenopathy and numerous systemic symptoms, UCD is not typically associated with generalized symptoms. Three main distinct histologic variants are recognized: hyaline-vascular type, plasma cell type, and mixed type. Extranodal CD is rare. Specifically, UCD exclusively in the spleen is extremely rare, with only 2 cases described in the literature to date. Here, we describe an asymptomatic 75-year-old man with a 5.7 cm × 4.5 cm sized heterogenous enhanced mass located in the spleen. He underwent surgical resection for diagnosis and treatment. A pathologic examination indicated the hyaline-vascular type of CD. In this patient, the preoperative diagnosis was difficult to determine, and therefore, invasive procedures were required.

A 46-year-old male arrived at the emergency department with acute dyspnea. On the way to the hospital, heart massage was performed in the ambulance due to asystole on electrocardiography. After 2 hr of resuscitation, sinus rhythm was restored. Extracorporeal life support and an intra-aortic balloon pump were applied due to cardiogenic shock, but the patient showed sustained hypotension. Echocardiography showed moderate pericardial effusion with physiological evidence of cardiac tamponade; emergency pericardiocentesis was performed, which produced bloody pericardial fluid. An explorative sternotomy revealed a massive hematoma in the mediastinum and right ventricular (RV) free wall rupture. After primary repair, echocardiography showed improved left ventricular systolic function and the patient was stable clinically. This case presents RV free wall rupture as an unusual complication of prolonged heart massage. Heart rupture should be considered in hemodynamically unstable patients after prolonged heart massage. (Korean J Med 2015;88:434-437)

Background/Aims: Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication. Methods: Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories. Results: Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant differ ence between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023). Conclusions: Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.

Background/Aims: For many years, conventional treatment for multiple myeloma (MM) not ineligible for high-dose therapy has been the combination of oral melphalan and prednisone (MP). However, melphalan-based regimens are associated with numerous complications. Another alkylating agent, cyclophosphamide, has similar effects on MM and is associated with fewer reports of complications. Therefore, cyclophosphamide-based regimens have usually been used as salvage therapy in patients with refractory or relapsed MM, despite the development of newer drugs. The purpose of this report was to evaluate the efficacy and tolerability of cyclophosphamide and prednisone as a first-line therapy for MM. Methods: For the period January 2002 to June 2012, we retrospectively analyzed 29 patients newly diagnosed with MM who underwent a treatment regimen consisting of intravenous cyclophosphamide (1,000 mg/kg) for 1 day and prednisone (100 mg) for 4 days. Results: The rate of response to this regimen was 31.1 percent. The median progression-free survival (PFS) was 5.5 months and the median overall survival (OS) was 47.3 months. The regimen was well tolerated. Adverse effects of grades above III were as follows: anemia in seven patients (24.1%), neutropenia in five patients (17.2%), and thrombocytopenia in two patients (6.8%). These adverse effects were easily adjusted. No one developed a secondary malignancy or hemorrhagic cystitis. Conclusions: Although PFS was less than for the MP regimen, median OS was better than for the MP regimen. Furthermore, the cyclophosphamide-prednisone regimen was well tolerated, and the adverse effects that did occur were easily adjusted. The cyclophosphamide-prednisone combination regimen may represent an effective and well tolerated first-line therapy for non-transplant candidates with MM. (Korean J Med 2013;84:690-697)

Cytomegalovirus (CMV) infection is associated with an exacerbations of systemic lupus erythematosus (SLE), but the role of CMV in disease pathogenesis remains unclear. CMV infection is often severe and difficult to diagnose in patients with SLE. Only a few cases of opportunistic CMV interstitial pneumonitis infection occurring in patients with SLE after intensive immunosuppressive therapy have been described. We report a case of CMV infection presenting with massive pericarditis and aggravating lupus nephritis

The design of an express service network is determined by considering the amount of initial investments and operating costs for terminals and service centres within the network. However, continuous modifications of network design are required to adjust to rapidly changing business environments. This study suggests an approach to the reconfiguration of an express courier service network with respect to assignments of service centres to consolidation terminals, adjustments of their cutoff times, and extensions of terminal capacities. We propose an integer programming model and a genetic algorithm based solution procedure for allowing express couriers to maximise their incremental profit. An illustrative numerical example with reduced data sets from an express courier in Korea is presented to demonstrate the practicality and efficiency of the proposed model and its solution procedure.

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic tumor (GTT) that has different behavior in disease process. The hysterectomy is general for PSTT, but hysterectomy is undesirable for patients who wish to remain fertile. We planned to preserve fertility of a young patient by first administering EMA/CO (Etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) chemotherapy and then performing an open uterine surgery to remove residual tumor. The patient who attempted primary chemotherapy for PSTT must be undergone a hysterectomy because this conservative regimen showed sign of chemoresistance. We report a case of chemoresistant PSTT with trial to preserve fertility with a brief review of literatures.

Purpose: To demonstrate the mammographic and sonographic appearances of metaplastic carcinoma of the breast. Materials and Methods: The mammographic and sonographic findings in eight female patients (aged: 28-78years, mean: 50.3 years) with pathologically proven metaplastic cancer were analyzed retrospectively by three radiologists. We analyzed the size, density, shape, margin, associated architectural distortion, calcification in the mass and enlarged lymph node at the axilla, on the mammograms. We also analyzed the shape, margin and echogenicity of the lesions on the sonograms. Results: On mammography, irregular (n=4), lobular (n=2) or oval (n=2) shaped high density masses were found. The margins of the masses were indistinct (n=4) or obscured (n=3). There were architectural distortions in three cases and pleomorphic calcifications in two cases. On sonography, irregular (n=5) or oval (n=3) shaped masses with microlobulated margins were found. The echopatterns of the masses were complex (n=5) or hypoechoic (n=3). Conclusion: The mammographic and sonographic findings of metaplastic carcinoma of the breast are nonspecific and similar to those of other forms of breast cancer. However, this type of tumor should be included in the differential diagnosis for breast masses which appear as an irregular or oval shape with a microlobulated margin and a complex or hypoechoic echopattern on sonography.