1.Risk Factors of Local Recurrence in Phyllodes Tumor of the Breast according to the Clinicopathological Characteristics.
Yeon Suk PARK ; Beom Seok KWAK ; Byung Ho SON ; Sei Hyun AHN ; Jin Ho KWAK
Journal of the Korean Surgical Society 2008;74(3):171-176
PURPOSE: Phyllodes tumor is a rare fibroepithelial disease of the breast that is classified as benign, borderline malignant, or malignant according to the pathological characteristics. To clarify diagnostic criteria for these groups, we analyzed the clinico-pathological characteristics of phyllodes tumors and the risk factors for local recurrence after surgery. METHODS: Between January 1997 and March 2003, we included 70 cases of recurring, pathologically-confirmed phyllodes tumors after surgery. Medical records were reviewed retrospectively for clinical characteristics and pathologic findings. RESULTS: The mean follow up period was 69.3 months (range 45.4 to 119.3 months) and mean age, 39.4 years old (range 18 to 63 years old). Benign phyllodes tumors were present in 45 cases (64.3%), borderline malignant tumors in 15 cases (21.4%), and malignant tumors in 10 cases (14.3%). A local recurrence developed in 9 cases (12.9%), with three of these cases benign (33.3%), 5 cases were borderline malignant (55.6%), and 1 case was malignant (11.1%). Borderline malignant cases showed a higher local recurrent rate (6.7%, 33.3%, and 10.0%, P=0.027). The local recurrence rate between the tumor-positive or close (<1 mm) resection margins and non-involved cases was different for benign (7.7% vs. 6.3%, P=0.031) and borderline malignant cases (60.0% vs. 20.0%, ns). CONCLUSION: Pathologic classification and small resection margins are risk factors for local recurrence in phyllodes tumors. Therefore, borderline malignant phyllodes tumors require wide excision with a sufficient resection margin or a mastectomy to prevent local recurrence.
Breast
;
Follow-Up Studies
;
Mastectomy
;
Medical Records
;
Phyllodes Tumor
;
Recurrence
;
Retrospective Studies
;
Risk Factors
2.Is a One Night Delay of Surgery Safe in Patients With Acute Appendicitis?
Jae Min LEE ; Beom Seok KWAK ; Young Jin PARK
Annals of Coloproctology 2018;34(1):11-15
PURPOSE: With varied reports on the impact of time to appendectomy on clinical outcomes, the purpose of this study was to determine the effect of preoperative in-hospital delay on the outcome for patients with acute appendicitis. METHODS: A retrospective review of 1,076 patients who had undergone an appendectomy between January 2010 and December 2013 was conducted. RESULTS: The outcomes of surgery and the pathologic findings were analyzed according to elapsed time. The overall elapsed time from onset of symptoms to surgery was positively associated with advanced pathology, increased number of complications, and prolonged hospital stay. In-hospital elapsed time was not associated with any advanced pathology (P = 0.52), increased number of postoperative complications (P = 0.14), or prolonged hospital stay (P = 0.24). However, the complication rate was increased when the in-hospital elapsed time exceeded 18 hours. CONCLUSION: Advanced pathology and postoperative complication rate were associated with overall elapsed time from symptom onset to surgery rather than in-hospital elapse time. Therefore, a short-term delay of an appendectomy should be acceptable.
Appendectomy
;
Appendicitis
;
Humans
;
Length of Stay
;
Pathology
;
Postoperative Complications
;
Retrospective Studies
3.A Case of Monoclonal Gammopathy in Extranodal Marginal Zone B-cell Lymphoma of the Small Intestine.
Do Yeun KIM ; Yong Seok KIM ; Hee Jin HUH ; Jong Sun CHOI ; Jeong Seok YEO ; Beom Seok KWAK ; Seok Lae CHAE
The Korean Journal of Laboratory Medicine 2011;31(1):18-21
Monoclonal gammopathy occurs in one-third of the patients with mucosa-associated lymphoid tissue lymphoma (MALT lymphoma). However, monoclonal gammopathy has been rarely reported in Korea. Paraprotenemia accompanying MALT lymphoma is strongly correlated with involvement of the bone marrow, and this involvement leads to the progression of the disease. Here, we present a case of a 66-yr-old man diagnosed with IgM monoclonal gammopathy and stage IV extranodal marginal zone lymphoma of the small intestine, with the involvement of the bone marrow.
