No abstract available.

No abstract available.

PURPOSE: Since its introduction in the mid-1990s, sentinel lymph node biopsy has been rapidly and widely adopted for the axillary staging of clinically node-negative breast cancer patients. However, there is some controversy in the clinical application because of its various identification rates and its false negative rates. The objective of this study was to assess the usefulness of endoscopic sentinel lymph node biopsy (ESNB) and to compare the value of two methods for identification of ESNB using blue dye only or a combination of blue dye and radioisotope. METHODS: This study was carried out in 137 breast cancer patients (bilateral breast cancer, 3 cases) who underwent ESBN, at the Department of Surgery in Soonchunhyang University from May of 2007 to August of 2008. The technique involved the injection of 5 mL of 0.5% indigocarmine or Tc-99m tin colloid into subareolar plexus. The Visiport docked with a telescope was inserted through a low transverse axillary incison (1.0 cm in size) lateral to the pectoralis major. During the dissection, we identified sentinel nodes by following blue-stained lymphatic duct directly into blue-stained lymph nodes. We compared the value of two methods for identification of ESNB using blue dye only or a combination of blue dye and radioactive tracer. RESULTS: The mean number of sentinel nodes was 1.27 (range, 1-4). The identification rate and false negative rate of the sentinel node were 94.3% (132/140) and 6.9% (3/43), respectively. We compared ESNB with using blue dye only (n=77) vs. a combination of blue dye and radioactive tracer (n=63). Sentinel lymph node identification rate were 90.9% (70/77) vs. 98.4% (62/63) (p=0.043). CONCLUSION: The endoscopic technique of sentinel node biopsy can keep better operative visual fields and is less invasive. The combination of blue dye and radioactive tracer was superior to blue dye only for identification rates.
Biopsy ; Breast ; Breast Neoplasms ; Colloids ; Humans ; Lymph Nodes ; Nitriles ; Pyrethrins ; Radioisotopes ; Sentinel Lymph Node Biopsy ; Telescopes ; Tin ; Visual Fields

PURPOSE: Since its introduction in the mid-1990s, sentinel lymph node biopsy has been rapidly and widely adopted for the axillary staging of clinically node-negative breast cancer patients. However, there is some controversy in the clinical application because of its various identification rates and its false negative rates. The objective of this study was to assess the usefulness of endoscopic sentinel lymph node biopsy (ESNB) and to compare the value of two methods for identification of ESNB using blue dye only or a combination of blue dye and radioisotope. METHODS: This study was carried out in 137 breast cancer patients (bilateral breast cancer, 3 cases) who underwent ESBN, at the Department of Surgery in Soonchunhyang University from May of 2007 to August of 2008. The technique involved the injection of 5 mL of 0.5% indigocarmine or Tc-99m tin colloid into subareolar plexus. The Visiport docked with a telescope was inserted through a low transverse axillary incison (1.0 cm in size) lateral to the pectoralis major. During the dissection, we identified sentinel nodes by following blue-stained lymphatic duct directly into blue-stained lymph nodes. We compared the value of two methods for identification of ESNB using blue dye only or a combination of blue dye and radioactive tracer. RESULTS: The mean number of sentinel nodes was 1.27 (range, 1-4). The identification rate and false negative rate of the sentinel node were 94.3% (132/140) and 6.9% (3/43), respectively. We compared ESNB with using blue dye only (n=77) vs. a combination of blue dye and radioactive tracer (n=63). Sentinel lymph node identification rate were 90.9% (70/77) vs. 98.4% (62/63) (p=0.043). CONCLUSION: The endoscopic technique of sentinel node biopsy can keep better operative visual fields and is less invasive. The combination of blue dye and radioactive tracer was superior to blue dye only for identification rates.
Biopsy ; Breast ; Breast Neoplasms ; Colloids ; Humans ; Lymph Nodes ; Nitriles ; Pyrethrins ; Radioisotopes ; Sentinel Lymph Node Biopsy ; Telescopes ; Tin ; Visual Fields

