Unusual, but important, peri- and extra-articular manifestations of rheumatoid arthritis: a pictorial essay

Ultrasonography is a useful technique to detect soft tissue changes of rheumatoid arthritisnot only synovitis, but also tenosynovitis, bursitis, and enthesitis-even at a subclinical stage. However, radiologists tend to focus on synovitis in daily practice, and unusual peri- or extraarticular manifestations of rheumatoid arthritis are difficult to detect at the initial presentation. This pictorial essay describes a broad spectrum of ultrasonographic findings in tendons, bursae, ligaments, subcutaneous tissues, bones, and nerves to assist in the accurate diagnosis of rheumatoid arthritis.

Diffuse-Type Tenosynovial Giant Cell Tumor of the Tendon Sheath in Both Wrists

Diffuse-type tenosynovial giant cell tumor (D-TSGCT), previously known as pigmented villonodular synovitis, is a locally aggressive neoplasm that may arise from the synovium, bursa, or tendon sheath. D-TSGCT is usually monoarticular and can be classified into intra- and extra-articular forms, the latter of which is rarer. Here, we report a case of D-TSGCT in a 64-year-old female that involved the entire flexor and extensor tendon sheaths of both wrists. We describe the ultrasonography and MRI findings, as well as review the relevant literature.

Mediastinal Lymph Node Metastasis from Head and Neck Cancer: Predictive Factors and Imaging Features

Purpose@#To assess the predictive factors and describe the imaging features of mediastinal lymph node (MLN) metastases in patients with head and neck cancer. @*Materials and Methods@#We compared the clinical features and disease characteristics (sex, age, site of primary tumor, histologic type, history of prior treatments, TNM stages, and metastasis in cervical LNs) of patients with head and neck cancers between the MLN metastasis and no MLN metastasis groups. We also evaluated the chest CT (distribution and maximum dimension of the largest LN) and PET/CT (maximum standardized uptake value) features of MLN metastases based on the MLN classification. @*Results@#Of the 470 patients with head and neck cancer, 55 (11.7%) had MLN metastasis, involving 150 mediastinal stations. Hypopharynx cancer, recurrent tumor, T4 stage, N2/N3 stages, and M1 stage were found to be significant predicting factors for MLN metastasis. The most common location of MLN metastasis was ipsilateral station 2 (upper paratracheal LNs, 36.4%), followed by ipsilateral station 11 (interlobar LNs, 27.3%) and ipsilateral station 10 (hilar LNs, 25.5%). @*Conclusion@#Metastasis to MLNs should be considered in patients with head and neck cancer, especially in cases that are associated with a hypopharyngeal cancer, recurrent tumor, and high TNM stages.

Research Ethics in the Process of Conducting Research / 대한소화기학회지

Compliance with research ethics is critical to the responsible conduct of research required by researchers. Research ethics means the rules and norms that researchers need to know and practice in the process of conducting their research. Therefore, it is important for researchers to accurately understand the specific contents of research ethics required at each stage of the research process. The paper explored the meaning and values of responsible conduct of research that researchers should pursue, and discussed what responsibilities researchers need to know and the specific roles they need to act on.

Mediastinal Lymph Node Metastasis from Head and Neck Cancer: Predictive Factors and Imaging Features

Purpose@#To assess the predictive factors and describe the imaging features of mediastinal lymph node (MLN) metastases in patients with head and neck cancer. @*Materials and Methods@#We compared the clinical features and disease characteristics (sex, age, site of primary tumor, histologic type, history of prior treatments, TNM stages, and metastasis in cervical LNs) of patients with head and neck cancers between the MLN metastasis and no MLN metastasis groups. We also evaluated the chest CT (distribution and maximum dimension of the largest LN) and PET/CT (maximum standardized uptake value) features of MLN metastases based on the MLN classification. @*Results@#Of the 470 patients with head and neck cancer, 55 (11.7%) had MLN metastasis, involving 150 mediastinal stations. Hypopharynx cancer, recurrent tumor, T4 stage, N2/N3 stages, and M1 stage were found to be significant predicting factors for MLN metastasis. The most common location of MLN metastasis was ipsilateral station 2 (upper paratracheal LNs, 36.4%), followed by ipsilateral station 11 (interlobar LNs, 27.3%) and ipsilateral station 10 (hilar LNs, 25.5%). @*Conclusion@#Metastasis to MLNs should be considered in patients with head and neck cancer, especially in cases that are associated with a hypopharyngeal cancer, recurrent tumor, and high TNM stages.

