PURPOSE: To evaluate the outcome of ductal carcinoma in situ (DCIS) patients who underwent surgery followed by radiation therapy (RT). MATERIALS AND METHODS: We retrospectively reviewed 106 DCIS patients who underwent surgery followed by postoperative RT between 1994 and 2006. Ninety-four patients underwent breast-conserving surgery, and mastectomy was performed in 12 patients due to extensive DCIS. Postoperative RT was delivered to whole breast with 50.4 Gy/28 fx. Tumor bed boost was offered to 7 patients (6.6%). Patients with hormonal receptor-positive tumors were treated with hormonal therapy. RESULTS: The median follow-up duration was 83.4 months (range, 33.4 to 191.5 months) and the median age was 47.8 years. Ten patients (9.4%) had resection margin <1 mm and high-grade and estrogen receptor-negative tumors were observed in 39 (36.8%) and 20 (18.9%) patients, respectively. The 7-year ipsilateral breast tumor recurrence (IBTR)-free survival rate was 95.3%. Resection margin (<1 or > or =1 mm) was the significant prognostic factor for IBTR in univariate and multivariate analyses (p < 0.001 and p = 0.016, respectively). CONCLUSION: Postoperative RT for DCIS can achieve favorable treatment outcome. Resection margin was the important prognostic factor for IBTR in the DCIS patients who underwent postoperative RT.
Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Estrogens ; Follow-Up Studies ; Humans ; Mastectomy ; Mastectomy, Segmental ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome*

Fatal complications including cerebral edema and neurologic collapse occur during treatment of diabetic ketoacidosis(DKA). A 6-week-old female infant with fever, dehydration and drowsy mental status was diagnosed as DKA and neurologically deteriorated during treatment. The cranial computed tomography scan revealed multifocal brain infarctions of the left caudate nucleus, bilateral frontal periventricular white matter, and right parietal cortex. A moderate amount of hemorrhage was also noted in both lateral ventricles. She recovered rapidly with supportive treatment over time. The clinical course and radiologic findings of this patient emphasize the importance of brain infarction as a cause of persistent neurologic loss in children with DKA.
Brain Edema ; Brain Infarction* ; Brain* ; Caudate Nucleus ; Child ; Dehydration ; Diabetic Ketoacidosis* ; Female ; Fever ; Hemorrhage* ; Humans ; Infant* ; Lateral Ventricles ; Rabeprazole

The endemic status of clonorchiasis and metagonimiasis along the Geum-gang (River) in Okcheon-gun (County) in Korea was examined. From February to December 2000, stools of total 1,081 inhabitants living in 5 villages were examined. Each stool specimen was examined by both the cellophane thick smear method and the formalin-ether sedimentation technique. Egg-positive cases were further analyzed by Stoll's egg-counting technique, and praziquantel was administered to positive cases. The egg-positive rates for Clonorchis sinensis and Metagonimus species were 9.3% and 5.5%, respectively, and the double infection rate was 3.5%. The numbers of eggs per gram (EPG) of feces of C. sinensis and Metagonimus sp. were 918 +/-1.463 and 711+/-947, respectively. The egg-positive rates for C. sinensis and Metagonimus sp. in the riverside area were 14.2% and 8.4%, respectively, which were significantly higher than those of the inland area (3.2% and 1.7%, respectively). The egg-positive rates of C. sinensis and Metagonimus sp. in males (16.7% and 10.0%) were significantly higher than those of females (3.5% and 1.8%). However, there were no significant differences of EPG values between localities and sexes. The prevalence of clonorchiasis and metagonimiasis in this survey was significantly lower than that in the previous reports. However, there is still a high prevalence of infection with C. sinensis and Metagonimus sp. in this region, especially in the riverside area.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Animals ; Child ; Clonorchiasis/*epidemiology/parasitology ; Clonorchis sinensis/isolation & purification ; Feces/parasitology ; Female ; Heterophyidae/isolation & purification ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Parasite Egg Count ; Prevalence ; Rural Population ; Sex Factors ; Time Factors ; Trematode Infections/*epidemiology/parasitology

PURPOSE: We wanted to evaluate the normal glenoid size of Koreans in their 7th and 8th decades by conducting Computed tomographic (CT) studies. MATERIALS AND METHODS: The CT images were obtained from the normal scapulae of the patients (mean age: 68.8) who had humeral fracture. A display workstation version 2.0.73.315 was used to measure the scans to determine the maximal superoinferior (SI) and anteroposterior (AP) diameters of the glenoid vault. RESULTS: The average diameters of curvature of the glenoid were 31.2 mm (range: 27 to 34 mm) in the superior-inferior direction and 26.1mm (range: 22 to 31mm) in the anterior-posterior direction. CONCLUSION: This study showed the normal glenoid size of Koreans and it is different from the size that the international literature reported. It should be an important factor for the treatment of fracture or in designing arthroplasty implants.
Arthroplasty ; Humans ; Humeral Fractures ; Scapula ; Shoulder

