• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.8-13
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• 2012

Purpose: Purpose: The free deep inferior epigastric artery perforator (DIEP) flap is a popular option for autologous breast reconstruction. However, the anatomy of the deep inferior epigastric artery(DIEA) may vary from one individual to another. Unexpected vascular anomaly can confuse the surgeon and affects on the safety of the free DIEP flap. Materials and Methods: Thirty five consecutive patients who underwent free DIEP/TRAM flap for immediate breast reconstruction between Mar. 2010 and Oct. 2010 were enrolled in this study. Computed tomography angiography (CT angiography) of abdomen was evaluated part of our standard preoperative assessment: atypical patterns of DIEA/DIEP were evaluated by preoperative CT angiography and compared with intraoperative finding. Results: Atypical patterns of DIEA/DIEP which may affect preoperative planning were noted as the following: Circummusclar/subfascial DIEA (n=1), DIEA running underneath rectus muscle (n=8), septocutaneous perforator (n=3), peritoneo-cutaneous perforator (n=1), a large branch going into peritoneum (n=1), and very early division and muscle penetration of DIEA (n=1). Conclusion: Atypical DIEA/DIEP that might change the operation plan is not rare, so the individualized planning based on the preoperative CT angiography is recommended. Preoperative CT angiography could help to select reliable and easy-to-dissect perforator in free DIEP/TRAM breast reconstruction.

• Archives of Plastic Surgery
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• v.34 no.6
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• pp.796-798
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• 2007

Purpose: Giant cell tumor is the second most common benign neoplasm in upper extremity. Unlike usual chief complaint of painless mass, an atypical case with giant cell tumor presented a distinguishing characteristics of which accompany pain and tenderness and is histologically giant-cell free. Methods: A 31-year-old male patient complained of a rapid growing painful mass on the proximal phalanx of the left ring finger. Under microscopic operation, a $1.6{\times}1.3cm$ sized mass was found to be surrounded by areolar tissue and attached to a tendon sheath, encircling the digital nerve and artery. Diagnostic confirmation was assisted by positive finding in histologic immunohistochemical stain-CD68. Characteristic pathologic finding is an atypical distribution of spindle cells & histiocytes without giant cells in fascicular pattern. Results: Giant cell tumor was carefully removed under microscopic approach, while preserving digital nerve & artery. In postoperative 13th month, the patient presented with a 6mm of static two-point discrimination test, similar to that of the adjacent fingers. Conclusion: We report an atypical case with painful mass on tendon sheath, surrounding the digital nerve and artery that was diagnosed of giant cell tumor, but without giant cells on pathology. This case provides broader understanding of the giant cell tumor that should not only rely its typical findings of the painless mass and positive sign on H&E stain.

• The Korean Journal of Physiology and Pharmacology
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• v.9 no.1
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• pp.17-22
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• 2005

We examined whether the abnormal EEG state by NMDA receptor blocker MK-801 can be reversed by typical and atypical antipsychotics differentially by comparing their spectral profiles after drug treatment in rats. The spectral profiles produced by typical antipsychotics chlorpromazine (5 mg/kg, i.p.) and haloperidol (0.5 mg/kg, i.p.) were differ from that by atypical antipsychotic clozapine (5 mg/kg, i.p.) in the rats treated with or without MK-801 treatment (0.2 mg/kg, i.p.) which produce behavioral abnormalities like hyperlocomotion and stereotypy. The dissimilarity between the states produced by antipsychotics and the control state was examined with the distance of the location of the canonical variables calculated by stepwise discriminant analysis with the relative band powers as input variables. Although clozapine produced more different state from normal state than typical antipsychotics, clozapine could reverse the abnormal schizophrenic state induced by MK-801 to the state closer to the normal state than the typical antipsychotics. The results suggest that atypical anesthetic can reverse the abnormal schizophrenic state with negative symptom to the normal state better than typical antipsychotic. The results indicate that the multivariate discriminant analysis using the spectral parameters can help differentiate the antipsychotics with different actions.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.8
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• pp.3733-3736
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• 2016

