PURPOSE: Malignant phyllodes tumors are rare lesions of the breast. The purpose of this study was to evaluate the clinical charateristics and the recurrence patterns of malignant phyllodes tumors. METHODS: Twelve patients with malignant phyllodes tumors who had undergone surgery at the Breast Clinic, Asan Medical Center, from February 1991 to October 1997 were analyzed retrospectively. Histologic criteria of malignant phyllodes tumor was more than 10 mitoses/10 high-power fields in this study. RESULTS: The mean age of the patients was 40.7 years. As regards to preoperative histological confirmation, malignant phyllodes tumors were proven in all 6 cases with an excision biopsy, but in only one of the 4 cases with fine needle aspiration. All the patients received surgical treatment: a modified radical mas tectomy in 4 cases, a simple mastectomy in 5 cases, a simple mastectomy with reconstruction in 2 cases, and a subcutaneous mastectomy in one case. During 34 months of mean follow-up, 3 patients had a recurrence. One patient had a chest wall recurrence at 29 months and lung metastasis at 48 months; the others had lung metastasis at 14 and 16 months, respectively. CONCLUSION: Malignant phyllodes tumors were difficult to confirm with fine needle aspiration preoperatively. The lung was the main site of metastasis, and if metastasis occurred, the prognosis was very poor.
Biopsy ; Biopsy, Fine-Needle ; Breast ; Chungcheongnam-do ; Diagnosis ; Follow-Up Studies ; Humans ; Lung ; Mastectomy, Simple ; Mastectomy, Subcutaneous ; Neoplasm Metastasis ; Phyllodes Tumor* ; Prognosis ; Recurrence* ; Retrospective Studies ; Thoracic Wall

Charcot spine is a progressive and destructive process that affects the vertebral bodies, intervertebral discs, and posterior facets. It is the result from repetitive microtrauma in patients who have decreased joint protective mechanisms due to loss of deep pain and proprioceptive sensation, typically because of spinal cord injury. The objective of the study is to report an unusual case of Charcot spine, as a late complication of traumatic spinal cord injury, treated by a circumferential arthrodesis performed with a single staged posterolateral costotransversectomy approach.
Arthrodesis ; Humans ; Intervertebral Disc ; Joints ; Sensation ; Spinal Cord Injuries* ; Spinal Cord* ; Spine*

Chios gum mastic (CGM) is produced from Pistiacia lentiscus L var chia, which grows only on Chios Island in Greece. CGM is a kind of resin extracted from the stem and leaves, has been used for many centuries in many Mediterranean countries as a dietary supplement and folk medicine for stomach and duodenal ulcers. CGM is known to induce cell cycle arrest and apoptosis in some cancer cells. This study was undertaken to investigate the alteration of the cell cycle and induction of apoptosis following CGM treatment of HL-60 cells. The viability of the HL-60 cells was assessed using the MTT assay. Hoechst staining and DNA electrophoresis were employed to detect HL-60 cells undergoing apoptosis. Western blotting, immunocytochemistry, confocal microscopy, FACScan flow cytometry, MMP activity and proteasome activity analyses were also employed. CGM treatment of HL-60 cells was found to result in a dose- and time-dependent decrease in cell viability and apoptotic cell death. Tested HL-60 cells showed a variety of apoptotic manifestations and induced the downregulation of G1 cell cycle-related proteins. Taken collectively, our present findings demonstrate that CGM strongly induces G1 cell cycle arrest via the modulation of cell cycle-related proteins, and also apoptosis via proteasome, mitochondrial and caspase cascades in HL-60 cells. Hence, we provide evidence that a natural product, CGM could be considered as a novel therapeutic for human leukemia.
Apoptosis ; Blotting, Western ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Death ; Cell Survival ; Dietary Supplements ; DNA ; Down-Regulation ; Duodenal Ulcer ; Electrophoresis ; Flow Cytometry ; G1 Phase Cell Cycle Checkpoints ; Gingiva ; Greece ; HL-60 Cells ; Humans ; Immunohistochemistry ; Leukemia ; Medicine, Traditional ; Microscopy, Confocal ; Proteasome Endopeptidase Complex ; Proteins ; Resins, Plant ; Stomach