Research Ethics in the Process of Conducting Research / 대한소화기학회지

Compliance with research ethics is critical to the responsible conduct of research required by researchers. Research ethics means the rules and norms that researchers need to know and practice in the process of conducting their research. Therefore, it is important for researchers to accurately understand the specific contents of research ethics required at each stage of the research process. The paper explored the meaning and values of responsible conduct of research that researchers should pursue, and discussed what responsibilities researchers need to know and the specific roles they need to act on.

Factor Analysis of Intraoperative Radical Conversion During Partial Nephrectomy: Single Surgeon Experience

PURPOSE: Preoperative aspects and dimensions used for an anatomical (PADUA) classification is useful to predict perioperative complications and warm ischemia time. However, it remains uncertain whether PADUA classification can predict intraoperative conversion from partial nephrectomy (PN) to radical nephrectomy (RN). We evaluate whether PADUA classification parameters can predict conversion to RN during PN. MATERIALS AND METHODS: We retrospectively assessed data of 593 patients who underwent open PN and robotic PN for renal tumors by a single surgeon at a single tertiary center between December 2003 and September 2017. Intraoperative conversion to RN was performed in 17 of 593 patients who initially underwent PN. We evaluated the factors influencing the surgical modalities including PN and radical conversion cases. Then, the factors significantly associated with conversion to RN were further analyzed. RESULTS: There were no significant differences between the 2 groups in age, longitudinal location, exophytic rate, and rim or face locations of renal masses. Renal sinus involvement, urinary collecting system involvement, and renal mass size were variables that predicted radical conversion, using univariate analysis. Renal sinus involvement (odds ratio [OR], 9.075; p=0.049) and urinary collecting system involvement (OR, 3.944; p=0.029) were independent predictors of intraoperative radical conversion, using multivariate analysis. CONCLUSIONS: The PADUA classification is a useful tool to predict intraoperative conversion from PN to RN. Renal sinus involvement and urinary collecting system involvement are the best predictors of intraoperative conversion from PN to RN.

Clinical Significance of Positive Surgical Margin after Radical Prostatectomy according to Pathological Stage

PURPOSE: The purpose of this study was to investigate the positive surgical margin (PSM) as a predictive factor of biochemical recurrence (BCR) in prostate cancer (PCa) patients after radical prostatectomy (RP) according to each pathological stage. MATERIALS AND METHODS: The records of 3,037 patients receiving RP were retrospectively reviewed. All patients were divided into 6 groups depending on pathological stage and presence of PSM. Cox proportional hazard analyses were performed to show the significance of PSM in all patients and in subgroup patients (T2, T3a, and T3b). The Kaplan-Meier analysis showed BCR-free survival rate of each group. RESULTS: Among total 3.307 patients, the mean age was 65.89 years and PSM rate was 18.7%. During the 47.1 months, 550 patients had experienced BCR (26.2%). According to groups, prostate-specific antigen, Gleason score, and BCR were significantly different. Ten-year BCR-free survival rate was 87.1% (T2R0), 65.9% (T2R1), 60.1% (T3aR0), 43.0% (T3aR1), 20.8% (T3bR0), and 5.8% (T3bR1). Each group had statistical differences with BCR-free survival except T2R1 and T3aR0 (p=0.090). PSM was significant in multivariate Cox analyses in total patients (hazard ratio, 2.091; 95% confidence interval, 1.724–2.536; p<0.001) and in all subgroup with each stages. CONCLUSIONS: PSM is a significant predictor to BCR after RP in all PCa patients and in each stage. T2R1 PCa had a similar BCR-free survival rate to T3R0 patients during long-term follow-up, therefore careful management to T2R1 PCa as T3 should be necessary.