Neuroinflammation such as reactive gliosis and microglial activations are important pathological findings of ALS. We present a first autopsy case of ALS in Korea related with neuroinflammatory change. A 67-year-old ALS patient suddenly expired due to accidental head trauma. Gross autopsy finding showed marked atrophic change in spinal cord. Pathological finding include a marked loss of motor neurons, reactive gliosis and microglial infiltrations. These findings suggest neuroinflammation may play a role in pathogenesis of ALS.
Aged ; Amyotrophic Lateral Sclerosis ; Autopsy ; Craniocerebral Trauma ; Gliosis ; Humans ; Korea ; Motor Neurons ; Spinal Cord

BACKGROUND: Although pneumonia is the third most common type of nosocomial infection following urinary tract infection and surgical wound infection, it is associated with the highest mortality rate (28-37%), and 16% of deaths in hospitals are caused by it. The purpose of this study was to analyze our cases of postoperative pneumonia and to establish the principles of prevention and treatment for postoperative pneumonia. METHODS: Thirteen cases diagnosed as postoperative pneumonia out of 11,227 patients who were operated on from Jan. 1994 to June 1997 at the Department of Surgery, Seoul National University Hospital, were analyzed by a retrospective review of their medical records. The diagnosis of postoperative pneumonia was based on the `Center for Disease Control' criteria. RESULTS: The incidence of postoperative pneumonia was 0.12%. The median patient age was 58 years (ranging from 31 to 70 years). There were 7 males and 6 females. The causal diseases for the operations were 7 gastric cancers, 2 ileus, and 4 others. Five subtotal gastrectomies, 3 total gastrectomies, and 5 other operations were performed, and there were 10 elective and 3 emergent operations. The preoperative status was investigated. Two cases were preoperatively diagnosed as bronchiectasis. Other associated medical illnesses were 2 coronary arterial diseases, 2 hypertensions, and 2 others. Six patients had a history of smoking. The `American Society of Anesthesiologist' physical status score was checked in 11 cases. There were 2 cases with one points, six cases with two points, and 3 cases with a higher number of points. The average time until diagnosis after operation was 4.0 +/- 3.85 days. All had purulent sputum and high fever, and showed pneumonic infiltration on Chest PA. Four Gram positive and 7 Gram negative bacteria were isolated from the sputum of 12 patient, including three cases with Pseudomonas aeruginosa and two cases with MRSA. All patients were treated with antibiotics. Five patients were admitted to the ICU, and 3 patients maintained intubation after anesthesia. Twelve patients had a nasogastric tube, for which the average period of intubation was 14.1 +/- 14.61 days. One patient expired, and 12 improved. CONCLUSIONS: There was a very low incidence of postoperative pneumonia, and most patients were old. Upper abdominal surgery proved to be an important risk factor, and prolonged maintenance of the nasogastric tube may predispose postoperative patients to pneumonia. The appearance of many antibiotics- resistant bacteria demanded the judicious use of antibiotics.
Anesthesia ; Anti-Bacterial Agents ; Bacteria ; Bronchiectasis ; Cross Infection ; Diagnosis ; Female ; Fever ; Gastrectomy ; Gram-Negative Bacteria ; Humans ; Ileus ; Incidence ; Intubation ; Male ; Medical Records ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Pneumonia* ; Pseudomonas aeruginosa ; Retrospective Studies ; Risk Factors* ; Seoul ; Smoke ; Smoking ; Sputum ; Stomach Neoplasms ; Surgical Wound Infection ; Thorax ; Urinary Tract Infections

Background: Although coronavirus disease 2019 (COVID-19) vaccines have been distributed worldwide under emergency use authorization, the real-world safety profiles of mRNA vaccines still need to be clearly defined. We aimed to identify the overall incidence and factors associated with adverse events (AEs) following mRNA COVID-19 vaccination. Methods: We conducted web-based survey from December 2 to 10 in 2021 with a 2,849 nationwide sampled panel. Study participants were individuals who had elapsed at least twoweeks after completing two dosing schedules of COVID-19 vaccination aged between 18–49 years. We weighted the participants to represent the Korean population. The outcome was the overall incidence of AEs following mRNA COVID-19 vaccination and associated factors.We estimated the weighted odds ratios (ORs) using multivariable logistic regression models to identify the factors associated with AEs. Results: Of the 2,849 participants (median [interquartile range] age, 35 [27–42] years; 51.6% male), 90.8% (n = 2,582) for the first dose and 88.7% (n = 2,849) for the second dose reported AEs, and 3.3% and 4.3% reported severe AEs, respectively. Occurrence of AEs was more prevalent in mRNA-1273 (OR, 2.06; 95% confidence interval [CI], 1.59–2.67 vs. BNT162b2), female sex (1.88; 1.52–2.32), and those with dermatologic diseases (2.51; 1.32–4.77). History of serious allergic reactions (1.96; 1.06–3.64) and anticoagulant medication use (4.72; 1.92–11.6) were associated with severe AEs. Conclusion Approximately 90% of participants reported AEs following mRNA COVID-19 vaccination. Substantial factors, including vaccine type (mRNA-1273), female sex, and dermatologic diseases were associated with AEs. Our findings could aid policymakers in establishing vaccination strategies tailored to those potentially susceptible to AEs.