PURPOSE: The purpose of this study was to determine if there were prognostic differences between BRCA related and BRCA non-related Korean patients with early-onset breast carcinomas. MATERIALS AND METHODS: Sixty women who had developed breast cancers before the age of 40, and who were treated at the Soonchunhyang University Hospital, were studied independently of their family histories. The age range was 18 to 40 with a median of 34.5 years. Lymphocyte specimens from peripheral blood were studied for the heterozygous mutations of BRCA1 and BRCA2 using direct sequencing methods. Immunohistochemistry was performed on the paraffin-embedded tissue blocks that were available. RESULTS: Eleven deleterious mutations (18.3%, 6 in BRCA1 and 5 in BRCA2) and 7 missense mutations of unknown significance (11.7%), were found among the 60 patients. More than half of the mutation were novel, and were not reported in the database. Most of the BRCA-associated patients had no history of breast cancer. No treatment related failures were observed in the BRCA carriers, with the exception of one patientthat had experienced a new primary tumor of the contralateral breast. The seven year relapse free survival rate were 50 and 79% in the BRCA carrier and BRCA negative patients, respectively. Although the expression of estrogen and progesterone receptors were less common, and histological features more aggressive, in the BRCA associated tumors, the outcome of the patients with BRCA mutations was not poorer than that of the patients without deleterious mutations. CONCLUSION: Despite the BRCA mutation carriers having adverse prognostic features, the recurrence rate was relatively lower than that in the BRCA non-carrying Korean patients with early-onset breast carcinomas. In addition, although the prevalence of the BRCA mutation in Korean patients was higher than that in white patients, the penetrance of the cancer seemed to be relatively low in Korean women carrying BRCA mutations. A large population based study of the BRCA mutation, with a long-term follow-up of the study patients will be required to confirm these results.
Breast Neoplasms* ; Breast* ; Estrogens ; Female ; Follow-Up Studies ; Germ-Line Mutation* ; Humans ; Immunohistochemistry ; Lymphocytes ; Mutation, Missense ; Penetrance ; Prevalence ; Receptors, Progesterone ; Recurrence ; Survival Rate

No abstract available.
Infarction

Intramuscular injection is a commonly used route of parenteral drug administration. Many types of complications following intramuscular injection into the gluteal muscles have been described. A retrospective review of 32 patients requiring surgical treatment for local compli-caations of the buttock injections in children was made at the Taegu Fatima Hospital from March 1990 to December 1997. Local complications consisted of acute inflammatory compli-cations including cellulitis and abscess (71.9%), fat necrosis (21.9%), and injection granu-loma (6.2%). Over the half of complications were situated in the upper outer quadrant of the buttock but the other 43.7% of them were in the upper inner or lower outer quadrant which were unsuitable sites for intramuscular injection. And the majority of complications were de-veloped within fat tissue (90.6%) rather than within muscle (9.4%). Two thirds of the patients were under 2 years of age, which suggested that there were some difficulties in accurate intra-muscular injection in small children who had smaller muscle masses compared with subcuta-neous fat and were irritable during injection. In patients with abscess, Staphylococcus aureus was the predominant organism, isolated in 84.6% of the patients. The treatment consisted of needle aspiration, incision and drainage or curettage, and surgical excision. In conclusion, we think that the major factor contributing development of complications following intramuscular injection in the buttock was inadvertent intrafat injection instead of intramuscular injection. In order to prevent those complications, it is necessary to inject accurately into the muscle with a knowledge of pelvic anatomy and complications associated with intramuscular injection.
Abscess ; Buttocks* ; Cellulitis ; Child* ; Curettage ; Daegu ; Drainage ; Fat Necrosis ; Humans ; Injections, Intramuscular* ; Muscles ; Needles ; Retrospective Studies ; Staphylococcus aureus

Between 1977 and 1987, 20 patients with mesothelioma were treated at Severance Hospital. Data was gathered from medical charts at the time of hospitalization of mesothelioma patients and from a follow-up questionnaire by mail or telephone. The results acquired were as follows: 1. Among the 20 patients, 11 men and 9 women with mesothelioma were identified. The mean age at hospitalization was 47 years and 11 mesothelioma patients were known or presumed to be dead during the different observation periods. 2. Only one mesothelioma patient had a definite history of occupational asbestos exposure. 3. The sites of orgin of mesothelioma were the pleura(13), peritoneum(2), pericardium(2), mediastinum(2), and pelvis(1). Common symptoms included dyspnea, chest pain, abdominal distension, etc. 4. Pathologically, mesotheliomas were divided into 14 malignant types and 6 benign types ; and histologically, 8 fibrous mesotheliomas and 3 epithelial mesotheliomas were shown. 5. There was a statistically significant difference in survival rate according to pathologic type and smoking status. In the groups with malignant mesothelioma, 50% survival time from first symptoms was 18 months and that from diagnosis was 11 months. Also, 75% survival time from diagnosis was 6 months in the smoking groups and 19 months in the non-smoking groups.
Asbestos ; Chest Pain ; Diagnosis ; Dyspnea ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Male ; Mesothelioma* ; Postal Service ; Surveys and Questionnaires ; Smoke ; Smoking ; Solitary Fibrous Tumor, Pleural ; Survival Analysis* ; Survival Rate ; Telephone