Comparison of Localized High Volume Tumor and Locally Advanced Low Volume Tumor after Radical Prostatectomy according to Risk Classification

PURPOSE: To investigate the percentage of pathologic tumor volume (pTPV) among patients who underwent radical prostatectomy (RP). MATERIALS AND METHODS: We reviewed 3,080 patients who underwent RP between September 2003 and March 2015 and with a postoperative follow-up for more than 1 year. The patient population was stratified into 4 disease risk groups according to tumor stage and pTPV (T2 low volume [T2LV], T2 high volume [T2HV], T3 low volume [T3LV], and T3 high volume [T3HV]). Probability of biochemical recurrence (BCR)-free survival was determined using Kaplan-Meier curves. pTPV was evaluated by Multivariate Cox proportional hazard analysis for predicting BCR. Subgroup analyses were performed according to preoperative risk. RESULTS: The median prostate-specific antigen (PSA) was 7.87 ng/mL, and pTPV was 10%. Among a total of 2,964 patients, T2LV had 1,473 (49.7%), T2HV was 598 (20.2%), T3LV with 199 (6.7%), and T3HV was 694 (23.4%). When comparing T2HV and T3LV, Gleason score and positive surgical margin rate was higher in T3LV. During a 50-month follow-up, BCR-free survival rate was higher in the T2HV group (p<0.001). pTPV was a significant factor to predict BCR in multivariate Cox analysis. In subgroup analyses, T2HV group had similar BCR-free survival rates to T3LV group in the preoperative high risk group while pTPV was significant in the high risk group. CONCLUSIONS: pTPV was a significant predictor of BCR among prostate cancer patients after RP, however T2HV had favorable BCR results. Among patients with a preoperative high PSA and Gleason score, T2HV had similar BCR results to T3LV.

Right middle lobe syndrome caused by eosinophilic mucoid impaction in adults

Right middle lobe syndrome (RMLS) is defined as a transient or recurrent, chronic collapse of the middle lobe of the right lung by certain pathologic conditions. RMLS is a relatively uncommon condition having multiple etiologies and various clinical presentations. Two patients were referred to Hallym University Sacred Heart Hospital, one for the treatment of coughing and the other for the treatment of pneumonia. A diagnosis of RMLS was identified through X-ray and computed tomography image evaluation for each condition. Bronchoscopy revealed mucus obstruction in the right middle lobe bronchus. Biopsy of the aspirated mucus showed mucus containing many eosinophils and Charcot-Leyden crystals. After removal of impacted mucus, clinical and radiological improvements were observed in both patients. Therefore, eosinophilic mucus impaction can be considered a potential cause of RMLS, irrespective of any underlying asthmatic symptoms.

A Case of Small Bowel Fistulas Caused by Multiple Magnet Ingestion: Usefulness of Ultrasonography

Foreign body ingestion is a common problem in the pediatric population and the majority of such cases occur between the ages of six months and three years. Most objects pass uneventfully through the gastrointestinal tract; however, ingestion of multiple magnets can cause serious gastrointestinal complications through interaction with each other across the bowel wall. In these situations, radiologic evaluation is imperative for proper treatment. This is a case report on ingestion of 32 magnets in a 10-year-old boy. We diagnosed a small bowel fistula caused by ingestion of multiple magnets using sonography, which showed hyperechoic magnetic foreign bodies attached together penetrating the thickened neighbouring jejunum.

