Purpose: The treatment of male breast cancer (MBC) has been extrapolated from female breast cancer (FBC) because of its rarity despite their different clinicopathologic characteristics. We aimed to investigate the distribution of intrinsic subtypes based on immunohistochemistry, their clinical impact, and treatment pattern in clinical practice through a multicenter study in Korea. Materials and Methods: We retrospectively analyzed clinical data of 248 MBC patients from 18 institutions across the country from January 1995 to July 2016. Results: The median age of MBC patients was 63 years (range, 25 to 102 years). Among 148 intrinsic subtype classified patients, 61 (41.2%), 44 (29.7%), 29 (19.5%), and 14 (9.5%) were luminal A, luminal B, human epidermal growth factor receptor 2, and triple-negative breast cancer, respectively. Luminal A subtype showed trends for superior survival compared to other subtypes. Most hormone receptor-positive patients (166 patients, 82.6%) received adjuvant endocrine treatment. Five-year completion of adjuvant endocrine treatment was associated with superior disease-free survival (DFS) in patients classified with an intrinsic subtype (hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.04 to 0.49; p=0.002) and in all patients (HR, 0.16; 95% CI, 0.05 to 0.54; p=0.003). Conclusion Distribution of subtypes of MBC was similar to FBC and luminal type A was most common. Overall survival tended to be improved for luminal A subtype, although there was no statistical significance. Completion of adjuvant endocrine treatment was associated with prolonged DFS in intrinsic subtype classified patients. MBC patients tended to receive less treatment. MBC patients should receive standard treatment according to guidelines as FBC patients.

Purpose: We investigated the consistent efficacy and safety of eflapegrastim, a novel long-acting granulocyte-colony stimulating factor (G-CSF), in Koreans and Asians compared with the pooled population of two global phase 3 trials. Materials and Methods: Two phase 3 trials (ADVANCE and RECOVER) evaluated the efficacy and safety of fixed-dose eflapegrastim (13.2 mg/0.6 mL [3.6 mg G-CSF equivalent]) compared to pegfilgrastim (6 mg based on G-CSF) in breast cancer patients who received neoadjuvant or adjuvant docetaxel/cyclophosphamide. The primary objective was to demonstrate non-inferiority of eflapegrastim compared to pegfilgrastim in mean duration of severe neutropenia (DSN) in cycle 1, in Korean and Asian subpopulations. Results: Among a total of 643 patients randomized to eflapegrastim (n=314) or pegfilgrastim (n=329), 54 Asians (29 to eflapegrastim and 25 to pegfilgrastim) including 28 Koreans (14 to both eflapegrastim and pegfilgrastim) were enrolled. The primary endpoint, DSN in cycle 1 in the eflapegrastim arm was non-inferior to the pegfilgrastim arm in Koreans and Asians. The DSN difference between the eflapegrastim and pegfilgrastim arms was consistent across populations: –0.120 days (95% confidence interval [CI], –0.227 to –0.016), –0.288 (95% CI, –0.714 to 0.143), and –0.267 (95% CI, –0.697 to 0.110) for pooled population, Koreans and Asians, respectively. There were few treatment-related adverse events that caused discontinuation of eflapegrastim (1.9%) or pegfilgrastim (1.5%) in total and no notable trends or differences across patient populations. Conclusion This study may suggest that eflapegrastim showed non-inferior efficacy and similar safety compared to pegfilgrastim in Koreans and Asians, consistently with those of pooled population.

