PURPOSE: In breast cancer patients, information of the axillary nodal status is essential for staging, determining the necessity of systemic therapy, and predicting the prognosis. The necessity of an axillary lymph node dissection in small breast cancers is controversial. The aim of this study is to identify the factors associated with axillary lymph node metastases and to determine the necessity of axillary lymph node dissections in T1 invasive ductal carcinomas of the breast. METHODS: From the June 1991 to the March 2004, of a total 919 cases who underwent surgery for breast cancer in Korea University Hospital, 230 cases of T1 invasive ductal carcinomas were reviewed retrospectively. All subjects were classified as T1a, T1b, or T1c. The rate of axillary lymph node metastasis was calculated for each group and the factors that have a statistically significant correlations with axillary lymph nodes metastases were investigated. RESULTS: Of the 230 cases of T1 invasive ductal carcinomas, 22 cases were T1a, 27 cases were T1b, and 181 cases were T1c. Axillary lymph node metastases were encountered in 4 T1a case (18%), 5 T1b cases (18.5%), and 67 T1c cases (30.3%). The overall rate of axillary lymph node metastases rate in T1 was 33% (76/230). The T stage had a statistically significant correlation (p=0.043) with the axillary lymph node metastases. Lymphovascular invasion of the tumor had a significant correlations with an axillary lymph node metastases (p=0.032). The MIB-1 labeling index was increased according to the tumor size, and correlated with the presence of an axillary lymph node metastasis (p=0.032, p=0.18). However age, hormone receptors, p53, HER2/neu , and nm23 were not associated with an axillary lymphnodes metastasis. CONCLUSIONS: The tumor size and the lymphovascular invasion could be significantly prognostic factors suggesting an axillary lymph node metastasis in T1 invasive ductal carcinomas. The MIB-1 immunostain was higher in the T1c cases. Therefore, a combination of the tumor size and MIB-1 immunostain would be an indicator for an axillary lymph node dissection. A sentinel lymph node biopsy may be of more benefit in T1a invasive ductal carcinomas of the breast.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis* ; Prognosis ; Retrospective Studies ; Sentinel Lymph Node Biopsy

PURPOSE: In breast cancer patients, information of the axillary nodal status is essential for staging, determining the necessity of systemic therapy, and predicting the prognosis. The necessity of an axillary lymph node dissection in small breast cancers is controversial. The aim of this study is to identify the factors associated with axillary lymph node metastases and to determine the necessity of axillary lymph node dissections in T1 invasive ductal carcinomas of the breast. METHODS: From the June 1991 to the March 2004, of a total 919 cases who underwent surgery for breast cancer in Korea University Hospital, 230 cases of T1 invasive ductal carcinomas were reviewed retrospectively. All subjects were classified as T1a, T1b, or T1c. The rate of axillary lymph node metastasis was calculated for each group and the factors that have a statistically significant correlations with axillary lymph nodes metastases were investigated. RESULTS: Of the 230 cases of T1 invasive ductal carcinomas, 22 cases were T1a, 27 cases were T1b, and 181 cases were T1c. Axillary lymph node metastases were encountered in 4 T1a case (18%), 5 T1b cases (18.5%), and 67 T1c cases (30.3%). The overall rate of axillary lymph node metastases rate in T1 was 33% (76/230). The T stage had a statistically significant correlation (p=0.043) with the axillary lymph node metastases. Lymphovascular invasion of the tumor had a significant correlations with an axillary lymph node metastases (p=0.032). The MIB-1 labeling index was increased according to the tumor size, and correlated with the presence of an axillary lymph node metastasis (p=0.032, p=0.18). However age, hormone receptors, p53, HER2/neu , and nm23 were not associated with an axillary lymphnodes metastasis. CONCLUSIONS: The tumor size and the lymphovascular invasion could be significantly prognostic factors suggesting an axillary lymph node metastasis in T1 invasive ductal carcinomas. The MIB-1 immunostain was higher in the T1c cases. Therefore, a combination of the tumor size and MIB-1 immunostain would be an indicator for an axillary lymph node dissection. A sentinel lymph node biopsy may be of more benefit in T1a invasive ductal carcinomas of the breast.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis* ; Prognosis ; Retrospective Studies ; Sentinel Lymph Node Biopsy