Standardization Study of the Korean Version of the Stages of Change Readiness and Treatment Eagerness Scale for Smoking Cessation (K-SOCRATES-S) and Its Predictive Validity

OBJECTIVE: The purpose of the study was to develop the Korean version of the Stage of Change Readiness and Treatment Eagerness Scale for Smoking Cessation (K-SOCRATES-S) based on the Korean version of the Stages of Readiness for Change and Eagerness for Treatment scale (K-SOCRATES). This paper also demonstrates its reliability and validity among patients with nicotine dependence in South Korea. METHODS: At seven healthcare promotion centers in Gyeonggi-do, 333 male smokers aged 20 to 70 who visited smoking cessation clinic were recruited for this study and the K-SOCRATES-S was administered. After three months, the number of respondents who successfully stopped smoking was assessed by testing their urine cotinine level. Subsequently, exploratory factor analysis was performed to verify the reliability and validity of the K-SOCRATES-S. Also, a logistic regression analysis was performed to examine the variables that can predict the successful cessation of smoking on subscales of the K-SOCRATES-S. RESULTS: Exploratory factor analysis of the K-SOCRATES-S showed that the scale consisted of three factors: Taking Steps, Recognition, and Ambivalence. The scales measuring Taking Steps and Recognition in this scale had a significantly positive correlation with the scores observed on Kim's smoking cessation motivation scale. The scales measuring Taking Steps and Recognition had a significantly negative correlation with Ambivalence. Overall, the results indicate that the K-SOCRATES-K scale showed high validity. CONCLUSION: The K-SOCRATES-S developed in the present study is highly reliable and valid for predicting a patient's likelihood of success in quitting smoking among patients who want to cease smoking.

Standardization Study of Internet Addiction Improvement Motivation Scale

OBJECTIVE: The purpose of this study was to develop a scale to measure motivation to improve Internet addiction. Motivation is known to be important to treat Internet addiction successfully. The reliability of the scale was assessed, and its concurrent validity was evaluated. METHODS: Ninety-two adolescents participated in this study. The basic demographic characteristics were recorded and the Korean version of the Stages of Readiness for Change and Eagerness for Treatment Scale for Internet Addiction (K-SOCRATES-I) was administered. Subsequently, the Internet Addiction Improvement Motivation Scale was developed using 10 questions based on the theory of motivation enhancement therapy and its precursor version designed for smoking cessation. RESULTS: The motivation scale was composed of three subscales through factor analysis; each subscale had an adequate degree of reliability. In addition, the motivation scale had a high degree of validity based on its significant correlation with the K-SOCRATES-I. A cut-off score, which can be used to screen out individuals with low motivation, was suggested. CONCLUSION: The Internet Addiction Improvement Motivation Scale, composed of 10 questions developed in this study, was deemed a highly reliable and valid scale to measure a respondent's motivation to be treated for Internet addiction.

Coronary to Bronchial Artery Fistula Causing Massive Hemoptysis in Patients with Longstanding Pulmonary Tuberculosis

We report on three cases of longstanding pulmonary tuberculosis patients with coronary to bronchial artery fistula (CBF) who presented with recurrent massive hemoptysis. The first and second patients died because of decreased functional pulmonary volume plus massive hemoptysis and cannulation failure of CBF due to hypovolemic vasospasm, respectively. When recurrent hemoptysis occurs despite successful embolization treatment, CBF should be considered as a potential bleeding source. Moreover, a coronary angiography should be performed, especially in patients with longstanding cardiopulmonary disease such as pulmonary tuberculosis.

The Understanding of Research Ethics for a Desirable Academic Writing

No abstract available.

A Case of Thyroid Cancer Combined with Pulmonary Sarcoidosis / 결핵및호흡기질환

Sarcoidosis is a systemic granulomatous disease that primarily affects the lung and lymphatic system of the body. Since Brincker first noted a statistically significant increase of malignant tumors among sarcoidosis patients, there have been several reports on simultaneously developed sarcoidosis and malignancy. A 30-year-old man was admitted to our hospital because of multiple enlarged mediastinal lymph nodes. The patient had been well until approximately 10 days before admission, when he developed a cough. Chest X-ray and computed tomography (CT) of the chest that were performed at the outpatient department revealed multiple enlarged mediastinal lymph nodes. Cervical lymph node biopsy revealed both non-caseating granuloma and metastatic papillary carcinoma, whereas the mediastinal lymph node showed only non-caseating granuloma. The thyroid gland surgical specimen showed papillary carcinoma. We report here on a case of a 30-year-old man who had sarcoidosis and thyroid cancer, and we include a review of the literature.