Aged
;
Antineoplastic Agents/therapeutic use
;
Bone Marrow/pathology
;
Drug Therapy, Combination
;
Electrophoresis, Polyacrylamide Gel
;
Humans
;
Immunoglobulin M/analysis
;
Intestinal Neoplasms/complications/drug therapy/*pathology
;
Lymphatic Metastasis
;
Lymphoma, B-Cell, Marginal Zone/complications/drug therapy/*pathology
;
Male
;
Neoplasm Staging
;
Paraproteinemias/blood/complications/*pathology
;
Positron-Emission Tomography
;
Tomography, X-Ray Computed
4.Skin-sparing Mastectomy with Immediate Breast Reconstruction for the Treatment of Advanced Breast Cancer.
Ui Kang HWANG ; Ho Sung YOON ; Beom Seok KWAK ; Byeong Ho SON ; Sei Hyun AHN ; Taik Jong LEE
Journal of Korean Breast Cancer Society 2004;7(2):126-131
PURPOSE: This study was performed to show the several clinical variables before and after the surgery that need to be considered for patient selection and whether there is an increased possibility of recurrence after surgery and whether this possibility can be reduced when adjuvant treatment is applied. METHODS: The outcome of SSM with immediate breast reconstruction, using follow-up data of cases performed at Asan Medical Center between September, 1996 and December, 2002, were retrospectively assessed and pathologically advanced breast cancer patients (stage III) were analyzed separately. RESULTS: 191 patients had undergone SSM with immediate reconstruction during the study period. The percentage of cases stage III was 15.2% (29 cases). Among these patients, 6 (20.7%) were suspected of being in the early stages of breast cancer prior to the surgery. The mean age of the advanced breast cancer patients was 37 years. Immediate breast reconstruction consisted of a pedicled TRAM flap (n=24), a insertion of tissue expander (n=4) or direct implant (n=1). Radiotherapy was performed in 16 patients (53.3%) and chemotherapy was conducted without delay in all case. With a median length of follow-up of 36.1 months for 22 patients, who under went the operation until December, 2001, local recurrence was 4.5% (1/22) with successful local treatment, and distant metastasis was 13.7% (3/22). There was no difference in the disease free survival compared to that of the non-reconstruction group (P=0.093). CONCLUSION: SSM with immediate reconstruction seems safe and effective for patients with advanced breast cancer. However an accurate preoperative assessment of the extent of the disease and discussion for the planning of treatment between surgeon and patient is required.
Breast Neoplasms*
;
Breast*
;
Chungcheongnam-do
;
Disease-Free Survival
;
Drug Therapy
;
Female
;
Follow-Up Studies
;
Humans
;
Mammaplasty*
;
Mastectomy*
;
Neoplasm Metastasis
;
Patient Selection
;
Radiotherapy
;
Recurrence
;
Retrospective Studies
;
Tissue Expansion Devices
5.The Learning Curve for Laparoscopic Totally Extraperitoneal Herniorrhaphy by Logarithmic Function.
Oh Chul KWON ; Yong Hae BAIK ; Min Gu OH ; Yeong Jin PARK ; Beom Seok KWAK ; In Woong HAN
Journal of Minimally Invasive Surgery 2016;19(4):126-129
PURPOSE: Totally extraperitoneal (TEP) hernia repair has gained in popularity in the past two decades. Despite the advantages TEP hernia repair, the approach is hindered by the relatively long learning curve of the surgery. We tried to estimate the necessary number of repetitions of TEP hernia repair in the learning curve using logarithmic and exponential function models. METHODS: We performed a retrospective review of all patients who underwent TEP hernia repair by a single surgeon consecutively at a single center. We calculated how many operations were needed to achieve a reduction in the expected operating time to mean operating time using logarithmic and exponential function models. RESULTS: In the 91 patients, the logarithmic function model predicted that 37 cases were needed to overcome the learning curve for TEP hernia repair while the exponential model predicted that 39 cases were needed. CONCLUSION: According to this study, at least 37 to 39 cases are needed in the overcome learning curve of TEP hernia repair. Further studies are needed to optimize surgical education and maximize quality.