Background: Burnout syndrome (BOS) is defined by the World Health Organization (WHO) as a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. This study aims to create the Korean version burnout syndrome scale (KBOSS) that conforms to WHO’s definition of BOS and present the cut-off points for screening. Methods: We developed the KBOSS based on WHO’s definition of BOS. An online survey was conducted through a specialized online research company. We recruited 444 workers for this research. The validity of the KBOSS was assessed using factor analysis and Pearson’s correlation. The KBOSS reliability was assessed using Cronbach’s alpha coefficient. The cut-off points for each of the three dimensions were derived using the upper quartile score. Results: The validity and reliability of the KBOSS were good. Regarding reliability, the scale’s overall Cronbach’s alpha was 0.813. Cronbach’s alpha of each three-dimension was as follows: exhaustion, 0.916; cynicism, 0.865; and professional inefficacy, 0.819. The cut-off points of BOS three dimensions are exhaustion ≧ 21; cynicism ≧ 18; and inefficacy ≧ 15. Conclusion The developed questionnaire (KBOSS) can be a useful tool for screening of BOS.

BACKGROUND: Calcineurin plays a crucial role in T cell activation, cell growth, apoptosis, and angiogenesis, and its over-expression has been implicated in the pathogenesis of cardiomyopathy and stroke. However, the expression and function of calcineurin in the pathologic lesion of chronic inflammatory diseases, like rheumatoid synovium, remain to be defined. This study was aimed to determine the role of calcineurin in inflammatory arthritis and investigate the expression and function of calcineurin in the rheumatoid synovium and synoviocytes, the actual site of chronic inflammation. METHODS: Immunohistochemical staining using specific antibody to calcineurin was perfomed in the synovium of rheumatoid arthritis (RA). Fibroblast-like synoviocytes (FLS) from RA and osteoarthritis (OA) patients were isolated from RA and OA patients, and cultured with IL-1beta and TNF-alpha in the presence or absence of cyclosporin A, a calcineurin inhibitor. The calcineurin expression was assessed by phosphatase assay and Western blotting analysis. IL-6, -10, -17, matrix metalloproteinase (MMP)-1, -2, -3, and -9 released into the culture supernatants were measured by ELISA. After transfection with GFP-Cabin 1 gene into synoviocytes, the levels of IL-6 and MMPs were measured by ELISA. RESULTS: Calcineurin was highly expressed in the lining layer of synovium and cultured synoviocytes of RA patients. The elevated calcineurin activity in the rheumatoid synoviocytes was triggered by proinflammatory cytokines such as IL-1beta and TNF-alpha. In contrast, IL-10, an anti-inflammatory cytokine, failed to increase the calcineurin activity. The targeted inhibition of calcineurin by the over-expression of Cabin 1, a natural calcineurin antagonist, inhibited the production of IL-6 and MMP-2 by rheumatoid synoviocytes in a similar manner to the calcineurin inhibitor, cyclosporin A. CONCLUSION: These data suggest that abnormal activation of calcineurin in the synoviocytes may contribute to the pathogenesis of chronic arthritis, and thus provide a potential target for controlling inflammatory arthritis.
Apoptosis ; Arthritis* ; Arthritis, Rheumatoid ; Blotting, Western ; Calcineurin* ; Cardiomyopathies ; Cyclosporine ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Matrix Metalloproteinases ; Osteoarthritis ; Stroke ; Synovial Membrane ; Transfection ; Tumor Necrosis Factor-alpha

