The pregnancy-associated breast cancer is one of the most common malignacy developed during pregnant period and occupies 1-2% of the all breast cancer pateints. It is easy to miss appropriate diagnosis due to difficulty of physical examination of the breast and limitation of proper diagnostic modality. The pregnancy-associated breast cancer has been reported to portend an extremely poor outcome. But recent studies have found no difference in survival between general breast cancer and pregnancy-associated breast cancer. The treatment of choice is the modified radical mastectomy and adjuvant chemotherapy if needed. The authors report two patients of breast cancer diagnosed and treated during pregnancy with review of literature.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Diagnosis ; Humans ; Mastectomy, Modified Radical ; Physical Examination ; Pregnancy*

OBJECTIVE: To compare pregnancy and delivery complications in first births between women 35 years or older and those who are younger. METHODS: Matemal and newborn records for first births at Chonnam university hospital from January 1, 1988 to December 31, 1996 were studied. The study group included 123 women who were 35 years or older. A control group consisting of 120 younger women was used for comparison. The X2 test was used to identify trends in individual variables and outcomes. RESULTS: Premature rupture of membrane, uterine myoma, and malpresentation were much mare prevalent in the older nullipara. However, there were no significant differences in incidences of preeclampsia, placenta previa, and pyelonephritis between the older nullipara and younger nullipara groups. Older nullipara had a significantly higher incidence of Cesarean delivery than younger women, Elective cesarean section was performed only in the older nullipara and it was the most common indication for Cesarean delivery in older nullipara. Fetal distress and breech presentation as indications for Cesarean delivery were significantly more common in the older study group. There were no noticeable differences in postpartal complication between the groups. Pretam birth and low birth weight were much more common in the older nullipara. but there were no significant differences in small for gestational age, low Apgar score, perinatal morbidity and deaths between the groups. CONCLUSION: From the results, it was difficult to conclude that women 35 or older are pmne to higher risk pregnancies, compared to their younger counterparts. Although more incidences of premature rupture of membrane, preterm delivery, and Cesarean delivery were observed, there were no significant differences in other pregnancy and delivery complications. With appropriate obstetric care, it is most probable that first time pregnancies in older women will result in similar outcome as those in younger women.
Apgar Score ; Birth Order ; Breech Presentation ; Cesarean Section ; Female ; Fetal Distress ; Gestational Age ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Jeollanam-do ; Leiomyoma ; Membranes ; Parturition ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Pyelonephritis ; Rupture

The pregnancy-associated breast cancer is one of the most common malignacy developing during the period of pregnancy and occupies 1-2% of the all breast cancer patients. It is not easy to make an appropriate diagnosis due to difficulty of physical examination of the breast and limitation of proper diagnostic modalities. The pregnancy-associated breast cancer had been reported to portend an extremely poor outcome. But recent studies have found no difference in survival between general breast cancer and pregnancy-associated brest cancer. The treatment of choice is the modified radical mastectomy and adjuvant chemotherapy of needed. The authors report two patients of breast cancer diagnosed and treated during pregnancy with review of literature.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Diagnosis ; Humans ; Mastectomy, Modified Radical ; Physical Examination ; Pregnancy*

A 63-year-old woman was referred to a breast surgeon with a breast mass discovered incidentally during follow-up study after colon cancer surgery. Invasive adenocarcinoma was revealed on core needle biopsy. Wide excision of the breast including the tumor was performed. On standard histological examination the tumor showed features of moderately differentiated adenocarcinoma. The immunohistochemistry study revealed positive results for cytokeratin (CK)20 and CDX2, but negative for CK7. These are typical characteristics for colon cancer. Considering her history of subtotal colectomy for sigmoid colon cancer, it is presumable that the mass in the breast was of colonic origin, and it was an extremely rare case of metastasis to the breast from primary colorectal neoplasm. Although the instance is rare, clinicians should keep the possibility of breast metastasis from colorectal cancer in mind for early and correct diagnosis.
Adenocarcinoma ; Biopsy, Large-Core Needle ; Breast ; Colectomy ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Middle Aged ; Neoplasm Metastasis ; Sigmoid Neoplasms