Education
;
Herniorrhaphy*
;
Humans
;
Learning Curve*
;
Learning*
;
Likelihood Functions
;
Retrospective Studies
6.Primary Fibrosarcoma of the Breast: A Case Report.
Jin Young LEE ; Dae Bong KIM ; Beom Seok KWAK ; Eo Jin KIM
Journal of Breast Cancer 2011;14(2):156-159
A primary fibrosarcoma of the breast is a rare tumor. Here we report on a case of a primary fibrosarcoma of the breast that presented as a palpable left breast mass in a 47-year-old woman. The physical examination revealed a 3 cm sized, round mass in the left upper outer breast. The mammograms revealed a 3 cm sized, partially circumscribed and partially obscured, high density mass in the upper outer quadrant of the left breast. An ultrasonogram demonstrated a 3 cm sized, ovoid, circumscribed and hypoechoic mass with peripheral increased vascularity on Doppler imaging. Surgical excision was performed and the pathology revealed a low grade fibrosarcoma.
Breast
;
Female
;
Fibrosarcoma
;
Humans
;
Mammography
;
Middle Aged
;
Physical Examination
7.Comparison of Hemodynamic Effects between Dobutamine and Amrinone in the Patients with Pulmonary Hypertension.
Yong Woo HONG ; Young Lan KWAK ; Sang Kee MIN ; Sang Beom NAM ; Seo Ouk BANG ; Eun Sook YOO ; Myoung Ouk KIM ; Min Seok KIM
Korean Journal of Anesthesiology 1997;33(5):928-936
BACKGROUND: Dobutamine and amrinone, phosphodiesterase-III inhibitor, are known to have both inotropic and vasodilatory properties. We evaluated the effects of both drugs on systemic and pulmonary hemodynamics in patients with pulmonary hypertension (PH). METHODS: With Institutional Review Board approval, 45 patients whose mean pulmonary arterial pressure was greater than 30 mmHg were studied. After sternotomy under the steady state of anesthesia and controlled ventilation (30 mmHg < PaCO2 < 40 mmHg), patients recieved one of following drugs for 30minutes (min); dobutamine 5.0ug/kg/min (Group I), low dose amrinone (loading dose 1.0 mg/kg, followed by infusion 7.5 g/kg/min, Group II) or high dose amrinone (loading dose 2.0 mg/kg, followed by infusion 10 g/kg/min, Group III). Hemodynamic variables were measured at 10 min and 30 min after start of infusion. RESULTS: Dobutamine didn't decrease pulmonary arterial pressure (PAP) and cause no hemodynamic change while low and high dose amrinone reduced PAP and especcially decrease of PAP in low dose amrinone group was statistically significnat. High dose amrinone increased cardiac index (CI) and decreased both systemic vascular resistance index (SVRI) and central venous pressure (CVP) more significantly than control value. CONCLUSIONS: In patients with chronic right ventricular failure associated with PH, amrinone may decrease the PAP and improve cardiac performance more effectively than dobutamin does. Increment of dosage of amrinone may not result in significant reduction of PAP.
Amrinone*
;
Anesthesia
;
Arterial Pressure
;
Central Venous Pressure
;
Dobutamine*
;
Ethics Committees, Research
;
Hemodynamics*
;
Humans
;
Hydrogen-Ion Concentration
;
Hypertension, Pulmonary*
;
Sternotomy
;
Vascular Resistance
;
Ventilation
8.Telemedicine in Dermatology.
