BACKGROUND: Breast cancer is the most frequent malignant neoplasm among women in the Orient. This cancer is also increasing in Korea due to westernization of the living pattern, increased recognition among the general population, and improved methods for early detection. In the surgical treatment of breast cancer, cosmetic conservation of the breast has drawn the patients' attention so that conservative surgery is increasing nowadays. The purpose of this study is to describe the current status of breast cancer management at our institution and to identify the survival and the recurrence rates according to the stage and the surgical method used. METHODS: We reviewed the medical records of 150 patients diagnosed as having breast cancer on pathologic examination at the Department of General Surgery, EulJi College of Medicine, from January 1991 to December 1996 and evaluated the clinical findings, the diagnostic method, operation, and the prognosis. RESULTS: The mean age of the patients was 49.1 years, and 34.0% of the patients was in the fifth decade. A palpable mass in the breast was the most frequent clinical symptom and sign (80.7%). The interval between symptom onset and diagnosis was about 6 months in 76.0% of patients. The size of the mass was 2~5 cm in 51.3% of the patients. A modified radical mastectomy was the most frequently employed surgical method (74.0%), but conservative surgery has increased lately. Seventy-ight patients (52.0%) were in stage II. The five-ear survival rates for stages I, II, III were 100%, 82.9%, and 55.0% (p=0.00006). The five-ear survival rates for 0, 1~3, 4~9, and more than 10 axillary-ode metastases were 85.9%, 55.3%, 53.6%, and 21.1%, respectively (p=0.0007). The five-ear survival rates for breast-conserving surgery and a modified radical mastectomy, for both stage of I and II, were 90.9% and 89.3% (p=0.8114), respectively, and the recurrence rates were 17.9% and 23.8% (p=0.88). CONCLUSIONS: The authors may conclude that breast-onserving surgery may offer an effective alternative to a modified radical mastectomy for patients with stage I & II breast cancer.
Breast Neoplasms* ; Breast* ; Diagnosis ; Female ; Humans ; Korea ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Survival Rate

Psoriasis and eczematous dermatitis are two major different inflarnmtory dermatitis but differential diagnosis is sometimes difficult by histologic patterns. The object of this study is to find out whether there are any differences in the expressions of proliferation related pntein between psoriasis and eczematous dermatitis by chronological evaluation on the proliferating cell nuclear antigen(PCNA) and epidermal growth factor receptor(EGFR). The detections of PCNA and EGFR were done by immunohistoc.ienical methods(alkaline phosphatase anti-alkaline phosphatase method with new fuchsin substrated usir g respective polyclonal antibod ies in the paraffin embedded tissue from psoriasis(21 cases) and eczomtous dermatitis(26 cases). The labelling indeces of PCNA were 2.4+0.9% in normal. Indece; were 27.3+2.9% in acute, 20.7+ 3.7% in chronic psoriasis, while 12.4+5.6% in acute and 21.8% 5.0% in chronic eczematous dermtitis. The expressions of EGFR were very weak in normal, and increased in acute psoriasis and chronic eczematous dermatitiy. Our immunohistochemical results of PCNA and EGFR suggest that activated proliferation is rather pronounced in acute psoriasis and chronic eczemat.ous dermatitis, thouh proliferative activity is more marked in psoriasis.
Dermatitis ; Diagnosis, Differential ; Eczema* ; Epidermal Growth Factor* ; Paraffin ; Proliferating Cell Nuclear Antigen* ; Psoriasis ; Receptor, Epidermal Growth Factor* ; Rosaniline Dyes

BACKGROUND: Overstimation of blood pressure(BP) by clinic measurements occur in about 20 to 30% of subjects(white-coat hypertension) who may, consequently, be misdiagnosed as hypertensives and received unnecessary medications. The clinical significance of white-coat hypertension and its effects on the cardiovascular wystem have not been studied systematically.This study was designed to evaluate the influences of white-coat hypertension and white-coat effect, defined as difference between clinic and ambulatory BP, on the LV mass and diastolic function. METHODS: LV mass index was calculated and LV systolic and diastolic function were assessed by the analysis of mitral and pulmonary venous flow velocity in 45 untreated essential hypertensives and 20 normotensives(NT). Ambulatory BP monitoring classified hypertensives as white-coat hypertensives(WCHT,n=20) and sustained hypertensives(SHT, n=25). RESULTS: 1) Left ventricular systolic indices were not different among the three groups. 2) Left ventricular mass inedx of WCHT(114.5+/-36.3g/m2) was similar to that of SHT(115.6+/-34.9g/m2) and was significantly greater than that of NT(86.5+/-37.7g/m2)(p<0.05). 3) Some of left ventricular diastolic parameters(isovolumic relaxation time, E/A ratio, A velocity, pulmonary systolic fraction, ratio of systolic to diastolic forward flow velocity) of WCHT and SHT were significantly different from those of NT(p<0.05), but there were no differences between two hypertensive groups. 4) Even though both systolic and diastolic white-coat effect in WCHT were significantly greater than those of SHT(o<0.05),white-coat effect did not influence on the left ventricular mass or function in both groups. CONCLUSION: An increased left ventricular mass and diastolic dysfunction in WCHT suggests that white-coat hypertension could not be considered as an entirely innocuous clinical condition.
Blood Pressure Monitoring, Ambulatory ; Hypertension* ; Relaxation

