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Purpose@#The aim of this study was to determine the accuracy of 3-dimensional (3D) pelvic floor ultrasonography and compare it with defecography in assessment of posterior pelvic disorders. @*Methods@#Eligible patients were consecutive women undergoing 3D pelvic floor ultrasonography at one hospital between August 2017 and February 2019. All 3D pelvic floor ultrasonography was performed by one examiner. A total of 167 patients with suspected posterior pelvic disorder was retrospectively enrolled in the study. The patients were divided into 3 groups according to the main symptoms. @*Results@#There were 82 rectoceles on defecography (55 barium trapping) and 84 on 3D pelvic floor ultrasonography. Each modality identified 6 enteroceles. There were 43 patients with pelvic floor dyssynergia on defecography and 41 on ultrasonography. There were 84 patients with intussusception on defecography and 41 on 3D pelvic floor ultrasonography.Agreement of the 2 diagnostic tests was confirmed using Cohen’s kappa value. Rectocele (kappa, 0.784) and enterocele (kappa, 0.654) both indicated good agreement between defecography and 3D pelvic floor ultrasonography. In addition, pelvic floor dyssynergia (kappa, 0.406) showed moderate agreement, while internal intussusception (kappa, 0.296) had fair agreement. @*Conclusion@#This study showed good agreement for detection of posterior pelvic disorders between defecography and 3D pelvic floor ultrasonography.
ABSTRACT
PURPOSE@#To investigate the correlation of the strain elasticity of breast cancer with histologic features, immunohistochemical markers and molecular subtypes that are known to be factors related to prognosis.@*MATERIALS AND METHODS@#B-mode ultrasound and strain elastography were performed in 123 patients (mean age, 53.4; range, 28–82) with invasive ductal carcinoma (IDC) (mean size, 1.54 cm; range, 0.4–7.0 cm). Histologic grade, lymph node (LN) status, lymphovascular invasion, immunohistochemical biomarkers [estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2), CK5/6, epidermal growth factor receptor, and Ki-67] and molecular subtypes were determined from surgical pathology reports. The relationships between these factors and elasticity scores were evaluated.@*RESULTS@#LN involvement was associated with a higher elasticity score which was statistically significant (p = 0.042). The tumor size, lymphovascular invasion, histologic grades, immunohistochemical markers and molecular subtypes had no significant correlation with the elasticity score (p > 0.05 for all). However, the IDCs with larger size and a positive lymphovascular invasion tended to have higher elasticity scores. Furthermore, higher histologic grade cancers and the HER2 overexpression-type tended to have lower elasticity scores.@*CONCLUSION@#The elasticity score of IDC had a significant correlation with LN involvement but no statistically significant correlation with the histologic features, immunohistochemical markers or molecular subtypes.
ABSTRACT
Pancreatic panniculitis is a rare complication characterized by subcutaneous fat necrosis associated with pancreatic disease. It has been postulated that pancreatic panniculitis is caused by the systemic activity of pancreatic enzymes that lead to microcirculatory disturbances. We report a 41-year-old heavy alcoholic woman with pancreatic panniculitis that coexisted with acute and chronic pancreatitis. She was diagnosed with chronic pancreatitis and alcoholic liver cirrhosis 5 years ago. She presented with multiple, tender, erythematous, subcutaneous nodules with heat sensation on both lower legs. Laboratory evaluation revealed an increase in the serum blood amylase and lipase. Histopathologic findings showed fat necrosis with inflammation around the necrotic subcutaneous fat tissue. The lesions subsided gradually with an improvement of acute pancreatitis.