Percutaneous Needle Aspiration Biopsy (PCNA) of Pulmonary Lesions: Evaluation of a Reaspiration or a Rebiopsy (second PCNA)

PURPOSE: To evaluate the effectiveness of the reaspiration or rebiopsy of pulmonary lesions (second PCNA) in cases where the pathologic results are inconclusive upon initial percutaneous needle aspiration biopsy (PCNA). MATERIALS AND METHODS: A total of 364 PCNA cases (350 initial PCNA, 14 second PCNA) were performed under CT or fluoroscopy guidance for all the 350 patients enrolled. The procedure was performed by either using an automated biopsy gun with a 20-G needle (298 cases) or a 20-G aspiration needle (66 cases). The pathologic agreement rates between the initial and second PCNA, as well as the causes for a second PCNA, were evaluated. Finally the type and rate of complication were also evaluated. RESULTS: The second PCNA rate was 4.0% (14/350). The causes for a second PCNA, following the initial PCNA included unexpected pathologic results (n = 7) and inconclusive pathologic results (n = 7). Of the seven cases which had unexpected pathologic results from their initial PCNAs, five had similar pathologic results after a second PCNA. Also, of the seven cases of inconclusive pathologic results, such as atypical cells, the scanty cellularity or necrosis upon an initial PCNA, six cases revealed a malignancy on a second PCNA. The overall complication rate, including both the initial and second PCNAs was 14.0% (51/364). CONCLUSION: A second PCNA was performed to help resolve the exact diagnosis for a pulmonary lesion in cases of inconclusive pathologic results upon an initial PCNA.

Angiomyofibroblastoma Arising from the Posterior Perivesical Space: a Case Report with MR Findings

Angiomyofibroblastoma is a rare benign soft tissue neoplasm that predominantly occurs in the genital region of middle-aged women. We present a case of an angiomyofibroblastoma that involved the posterior perivesical space in a 48-year-old woman. We have documented the magnetic resonance imaging features of this case.

A Case of Bronchus-Associated Lymphoid Tissue(BALT) Lymphoma Treated with Lobectomy / 결핵및호흡기질환

The bronchus-asociated lymphoid tissue(BALT) lymphoma is a low-grade primary malignant lymphoma that originates from bronchus associated lymphoid tissue. A 67-year-old woman was admitted for evaluation of cough, sputum, rhinorrhea which had persisted for one month. Physical examination showed decreased breathing sound on the left upper lung field. High resolution chest computed tomography demonstrated consolidation which showed air-bronchogram and surrounding ground glass opacity in left upper lobe. These findings implicated inactive tuberculosis, organizing pneumonia, or bronchiolo-alveolar carcinoma. The histologic findings from percutaneous needle aspiration biopsy revealed aggregated atypical small lymphoid cells with lymphoepithelial lesions. With immunohistochemical staining, the atypical lymphoid cells reacted positively with CD 20 antibody and negatively with CD 3 antibody. Thus, we could diagnosed her as a patient with BALT lymphoma. After left upper lobectomy, she has been well without recurrence of the disease for 14 months. In this country of Republic of Korea, it was the 1st case of BALT lymphoma surgically treated when histological diagnosis had been done. Based on this case, we wanted to demonstrate the importance of early histological diagnosis and treatment of BALT lymphoma.

Cardiac Spindle Cell Hemangioma: A Case Report

Spindle cell hemangioma is an uncommon vascular lesion histologically resembling a cavernous hemangioma and Kaposi's sarcoma with a predilection for the extremities. There are no radiologic reports concerning cardiac spindle cell hemangioma in the current literature. We report here a case of cardiac spindle cell hemangioma.