PURPOSE: Locoregional recurrence of breast cancer after surgery has been regarded as a harbinger of distant metastases. The present study was undertaken to determine survival following surgical excision of isolated locoregional recurrence and to analyze prognostic factors for their impact on survival after locoregional recurrence. Also, this study may provide information on the group that benefits from surgical management. METHODS: From March 1993 to December 1998, of 43 patients with isolated locoregional recurrence after breast cancer surgery, 26 patients were treated with surgical excision with or without irradiation. Survival was retrospectively analyzed according to prognostic factors. RESULTS: The median follow-up was 15 months. The 3-year disease-free survival rates were 50% for locoregional recurrences treated with surgical resection and 6% for patients treated without surgery (p=0.04), and the overall survival rates were 63% and 14%, respectively (p=0.07). Univariative analysis demonstrated that the initial axillary node status and the disease-free interval were significant prognostic factors for overall survival (p=0.04 and p=0.06, respectively). The disease-free interval from surgery to recurrence was also a significant prognostic factor for disease-free survival (p=0.03). CONCLUSION: These results suggest that patients suffering from isolated locoregional recurrence of breast cancer after a long disease-free interval and an initial node negative status may survive for long periods of time with aggressive surgical treatment.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence* ; Retrospective Studies ; Survival Rate

PURPOSE: In spite of improved local control and adjuvant therapy in breast cancer, many patients after a modified radical mastectomy suffer from locoregional or systemic failure. The purpose of this study was to assess both the patterns of failure following a mastectomy and the predictive factors affecting the risks of locoregional or systemic failure. METHODS: The study population consisted of 195 patients who developed locoregional or systemic failure from among 1,187 patients treated by using a modified radical mastectomy between July 1989 and October 1998 at the Asan Medical Center's Breast Clinic. The median follow-up time following the mastectomy was 41 months (range; 1-119 months). RESULTS: Isolated locoregional recurrence (LRR) developed in 46 patients (24%), LRR with distant metastasis in 43 (22%), and only distant metastasis in 106 (54%). The sites of LRR were as follows: the chest wall, 52%; the ipsilateral supraclaviclar node, 22%; and the axillary node, 15%; etc. The first sites of distant metastasis were as follows: bone, 46%; lung, 38%; liver, 12%; brain, 6%; and pleura, 6%; etc. Local or systemic failure appeared within the first 3 years following the mastectomy in 75-82% of the patients, and within 5 years in 95-98%. Multivariate analysis showed that increasing initial tumor size, increasing number of involved nodes, negative progesterone receptor, and increasing histologic grade were significant factors for increased risks of LLR or distant metastasis. CONCLUSION: Half of the locoregional recurrences following a mastectomy are isolated. T-stage, nodal status, progesterone receptor, and histo logic grade may help to identify patients at risk for locoregional or systemic failure after a mastectomy.
Brain ; Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Follow-Up Studies ; Humans ; Liver ; Logic ; Lung ; Mastectomy* ; Mastectomy, Modified Radical ; Multivariate Analysis ; Neoplasm Metastasis ; Pleura ; Receptors, Progesterone ; Recurrence ; Risk Factors* ; Thoracic Wall

PURPOSE: In Korea, the incidence of breast cancer is continuously growing year after year, and it has become the second most common cancer in females following stomach cancer. This study analyzed the clinical results of 2,101 breast cancer surgeries performed in Korea. METHODS: 2,101 breast cancer surgeries were performed between Mar. 1989 and Dec. 1999 at the Breast Clinic in Asan Medical Center. RESULTS: Of 2,101 patients, 2,085 cases were female (99.2%), and 16 cases were male (0.8%). The mean age of the patients was 46 and 65% of them were under the age of 50. A radical mastectomy was performed in 1.0% of cases, a modified radical mastectomy in 75.4%, a simple mastectomy in 4.1%, breast-conserving surgery in 15.5%, and other procedures in 3.9%. Immediate breast reconstruction was performed in 136 cases (tissue expander in 61 cases, direct implant in 10 cases, transverse rectus abdominis muscle (TRAM) flap in 62 cases, and latissimus dorsi myocutaneous flap in 3 cases). The majority of reconstruction was changed to skin-sparing mastectomy (SSM) with TRAM flap. According to TNM classification, there were 156 cases (7.4%) of stage 0, 538 cases (25.6%) of stage I, 1,062 cases (50.6%) of stage II, 241 cases (11.5%) of stage III, 65 cases (3.1%) of stage IV, and 39 cases (1.9%) of an unknown stage. The axillary lymph node metastasis was present in 43.2%. The 5-year overall and disease-free survival rates were 83.1% and 76.7%, respectively. CONCLUSION: This study shows several features suggesting that the peak age of breast cancer in Korea is younger than that seen in western countries and that the types of Korean breast cancer tend to be similar to western patterns.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Classification ; Disease-Free Survival ; Female ; Humans ; Incidence ; Korea* ; Lymph Nodes ; Male ; Mammaplasty ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mastectomy, Simple ; Myocutaneous Flap ; Neoplasm Metastasis ; Rectus Abdominis ; Stomach Neoplasms ; Superficial Back Muscles

