Breast cancer is the second leading cause of cancer death in women. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea. The purpose of the study is to analyze the results of breast reconstruction using free transverse rectus abdominis myocutaneous(TRAM) flap and to suggest the operative technique for more satisfactory results. 19 patients underwent immediate breast reconstruction from 1990 to 1998, and we experienced 2 cases of bilateral immediate reconstruction of breasts following mastectomy. We have performed the free TRAM flaps based on the deep inferior epigastric vessels using microvascular technique. TRAM flap included very small portion of rectus sheath and muscle-so called muscle sparing technique. So it reduced markedly donor site morbidity. The postoperative course of these cases was uneventful with minor complication. The free TRAM flap was an excellent method of immediate breast reconstruction using autogenous tissue and provided satisfactory outcome. The goals of the immediate breast reconstruction after mastectomy are to restore body image, to achieve near normal shape of breast, and to reduce the complications. This paper represents our experience of immediate breast reconstruction using free TRAM flap, and technical options to get more satisfactory result and reduce the complications. We think this method could be regarded as the first choice for immediate breast reconstruction.
Body Image ; Breast Neoplasms ; Breast* ; Female ; Humans ; Korea ; Mammaplasty* ; Mastectomy ; Rectus Abdominis* ; Tissue Donors

No abstract available.

The vagina is an infrequent site of primary sarcomas, which are less than 2% of all malignant vaginal neoplasm. The most common malignant mesenchymal tumor of the vagina is rhabdomyosarcoma, but leiomyosarcoma is rare type tumor of the vagina. Microscopically, spinle cells with pleomorphic nuclei and mitotic figures were frequently noted, but cross-striations were not found in the tissue. Alpha-smooth muscle actin and desmin were positive, but sarcomeric actin was negative in the tumor cells. The authors report a case of primary leiomyosarcoma of the vagina with brief literature review.
Actins ; Desmin ; Leiomyosarcoma* ; Rhabdomyosarcoma ; Sarcoma ; Vagina* ; Vaginal Neoplasms

This paper represents the versatility of buccinator myomucosal flap for intraoral and orbital reconstruction of mild to moderate defect and we introduce recontructive methods are introduced along with our clinical experience. Buccal artery from internal maxillary artery is the main arterial pedicle, and buccal branch from facial artery also can supply blood for the buccinator muscle. The abundant blood flow from interconnected pedicles supports the reliable circulation of the buccal mucosa. So we could reconstruct the eye socket using reversed island buccinator myomucosal flap based on the angular vessel. The motor innervation of the buccinator muscle comes from the facial nerve. The buccinator muscle is considered to be a part of the sphincteric muscular system involving the functions of sucking, whistling, propelling food during mastication and voiding the buccal cavity. From 1990 to 1999, the flap was utilized in 8 patients to reconstruct the small to moderate intraoral defect and 1 patient for orbital mucosal defect. All flaps survived completely. There has been no flap necrosis and fistula. The results have been functionally and esthetically satisfactory. It is very reliable and safe flap with a minimal morbidity of donor site. It doesn't require microsurgical technique. Rapid healing may be achieved with its mucosal nature. We conclude that buccinator myomucosal flap can be widely used with a lot of advantages for intraoral and orbital defect because of its many advantages.
Arteries ; Facial Nerve ; Fistula ; Humans ; Mastication ; Maxillary Artery ; Mouth Mucosa ; Mouth* ; Necrosis ; Orbit* ; Singing ; Tissue Donors