HER2/neu is a well-established prognostic and predictive factor for invasive breast cancer. However, the role of HER2/neu in ductal breast carcinoma in situ (DCIS) is debated and recent data have suggested that it is mainly linked to in situ local recurrence. Although molecular data suggest that atypical ductal hyperplasia (ADH) and duct carcinoma in situ (DCIS) are related lesions, albeit with vastly different clinical implications, the role of HER2/neu expression in atypical ductal hyperplasia is not well defined either. The aim of this study was to evaluate over expression of HER2/neu in DCIS and cases of ADH in comparison with invasive breast carcinoma. Archival primary breast carcinoma paraffin blocks (n=15), DCIS only (n=10) and ductal epithelial hyperplasia and other breast benign lesions (n=25) were analyzed for HER2/neu immunoexpression. Follow up was available for 40% of the patients. HER2/neu was positive in 80%of both DCIS and invasive carcinoma, and 67% of atypical ductal hyperplasia (ADH) cases. Thus at least a subset of patients with preinvasive breast lesions were positive, which strongly suggests a role for Her2/neu in identifying high-risk patients for malignant transformation. Although these are preliminary data, which need further studies of gene amplification within these patients as well as a larger patient cohort with longer periods of follow up, they support the implementation of routine Her2/neu testing in patients diagnosed as pure DCIS and in florid ADH.

• Korean Journal of Clinical Pharmacy
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• v.30 no.2
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• pp.81-86
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• 2020

Background: The number of patients with dementia continues to increase as the age of aging continues to grow. Psychiatric symptoms caused by senile dementia are controlled using antipsychotics. However, these antipsychotics can lead to Parkinson's disease, and abuse of dopamine derivatives such as levodopa among Parkinsonian drugs can lead to psychosis. Therefore, we evaluated the patterns of prescribed antipsychotics and antiparkinsonian drugs in patients with senile dementia. Methods: We used data from the sample of elderly patients from the Health Insurance Review and Assessment Service (HIRA-APS-2016). We analyzed the patterns of prescribing antipsychotics and antiparkinsonian drugs including prescribed daily dosage, period of prescription, and number of patients with both antipsychotics and antiparkinsonian drugs for senile dementia. Results: Among the 159,391 patients with dementia included in this analysis, 4,963 patients (3.1%) and 16,499 patients (10.4%) were prescribed typical and atypical antipsychotic drugs, respectively. The most frequently prescribed typical antipsychotic was haloperidol (4,351 patients with dementia), whereas the atypical agent was quetiapine (12,719 patients). The most frequently prescribed antiparkinsonian drugs were in the order of levodopa/carbidopa, benztropine, and ropinirole. In addition, 1,103 and 3,508 patients prescribed typical and atypical antipsychotics, respectively, were co-prescribed antiparkinsonian drugs. Conclusions: Atypical antipsychotics were the preferred prescription in patients with senile dementia. The prescription dose was relatively low; however, the average treatment duration was mostly long-term. Selection of antipsychotics and/or antiparkinsonian drugs should be made carefully in senile dementia and the causal relationship of adverse drug reactions needs further study.

• The Korean Journal of Cytopathology
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• v.10 no.1
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• pp.1-5
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• 1999

To evaluate whether different qualifications of a cytologic diagnosis of "atypical squamous cells of undetermined significance(ASCUS)" predict a greater or lesser likelihood of tissue diagnosis of uterine cervix, we compared different cytologic qualifications of ASCUS with the tissue diagnosis. One hundred twenty-two consecutive Papanicolaou smears showing ASCUS in women who had undergone cervical biopsy within nearest 30 days were collected. The 122 smears were qualified as "favor reactive"(25%), "favor low grade squamous intraepithelial lesion (LSIL)"(24%), "favor squamous intraepithelial lesion(SIL)"(16%), "favor high grade squamous intraepithelial lesion(HSIL)"(16%), and "not otherwise specified"(19%). Squamous intraepithelial or invasive lesion was pathologically confirmed by cervical biopsy in 13%, of the "favor reactive", 27% in "favor LSIL", 70% in "favor SIL", 75%, in "favor HSIL", and 35% in "not otherwise specified" smears. There were significant associations between the favor reactive smear and the benign biopsy finding and between the favor SIL smear and the biopsy shewing a squamous intraepithelial or more severe lesion. Nevertheless, most of favor LSIL smears exhibit reactive process in tissue biopsy. Conclusively, qualified ASCUS stratifies women Into different risk groups for SIL. The cytopathologist should make the cytologic diagnosis of "ASCUS, favor LSIL" circumspectly.