PURPOSE: Angiogenesis plays a key role in the growth and metastasis of malignant tumor. Angiogenesis is reportedly enhanced by prostaglandins (PGs). Cyclooxygenase (COX)-2 is an inducible enzyme that catalyzes the formation of PGs from arachidonic acid. The COX enzyme system is composed of two isoenzymes, COX-1 and COX-2. Recent sources of experimental and epidemiological evidence suggest a significant role for the COX enzymes, particularly COX-2, in the pathogenesis of breast cancer. COX-2 overexpression in a murine mammary gland is sufficient to cause tumor formation. We performed our study to determine the effect of COX-2 inhibitor in a in vivo mouse mammary tumor (MMT) cell line. METHODS: In order to test our study, 24 C57BL/6 type mice (Jackson Laboratory, Bar Harbor, USA) were randomized to receive 35 days of either placebo supplemented diet (n=11) or a 1,500ppm celecoxib (CELEBREX, Pfizer Inc. St. Louis, USA) supplemented diet (n=13) beginning at day 0. At 14 days after the beginning day, 30 microliter of a 1% India ink solution that contained 500,000 of MMT cells or dye alone (control) was intradermally inoculated at each flank (day 14). The animals were sacrificed 21 days later (day 35) and skin specimens were harvested/processed for quantification of the microvessel density (MVD) that was associated with each inoculated site. The aortas that were isolated according to each treatment group at the time of animal sacrifice were used to create identical aortic ring angiogenesis assays (media 199 supplemented with 20% FBS). Explants were evaluated for 14 days in culture to determine both the rate of angiogenesis initiation (% of explants exhibiting the angiogenic phenotype) and the neovessel growth rate (using a subjective angiogenic index score for the wells exhibiting initiation). Analysis of variance (ANOVA) was used to evaluate the differences between groups for each assay. RESULTS: According to the immunohistochemical staining, celecoxib administration resulted in a parallel decrease in the MVD at both the control and MMT inoculated sites (22% and 21%, p = 0.025 and p = 0.010 respectively). On the aortic ring assay, the dietary treatment group was not significantly inhibited compared with the placebo group (75% and 63.3%, respectively, p = NS). However, dietary celecoxib administration significantly inhibited the angiogenic index of the neovessel growth rate (5.0 +/- 2.38 and 8.9 +/- 3.44, respectively, p < 0.001). CONCLUSION: These results suggest that a selective COX-2 inhibitor had an antiangiogenic effect on the in vivo tumor cells. We will perform more investigations of a selective COX-2 inhibitors, and these may will be crucial drugs to use as new chemotherapy agents for treating in cancer.
Animals ; Aorta ; Arachidonic Acid ; Breast Neoplasms ; Celecoxib ; Cell Line ; Cyclooxygenase 2 Inhibitors ; Cyclooxygenase 2* ; Diet ; Drug Therapy ; India ; Ink ; Isoenzymes ; Mammary Glands, Human ; Mice* ; Microvessels ; Neoplasm Metastasis ; Prostaglandin-Endoperoxide Synthases ; Prostaglandins ; Skin

PURPOSE: Skin-sparing mastectomy (SSM) involves the resection of the nipple-areolar complex (NAC) along with the breast parenchyma, and this improves aesthetic outcome for breast cancer patients. Yet most patients desire preservation of the NAC. The purpose of this study was to determine the associated risk factors of NAC involvement and to identify the value of preoperative breast magnetic resonance imaging (MRI) for measuring the tumor-nipple distance (TND). METHODS: This prospective study was carried out in 92 breast cancer (3 patients with bilateral breast cancer) patients who underwent MRI and they had undergone modified radical mastectomy or SSM at the Department of Surgery in Soonchunhyang University Hospital from November of 2003 to March of 2006. The patients were divided into two groups: nipple-positive for malignancy (group 1; n=9) and nipple-negative for malignancy (group 2; n=86). We analyzed the risk factors of NAC involvement, including tumor size, nuclear grade, lymph node invasion, muticentricity, TND, the hormone recepor status, and lymphovascular invasion. The TND was measured by preoperative breast MRI (the imaging distance) in all patients and by the distance of specimens which were obtained postoperatively (the real distance) in 31 patients. RESULTS: The overall frequency of malignant nipple involvement was 9 of 95 (9.4%). There were no differences in tumor size, nuclear grade, lymph node invasion, muticentricity, the hormone recepor status and lymphovascular invasion between the two groups. The TND was identified as an independent predictor of malignant NAC involvement: the mean TND by breast MRI was 0.7 cm in group 1 and 2.7 cm in group 2 (p=0.01) the mean TND by pathologic measuring the specimen was 0.7 cm in group 1 and 3.2 cm in group 2 (p=0.02). In all the nipple involved cases, the tumor was within 2 cm of the nipple. In measuring the TND, there was no significant difference between the imaging distance of MRI and real distance of the sepcimen (p=0.166). CONCLUSION: The only predictive factor for malignant NAC invasion was TND in our study. NAC preservation would be appropriate for the patients with tumor located more than 2 cm away from the nipple. The TND as determined by preoperative MRI is considered to be helpful when deciding whether to preserve the NAC.
Breast Neoplasms* ; Breast* ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Mastectomy ; Mastectomy, Modified Radical ; Nipples* ; Prospective Studies ; Risk Factors