The patient with complaints of seizure, headache and upward gaze paralysis underwent V-P shunt under the impression of pinealoma. The diagnosis of cerebral paragonimiasis was eventually made by the aid of brain CT scan and PW skin test. The case showed a positive intradermal test with relevant histories of eating rare crayfishes and the characteristic CT findings. Plain skull X-ray showed the round calcifications around the pineal region. Brain CT demonstrated multiple round calcifications in the left fronto-occipital region and dilation of the left lateral ventricle with cortical atrophy.
Astacoidea ; Atrophy ; Brain ; Diagnosis ; Eating ; Headache ; Humans ; Intradermal Tests ; Lateral Ventricles ; Ocular Motility Disorders* ; Paragonimiasis* ; Paralysis ; Pinealoma ; Seizures ; Skin Tests ; Skull ; Tomography, X-Ray Computed

BACKGROUND: Coronary heart disease (CAD) has been known to be a risk factor of ischemic stoke. But, in our country, there has been no systematized study about the incidence of ischemic stroke (IS) after CAD, influencing factors and interval to ischemic stroke . So there is a possibility of different result from previous studies in other countries. METHODS: In this study, we analyzed the stroke influencing factors, interval and stroke type of 2192 CAD patients composed of myocardial infarction (MI) (554 patients) and angina pectoris (1638 patients) who admitted Yonsei university Severance hospital since 1992 Jan. to 1994 Dec. through 3 year follow up. RESULTS: After 3 year follow up of 2192 CAD patients, total 40 cases of ischemic stroke (including transient ischemic attack) developed. Among total CAD patients, influencing factors of IS were atrial fibrillation (p<0.001) and ejection fraction lower than 55 % (p=0.034). Especially atrial fibrillation was the most powerful influencing factor (odds ratio=7.8201, 95 % confidence interval=2.9281-20.8854). IS occurrence was most frequent up to 1 year after diagnosis of CAD(60 % of IS cases), especially highest frequency was demonstrated up to 1 month (50 % of the IS cases within 1 year). This pattern was same to all CAD types. There were not any differences of incidence and interval to IS between acute MI and angina pectoris patients. In MI (554 patients) patients 2.5 % (14 cases) incidence of IS was demonstrated for 3 years and influencing factors of IS occurrence were age (p=0.044) and atrial fibrillation (p=0.004). The outstanding treatment of minimizing IS occurrence was not demonstrated. In angina pectoris (1638 patients) patients, 1.6 % (26 cases) incidence of IS was demonstrated for 3 years and influencing factors of IS occurrence were 1) atrial fibrillation (p=0.0031), 2) Diabetes mellitus (p=0.0058) 3) left ventricular hypertrophy (p=0.0057) 4) hypertension (p=0.0228). There was not an outstanding treatment which let IS occurrence minimalized in sta.
Angina Pectoris ; Atrial Fibrillation ; Coronary Disease* ; Diabetes Mellitus ; Diagnosis ; Follow-Up Studies ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Incidence ; Linear Energy Transfer ; Myocardial Infarction ; Risk Factors ; Stroke*

The diagnostic possibility and the incidence of ectopic pregnancy are increasing due to several factor. Furthermore, radioimmunoassay of serum β-HCG and US make it possible to diagnose early before the tubal rupture. A conventional surgical approach has been considered as a choice of treatments. Until recent years, however, surgery may have considerable risk of infertility and sugical hazard. In view of the natural tendency of some ectopic pregnancies to terminate in tubal abortion or complete resorption, we tried to cure ectopic pregnancy with nonsurgical transcervical intervention. Five of 8 patients with unruptured tubal pregnancies, it was possible to inject PGF2a into the tubes or gestational sac. 4 of them were ended up with satisfactory reduction of serum β-HCG level and improvement of symptoms & signs. In only one patient, β-HCG level remained a high level continuously, so salpingectomy was done. As a result, we consider that fluoroscopy-guided transcervical interventional procedure is a useful treatment modality for early unruptured ectopic pregnancy.
Abortion, Spontaneous ; Female ; Gestational Sac ; Humans ; Incidence ; Infertility ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Radioimmunoassay ; Rupture ; Salpingectomy