OBJECTIVE: The aim of this study was to investigate the correlation between meteorological factors and occurrence of spontaneous intracerebral hemorrhage (ICH) according to age. MATERIALS AND METHODS: We retrospectively analyzed the records of 735 ICH patients in a metropolitan hospital-based population. Observed and expected numbers of ICH patients were obtained at 5degrees C intervals of ambient temperature and a ratio of observed to expected frequency was then calculated. Changes in ambient temperature from the day before ICH onset day were observed. The Wilcoxon-Mann-Whitney test was used to test differences in meteorological variables between the onset and non-onset days. The Kruskal-Wallis test was used for comparison of meteorological variables across gender and age. RESULTS: ICH was observed more frequently (observed/expected ratio > or = 1) at lower mean, minimum, and maximum ambient temperature (p = 0.0002, 0.0003, and 0.0002, respectively). Significantly lower mean, minimum, and maximum ambient temperature, dew point temperature, wind speed, and atmospheric pressure (p = 0.0003, 0.0005, 0.0001, 0.0013, 0.0431, and 0.0453, respectively) was observed for days on which spontaneous ICH occurred. In the subgroup analysis, the ICH onset day showed significantly lower mean, minimum, and maximum ambient temperature, dew point temperature, relative humidity, and higher atmospheric pressure in the older (> or = 65 years) female group (p = 0.0093, 0.0077, 0.0165, 0.0028, 0.0055, and 0.0205, respectively). CONCLUSION: Occurrence of spontaneous ICH is closely associated with meteorological factors and older females are more susceptible to lower ambient temperature.
Atmospheric Pressure ; Cerebral Hemorrhage* ; Female ; Humans ; Humidity ; Meteorological Concepts* ; Meteorology ; Retrospective Studies ; Wind

No abstract available.
Parathyroid Neoplasms* ; Radionuclide Imaging* ; Thymoma*

Chronic hypoventilation due to injury to the brain stem respiratory center or high cervical cord (above the C3 level) can result in dependence to prolonged mechanical ventilation with tracheostomy, frequent nosocomial pneumonia, and prolonged hospitalization. Diaphragm pacing through electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. We performed chronic phrenic nerve stimulation for diaphragm pacing with the spinal cord stimulator for pain control in a quadriplegic patient with central apnea due to complete spinal cord injury at the level of C2 from cervical epidural hematoma. After diaphragmatic pacing, the patient who was completely dependent on the mechanical ventilator could ambulate up to three hours every day without aid of mechanical ventilation during the 12 months of follow-up. Diaphragm pacing through unilateral phrenic nerve stimulation with spinal cord stimulator was feasible in an apneic patient with complete quadriplegia who was completely dependent on mechanical ventilation. Diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.
Apnea ; Brain Stem ; Diaphragm* ; Electric Stimulation ; Follow-Up Studies ; Hematoma ; Hospitalization ; Humans ; Hypoventilation ; Phrenic Nerve* ; Pneumonia ; Quadriplegia ; Respiration, Artificial ; Respiratory Center ; Sleep Apnea, Central ; Spinal Cord ; Spinal Cord Injuries ; Tracheostomy ; Ventilators, Mechanical ; Wounds and Injuries

BACKGROUND: E-cadherin, one of the best known cell adhesion molecules plays an important role in embryonic cell development and architectural maintenance of adult tissues. This molecule is a calcium- dependent glycoprotein and is expressed in most normal epithelial tissues. Selective loss of E-cadherin has been observed in many carcinomas of various origins, and this phenomenon is thought to be an induction point for depression of cell adhesiveness and for metastasis. This study was conducted to evaluate the significance of E-cadherin expression as a prognostic factor in breast cancer and to examine the relationship between E-cadherin expression and clinicopathologic factors. METHODS: Surgical specimens were obtained from 73 patients with breast carcinoma from September 1993 to August 1996 in the Department of Surgery, Mok-Dong Hospital, Ewha Womans University. The immunohistochemical staining was performed by using the paraffin embedded tissues. These results were compared with previously known important clinicopathologic characteristics such as age, tumor location, chief complaint, mass size, tumor stage, lymph node invasion, mitosis, nuclear and histologic grades. RESULTS: The expression status of E-cadherin was normal in 41 cases (56%), reduced in 23 cases (32%), lost in 9 cases (12%). When compared with clinicopathologic variables, loss of E-cadherin expression was found in high nuclear and histologic grade, high stage, and severe lymph node invasion cases. However, there was no significant difference in survival rate according to E-cadherin expression. CONCLUSION: This study suggests that E-cadherin expression may be related with the histologic and nuclear grades, the stage and lymph node invasiveness, so it can be used as predictive factor for metastasis.
Adhesiveness ; Adult ; Breast Neoplasms* ; Breast* ; Cadherins* ; Cell Adhesion Molecules ; Depression ; Female ; Glycoproteins ; Humans ; Lymph Nodes ; Mitosis ; Neoplasm Metastasis ; Paraffin ; Survival Rate

