No abstract available.
Fistula* ; Thyroglossal Cyst*

No abstract available.
Hypocalcemia*

No abstract available.
Liver Transplantation* ; Liver*

PURPOSE: Phyllodes tumor is a rare fibroepithelial tumor of the breast, first described by Johannes Muller in 1838. Much has been written about phyllodes tumor, but very few widely accepted conclusions about its clinical behavior, treatment modality, and prognosis have been reached. This study aims to analyze the clinical, radiological, and pathological characteristics of phyllodes tumor of the breast. METHODS: The medical records of 41 patients with phyllodes tumor who had been treated between February 1982 and August 1998 at the Department of Surgery, Seoul National University Hospital, were retrospectively reviewed for clinical, radiological and pathological findings, treatment modalities, and follow-up results. RESULTS: Of these 41 cases, there were 28 cases (68.3%) of benign tumors and 13 cases (31.7%) of malignanat tumors. All patients were females, and the mean ages of onset were 33.2 years for benign tumors and 40.8 years for malignant tumors. Most patients, 100% of benign and 92.3% of malignant, presented with a papable mass in the breast. The median duration of illness was 2 months for malignant tumors and 8 months for benign tumors. The tumor size was greater than 10 cm in diameter in 5 cases (38.5%) of malignant tumors and in 3 cases (10.7%) of benign tumors. Only 4 cases were preoperatively diagnosed as having a phyllodes tumor by using radiological and fine needle aspiration cytology. Out of the 10 malignant cases reviewed, 5 cases were confirmed as malignant, and 5 cases were confirmed as borderline phyllodes tumors. Cellularity was moderate or above in all 5 malignant and 5 borderline cases. Atypism above moderate degree was found in 4 of 5 (80%) malignant tumors, in 3 of 5 (60%) borderline tumors, and in 4 of 24 (16.7%) benign tumors. Mitotic counts in all 5 malignant cases were 5 or more per 10 high power field while those in the 5 borderline tumors were 2-5 mitoses per 10 high power field. The most commonly performed operative procedures were a simple mastectomy (50%) for malignant tumors and a simple excision (64.3%) for benign tumors. Post-operative adjuvant therapy was done for 4 cases; out of these, 1 case had been initially diagnosed as a malignant phyllodes tumor, but the diagnosis was changed to a benign phyllodes tumor upon review. Of the 27 follow-up cases, recurrences developed in 3 cases (16.7%) of benign tumors. CONCLUSION: From the above results, there were no specific clinical features for differentiating benign from malignant phyllodes tumor preoperatively; therefore, we cannot help depending on the pathologic findings. Pathologic reviews showed that among several criteria, atypism, cellularity, and mitotic count were the most definite pathologic characteristics in differentiating benign from malignant phyllodes tumor. But much more experience and long-term follow-up may be needed to define optimal treatments and to analyze the prognosis for phyllodes tumors of the breast.
Biopsy, Fine-Needle ; Breast* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Mastectomy, Simple ; Medical Records ; Mitosis ; Phyllodes Tumor* ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Surgical Procedures, Operative

PURPOSE: The more frequent use of screening mammography, along with improved imaging equipment and techniques, is today resulting in an increasing detection rate for suspicious nonpalpable lesion and thus an increasing need for needle localizations and biopsies. We evaluate the efficacy of hooked-wire fine needle localization. METHODS: From August 1992 to August 1999, 146 hooked-wire needle biopsies were performed at our institution for nonpalpable mammographically detected abnormalities. Specimen roentgenographies were done in all cases. The clinical datas, including mammographic findings and pathologic results, were reviewed retrospectively. RESULTS: Patients ranged in age from 13 to 74 years (a mean of 45.7 years). Of the total 146 cases, 23 (15.7%) were found to be malignants (52.2 percent of these malignancies were carcinomas in situ and 47.8 percent were invasive carcinoma). The chance of a biopsy containing a malignant lesion was 17.2 percent if the biopsy was done for a microcalcification found on a mammograms, 7.7 percent for mass densities, and 28.6 percent if both were present. Benign pathological lesions were proven in 123 cases (84.3%) of the total 146 cases. The most common benign lesion was fibrocystic disease. A minor complication of the hooked-wire needle insertion occurred in one patient who had a hematoma requiring evacuation. Three patients experienced faintness, dizziness, and syncope during needle localization. The morbidity and the mortality rates for biopsies of the breast were nil. CONCLUSION: These results suggest that hooked-wire needle localization for nonpalpable lesion in the breast is a most useful diagnostic modality.
Biopsy ; Biopsy, Needle ; Breast* ; Dizziness ; Hematoma ; Humans ; Mammography ; Mass Screening ; Mortality ; Needles* ; Retrospective Studies ; Syncope