p53 is a tumor suppressor gene product identified in a wide range of tumor including colorectal carcinoma. Genetic alterations in the p53 tumor suppressor gene are common in human colorectal carcinoma. bcl-2 is a protooncogene that inhibits apoptosis. The products of mutant p53 gene and bcl-2 have been associated with prognosis in several malignancies including colorectal carcinomas. This study was undertaken to evaluate values of p53 and bcl-2 oncoproteins as prognostic factors relative to clinicopathological factors and correlation of their expression. Analyses were made on achieval pathologic tissues of 80 patients with colorectal carcinomas including 34 patients able to follow-up over 5 years. The oncoproteins were localized using commercially available monoclonal antibodies:DO-7 for p53, clone124 for bcl-2. Expression of bcl-2 was cytoplasmic, whereas nuclear p53 expression was localized in carcinoma cells. The patients were 17 to 83 years of age. The expression of p53 and bcl-2 was determined respectively in 30 (37.5%) and 21 (26.3%)cases. The expression of p53 nuclear expression was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and tumor recurrence. The cytoplasmic expression of bcl-2 was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and recurrence. Univariate analysis showed that patients with p53 nuclear expression were not associated with poorer overall survival than patients with p53 negative, and also showed in patients with bcl-2 expression. The expression of p53 did not affect to that of bcl-2. We concluded that the p53 nuclear and bcl-2 cytoplasmic expression were not independent prognostic factors in colorectal carcinomas. Evidence of reciprocity of bcl-2 and p53 expression was not found.
Apoptosis ; Classification ; Colorectal Neoplasms* ; Cytoplasm ; Follow-Up Studies ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Oncogene Proteins ; Prognosis ; Recurrence

Advanced or complete atrioventricular (AV) block is frequently regarded as a cause of informed syncopal attacks even though escape rhythm is maintained. Torsades de pointes (TdP) may be a significant complication of AV block associated with QT prolongation. Maintaining ventricular rate over 70 beats/min is known to be important to normalize QT interval and to reduce the possibility of bradycardia-related TdP recurrence after pacemaker implantation. We report one case of syncopal attacks associated with TdP in a 70 year old female patient with advanced AV block and prolonged QT interval. She was referred to evaluate palpitation and syncope. Advanced AV block and QT interval prolongation were seen with electrocardiography, but junctional escape rhythm was maintained. Syncopal attacks occurred during temporary pacemaker insertion. Multiple episodes of nonsustained polymorphic ventricular tachycardia and TdP related to syncopal attacks were demonstrated by 24-hour Holter monitoring. A permanent pacemaker was implanted and ventricular rate was set over 70 beats/min resulting in no recurrence of TdP and syncope.
Atrioventricular Block* ; Electrocardiography ; Electrocardiography, Ambulatory ; Female ; Humans ; Recurrence ; Syncope* ; Tachycardia, Ventricular ; Torsades de Pointes* ; United Nations

Gaucher's disease (GD) is the most common inherited lysosomal storage disease, manifested by generalized accumulation of glucocerebroside in macrophages of the reticuloendothelial system due to a deficient lysosomal beta-glucocerebrosidase (GC). It is inherited by an autosomal recessive pattern in which three clinical phenotypes have been described based on the presence and severity of neurologic involvement. GD is treated possible by GC enzyme replacement therapy, allogeneic bone marrow transplantation (BMT), and gene therapy. We here report the exprience of successful allogeneic BMT in a 16-year-old female patient with GD type III which was demostrated markedly increased Gaucher cells in bone marrow and absence of GC activity in peripheral blood monocytes by FACS using 5'- pentafluorobenzoylaminofluorescein-di-beta-D-glucoside (PFBFDGlu) as substrate. Donor marrow engraftment was confirmed by chromosome analysis using microsatellite and by bone marrow examination. Assay of GC activity using FACS revealed normal level of enzyme activity. She remains alive and well after 12 months of BMT.
Adolescent ; Bone Marrow Examination ; Bone Marrow Transplantation* ; Bone Marrow* ; Enzyme Replacement Therapy ; Female ; Gaucher Disease* ; Genetic Therapy ; Glucosylceramidase ; Humans ; Lysosomal Storage Diseases ; Macrophages ; Microsatellite Repeats ; Monocytes ; Mononuclear Phagocyte System ; Phenotype ; Tissue Donors

