500 research outputs found

    The Morphologic Assessment of Rectal Neuroendocrine Tumors

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    AbstractBackground and aimsThe histopathologic features of rectal neuroendocrine tumors (NETs), including size, lymphovascular invasion, invasion of proper muscle, and mitotic rate, have a limited role to play in determining a treatment plan preoperatively. We aimed to investigate the morphologic parameters associated with metastasis, and to evaluate their predictive value.MethodsBetween January 2000 and May 2011, the medical records and endoscopic findings of 468 patients presenting with rectal NETs at the Samsung Medical Center were analyzed retrospectively. All tumors were classified according to size and endoscopic features such as color, shape, contour, and surface change.ResultsTwenty-one of the 468 patients (4.5%) with rectal NETs had lymph node (LN) metastasis and 11 patients (2.4%) had distant metastasis. Risk factors for metastasis included tumor size (≥10mm in diameter), hyperemic change, polypoid lesions, irregular contours, and surface ulceration (p=0.000). Independent risk factors that were predictive of metastasis on multivariate analysis included tumor size (≥10mm in diameter), hyperemic change, and surface ulceration. As the number of independent risk factors for metastasis increased, the risk of metastasis rose.ConclusionsEndoscopic features such as hyperemic change, polypoid lesions, irregular contours, and surface ulcers with tumor size ≥10mm in diameter are associated with metastasis in rectal NETs. In particular, atypical endoscopic features including hyperemic change, and surface ulcer with tumor size ≥10mm in diameter may help to predict the risk of metastasis of rectal NETs

    Psychotic Features as the First Manifestation of 22q11.2 Deletion Syndrome

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    The 22q11.2 deletion is a genetic disorder which is characterized by abnormalities in cardiac functioning, facial structure, neurobehavioral development, T cell functioning, and velopharyngeal insufficiencies. In the presented case study, 22q11.2 deletion was found in a patient who has psychotic symptoms only. A 25-year-old woman with a history of hypoparathyroidism and hypothyroidism presented with auditory hallucinations and persecutory delusions. After three months of treatment with antipsychotic medications, the patient was readmitted with generalized tonic-clonic seizures. The following week, the patient went into sepsis. A fluorescent in situ hybridization (FISH) analysis revealed the presence of a 22q11.2 microdeletion. This case study suggests that psychotic symptoms can develop prior to the typical symptoms of a 22q11.2 deletion. As such, psychiatrists should test for genetic abnormalities in patients with schizophrenia when these patients present with seizures and immunodeficiencies

    pneumonia in pediatric patients: an analysis of 15 confirmed consecutive cases during 14 years

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    PurposePneumocystis jirovecii pneumonia occurs in various immunocompromised patients. Despite the prophylaxis strategies in clinical practice, certain patients develop P. jirovecii pneumonia. This study was performed to investigate pediatric cases with P. jirovecii pneumonia in a single center.MethodsWe identified pediatric patients younger than 19 years with microbiologically confirmed P. jirovecii pneumonia from January 2000 to February 2014. A retrospective chart review was performed.ResultsFifteen episodes of P. jirovecii pneumonia in 14 patients were identified with median age of 8.3 years (range, 0.4–18.6 years). Among these patients, 11 patients had hematology-oncology diseases, 2 had primary immunodeficiency disorders (one with severe combined immunodeficiency and the other with Wiskott Aldrich syndrome), 1 had systemic lupus erythematosus and 1 received kidney transplant. Four patients were transplant recipients; 1 allogeneic and 2 autologous hematopoietic cell transplant and 1 with kidney transplant. The median absolute lymphocyte count at the diagnosis of P. jirovecii pneumonia was 5,156 cells/mm3 (range, 20–5,111 cells/mm3). In 13 episodes (13 of 15, 86.7%), patients were not receiving prophylaxis at the onset of P. jirovecii pneumonia. For treatment, trimethoprim/sulfamethoxazole was given as a main therapeutic agent in all 15 episodes. Steroid was given in 9 episodes (60%). Median treatment duration was 15 days (range, 4–33 days). Overall mortality at 60 days was 35.7% (5 of 14).ConclusionMajority of our patients developed P. jirovecii pneumonia while not on prophylaxis. Continuous efforts and more data are needed to identify high risk patients who may get benefit from P. jirovecii pneumonia prophylaxis

    Relationship between Physical activity and Cardiovascular Outcomes in the Korean Elderly: Review of Experimental Studies