The diagnostic possibility and the incidence of ectopic pregnancy are increasing due to several factor. Furthermore, radioimmunoassay of serum β-HCG and US make it possible to diagnose early before the tubal rupture. A conventional surgical approach has been considered as a choice of treatments. Until recent years, however, surgery may have considerable risk of infertility and sugical hazard. In view of the natural tendency of some ectopic pregnancies to terminate in tubal abortion or complete resorption, we tried to cure ectopic pregnancy with nonsurgical transcervical intervention. Five of 8 patients with unruptured tubal pregnancies, it was possible to inject PGF2a into the tubes or gestational sac. 4 of them were ended up with satisfactory reduction of serum β-HCG level and improvement of symptoms & signs. In only one patient, β-HCG level remained a high level continuously, so salpingectomy was done. As a result, we consider that fluoroscopy-guided transcervical interventional procedure is a useful treatment modality for early unruptured ectopic pregnancy.
Abortion, Spontaneous ; Female ; Gestational Sac ; Humans ; Incidence ; Infertility ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Radioimmunoassay ; Rupture ; Salpingectomy

Extracorporeal shock wave lithotripsy(ESWL) for urinary calculi is usually performed under general anesthesia, regional anesthesia or intravenous anesthesia. We evaluated the sedativeanalgesic effeet and untoward effects of diazepam-fentanyl for ESWL. 60 patients were belonged to physical status 1 or 11 of ASA classification who injected diazepam(5~10 mg) and fentanyl(1.5 ug/kg) at 2 minutes were as follows The results were as follows; 1) Mean arterial pressure(MAP) was significantly decreased in 3-10 minutes after injection compared to baseline value. 2) Heart rate(HR) was statistically nonsignificant but slightly decreased from 2 minutes after injection. 3) Respiratory rate(RR) and arterial oxygen saturation(SaO2) were significantly decreased until 15 miuntes after injection but SaO was not decreased below 92.7% and RR was not decreased below 13 rates/minute. 4) Pain and movement during ESWL developed in 18 cases but repositioning and discon- tinuation of EWSL were not necessary. Episodes of desaturation(SaO2<90%) developed in 2 cases. 5) Postoperative dizziness developed in 24 cases. nausea and vomiting developed in a few cases. We concluded that intravenous administration of diazepam-fentanyl is more convenient and simpler than other anesthetic technique for ESWL.
Administration, Intravenous ; Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Intravenous ; Classification ; Diazepam* ; Dizziness ; Fentanyl* ; Heart ; Humans ; Lithotripsy* ; Nausea ; Oxygen ; Shock* ; Urinary Calculi ; Vomiting

BACKGROUND: Diverticulosis of the cecum and ascending colon is a rare disease in Western countries, it is more common in the Orient. Making the diagnosis preoperatively could be difficult, and the intraoperative assessment and decision of optimal treatments are difficult. METHODS: Therefore, we reviewed the patient's charts of diverticulosis of the cecum and ascending colon at our hospital from 1992 to 1997. RESULTS: During the past 5 years, a total of 53 cases of diverticulosis of the cecum and ascending colon had been treated at this hospital. Mean age was 41.8 years (range 20-70). The male to female ratio was 1.8 : 1. Frequent complaints were abdominal pain (46 cases, 86.8%), followed by diarrhea (5 cases, 9.3%), indigestion (4 cases, 7.5%), and bowel habits change (2 cases, 3.8%). Mean duration of illness was 3.5 days(range 24 hours~15 days). In non-surgical cases, diagnoses were established with barium enema, CT scan, or ultrasonography. The accuracy of these methods was 91%, 75%, and 25%. In surgical cases, the preoperative diagnoses were appendicitis(13 cases, 50.1%), diverticulitis (7 cases, 31.8%), and abscess (2 cases, 9.1%). Treatments of the cecum and ascending colon diverticulitis were conservative management (3 teases,58.5%) and surgical treatment (22 cases,41.5%). The operative procedures were right hemicolectomies (2 cases), ileocecal resections (2 cases), diverticulectomies (6 cases) and appendectomies only (11 cases). CONCLUSION: These results suggest that correct diagnosis of the diverticulitis of the cecum and ascending colon made before treatment is very important because correct assessment of diverticulitis intraoperatively is difacut. Liberal use of diagnostic modalities could facilitate to make correct diagnosis to set a proper plan for treatment.
Abdominal Pain ; Abscess ; Appendectomy ; Barium ; Cecum* ; Colon, Ascending* ; Diagnosis ; Diarrhea ; Diverticulitis ; Diverticulum* ; Dyspepsia ; Enema ; Female ; Humans ; Male ; Rare Diseases ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Ultrasonography

The incidence of metastasis to the eye and its related structure on recent studies appear to be more common than previous studies demonstrate. The authors experienced a case of hepatocellular carcinoma metastatic to the conjunctiva. A 48-year-old man with known hepatocellular carcinoma in the liver had a mass surrounded with blood clot on the upper palpebral conjunctiva of right eye. A biopsy demonstrated that the lesion was hepatocellular carcinoma metastatic to the conjunctiva.
Biopsy ; Carcinoma, Hepatocellular ; Conjunctiva ; Humans ; Incidence ; Liver ; Middle Aged ; Neoplasm Metastasis