BACKGROUND: Recent research has shown that reactive oxygen species (ROS) play a significant role in the development and persistence of neuropathic pain through central sensitization via N-methyl-D-aspartate (NMDA) receptor activation. In the present study, we examined whether the intraperitoneal administration of vitamins C and E alone or together could alleviate mechanical allodynia in a chronic post-ischemia pain (CPIP) rat model. METHODS: Vitamins C and E were administered intraperitoneally to 48 male Sprague Dawley rats once per day for 3 days before hindpaw ischemia-reperfusion (I/R) injury was induced. On the third day, the CPIP rat model was produced by inducing ischemia in the left hindpaw by applying an O-ring for 3 h, followed by reperfusion. Three days after reperfusion, hindpaw mechanical allodynia was assessed by measuring the withdrawal response to von Frey filament stimulation. The rats were sacrificed immediately after behavioral testing to determine the phosphorylated NMDA receptor subunit 1 (pNR1) and extracellular-signal-regulated kinases (pERK) levels in the spinal cord. RESULTS: When the antioxidant vitamins C and E were administered intraperitoneally to CPIP rats, I/R injury-induced mechanical allodynia was attenuated, and pNR1 and pERK levels were decreased in the rat spinal cord. Additionally, the co-administration of both vitamins had an increased antiallodynic effect. CONCLUSIONS: The reduced phosphorylated NR1 and ERK levels indicate that vitamins C and E inhibit the modulation of spinal cord neuropathic pain processing. Co-administration of vitamins C and E had a greater antiallodynic effect.
Animals ; Antioxidants ; Ascorbic Acid* ; Central Nervous System Sensitization ; Complex Regional Pain Syndromes ; Humans ; Hyperalgesia ; Inositol Phosphates ; Ischemia ; Male ; Mitogen-Activated Protein Kinases ; Models, Animal* ; N-Methylaspartate ; Neuralgia ; Phosphotransferases ; Prostaglandins E ; Rats* ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Receptors, N-Methyl-D-Aspartate ; Reperfusion ; Reperfusion Injury ; Spinal Cord ; Vitamin E* ; Vitamins*

BACKGROUND: Mirror-image allodynia is a mysterious phenomenon that occurs in association with many clinical pain syndromes including complex regional pain syndromes (CRPS). Underlying mechanisms for the development of such pain are still a matter of investigation. Several studies suggest that activation of the N-methyl-D-aspartate (NMDA) receptor is essential for central sensitization as a base for persistent pain. The aim is to assess whether alteration of NMDA receptor expression correlates with the contralateral allodynia in the chronic post-ischemia pain (CPIP) model rats representing CRPS-Type I. METHODS: Application of a tight-fitting tourniquet for a period of 3 hours before reperfusion produced CPIP in male Sprague-Dawley rats. The mechanical paw withdrawal thresholds to von Frey stimuli (using a dynamic plantar aesthesiometer) were measured as pain indicators in ipsilateral and contralateral hindpaws. Phosphorylation of the NMDA receptor 1 subunit (pNR1), assessed with Western blot, was measured in the contralateral L4-6 spinal cord. RESULTS: Ipsilateral and contralateral mechanical allodynia is present at 4 hours after reperfusion, peaked at 3 days, and continued for 7 days after reperfusion. The relative density of pNR1 of CPIP rats significantly decreased in the contralateral L4-6 spinal cord compared to baseline value (P < 0.05). There was significant correlation between paw withdrawal threshold and the relative density of pNR1 (ipsilateral; R2 = 0.75, P < 0.01, contralateral; R2 = 0.60, P < 0.01). CONCLUSIONS: These data suggest that pNR1 is correlated to the contralateral mechanical allodynia in CPIP rats.
Animals ; Blotting, Western ; Central Nervous System Sensitization ; Complex Regional Pain Syndromes ; Humans ; Hyperalgesia ; Inositol Phosphates ; Male ; N-Methylaspartate ; Phosphorylation ; Prostaglandins E ; Rats ; Rats, Sprague-Dawley ; Reperfusion ; Specific Gravity ; Spinal Cord ; Tourniquets