BACKGROUND: 99mTc MIBI(Methoxyisobutylisonitrile complex), a member of the isonitrile class of coordination compounds, is a lipophilic cation presently under investigation for clinical use as myocardial perfusion imaging agent and is widely used to detect myocardial infarction. Preliminary reports indicate that T1-201 accumulate in human neoplasm and several authors reported 99mTc MIBI may also localized in primary malignant tumor and metastatic deposits from lung cancer. We evaluated the uptake of 99mTc MIBI in lung cancer and localization of mediastinal and other site metastasis, and compared the benign lesion of the lung. METHOD: Thirty four patients of lung cancer and ten patients of benign lung lesion were studied with chest CT and 99mTc MIBI Lung SPECT. 99mTc MIBI uptake ratio was assessed by TR/NL(Lung lesion/ Normal area), HT/NL (Heart/ Normal area) and HT/TR(Heart/Lung lesion). RESULTS: 1) All lung cancer patients showed increased uptakes of 99mTc MIBI in malignant lung lesion and Tc-99m MIBI uptake was also increased in mediastinal and lymph node metastasis except two cases. 2) There was significant different ratio of TR/NL between malignant and benign lesion, 3.79 +/- 1.82 and 1.67+/-0.63 on planar images, respectively(p <0.001). 3) There was no significant difference of 99mTc MIBI uptake ratio between squamous cell carcinoma, small cell carcinoma and adeno carcinoma(3.64+/- 1.66, 3.57+/-0.72, 4.31 +/-2.28 respectively). CONCLUSION: 99mTc MIBI lung SPECT was useful in the localization of tumor and mediastinal or other site metastatic lesion in lung cancer and also in the differential diagnosis between benign and malignant lesion.
Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis, Differential ; Humans ; Lung Neoplasms ; Lung* ; Lymph Nodes ; Myocardial Infarction ; Myocardial Perfusion Imaging ; Neoplasm Metastasis ; Tomography, Emission-Computed, Single-Photon* ; Tomography, X-Ray Computed

Spontaneous bleeding in various parts of the body has been reported in patients receiving maintenance hemodialysis, but reports on spontaneous subcapsular hematoma of the liver are scarce. We present a case of spontaneous subcapsular hematoma of the liver which developed in a 53-year-old man with maintenance hemodialysis. He was admitted to our hospital with epigastric pain and abnormal liver function test. On abdominal computed tomographic (CT) scan, a large, well-defined subcapsular mass of the liver with a density consistent with blood was observed. We performed embolization of the bleeding vessel and percutaneous drainage of the hematoma. Five months later, follow up abdominal CT scan revealed a moderate reduction of the subcapsular hematoma. In conclusion, the possibility of spontaneous hematoma of the liver should be considered in hemodialysis patients with epigastric pain, unexplained anemia and abnormal liver function.
Anemia ; Drainage ; Follow-Up Studies ; Hematoma* ; Hemorrhage ; Humans ; Liver Function Tests ; Liver* ; Middle Aged ; Renal Dialysis* ; Tomography, X-Ray Computed

Small cell carcinoma is usually seen in the lung, but rarely involves the gastrointestinal tract including biliary tract. A 65 year-old man was admitted because of obstructive jaundice. A smooth-surfaced round intraluminal mass with proximal bile duct dilatation was seen in the proximal common bile duct on endoscopic retrograde cholangiogram. Under the diagnosis of bile duct cancer, pylorus-preserving pancreatoduodenectomy was done. Pathology revealed a 2 cm sized small cell carcinoma in the proximal common bile duct and distal common hepatic duct. On immunohistochemical stain, the tumor cells were positive for neuroendocrine markers CD56 and synaptophysin. After surgery, the patient received 5 cycles of adjuvant chemotherapy with VIP (etoposide, ifosfamide, and cisplatin) regimen. However, the patient died of liver metastasis 12 months after the diagnosis. We report a case of extrapulmonary small cell carcinoma arising from the common bile duct.
Aged ; Bile Duct Neoplasms/complications/*diagnosis/surgery ; Carcinoma, Small Cell/complications/*diagnosis/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; *Common Bile Duct/radiography/radionuclide imaging/surgery ; Fatal Outcome ; Humans ; Liver Neoplasms/diagnosis/secondary ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