BACKGROUND/AIMS: Thymidylate synthase (TS) is a target enzyme of 5-fluorouracil (5-FU) and has a polymorphic 28 bp tandem repeated sequence. TS enhancer region (TSER) polymorphism has been associated with the efficacy of 5-FU-based chemotherapy in colon cancer. Methylenetetrahydrofolate reductase (MTHFR) plays a central role in converting folate to methyl donor for DNA methylation. The aim of this study was to determine the clinical value of TSER and MTHFR polymorphism in gastric cancer. METHODS: From October, 1995 to February, 2002, 40 gastric cancer patients underwent operation and 25 patients among those patients have received postoperative 5-FU-based chemotherapy (5-FU (+) group). Peripherial blood were sampled for TSER and MTHFR genotype analysis by PCR amplification of genomic DNA. The survival of patients according to TSER and MTHFR polymorphism were compared. RESULTS: We observed a longer survival in stage II than stage III of the patients (p=0.0037). However, the TSER and MTHFR C677T polymorphisms were not associated with better survival of gastric cancer patients as well as combined TSER and MTHFR genotypes with 5-FU chemotherapy. CONCLUSIONS: The TSER and MTHFR genotypes are not effective markers for tumor sensitivity to 5-FU-based chemotherapy in Korean gastric cancer patients after curative resection. These results may suggest further large-scale study about TSER and MTHFR polymorphism for the prediction of efficacy of 5-FU-based chemotherapy in gastric cancer in Korea.
Aged ; Antimetabolites, Antineoplastic/*therapeutic use ; Drug Screening Assays, Antitumor ; Female ; Fluorouracil/*therapeutic use ; Humans ; Male ; Methylenetetrahydrofolate Reductase (NADPH2)/*genetics ; Middle Aged ; *Polymorphism, Genetic ; Stomach Neoplasms/*drug therapy/genetics/mortality ; Survival Rate ; Thymidylate Synthase/*genetics

Negative pressure pulmonary edema is a recognized complication of airway obstruction, particularly after endotracheal extubation. The application of oxygen therapy and continuous positive airway pressure with the administration of diuretics under a rapid diagnosis usually clears pulmonary edema. We report a case of 61-year-old man who developed negative pressure pulmonary edema following extubation after an endoscopic submucosal dissection under general anesthesia.
Airway Extubation ; Airway Obstruction ; Anesthesia, General ; Continuous Positive Airway Pressure ; Diuretics ; Humans ; Middle Aged ; Oxygen ; Pulmonary Edema

PURPOSE: The tumor suppressor gene PTEN is located on chromosome 10q23 and is mutated in a variety of sporadic cancers. The aim of this study is to understand the expression of the PTEN gene product in invasive breast cancer and its relationships with clinicopathologic factors of breast cancer. METHODS: The hospital records and pathologic findings of 57 patients who underwent breast operation due to invasive breast carcinoma between January 1996 and June 2002 were reviewed. We examined the relationships between PTEN expression and various clinicopathologic factors of breast cancer such as age, tumor size, lymph node metastasis, histologic grade, nuclear grade, stage and estrogen, and progesterone receptors. RESULTS: Among the 57 invasive breast cancers, 5 (8.8%) were immunohistochemically negative, and 14 (24.6%) had reduced expression of PTEN. Among clinicopathologic factors, age, tumor size, lymph node metastasis, stage, histologic grade, and estrogen receptor had no correlation with PTEN expression. Nuclear grade and positive progesterone receptor were significant correlated with decreased PTEN expression. However, these results are different from those of other reports showing that negative progesterone receptor was significantly correlated with the decrease of PTEN expression. CONCLUSION: According to other reports, PTEN expression does play some role as a prognostic factor for breast cancer, but the results of our study did not support this hypothesis. Further evaluation and study are required into the role of PTEN as a prognostic factor of breast cancer.
Age Factors ; Breast ; Breast Neoplasms* ; Estrogens ; Genes, Tumor Suppressor ; Hospital Records ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Receptors, Progesterone