PURPOSE: Cyclin D1, which is known as a cell regulatory protein in G1-S phase, is overexpressed in 30-90% of breast cancers. Published data on the relationships between cyclin D1 and the established clinicopathologic factors of breast cancer have been controversial, so we investigated the clinical significance of cyclin D1 and its associations with established clinicopathologic factors in 103 primary breast-cancer patients. METHODS: Cyclin D1 overexpression was measured by using immunohistochemical assays, and the results were compared with clinicopathologic factors. RESULTS: Expression of cyclin D1 was detected in 60.2% (62/103) and cyclin D1 was significantly correlated with the estrogen receptor, the progesterone receptor, lymph-node metastasis, histologic grade, and nuclear grade. But there were no associations between cyclin D1 and tumor size, tumor stage, vascular invasion of tumor, DNA ploidy and S phase. CONCLUSION: We found that breast cancer with cyclin D1 overexpression was associated with predictive factors such as the estrogen receptor and the progesterone receptor. Thus, we suggest that aggressive treatment is needed in breast cancer with cyclin D1 overexpression. For cyclin D1 to become a more informative clinical prognostic factor, more prospective studies with large sample sizes are needed.
Breast Neoplasms* ; Breast* ; Cyclin D1* ; Cyclins* ; DNA ; Estrogens ; Humans ; Neoplasm Metastasis ; Ploidies ; Receptors, Progesterone ; S Phase ; Sample Size

PURPOSE: Tumor size is a prognostic factor, as well as an important factor, in staging. Also, tumor size is a major factor in determining if a woman is a suitable candidate for various treatments, including a mastectomy or breast-conserving surgery. Thus, an accurate assessment of breast tumor size is important in making a prognosis and in planning treatment. METHODS: One hundred fifty-two patients presenting with palpable primary breast cancer were studied to evaluate the accuracies of clinical assessment, mammography, and ultrasonography in measuring tumor size. The clinical, mammographic, and ultrasonographic diameters of the tumors were compared to histological diameters. RESULTS: The average histological diameter of the tumors was 27.0+/-12.9 mm. The average diameter of the tumors on clinical assessment was 33.8+/-13.1 mm, and its correlation coefficient to the histological size was 0.73. The average size on mammography was 21.4+/-9.0 mm and its correlation coefficient to the histological size was 0.71. The tumor size on ultrasonography in 22 patients was 22.3+/-10.4 mm. The sonographic measurement demonstrated the highest correlation coefficient (0.83). The clinical assessment overestimated the histological tumor size, but the mammographic and sonographic measurement underestimated it. A combined measurement using both the clinical and the ultrasonographic methods slightly improved the correlation with the histological size (0.86). CONCLUSION: Ultrasonography could be a useful method for estimating tumor size preoperatively, and when it is combined with clinical assessment, it is the most reliable and accurate technique.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Mammography ; Mastectomy ; Mastectomy, Segmental ; Prognosis ; Ultrasonography

