• Clinical Endoscopy
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• v.57 no.3
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• pp.393-401
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• 2024

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method for diagnosing pancreatic neuroendocrine tumors (PNETs); however, some PNETs are difficult to diagnose. Recently, the efficacy of needle-based confocal laser endomicroscopy (nCLE) in diagnosing solid pancreatic masses has been reported. However, the efficacy of nCLE in the diagnosis of PNETs remains unknown and only a small number of cases have been reported. Hence, this study aimed to evaluate the efficacy of nCLE in the diagnosis of PNETs. Methods: This single-center retrospective study evaluated 30 consecutive patients with suspected PNETs on contrast-enhanced computed tomography, who consented to nCLE combined with EUS-FNA and were diagnosed using EUS-FNA or surgical resection. The diagnostic criteria for PNETs using nCLE were based on the nesting and trabecular and glandular arrangement of tumor cell clusters surrounded by capillary vessels and fibrosis, as reported in previous studies. Results: The diagnosis using nCLE was classified into three categories: misdiagnosis in three cases (10%), non-diagnostic in six cases (20%), and diagnostic in 21 cases (70%). nCLE was able to diagnose PNET in one of the two cases with inconclusive EUS-FNA. Conclusions: Although further development of the resolution and optimization of the diagnostic criteria are required, nCLE may constitute a useful diagnostic option in cases of inconclusive EUS-FNA for PNETs.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.480-486
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• 2009

Background: The Fogarty thromboembolectomy catheter technique was devised to extract distal arterial emboli and it represents a milestone for the treatment of patients with acute arterial occlusion since the 1960s. The major causes of arterial occlusion have changed from emboli of a heart origin to atherosclerosis over the past 30 years. Accordingly, questions have been raised about the effectiveness of simple Fogarty thromboembolectomy. Material and Method: During the period from March 1990 through August 2008, 156 patients who requiring Fogarty thromboembolectomy were analyzed. The patients were divided into two groups: those with simple Fogarty thromboembolectomy (Group 1, 79 patients) and those with additional vascular bypass graft surgery (Group 2, 77 patients). The duration of symptoms, the cause of thrombi, admission via the emergency room, a history of acupuncture or misdiagnosis, combined diseases, the anatomic occlusion site and the cause of death were analyzed using T-tests, cross tab tests, Chi square tests and Kaplan-Meier tests, respectively. Result: The mean age was 64$\pm$10 years in the 2 groups. The duration of symptoms (pain) in Group 1 vs Group 2 was 12$\pm$4 days vs 71$\pm$14 days (p=0.001). 50 (63%) patients in Group 1 were admitted via the emergency room vs 18 (23%) patients in Group 2 (p=0.005). Misdiagnosis and the treatment for herniated intervertebral disc or acupuncture were given to, 20 (25%) patients in Group 1 vs 30 (39%) patients in Group 2. Anticoagulation treatment before admission was performed in 22 (28%) patients in Group 1 vs 11 (14%) patients in Group 2. The causes of thrombi were heart disease in, 24 (30%) patients in Group 1 vs 6 (8%) patients in Group 2 (p=0.001), atherosclerosis in 46 (58%) patients in Group 1 vs 67 (87%) patients in Group 2 (p=0.001) and trauma in 9 (11%) patients in Group 1 vs 6 (8%) patients in Group 2. The combined diseases were cerebrovascular accident, hypertension and diabetes mellitus in 22 $\sim$ 37% of the total patients. The occlusion sites were mainly in the iliac and femoral arteries. Endarterectomy was performed in 7 (9%) patients in Group 1 vs 18 (23%) patients in Group 2 (p=0.012). Treatment was successful in 27 (34%) patients in Group 1 and in 40 (52%) patients in Group 2 (p=0.019). Reocclusion occurred in 37(47%) patients in Group 1 vs 20 (26%) patients in Group 2 (p=0.000), Amputation was done in 4 (5%) patients in Group 1 vs 12 (16%) patients in Group 2 (p=0.012) and death occurred in 10 (13%) patients (Group 1) vs 3(4%) patients (Group 2) (p=0.044). Conclusion: The recent past has shown a decline in the effectiveness of simple Fogarty thromboembolectomy with a changing pattern of acute arterial occlusion from a rheumatic heart origin to atherosclerosis. Additional bypass procedures play a role for the treatment of arterial occlusion instead of always performing simple Fogarty thromboembolectomy.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.4
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• pp.442-448
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• 2000