Subject(s)
Adult , Female , Humans , Alcoholics , Amylases , Fat Necrosis , Hot Temperature , Inflammation , Leg , Lipase , Liver Cirrhosis, Alcoholic , Necrosis , Pancreatic Diseases , Pancreatitis , Pancreatitis, Chronic , Panniculitis , Sensation , Subcutaneous FatABSTRACT
PURPOSE: The purpose of this study was to compare the efficacy of dexpanthenol in postoperative patients. Dexpanthenol, the alcohol derivative of pantothenic acid, is believed to be a precursor of acetylcholine through its incorporation into coenzyme-A. METHODS: From June 2005 to December 2005, 130 curative abdominal surgery, which were divided into a dexpanthenol group with 65 patients and a control group with 65 patients, were prospectively and randomly studied for recovery of bowel motility. RESULTS: No significant difference was found between the two groups as to incidence of postoperative ileus (16.9% vs. 15.4%, P=0.081), the time to flatus (77.2+/-38.4 vs. 77.9+/-31.9 hours, P=0.90), the time to defecation (5.3+/-2.7 vs. 5.1+/-2.6 days, P=0.77), the time to resumption of meals (7.9+/-4.0 vs. 8.9+/-4.2 days, P=0.17), and the duration of hospital stay (16.4+/-7.8 vs. 17.9+/-11.5 days, P=0.39). CONSLUSIONS: Since no differences in the postoperative bowel motility were observed between the two groups, dexpanthenol is not recommended for general surgical use.
Subject(s)
Humans , Acetylcholine , Defecation , Flatulence , Ileus , Incidence , Length of Stay , Meals , Pantothenic Acid , Prospective StudiesABSTRACT
A stercoral perforation of the colon is a rare phenomenon and is caused by severe prolonged constipation. Since the first reported case in 1894, approximately 80 additional cases have been reported. However, this rare condition seems to have been underestimated because of not only obscure diagnostic standards but also ignorance and failure to notice by surgeons. Due to its high mortality rate of about 35~40%, a stercoral ulcer perforation should be considered in any patient with chronic constipation who presents with peritonitis. We report a case of a 75-year-old female who was diagnosed as having a stercoral perforation of the sigmoid colon and review the clinical features, the diagnosis, and the treatment.
Subject(s)
Aged , Female , Humans , Colon , Colon, Sigmoid , Constipation , Diagnosis , Mortality , Peritonitis , UlcerABSTRACT
The Mirizzi syndrome is a rare benign cause of obstructive jaundice. It is particularly interesting to surgeons because the surgery has to be carefully planned to avoid unnecessary damage to the common bile duct. Furthermore, it gives a differential diagnosis dilemma for surgeons as well as radiologist because there are no diagnostic procedures or clinical features that have a perfect access. As a result, the Mirizzi syndrome often has been mistaken for gallbladder cancer and cholangiocarcinoma. We experienced of a 76-year-old male patient, whose clinical symptoms were jaundice, epigastric pain and fever with chill and misdiagnosed as a cholangiocarcinoma with liver metastasis.
Subject(s)
Aged , Humans , Male , Bile Duct Diseases , Cholangiocarcinoma , Cholelithiasis , Cholestasis , Common Bile Duct , Cystic Duct , Diagnosis, Differential , Fever , Gallbladder Neoplasms , Jaundice , Jaundice, Obstructive , Liver , Mirizzi Syndrome , Neoplasm MetastasisABSTRACT
PURPOSE: The clinical significance of preoperative serum levels of tumor markers CEA and CA19-9 was evaluated in gastric cancer patients. METHODS: Serum levels of CEA and CA19-9 were measured in 1, 310 patients with gastric cancer who underwent laparotomies over a recent 10-year period (1992~2001). The correlations between the serum levels of tumor markers and several clinicopathological factors were evaluated by univariate analysis. The significance of the tumor markers as prognostic factor was assessed by multivariate analysis. RESULTS: The positivity rates of CEA and CA19-9 were 17.5% and 13.4%, respectively. The positivity rate of CEA was higher in the elderly, in male patients, and in those with histologically differentiated tumors, whereas CA19-9 positivity was related to tumor location. In addition, the positivity rates of each tumor marker were significantly correlated with tumor size, gross type, depth of invasion, lymph node metastasis, peritoneal and liver metastases, and cancer stage. A significant difference in survival was observed between patients positive and negative for CEA and CA19-9. The multivariate analysis showed that in addition to gross type, depth of invasion, lymph node metastasis, peritoneal and liver metastasis, preoperative serum CEA and CA19-9 levels among those undergoing However, multivariate analysis of curatively resected cases identified gross type, depth of invasion, lymph node metastasis, and CA19-9 as significant prognostic variables. CONCLUSION: Preoperative serum CEA and CA19-9 determination in patients with gastric cancer is of value for the prediction of tumor progression and prognosis. However, serum CA19-9 level was more useful than CEA as a1 prognostic factor in patients undergoing curative resection.