Clinical Manifestations of Recurrent Parotid Pleomorphic Adenoma

Objectives. This study was undertaken to confirm the clinical characteristics of recurrent pleomorphic adenoma (RPA), and to identify those factors that affect the development of malignant transformation (MT) from RPA. Methods. The medical records of 270 patients, who were operated upon for parotid PA, were retrospectively reviewed. The pathologic specimens of a selected series of 23 patients were reviewed for histologic subtype and microscopic multi-nodularity. Results. Mean age of initial operation in RPA without MT (RPA(-MT)) group was significantly lower than that of primary PA group. Mean age of the revision operation in RPA with MT (RPA(+MT)) group was significantly greater than that of RPA(-MT) group. Mean interval from operation to recurrence shortened after each revision operation. The risk of MT and additional recurrence increased significantly with recurrence. In RPA(-MT) group tumor recurrence occurred in 21.4% of patients despite a clear resection margin. Conclusion. The risk factors for MT may be an age of over 45 yr and multiple recurrences. However, younger patients are more at risk of recurrence. A clear resection margin cannot guarantee a cure in RPA, and it seems that parotid pleomorphic adenomas slowly gain malignant characteristics after repeated recurrences.SUH MW, 2005, KOREAN J HEAD NECK O, V21, P146HANNA EY, 2005, CUMMINGS OTOLARYNGOL, P1348Ghosh S, 2003, CLIN OTOLARYNGOL, V28, P262Glas AS, 2002, CANCER, V94, P2211, DOI 10.1002/cncr.10445Glas AS, 2001, HEAD NECK-J SCI SPEC, V23, P311BRADLEY PJ, 2001, CURR OPIN OTOLARYNGO, V9, P100Carew JF, 1999, OTOLARYNG HEAD NECK, V121, P539Junquera L, 1999, HEAD NECK-J SCI SPEC, V21, P652Hancock BD, 1999, ANN ROY COLL SURG, V81, P299Bankamp DG, 1999, LARYNGO RHINO OTOL, V78, P77Hoorweg JJ, 1998, EUR J SURG ONCOL, V24, P452Henriksson G, 1998, CANCER, V82, P617Laskawi R, 1998, BRIT J ORAL MAX SURG, V36, P48Klijanienko J, 1997, HEAD NECK-J SCI SPEC, V19, P629Leverstein H, 1997, EUR ARCH OTO-RHINO-L, V254, P313SunardhiWidyaputra S, 1995, PATHOL RES PRACT, V191, P1186PHILLIPS PP, 1995, ANN OTO RHINOL LARYN, V104, P100BUCHMAN C, 1994, LARYNGOSCOPE, V104, P1231NATVIG K, 1994, HEAD NECK-J SCI SPEC, V16, P213JACKSON SR, 1993, J LARYNGOL OTOL, V107, P546MCGREGOR AD, 1988, BRIT J PLAST SURG, V41, P177FEE WE, 1978, LARYNGOSCOPE, V88, P265SEIFERT G, 1976, HNO, V24, P415NAEIM F, 1976, ARCH PATHOL LAB MED, V100, P271FRAZELL EL, 1954, CANCER, V7, P637

Monitoring Coastal Chlorophyll-a Concentrations in Coastal Areas Using Machine Learning Models

Harmful algal blooms have negatively affected the aquaculture industry and aquatic ecosystems globally. Remote sensing using satellite sensor systems has been applied on large spatial scales with high temporal resolutions for effective monitoring of harmful algal blooms in coastal waters. However, oceanic color satellites have limitations, such as low spatial resolution of sensor systems and the optical complexity of coastal waters. In this study, bands 1 to 4, obtained from Landsat-8 Operational Land Imager satellite images, were used to evaluate the performance of empirical ocean chlorophyll algorithms using machine learning techniques. Artificial neural network and support vector machine techniques were used to develop an optimal chlorophyll-a model. Four-band, four-band-ratio, and mixed reflectance datasets were tested to select the appropriate input dataset for estimating chlorophyll-a concentration using the two machine learning models. While the ocean chlorophyll algorithm application on Landsat-8 Operational Land Imager showed relatively low performance, the machine learning methods showed improved performance during both the training and validation steps. The artificial neural network and support vector machine demonstrated a similar level of prediction accuracy. Overall, the support vector machine showed slightly superior performance to that of the artificial neural network during the validation step. This study provides practical information about effective monitoring systems for coastal algal blooms