PURPOSE: In Korea, the incidence of breast cancer is continuously growing year after year, and it has become the second most common cancer in females following stomach cancer. This study analyzed the clinical results of 2,101 breast cancer surgeries performed in Korea. METHODS: 2,101 breast cancer surgeries were performed between Mar. 1989 and Dec. 1999 at the Breast Clinic in Asan Medical Center. RESULTS: Of 2,101 patients, 2,085 cases were female (99.2%), and 16 cases were male (0.8%). The mean age of the patients was 46 and 65% of them were under the age of 50. A radical mastectomy was performed in 1.0% of cases, a modified radical mastectomy in 75.4%, a simple mastectomy in 4.1%, breast-conserving surgery in 15.5%, and other procedures in 3.9%. Immediate breast reconstruction was performed in 136 cases (tissue expander in 61 cases, direct implant in 10 cases, transverse rectus abdominis muscle (TRAM) flap in 62 cases, and latissimus dorsi myocutaneous flap in 3 cases). The majority of reconstruction was changed to skin-sparing mastectomy (SSM) with TRAM flap. According to TNM classification, there were 156 cases (7.4%) of stage 0, 538 cases (25.6%) of stage I, 1,062 cases (50.6%) of stage II, 241 cases (11.5%) of stage III, 65 cases (3.1%) of stage IV, and 39 cases (1.9%) of an unknown stage. The axillary lymph node metastasis was present in 43.2%. The 5-year overall and disease-free survival rates were 83.1% and 76.7%, respectively. CONCLUSION: This study shows several features suggesting that the peak age of breast cancer in Korea is younger than that seen in western countries and that the types of Korean breast cancer tend to be similar to western patterns.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Classification ; Disease-Free Survival ; Female ; Humans ; Incidence ; Korea* ; Lymph Nodes ; Male ; Mammaplasty ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mastectomy, Simple ; Myocutaneous Flap ; Neoplasm Metastasis ; Rectus Abdominis ; Stomach Neoplasms ; Superficial Back Muscles

PURPOSE: In Korea, the incidence of breast cancer is continuously growing year after year, and it has become the second most common cancer in females following stomach cancer. This study analyzed the clinical results of 2,101 breast cancer surgeries performed in Korea. METHODS: 2,101 breast cancer surgeries were performed between Mar. 1989 and Dec. 1999 at the Breast Clinic in Asan Medical Center. RESULTS: Of 2,101 patients, 2,085 cases were female (99.2%), and 16 cases were male (0.8%). The mean age of the patients was 46 and 65% of them were under the age of 50. A radical mastectomy was performed in 1.0% of cases, a modified radical mastectomy in 75.4%, a simple mastectomy in 4.1%, breast-conserving surgery in 15.5%, and other procedures in 3.9%. Immediate breast reconstruction was performed in 136 cases (tissue expander in 61 cases, direct implant in 10 cases, transverse rectus abdominis muscle (TRAM) flap in 62 cases, and latissimus dorsi myocutaneous flap in 3 cases). The majority of reconstruction was changed to skin-sparing mastectomy (SSM) with TRAM flap. According to TNM classification, there were 156 cases (7.4%) of stage 0, 538 cases (25.6%) of stage I, 1,062 cases (50.6%) of stage II, 241 cases (11.5%) of stage III, 65 cases (3.1%) of stage IV, and 39 cases (1.9%) of an unknown stage. The axillary lymph node metastasis was present in 43.2%. The 5-year overall and disease-free survival rates were 83.1% and 76.7%, respectively. CONCLUSION:This study shows several features suggesting that the peak age of breast cancer in Korea is younger than that seen in western countries and that the types of Korean breast cancer tend to be similar to western patterns.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Classification ; Disease-Free Survival ; Female ; Humans ; Incidence ; Korea* ; Lymph Nodes ; Male ; Mammaplasty ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mastectomy, Simple ; Myocutaneous Flap ; Neoplasm Metastasis ; Rectus Abdominis ; Stomach Neoplasms ; Superficial Back Muscles