Ha Seok RHO ; Ki Beom SHUR ; Jeung Hoon LEE ; Jang Kyu PARK ; Hoe Kyung JUNG ; Sang Tae KWAK
Korean Journal of Dermatology 2000;38(11):1468-1474
BACKGROUND: Telemedicine can be useful in dermatology in which there is a physical barrier between the dermatologist and patient or primary care giver. OBJECTIVE: Our purpose of this study is to examine a usefulness of teledermatology system in Korean situation. METHODS: We made store-and forward teledermatology system on world wide web for it's usefulness. We examined the difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images. RESULTS: The merits of our teledermatology system are summarized as follows1. It has more diagnostic accuracy than classic store-and forward system. 2. The real-time additional history taking and request of laboratory examinations are possible by chatting system between dermatologist and primary care giver. 3. Patient follow-up is easier than store-and forward system. The difference of diagnostic accuracy, level of certainty, and quality of images of photographs and still digital images are summarized as follows. 1. There is no difference of diagnostic accuracy between photographic readers and digital image readers. 2. There is no difference of level of certainty between photographic readers and digital image readers. 3. In assesment of quality of photographs, no difference was founded between photographic readers and digital image readers 4. The satisfaction of quality of photographs is very high in all groups. The average is 97.5%. CONCLUSION: This study provides evidence that our teledermatology system is useful in korean situation and still digital image can substitute historic photographs in teledermatology.
Dermatology*
;
Equidae
;
Follow-Up Studies
;
Humans
;
Internet
;
Primary Health Care
;
Telemedicine*
9.The Effect of Norepinephrine on Blood Pressure and Blood Flow of the Brachial and Femoral Arteries.
Jin Ho KIM ; Young Hwan PARK ; Sang Beom NAM ; Yong Woo HONG ; Mun Seok SEO ; Young Lan KWAK
Korean Journal of Anesthesiology 2000;39(3):417-422
BACKGROUND: Arterial pressure is the most commonly utilized guideline for the management of critically ill patients. However, the site of arterial pressure monitoring can impact the observed pressure. In patients undergoing cardiac surgery, peripheral arterial pressure can underestimate central aortic pressure and vasodilators magnify this phenomenon. There was also a large discrepancy between radial and femoral artery pressure in endotoxemic patients treated with vasopressors or hypothermic patients. We evaluated the effect of the continuous infusion of norepinephrine, the most commonly used vasopressor, on pressure and blood flow in both the brachial and femoral artery in dogs in normal condition. METHODS: Both the brachial and femoral arteries were cannulated for pressure monitoring and the other side arteries were exposed for the measurement of blood flow in 10 dogs. Two doses of norepinephrine (NE), 0.05 microgram/kg/min and 0.1 microgram/kg/min, were infused for 10 minutes each in sequence. Hemodynamic variables and blood flow were measured before the infusion of NE, and immediately after the infusion of the two doses of NE. RESULTS: NE increased both brachial and femoral arterial pressures with no difference between the two pressures. NE decreased blood flow in both brachial and femoral arteries even though cardiac output was maintained constantly which means NE caused the redistribution of blood flow. CONCLUSIONS: Unlike endotoxemic shock conditions or hypothermic vasoconstriction, NE didn't show different effects on pressure monitoring sites regardless of their diameter in normal condition. NE increased blood pressure and decreased blood flow in the same degree in both the brachial and femoral artery.
Animals
;
Arterial Pressure
;
Arteries
;
Blood Pressure*
;
Cardiac Output
;
Critical Illness
;
Dogs
;
Femoral Artery*
;
Hemodynamics
;
Humans
;
Norepinephrine*
;
Shock
;
Thoracic Surgery
;
Vasoconstriction
;
Vasodilator Agents
10.Microdochectomy Assisted by Ultrasound-Guided Indigo Carmine Staining of Intraductal Lesions: A Case Report.
Bo Young JEONG ; Dae Bong KIM ; Beom Seok KWAK
Journal of Breast Cancer 2014;17(2):184-187
Spontaneous bloody nipple discharge from a single duct is a significant clinical problem. When performing preoperative marking of the discharging duct, it is sometimes difficult to identify the duct owing to intermittent discharge. Precise preoperative marking of the discharging duct and intraductal lesions is very important to avoid unnecessary wide excision of breast tissue or failure to remove the cause of nipple discharge. We herein present a case of preoperative ultrasound-guided indigo carmine staining in a patient with no discharge on the day of surgery. When a dilated duct is visualized on ultrasound, the targeted duct can be localized using indigo carmine staining, and it is possible to perform a precise minimal volume microdochectomy.
Breast
;
Humans
;
Indigo Carmine*
;
Nipples
;
Ultrasonography