In-stent restenosis-prone coronary plaque composition: A retrospective virtual histology-intravascular ultrasound study

  Background: The mechanism of in-stent restenosis (ISR) is multifactorial, which includes biological, mechanical and technical factors. This study hypothesized that increased inflammatory reaction, which is known to be an important atherosclerotic process, at a culprit lesion may lead to higher restenosis rates. Methods: The study population consisted of 241 patients who had undergone percutaneous coronary intervention with virtual histology-intravascular ultrasound (VH-IVUS) and a 9-month follow-up coronary angiography. Compared herein is the coronary plaque composition between patients with ISR and those without ISR. Results: Patients with ISR (n = 27) were likely to be older (66.2 ± 9.5 years vs. 58.7 ± 11.7 years, p = 0.002) and have higher levels of high-sensitivity C-reactive protein (hs-CRP, 1.60 ± 3.59 mg/dL vs. 0.31 ± 0.76 mg/dL, p < 0.001) than those without ISR (n = 214). VH-IVUS examination showed that percent necrotic core volume (14.3 ± 8.7% vs. 19.5 ± 9.1%, p = 0.005) was higher in those without ISR than those with ISR. Multivariate analysis revealed that hs-CRP (odds ratio [OR] 3.334, 95% con­fidence interval [CI] 1.158–9.596, p = 0.026) and age (OR 3.557, 95% CI 1.242–10.192, p = 0.018) were associated with ISR. Conclusions: This study suggests that ISR is not associated with baseline coronary plaque composition but is associated with old age and increased expression of the inflammatory marker of hs-CRP. (Cardiol J 2018; 25, 1: 7–13

Development of a clinical scoring system for appendicitis in children with presumed appendicitis

Purpose To develop a clinical scoring system for children with presumed appendicitis who visit the emergency department. Methods A registry based-retrospective study was conducted in the pediatric emergency department between September 2015 and December 2016. Patients aged 4 to 17 years who had a > 1 of 5 Likert scale for possibility of appendicitis were included. Multiple logistic regressions based on Akaike information criterion were performed using variables regarding clinical features and inflammatory markers to develop the clinical scoring system. Results A total of 233 patients were included, and 93 (39.9%) had the final diagnosis of appendicitis. The final model with the lowest Akaike information criterion (171.7) consisted of 5 variables, including vomiting (1 point), absence of watery diarrhea (1 point), duration of symptoms ≤ 3 days (1 point), rebound tenderness (1 point), and white blood cell count > 10.0 × 109/L (2 points). If the clinical score was ≥ 4 of 6 points, the area under the receiver operating characteristic curve was 0.78 (95% confidence interval, 0.71-0.86) with a 78.9% sensitivity, 66.7% specificity, positive and negative predictive values of 70.0% and 76.2%, respectively, and positive and negative likelihood ratios of 2.4 and 0.3, respectively. Conclusion The 5-item clinical scoring system shows a fair performance for prediction of pediatric appendicitis. This simple tool could be applied to predict the pediatric appendicitis, and to avoid the use of potentially unnecessary computed tomography

Strongyloidiasis Presenting as Yellowish Nodules in Colonoscopy of an Immunocompetent Patient