STUDY DESIGN: A prospective study. OBJECTIVES: To report the results of new designed dual growing rods system for progressive pediatric spinal deformity. SUMMARY OF LITERATURE REVIEW: The current expandable spinal implant system appears effective in controlling progressive pediatric spinal deformity, allowing for spinal growth. However, there was no report concerning the growing rod in Korea. MATERIALS AND METHODS: Between 2010 and 2011, seven pediatric patients, who had a minimum of 1year follow-up, had undergone surgery for spinal deformity correction with a dual growing rods technique. We analyzed the demographic and radiologic data, including height, weight, age at surgery, diagnosis, number of lengthening, Cobb's angle of the major curve, thoracic kyphosis angle, lumbar lordosis angle, T1-S1 length, instrumented segment length, and complications, from the preoperative period to the last follow up period. RESULTS: Four male and three female patients with 5 neuromuscular scoliosis, 1 idiopathic juvenile osteoporosis and 1 spondyloepiphyseal dysplasia had underwent corrective surgery with dual growing rods. The mean age at the initial surgery was 11.6 years (7-13.8). The mean follow-up duration was 19.3 months (12-24), and the mean lengthening procedure time was 2.8 (2-4) for every patient. Cobb's angle of scoliosis curve was corrected from preoperative 80.2degrees(55-136) to 37.6degrees (15-81) on the last follow-up. Thoracic kyphosis angle and lumbar lordosis angle were changed from preoperative 48.7degrees(12-101) and 38.3degrees(9-72) to 44.5degrees(12-75) and 18.8degrees(1-46) on the last follow-up, respectively. Growth length during the follow-up period was measured as instrumented segment is 46 mm (33-59) and T1-S1 segment is 82 mm (66-98). Complications, such as breakage of rod in 3 cases and soft tissue infection in 1 case, occurred during the follow-up period. CONCLUSIONS: New designed dual growing rods system for pediatric patients with progressive spinal deformity is an effective and relatively safe method because of adequate correction and acceptable rate of complications.
Animals ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Male ; Osteochondrodysplasias ; Osteoporosis ; Preoperative Period ; Prospective Studies ; Scoliosis ; Soft Tissue Infections

Azathioprine is a conventional immunosuppressant in renal transplantation but long-term administration may lead to hematologic complications. We here report a cauda equina syndrome caused by spontaneous epidural hematoma in a renal transplant recipient who had undergone long-term azathioprine treatment. A 34 year-old male was admitted to our hospital with complaints of numbness of the lower extremities and back pain. He had received renal transplantation 14 years ago and had been on sole therapy with azathioprine for 11 years. Three months before admission, the patient developed pancytopenia, and a subsequent bone marrow biopsy revealed hypocellularity. Azathioprine was replaced by tacrolimus and steroids thereafter. After a three months discontinuation of azathioprine, an epidural hematoma developed and resulted in cauda equina syndrome. Regular follow-up of complete blood count and change of immunosuppressants with less bone marrow toxicity should be considered in patients receiving azathioprine for long-term period.
Adult ; Azathioprine* ; Back Pain ; Biopsy ; Blood Cell Count ; Bone Marrow ; Cauda Equina* ; Follow-Up Studies ; Hematoma ; Humans ; Hypesthesia ; Immunosuppressive Agents ; Kidney Transplantation ; Lower Extremity ; Male ; Pancytopenia ; Polyradiculopathy* ; Steroids ; Tacrolimus ; Transplantation

BACKGROUND AND OBJECTIVES: Canal paresis in patients with BPPV has been variously reported to present in 13% to 57%. Should disorders affecting the peripheral vestibular system, such as vestibular neuronitis, head trauma precede or coexist the onset of BPPV, then particle repositioning maneuver (PRM) may be less effective or ineffective and need further vestibular rehabilitation after the particle repositioning maneuver. The purpose of this study is to investigate the clinical feature and importance of vestibular rehabilitation in patients with BPPV associated with canal paresis. MATERIALS AND METHODS: A retrospective review was made of 212 patients who visited and diagnosed as BPPV at Hallym university medical center from March 2004 to September 2006. We evaluated the coexistence of canal paresis, methods of treatment and outcome of 128 patients who performed bithermal caloric test. RESULTS: The vestibular assessment by bithermal caloric test showed the canal paresis in 28 patients. In 21 patients, the canal paresis was ipsilateral, in 2 patients, it was contralateral to the BPPV, and in 5 patients, canal paresis was bilateral. Among 28 patients with canal paresis, 12 patients demonstrated as primary BPPV, 16 patients as secondary BPPV. 28 patients with canal paresis were performed PRM. Vestibular rehabilitation was performed in 18 patients who had ongoing symptoms such as nonspecific continuous dizziness after PRM. Among 18 patients, 14 patients were improved, 4 patients were treatment resistant. CONCLUSION: This study shows the importance of detailed vestibular testing such as bithermal caloric test in BPPV patients. Patients with evidence of concomitant vestibular pathology would be expected to require further vestibular rehabilitation.
Academic Medical Centers ; Caloric Tests ; Craniocerebral Trauma ; Dizziness ; Humans ; Paresis* ; Pathology ; Rehabilitation ; Retrospective Studies ; Vertigo* ; Vestibular Neuronitis