PURPOSE: Granulomatous mastitis (GM), reported for the first time by Kessler and Wolloch in 1972, is a rare and benign inflammatory lesion of the breast. The etiology of GM is currently unknown, but some reports have suggested autoimmunity. The aim of this study was to evaluate the clinical characteristic, clinical presentations and radiological features of GM. METHODS: A chart review was performed for 23 patients, with GM confirmed by a pathological examination, between July 1999 and December 2005. A retrospective review of the clinical and radiological finding, as well as the cytological results of the patients was undertaken. RESULTS: The ages of these patients ranged between 29 and 74 years, with a mean of 39.7 years. The median follow-up was 8 months. Twenty patients (87%) presented with a mass as the chief complaint, with a median size of 2.56 cm (range 0.78~6.5 cm). Eight patients (34.8%) had radiological findings suspicious of malignancy. Tuberculosis was diagnosed using Tb-PCR in 1 patient. Twenty-two of the 23 patients underwent a wide excision, and the one remaining patient underwent incision and drainage. One of 23 patients had a recurrent disease. CONCLUSION: GM is a rare breast disease, which clinically mimics cancer. As radiological imaging, such as mammography or ultrasonography, are unreliable in distinguishing GM from breast cancer, further special examinations, for example FNAB and gun biopsy, are necessary. The single most important differential diagnosis of GM is tuberculosis, especially in developing countries. We suggest that the evaluation for tuberculosis is essential for the differential diagnosis of GM using clinical and pathological methods.
Autoimmunity ; Biopsy ; Breast ; Breast Diseases ; Breast Neoplasms ; Developing Countries ; Diagnosis, Differential ; Drainage ; Follow-Up Studies ; Granulomatous Mastitis* ; Humans ; Mammography ; Retrospective Studies ; Tuberculosis ; Ultrasonography

BACKGROUND: Surgical excision is generally recommended for the treatment of nodular fasciitis (NF) to rule out sarcoma. However, in cases of NF occurring on the face, the reported recurrence rate is higher and the surgical approach may result in considerable aesthetic concern. OBJECTIVE: To describe our experience with NF occurring on the face and evaluate the outcomes of surgical and nonsurgical methods of treatment. METHODS: We performed a retrospective review of 16 patients with NF on the face. The patients were treated with surgical excision or nonsurgical methods such as triamcinolone intralesional injection (TA ILI) and pinhole method with a carbon dioxide (CO2) laser. RESULTS: Among the 16 patients, surgical treatment was performed in 9 and recurrence occurred in 7 of these 9 patients (77.8%). The recurred lesions showed regression after repeated TA ILI. On the other hand, five patients underwent nonsurgical treatment after the histologic exclusion of malignancy. Their lesions showed regression after repeated pinhole treatment and TA ILI. In one case, NF spontaneously regressed. On a visual analogue scale, the nonsurgical approach showed superior results. However, the values were not statistically significant (6.90+/-1.56 vs. 5.61+/-1.36; p=0.163). The satisfaction level was lower in patients who experienced recurrence after surgical excision. CONCLUSION: Surgical treatment for NF on the face showed a noticeable recurrence rate and resulted in scarring. Therefore, considering the possibility of spontaneous regression, the nonsurgical method can be considered as an alternative treatment option for NF on the face.
Carbon Dioxide ; Cicatrix ; Fasciitis* ; Hand ; Humans ; Injections, Intralesional ; Laser Therapy ; Recurrence ; Retrospective Studies ; Sarcoma ; Triamcinolone