Strongyloides stercoralis is endemic to tropical and subtropical regions, and infections are usually asymptomatic. However, immunocompromised patients, such as those receiving immunosuppressive therapy, high-dose steroids, or chemotherapy, can develop fatal hyperinfections. An 84-year-old man without any symptoms was diagnosed with strongyloidiasis during a regular screening colonoscopy. His medical history only involved a gastric endoscopic submucosal dissection for early gastric cancer 6 months previously. Few cases have been published about asymptomatic strongyloidiasis diagnosed in an immunocompetent host via endoscopic mucosal resection with characteristic colonoscopic findings. We report a case of colon-involved asymptomatic strongyloidiasis with specific colonic findings of yellowish-white nodules. This finding may be an important marker of S. stercoralis infection, which could prevent hyperinfections

The difference of Use of CT in the general versus pediatric emergency departments for adolescent patients in the same tertiary hospital

Objective The use of computed tomography (CT) in pediatric patients has decreased since the association between radiation and cancer risk has been reported. However, in adolescent patients being treated as adult patients, there has been a high incidence of CT use in emergency departments (EDs). Thus, this study aimed to evaluate the CT use in adolescent patients with complaints of headache or abdominal pain in the general and pediatric EDs of the same hospital. Methods A retrospective chart review of patients aged 15 to 18 years, who presented with headache or abdominal pain at the general and pediatric EDs of Seoul National University Hospital from January 2010 to December 2014, was conducted. Results A total of 407 adolescent patients with complaints of headache and 980 with abdominal pain were included in this study. The adolescent patients in the general ED were more likely to undergo CT scans than those in the pediatric ED, with both patients having headache (42.4% vs. 20.5%, respectively, P<0.001) and abdominal pain (29.0% vs. 18.4%, respectively, P<0.001). There was no statistical difference in the rates of positive CT findings between the general and pediatric EDs. The frequency of visits to the general ED was associated with high rates of CT use in adolescent patients with complaints of headache (odds ratio, 3.95; 95% confidence interval, 2.01 to 7.77) and those with abdominal pain (odds ratio, 1.76; 95% confidence interval, 1.18 to 2.64). Conclusion The ED setting influences the use of CT on adolescent patients, and a child-friendly environment could reduce the radiation risks

Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors

Background/AimsRectal neuroendocrine tumors (NETs) are among the most common of gastrointestinal NETs. Due to recent advances in endoscopy, various methods of complete endoscopic resection have been introduced for small (≤10 mm) rectal NETs. However, there is a debate about the optimal treatment for rectal NETs. In our study, we aimed to evaluate the efficacy and feasibility of endoscopic resection using pneumoband and elastic band (ER-BL) for rectal NETs smaller than 10 mm in diameter.MethodsA total of 55 patients who were diagnosed with rectal NET from January 2004 to December 2011 at Gil Medical Center were analyzed retrospectively. Sixteen patients underwent ER-BL. For comparison, 39 patients underwent conventional endoscopic mucosal resection (EMR).ResultsThere was a markedly lower deep margin positive rate for ER-BL than for conventional EMR (6% [1/16] vs. 46% [18/39], P=0.029). Four patients who underwent conventional EMR experienced perforation or bleeding. However, they recovered within a few days. On the other hand, patients whounderwent endoscopic resection using a pneumoband did not experience any complications. In multivariate analysis, ER-BL (P=0.021) was independently associated with complete resection.ConclusionsER-BL is an effective endoscopic treatment with regards to deep margin resection for rectal NET smaller than 10 mm

A Case of Hemolytic Uremic Syndrome Caused by Escherichia coli O104:H4

A 29-year-old woman presented with bloody diarrhea, abdominal pain, hemolytic anemia, thrombocytopenia, and acute renal failure. She was diagnosed with Escherichia coli O104:H4-associated hemolytic-uremic syndrome (HUS) and treated with plasmapheresis and hemodialysis for 3 weeks. She recovered without sequelae. To the best of our knowledge, this is the first report of Escherichia coli O104:H4-associated HUS in Korea. We recommend that Escherichia coli O104:H4, as well as the more common O157:H7, be considered in the diagnosis of bloody diarrhea-associated HUS