Developmental anomalies arising from the branchial apparatus include cysts, external sinuses, internal sinuses, and complete fistulas. Second branchial cleft cysts are by far the most common among these anomalies. It may occur at any age, being most common in the third decade, and more frequent in the male than in the female. It usually presents a smooth, round, nontender fluctuant mass located between the level of the tragus and the clavicle along the anteromedial border of the sternocleidomastoid muscle. It is lined by respiratory or squamous epithelium unless inflammation is present. The considerable amount of lymphoid tissue may be found beneath the epithelium. The treatment of choice of branchial cleft cyst is surgical excision. If the lesion is acutely infected, however, it is essential to relieve the infection prior to the surgery. This report deals with two cases of second branchial cleft cyst. In case 1, the cyst had rapidly increased in size over pregnant period. In case 2, the patient presented the swelling in the left neck, and had the history of incision and drainage because of misdiagnosis as submandibular space abscess. The infection was treated by antibiotic therapy in the first place, and then complete surgical excision was made. There was no evidence of any recurrence or complications for these $3{\sim}4$ years.

• Journal of the Korea Institute of Information and Communication Engineering
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• v.15 no.7
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• pp.1573-1582
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• 2011

Risk of lung cancer among lung-related diseases has gradually increased during last decades. The chest digital radiography is the primary diagnosis method for lung cancer. Diagnosing lung cancer using this method requires doctors of ripe experience. Despite their experience there are often wrong diagnoses, which decrease early diagnosis and survival rates of patients. The aim of this study was intended to establish the base on the Computer Aided Diagnosis (CAD) by analyzing Image Recognition Algorithm using Principle component Analysis (PCA) and diagnosing patient's chest X-ray image. The database obtained through this approach enables a doctor to significantly reduce misdiagnosis during the early diagnosis stage, if he or she utilizes it as the preliminary reading step. Case studies were carried out using normal organ, and organs suffering from bronchogenic carcinoma and granuloma. A normal image and unique disease images were extracted after PCA analysis, and their cross-recognition efficiency were compared each other. The result revealed that the recognition rate was much high between normal and disease images, but relatively low between two disease images. In order to increase the recognition efficiency among chest diseases the related algorithms have to be developed continuously in the future study, and such effort will establish the resolute base for CAD.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.764-768
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• 2006

Purpose: Parotid neoplasia are relatively frequent, representing approximately 3% of all tumors in the head and neck regions. But incomplete resection and misdiagnosis of parotid gland is followed by multiple tumor invasion, tumor recurrence, and other iatrogenic tumor formation. In patients undergoing parotidectomy for confirmed or suspected malignancy, the traditional or modified rhytidectomy incision may prove suboptimal because it does not easily lend itself to a continuous neck dissection. Similarly, patients with tumors of the anterior accessory lobe or patients with large anterior tumors may also require the modified Blair incision for adequate surgical exposure. This report serves to revisit the topic of accessory and parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of recurrence are avoided. Methods: This is a retrospective review of our experience with two cases of parotid tumors; one accessory parotid gland neoplasm and one parotid gland neoplasm. We report the case of parotid tumor and epidermal cyst in a 54-year old male patient and the case of case of recurrent parotid tumor with local invasion in 30-year old male patient. Results: All were removed through a modified Blair incision. Pathologic report notified that One was found pleomorphic adenoma and epidermal cyst, and the other one pleomorphic adenoma with subcutenous invasion. The patients recovered well without any complication such as infection, hematoma, facial nerve palsy, and necrosis of skin flap. Patients were discharge POD#7. Patients were followed up to for 1 year and they have no sign of recurrence. Conclusions: A high index of suspicion, prudent diagnostic skills(including fine-needle aspiration biopsy, CT, US), and meticulous surgical approach are the keys to a successful management of these lesions. We experienced two cases of parotid neoplasia, in the treatment of tumor reccurence & iatrogenic tumor arising from the parotid gland and are presented with the review of literatures.

• The Korean Journal of Cytopathology
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• v.15 no.2
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• pp.92-100
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• 2004

Due to insufficient clinical information, most cervicovaginal smears from pregnant or postpartum women have been screened without regard to pregnancy-related cytological changes. Here, we have reviewed 116 abnormal cervicovaginal smears from 103 pregnant and postpartum women. Initial cytological diagnoses revealed the following: 9 cases of high-grade squamous intraepithelial lesions (HSIL), 8 cases of low-grade squamous intraepithelial lesions (LSIL), 85 cases of atypical squamous cells of undetermined significance (ASCUS), and 14 cases involving atypical glandular cells of undetermined significance (AGUS). 31 cases upon review, involved pregnancy-related cytological changes, comprising 25 cases of decidua cells, 4 cases of Arias-Stella reaction, and 2 cases of cedidual cells coupled with Arias-Stella reaction. Interpretation errors were detected in 14 cases: 13 cases of decidual cells interpreted as either ASCUS favor reactive or ASCUS ruled out HSIL, and one case of Arias-Stella reaction was interpreted as ASCUS ruled out HSIL. Decidual cells and degenerated glandular cells with Arias-Stella reaction can result in diagnostic mistakes. In order to avoid misdiagnosis and unnecessary surgeries, both clinicians and pathologists must be aware of the pregnancy-related cytological changes. The clinician should also always inform the pathologist on the pregnancy status of the patient.