BACKGROUND: The gut is an important area for inflammatory responses. Gut manipulation during open laparotomy compared with laparoscopic surgery, increases the inflammatory responses. Laparoscopic assisted colectomy (LC) with less bowel manipulation might minimize the inflammatory responses and oxidative stress, and offer a faster postanesthetic recovery than an open colectomy (OC). This study evaluated the effect of N-acetyl-cysteine (NAC), an antioxidant, on the recovery after colectomy. METHODS: 116 colorectal tumor patients were reviewed retrospectively. The patients were divided into 3 groups; LC by surgeon A (A - L), OC by surgeon A (A - O) and OC by surgeon B (B - O). The postanesthetic recovery scores (PARS) were compared. In the prospective randomized controlled trial, the colorectal tumor patients were assigned to one of four groups; laparoscopic assisted colectomy (L - N) with NAC infusion (L + N), open colectomy (O - N) with NAC infusion (O + N). In the NAC groups, NAC (5 mg/kg/h) was infused after intubation to extubation. The PARS were compared. RESULTS: In the retrospective study, the time to reach 10 points, which satisfies the discharge criteria in the PACU, was significantly lower in the A-L group than in the other groups. In the prospective study, the time to 10 points was shorter in the O + N group than in the O-N group. NAC offered no added benefits to the L + N and L-N groups. CONCLUSIONS: NAC offered faster recovery in the OC group but not in the LC group.
Colectomy ; Colorectal Neoplasms ; Colorectal Surgery* ; Humans ; Intubation ; Laparoscopy ; Laparotomy ; Oxidative Stress ; Prospective Studies ; Retrospective Studies

BACKGROUND: Reduction aortoplasty has been advocated for dilatation of the ascending aorta associated with aortic valve disease in older, high-risk patients. We report our results with modification of reduction aortoplasty and aortic valve replacement. MATERIAL AND METHOD: Between July 2001 and December 2002, 14 consecutive patients who underwent modification of reduction aortoplasty, suture plication technique without excision of the dilated aortic wall, were reviewed. The mean age was 63.7+/-6.7 (50 to 75) years. Ten patients had congenital bicuspid aortic valve. Twelve patients had severe aortic valve stenosis and 6 had regurgitation of grade III~IV. The diameter of the ascending aorta was measured before and immediately after surgery and 6 and 12 months postoperatively using echocardiography or computed tomography. Follow-up was complete in an average of 14.7+/-5.4 (7 to 24) months. RESULT: There were no early postoperative deaths and no bleeding complications. Reduction aortoplasty with suture plication technique decreased the diameter of ascending aorta from 49.4+/-3.5 mm preoperatively to 33.2+/-3.4 mm postoperatively (p<0.001). During follow-up, there were no late deaths and no aneurysm recurrence on the ascending aorta. CONCLUSION: Suture plication technique of reduction aortoplasty without excision of the dilated aortic wall offers good early and short-term results in older, high-risk patients with dilatation of the ascending aorta associated with aortic valve disease. Surgical long-term results of our technique should be evaluated in further studies.
Aneurysm ; Aorta* ; Aortic Valve Stenosis ; Aortic Valve* ; Bicuspid ; Dilatation* ; Echocardiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Recurrence ; Sutures*

BACKGROUND: The pringle maneuver (PM), hepatic inflow occlusion, during hepatic surgery reduces intraoperative bleeding and blood transfusion requirement, but hepatic ischemia/reperfusion injury is inevitable. During ischemia, xanthine oxidoreductase is converted to xanthine oxidase (XO), which can serve as a critical source of reactive oxygen species (reduces O2 to O2 .-) that contribute to inflammatory signaling, ischemia-reperfusion injury, and an impaired vascular function. The purpose of the present study was to follow changes of XO activity and O2 .- production during hepatic surgery under PM. METHODS: Eleven patients that underwent hepatectomy under intermittent PM were studied. Blood was withdrawn before PM, and 10 and 20 minutes after final reperfusion. Plasma XO activity was measured using a spectrophotometer after incubating plasma with/without xanthine for one-hour. Superoxide (O2 -) production was followed by measuring by cytochrome c reduction by plasma XO. RESULTS: After final reperfusion, plasma XO activity had increased four-fold (0.36 +/- 0.06 to 1.25 +/- 0.25 mU/ml) with a concomitant increase in O2 .- production (0.66 +/- 0.29 to 1.66 +/- 0.40microM/min). CONCLUSIONS: Significantly more XO is released into the systemic circulation after intermittent PM, with subsequently increased O2 .- production. The significant contribution of XO to hepatic surgery under PM might be beneficially managed using an anesthetic with a known antioxidative effect.
Blood Transfusion ; Cytochromes c ; Hemorrhage ; Hepatectomy ; Humans ; Ischemia ; Plasma* ; Reactive Oxygen Species ; Reperfusion ; Reperfusion Injury ; Superoxides ; Xanthine Dehydrogenase ; Xanthine Oxidase* ; Xanthine*