PURPOSE: The residual microscopic carcinoma after breast conserving surgery is the most important risk factor of local recurrence. As local recurrences usually develop around resected margins, it is ge nerally accepted that every effort should be made to achieve negative margins intraoperatively, and the presence of microscopically positive margins requires reexcision. Interestingly, sizable percentage of reexcisions results in a specimen free of residual tumor, and may not contribute to disease control, but do add morbidity, cost, and possibly compromise cosmetic result. The goal of our study was to identify which clinico-pathologic factors were associated with positive resection margin, and to identify the variables associated with no residual carcinoma on reexcision or total mastectomy specimens. METHODS: From Sepember 1994 to July 1999, 322 breast conserving surgery were performed on breast cancer patients at the Department of General Surgery, Samsung Medical Center. Among them, 13 patients had positive surgical margins and were treated with reexcision (reexcising the previous lumpectomy cavity with a margin of 1-2 cm of normal tissue) or total mastectomy. RESULTS: The factors associated with positive resection margins were large tumor size, the presence of extensive intraductal component (EIC), and suspicious mammographic microcalcifications without mass density. Six (46.3%) of these reoperation cases for positive margins were negative for residual tumor. The factors correlating with no residual carcinoma on reexcision or mastectomy specimens were small histologic primary tumor size and only one positive resection margin rather than 2 or more positive margins. CONCLUSION: The patients with above-mentioned factors associated with positive resection margins should be treated with more wide local excision or total mastectomy to avoid a second surgical procedure. If the patients with only one positive margin and small tumor size refuse second operation, they could be treated with irradiation only sparing an additional surgical procedure.
Breast Neoplasms ; Breast* ; Humans ; Mastectomy ; Mastectomy, Segmental* ; Mastectomy, Simple ; Neoplasm, Residual ; Recurrence ; Reoperation* ; Risk Factors

PURPOSE: Rapid progress in the development of communication devices has enabled us to use large amounts of various kinds of medical information, regardless of time or place. Today, in Korea there are many homepages on the web which provide medical information, hospital information, and counseling on medical fields in Korea, but more detailed recent medical informations, better quality control, and a greater variety of communication skills are needed. Methods and RESULTS: We analysed the data on the web from November 1998 to October 1999 about breast cancer clinic. The frequent questions were about breast mass (44%), breast pain (29%), and counseling on breast cancer (25%). The most frequent users were in their 3rd decade (55%), 4th decade (8%), and unknown age cases (23%). The average number of visitors on web was 454 per month. CONCLUSION: In near future, we believe that use of the web as an information source will grow rapidly and the most of the people in Korea will use internet. For that purpose, we should realize that virtual space is a reality, and we should use it as an effective technique for educating the public.
Breast Diseases* ; Breast Neoplasms ; Breast* ; Counseling* ; Internet* ; Korea ; Mastodynia ; Quality Control

PURPOSE: Conventional intravenous nutrition has been given as a solution of amino acids combined with dextrose and a separate line delivering a lipid emulsion. This technique was unsatisfactory, however, because of difficulties in managing technical and metabolic complications. Since the first clinical use of a single solution containing all the necessary nutrients was introduced in 1976, the total nutrient admixture (TNA) system has been used. However, despite the numerous advantages of this TNA system, it has not been used worldwide because of an assumption about unstability of this admixture. This study was conducted to compare the physical stability of TNA systems using two different 2 commercially available amino acid solutions and fat emulsions. METHODS: Each group contained 600 ml of 20% dextrose, 250 ml of 10% amino acid solution, 250 ml of 10% fat emulsion, 0.2 ml of heparin, and 20 ml of electrolyte solution was investigated for 7 days while being stored 4oC and at ambient temperature. The stabilities of these admixtures were compared by noting changes in macroscopic appearance, pH, osmolarity, Zeta-potential, peroxide value, particle size and distribution, and fat composition. RESULTS: When an amino acid solution containing P 2 was used, a supernatant yellow band was observed from the 3rd day at ambient temperature. The pH and peroxide value also showed significant changes, but these changes did not exceed the product-specifications. When an amino acid solution without P 2 was used, no significant change was observed. CONCLUSION: TNA systems are physically stable at 4oC temperature for at least 7 days, but TNA systems prepared with amino acid solution containing P 2 are not stable at ambient temperature from the 3rd day. On the other hand, TNA systems prepared with an amino acid solution without P 2 are stable at ambient temperature for 7 days. Various commercially available fat emulsions containing 10% soybean oil did not affect the stability of TNA systems.
Amino Acids ; Emulsions ; Glucose ; Hand ; Heparin ; Hydrogen-Ion Concentration ; Osmolar Concentration ; Parenteral Nutrition ; Particle Size ; Soybean Oil