• Archives of Plastic Surgery
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• v.33 no.3
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• pp.383-387
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• 2006

Atypical fibroxanthoma is a pleomorphic spindle cell neoplasm characterized by a variable combination of cells with fibroblastic and histiocytic features. It occurs mostly on sun-exposed area of the head and neck of elderly person and is a clinically benign reactive lesion despite apparent malignant histologic features. However, because of its potential for metastasis, it is widely regarded as a low-grade sarcoma. We report a 30-year-old woman with atypical fibroxanthoma developed on the left occipital area. The lesion was $1.5{\times}2cm$ sized papule. There was no skin lesion such as ulcer or eschar. However, mass was involving occipital bone and composed of dense, pleomorphic spindle cells and several bizarre multinucleated giant cells. After wide excision of the scalp and occipital bone, the defect was covered with bone cement, bipedicled local flap and the donor site was covered with STSG. The wound healed completely without complication. It remained free of recurrence for a period of about 1 year follow up.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.10
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• pp.5935-5939
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• 2013

Our study is to determine the presence of endometrial intraepithelial neoplasia (EIN) in endometrial biopsy specimens classified by the 1994 World Health Organization (WHO) criteria for endometrial hyperplasia. Endometrial biopsy specimens that were stained with hematoxylin and eosin (HE) were examined and categorized by the WHO 1994 criteria and for the presence of EIN as defined by the International Endometrial Collaborative Group. ${\beta}$-catenin expression was examined by immunohistochemistry. A total of 474 cases of HE stained endometrial biopsy tissues were reviewed. There were 379 cases of simple endometrial hyperplasia, 16 with simple atypical endometrial hyperplasia, 48 with complex endometrial hyperplasia, and 31 with complex atypical endometrial hyperplasia. Among the 474 endometrial hyperplasia cases, there were 46 (9.7%) that were classified as EIN. Of these 46 cases, 11(2.9%) were classified as simple endometrial hyperplasia, 1 (6.3%) as simple atypical endometrial hyperplasia, 6 (12.5%) as complex endometrial hyperplasia, and 28 (90.3%) as complex atypical endometrial hyperplasia. EIN was associated with a higher rate of ${\beta}$-catenin positivity than endometrium classified as benign hyperplasia (72% vs. 22.5%, respectively, P<0.001), but a lower rate than endometrial adenocarcinoma (72% vs. 96.2%, respectively, P<0.001). In benign endometrial hyperplasia, high ${\beta}$-catenin expression was noted in the cell membranes, whereas in EIN and endometrial adenocarcinoma high expression was noted in the cytoplasm. In conclusion, EIN is more accurate than the WHO classification for the diagnosis of precancerous lesions of the endometrium.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.8
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• pp.4815-4818
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• 2013

Background: Atrophic epithelium of cervix sampled from postmenopausal women may mimic high-grade cervical intraepithelial neoplasia in Papanicolaou-stained (Pap) smears. Ki-67 (MIB-1) protein presents on proliferating cells, and percentage of cells with positive nuclei provides a reliable tool for rapid evaluation of the growth fraction. The aim of this study was to determine the diagnostic value of protein Ki67 staining in atypical pap smears of postmenopausal women. Methods: In a case-control setting, pap smears of 75 women with an atypical pap smear (case group) and 75 with normal pap smears (controls) were obtained before and after estrogen treatment. Afterward, samples were exposed to the monoclonal antibody Ki-67 (MIB-1) and the immunohistochemically demonstrated Ki-67+ cells were compared. Results: Mean ages of cases and controls were $60.4{\pm}4.5$ and $59.9{\pm}4.3$ years respectively (P=0.50). There was one (2.7%) positive Ki-67 specimen in the case group, without any positive Ki-67 specimen in the control group (P=0.50). Conclusions: Measurement of proliferative activity index in Pap smears restrained with MIB1 is a simple, reliable, and cost-effective method for excluding negatives. This would imply that it might allow a substantial reduction of diagnostic estrogen courses and subsequent Pap smears in postmenopausal women with atypical findings.

• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.228-231
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• 2005

Atypical teratoid/rhabdoid tumor may arise at any central nervous system location, but it is most commonly located in the cerebellum(60 percent). The incidence of this tumor remains unclear but it occurs most commonly in children less than 2 years of age. This highly malignant tumor shows a rapid progression and nonspecific radiologic findings. We report a case of primary intracranial atypical teratoid/rhabdoid tumor arising from the supratentorial area in early infancy. The diagnosis was made based on distinctive light microscopy and immunohistochemical findings. Despite aggressive surgical treatment with adjuvant chemotherapy, he died six months after his second operation.