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    PURPOSE: The purpose of this study was to review the relationship between physical activity and cardiovascular outcomes in the Korean elderly. METHODS: Experimental studies were located using PubMed, CINAHL, PsycINFO, Cochrane, RISS, KISS, and KoreaMed. The selected studies for analysis were 20 articles of cardiovascular outcomes (total cholesterol, triglyceride, high density lipoprotein (HDL), low density lipoprotein (LDL), blood pressure, and pulse rate) from 515 articles. RESULTS: One-group pretest-posttest design was the most common. The main physical activity was an aerobic exercise. Five of 14 studies reported a significant improvement of total cholesterol. Four of 14 studies found relationship between exercise and triglyceride. Eight of 12 studies reported a significant improvement of HDL, whereas 3 of 9 studies reported a significant improvement of LDL. In over 60% of selected studies, reported significant improvement of blood pressure. CONCLUSION: Based on the review, it suggests that regular physical activity of the elderly may improve cardiovascular outcomes

    Etiology and clinical characteristics of fever of unknown origin in children: a 15-year experience in a single center

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    PurposeFever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories.MethodsAmong the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ≥38.0℃ for longer than ≥14 days and failure to reach a diagnosis after one week of investigations were included.ResultsTotal 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%).ConclusionAlmost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases

    Infectious pneumonia in immunocompetent patients: updates in clinical and imaging features

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    Morphologically pneumonia is usually classified into lobar pneumonia, bronchopneumonia, and interstitial pneumonia. Chronic pneumonia is also a kind of pneumonia in immunocompetent and mildly immunocompromised patients. Specific organisms may be involved in community-acquired pneumonia (CAP) according to patients’ age or underlying conditions. The organisms involved in CAP are different from those in hospital-acquired pneumonia. Mixed pneumonia includes septic pneumonia, lung abscess, and focal organizing pneumonia. The role of imaging in pneumonia includes the detection or exclusion of the presence of pneumonia, narrowing down of differential diagnosis of the pneumonia from other lung conditions, planning of further diagnostic procedure, and the assessment of treatment response with follow-up studies. New drugs for pneumonia are expected to open a door widely for antibiotic treatment for various pneumonias

    Impaired pattern separation in Tg2576 mice is associated with hyperexcitable dentate gyrus caused by Kv4.1 downregulation

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    Alzheimers disease (AD) is a progressive neurodegenerative disorder that causes memory loss. Most AD researches have focused on neurodegeneration mechanisms. Considering that neurodegenerative changes are not reversible, understanding early functional changes before neurodegeneration is critical to develop new strategies for early detection and treatment of AD. We found that Tg2576 mice exhibited impaired pattern separation at the early preclinical stage. Based on previous studies suggesting a critical role of dentate gyrus (DG) in pattern separation, we investigated functional changes in DG of Tg2576 mice. We found that granule cells in DG (DG-GCs) in Tg2576 mice showed increased action potential firing in response to long depolarizations and reduced 4-AP sensitive K+-currents compared to DG-GCs in wild-type (WT) mice. Among Kv4 family channels, Kv4.1 mRNA expression in DG was significantly lower in Tg2576 mice. We confirmed that Kv4.1 protein expression was reduced in Tg2576, and this reduction was restored by antioxidant treatment. Hyperexcitable DG and impaired pattern separation in Tg2576 mice were also recovered by antioxidant treatment. These results highlight the hyperexcitability of DG-GCs as a pathophysiologic mechanism underlying early cognitive deficits in AD and Kv4.1 as a new target for AD pathogenesis in relation to increased oxidative stress.This research was supported by the Korean Ministry of Science and ICT (NRF2017R1A2B2010186 and NRF-2020R1A2B5B02002070 to WH)

    Three-way Translocation of MLL/MLLT3, t(1;9;11)(p34.2;p22;q23), in a Pediatric Case of Acute Myeloid Leukemia

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    The chromosome band 11q23 is a common target region of chromosomal translocation in different types of leukemia, including infantile leukemia and therapy-related leukemia. The target gene at 11q23, MLL, is disrupted by the translocation and becomes fused to various translocation partners. We report a case of AML with a rare 3-way translocation involving chromosomes 1, 9, and 11: t(1;9;11)(p34.2;p22;q23). A 3-yr-old Korean girl presented with a 5-day history of fever. A diagnosis of AML was made on the basis of the morphological evaluation and immunophenotyping of bone marrow specimens. Flow cytometric immunophenotyping showed blasts positive for myeloid lineage markers and aberrant CD19 expression. Karyotypic analysis showed 46,XX,t(1;9;11)(p34.2;p22;q23) in 19 of the 20 cells analyzed. This abnormality was involved in MLL/MLLT3 rearrangement, which was confirmed by qualitative multiplex reverse transcription-PCR and interphase FISH. She achieved morphological and cytogenetic remission after 1 month of chemotherapy and remained event-free for 6 months. Four cases of t(1;9;11)(v;p22;q23) have been reported previously in a series that included cases with other 11q23 abnormalities, making it difficult to determine the distinctive clinical features associated with this abnormality. To our knowledge, this is the first description of t(1;9;11) with clinical and laboratory data, including the data for the involved genes, MLL/MLLT3
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