• Clinics in Shoulder and Elbow
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• v.14 no.2
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• pp.248-252
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• 2011

Purpose: We report a case of chronic recurrent multifocal osteomyelitis of the shoulder. Materials and Methods: A 16 year-old male who had suffered from chronic recurrent multifocal osteomyelitis of the shoulder was diagnosed by clinical features and biopsy and was treated with arthroscopic debridement and Naproxen. Results: Symptoms was subsided without relapse during 16 months follow up. Conclusion: Chronic recurrent multifocal osteomyelitis is rare disease and it can be misdiagnosis because of its rarity and non-specific clinical presentation. This is a report of a case of chronic recurrent multifocal osteomyelitis of the shoulder in 16 years man.

• Tuberculosis and Respiratory Diseases
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• v.54 no.2
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• pp.230-235
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• 2003

A primary pulmonary artery sarcoma is a rare malignant tumor derived from the intimal layer of the pulmonary artery. Its clinical presentation can lead to a misdiagnosis of more common diseases such as thromboembolic disease. It is known to have a very poor prognosis. Therefore, the correct diagnosis of a primary pulmonary artery sarcoma is difficult and often delayed. We experienced a case of primary pulmonary artery sarcoma mimicking a pulmonary thromboembolism. The patient was admitted as a result of progressive dyspnea and coughing. The lung perfusion scan showed a large perfusion defect involving almost the entire right lung and suspicious small perfusion defects in the left upper lobe. Magnetic resonance imaging of the chest showed an enhancing nodule within the thrombus in the right pulmonary artery. The mass was removed completely by surgery, but the patient died as a result of shock.

• Proceedings of the Korean Institute of Information and Commucation Sciences Conference
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• 2015.05a
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• pp.383-387
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• 2015

Bowel and rectal diseases are on the increase by irregular life and westernized eating habits of modern people, especially rectal cancer, which accounts for 50% of the entire colon cancer. For the initial rectal cancer, because there is no portion projecting on the surface, if not see inside the tissue with ultrasound, you make an errors that misdiagnosis as rectal abscess. However there is a need for more accurate diagnosis, because it is sometimes difficult to distinguish abscess from rectal cancer depending on staging, in spite of the ultrasonic diagnosis. Therefore, this study was performed quantitative analysis by using a computer algorithm for rectal cancer and abscess image. Each of 20 cases about normal, abscess and cancer by setting analysis region ($50{\times}50$ pixels) applies to GLCM algorithm and Autocorrelation, Max probability, Sum average, Sum variance in each image were analyzed by comparing the 4 single parameter. Consequently, The high lesion detection efficiency was presented 100% by the 3 parameter of Autocorrelation, Max probability, Sum variance and the parameter of Sum average presents 95% in cancer, more than 90% in abscess. Those parameters are valuable in distinction standard about normal, cancer and abscess in rectum. It is sufficient availability as a computer assisted diagnosis system depended on clinical using.

• Journal of the Economic Geographical Society of Korea
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• v.16 no.2
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• pp.198-217
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• 2013

This research aims to examine the behavior changes of telemedicine participants with regard to time-space reconfiguration and to address the implications of telemedicine in terms of extensibility and restrictions (ambilaterality). According to the results of this research, telemedicine can lead to behavior changes in telemedicine participants, particularly patients. However, it is difficult to anticipate the time-space reconfiguration of telemedicine participants drastically. In other words, although telemedicine minimizes patients' burden of accessibility to and utilization of medical institutions, it requires the patients to visit medical institutions at least once due to the restricted application of telemedicine related to technological problems, the characteristics of medical practice and mutual stakes among the medical institutions involved in telemedicine. And physicians (telemedicine providers as mediators between medical specialists and patients) and medical specialists (as the ultimate telemedicine providers) do not evidence considerable changes in their behaviors, except for offline meetings for information sharing and medical training. Because the present telemedicine system does not require simultaneity between physicians, patients and medical specialists. Furthermore, present telemedicine operation is absorbed into existing medical activities as a health care delivery method. These phenomena are due to 1) the interests among medical institutions and the limitation or generalization of telemedicine technologies to stimulate regional-based telemedicine operation and 2) the goal of face-to-face interactions between patients and doctors, which is to avoid misdiagnosis and side effects. Finally, medical activities related to telemedicine do not differ from general medical activities. The ambilaterality of telemedicine in terms of extensibility and the restriction of time-space reconfiguration is an unsettled problem in the ICT technologies of medical services.