BACKGROUND: Sevoflurane is the most recently available volatile agent which permits the rapid induction with its nonirritant nature. The goal of this study was to compare the hemodynamic responses of sevoflurane induction and maintenance period with those of fentanyl-midazolam/isoflurane anesthesia for CABG. METHODS: Twenty-eight patients who underwent CABG were given anesthesia, and were randomly assigned to receive sevoflurane (Sevo Group, n = 15) or fentanyl-midazolam/isoflurane (Iso-Fent Group, n = 13), as induction and maintenance agents. In the Sevo group, anesthesia was induced with two or three deep breaths of 7.5% sevoflurane, and maintained with 2% sevoflurane after intubation. The Iso-Fent Group received fentanyl 5microgram/kg and midazolam 0.2 mg/kg with oxygen for induction and maintained with 0.8% isoflurane and 5microgram/kg/hr of fentanyl by infusion. All were given vecuronium as a muscle relaxant. Cardiac and oxygen metabolic profiles were measured before and 10 minutes after tracheal intubation. RESULTS: Before induction, there was no difference between Sevo and Iso-Fent group in terms of cardiac and oxygen metabolic profiles. After intubation, mean arterial pressure, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, heart rate and mixed venous oxygen saturation in the Sevo group were higher than in the Iso-Fent group (P < 0.05). The ST-segment changes in the EKG monitoring was unremarkable during anesthesia induction in either group. CONCLUSIONS: For the induction and early anesthesia maintenance in patients undergoing CABG surgery, sevoflurane may be a substitute for fentanyl-midazolam/isoflurane without any significant hemodynamic changes.
Anesthesia* ; Arterial Pressure ; Coronary Artery Bypass* ; Coronary Vessels* ; Electrocardiography ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Isoflurane ; Metabolome ; Midazolam ; Oxygen ; Pulmonary Wedge Pressure ; Vecuronium Bromide

BACKGROUND: Anesthesia and surgery may exacerbate liver function in patients with pre-existing liver disease so it is important to choose less hepatotoxic anesthetics in patients with chronic liver disease. METHODS: This study was designed to examine the postoperative liver function test in 150 patients after hepatectomy with portal triad clamping through retrospective chart review. Patients were divided into an isoflurane group (group I, n = 56) and a propofol group (group P, n = 57) by used anesthetics for maintaining anesthesia. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase, alkaline phosphatase, total bilirubin, albumin, and prothrombin time were checked at preoperation, and postoperatively at 1, 3, 7 and 14 days in the two groups. Indocyanine retention rate (ICG-R15) was measured at preoperation, and postoperatively at 1 and 7 days. RESULTS: AST values increased postoperatively at 1, 3, 7, and 14 days compared with preoperation. ALT values increased postoperatively at 1, 3 and 7 days compared with preoperation and there was difference between group I (443.8 +/- 52.1 U/L) and group P (202.7 +/- 24.7 U/L) at postoperative 1 day. Other values had no significant difference between the two groups. CONCLUSIONS: Though it might need a well controlled study to find the differences in effect between isoflurane and propofol on the postoperative liver function test, we concluded that total intravenous anesthesia using propofol is also one of the safest anesthetic methods for hepatic resection with minimal hepatotoxicity.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia ; Anesthesia, Intravenous ; Anesthetics ; Aspartate Aminotransferases ; Bilirubin ; Constriction* ; Hepatectomy ; Humans ; Isoflurane* ; L-Lactate Dehydrogenase ; Liver Diseases ; Liver Function Tests* ; Liver* ; Propofol* ; Prothrombin Time ; Retrospective Studies

No abstract available
Hemodynamics*