Profound hypothermia protects cerebral function during total circulatory arrest(TCA) in the surgical treatment of a variety of cardiac and aortic diseases. Despite its importance, there is no ideal technique to monitor the brain injury from ischemia. Since 1994, we have developed compressed spectral array(CSA) of electroencephalography(EEG) and monitored cerebral activity to reduce ischemic injury. The purposes of this study are to analyse the efficacy of CSA and to establish objective criteria to consistently identify the safe level of temperature and arrest time. We studied 6 patients with aortic dissection(AD, n=3) or aortic arch aneurysm(n=3, ruptured in 2). Body temperatures from rectum and esophagus and the EEG were monitored continuously during cooling and rewarming period. TCA with cerebral ischemia was performed in 3 patients and TCA with selective cerebral perfusion was performed in 3 patients. Total ischemic time was 30, 36 and 56 minutes respectively for TCA group and selective perfusion time was 41, 56 and 92 minutes respectively for selective perfusion group. The rectal temperatures for flat EEG were between 16.1 and 22.1 degrees C (mean:18.4+/-2.0); the esophageal temperatures between 12.7 and 16.4 degrees C(mean : 14.7+/-1.6). The temperatures at which EEG reappeared 5~15.4 degrees C for esophagus. There was no neurological deficit and no surgical mortality in this series. In summary, the electrical cerebral activity reappeared within 23 minutes at the temperature less than 16degrees C for rectum. It seemed that 15 degrees C of esophageal temperature was not safe for 30 minutes of TCA and continuous monitoring the EEG with CSA to identify the electrocerebral silence was useful.
Aorta, Thoracic ; Aortic Diseases ; Body Temperature ; Brain Injuries ; Brain Ischemia ; Electroencephalography ; Esophagus ; Humans ; Hypothermia* ; Hypothermia, Induced ; Ischemia ; Mortality ; Perfusion ; Rectum ; Rewarming

With the development of microsurgery, autogenous nerve grafting is being used widely in the treatment of the injured facial nerve. To use a donor graft for repair of the facial nerve, fascicular area and fascicular number should be considered in the selection of the donor site. This study demonstrated a detailed morphologic description of the facial nerve, including a microscopic assessment of nerve size and shape, and fascicular number and diameters. 40 embalmed hemi-sectioned head specimens from Korean adult cadavers were dissected to identify the facial nerve branches and nerve samples for histologic examination were cut from the anterior margin of the parotid gland.At the border of the parotid gland, the facial nerve specimens were found to have an average of 11 branches (ranging from 8 to 16). The branches were distributed among the five distinct branches, the buccal branch had the greatest number of branches (3.47), and the zygomatic branch had the largest diameters (0.93 mm). The number of fascicles varied from one to 9 over the course of the nerve, the trunk had the greatest number of fascicles (4.36), and averages indicated a tendency for fascicular numbers to decrease distally, from trunk (4.36) to upper division (3.72) to lower division (3.60) to marginal mandibular branch (2.37). The total fascicular area was averaging 2.72 mm2, 1.88 mm2, and 1.04 mm2 at trunk, upper division, and lower division, respectively. However no significant differences of the fascicular diameter could be shown between five branches. This results of detailed facial nerve microanatomy should help in the treatment of the injured facial nerve.
Adult ; Cadaver ; Facial Nerve ; Head ; Humans ; Microsurgery ; Parotid Gland ; Tissue Donors ; Transplants