PURPOSE: This study was performed to evaluate the cosmetic outcome of conservative treatment for early breast cancer and to analyze the factors influencing cosmetic outcome. MATERIALS AND METHODS: From February 1992 through January 1997, 120 patients with early breast cancer were treated with conservative surgery and postoperative radiotherapy. The types of conservative surgery were quadrantectomy and axillary node dissection for 108 patients (90%) and lumpectomy or excisional biopsy for 10 patients (8.3%). Forty six patients (38%) received adjuvant chemotherapy (CMF or CAF). Cosmetic result evaluation was carried out between 16 and 74 months (median, 33 months) after surgery. The cosmetic results were classified into four categories, i.e., excellent, good, fair, and poor. The appearances of the patients' breasts were also analyzed for symmetry using the differences in distances from the sternal notch to right and left nipples. A logistic regression analysis was performed to identify independent variables influencing the cosmetic outcome. RESULTS: Cosmetic score was excellent or good in 76% (91/120), fair in 19% (23/120) and poor in 5% (6/ 120) of the patients. Univariate analysis showed that tumor size (T1 versus T2) (p=0.04), axillary node status (N0 versus N1) (p=0.0002), extent of surgery (quadrantectomy versus lumpectomy or excisional biopsy) (p=0.02), axillary node irradiation (p=0.0005) and chemotherapy (p=0.0001) affected cosmetic score. Multivariate analysis revealed that extent of surgery (p=0.04) and chemotherapy (p=0.0002) were significant factors. For breast symmetry, univariate analysis confirmed exactly the same factors as above. Multivariate analysis revealed that tumor size (p=0.003) and lymph node status (p=0.007) affected breast symmetry. CONCLUSION: Conservative surgery and postoperative radiotherapy resulted in excellent or good cosmetic outcome in a large portion of the patients. Better cosmetic results were achieved generally in the group of patients with smaller tumor size, without axillary node metastasis and treated with less extensive surgery without chemotherapy.
Biopsy ; Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Drug Therapy ; Humans ; Logistic Models ; Lymph Nodes ; Mastectomy, Segmental ; Multivariate Analysis ; Neoplasm Metastasis ; Nipples ; Radiotherapy

PURPOSE: We investigated the prognostic impacts of p53, c-erbB-2, nm23 and Ki-67 expression in patients with stage II and IIIA gastric carcinoma who underwent curative (RO) resections. MATERIALS AND METHODS: 261 paraffin-embedded gastric carcinoma tissues (stage II, 121; stage IIIA, 135) were stained with the monoclonal antibodies, p53, c-erbB-2, nm23 and Ki-67 using the labelled streptovidin biotin method. The positivity was determined by two pathologists who were kept blind for the patients outcome. RESULTS: The overexpression was seen in 51.7% for p53, 11.9% for c-erbB-2, and 70.1% for nm23. The mean Ki-67 labelling index was 25.5+ 16.7. The rates of overexpression between the stage II and stage IIIA were not significantly different in all these molecules. Overexpression of p53 was more likely to be associated with old age and lymph node metastasis. Overexpression of c-erbB-2 was more likely to be associated with Borrmann type I, II and well-differentiated tumor. However, nm23 was more frequently expressed in patients with older age and well-differentiated tumor. In survival analysis, the overexpressions of p53 and Ki-67 were significantly associated with poor prognosis of the patients (p<0.01), but c-erbB-2 and nm23 were not related to the patients outcome. In a multivariate analysis of prognostic factors, only. the lymph node metastasis was an independent prognostic factor. CONCLUSION: Although the values did not reach statistical significance in a multivariate analysis, the overexpression of p53 and Ki-67 tended to have adverse effects an the prognosis of patients with gastric cancer.
Antibodies, Monoclonal ; Biotin ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms

Regardless of an appropriate radiation therapy administered to a patient with a brain tumor, clinical and radiological evidence of progression may still develop because of a recurrence of the tumor and/or radiation necrosis, or even rarely, a radiation induced neoplasm. The evaluation of tumor recurrence and radiation-induced necrosis presents a diagnostic challenge. A thirty eight year old woman was treated for a focal motor seizure on the right side of her face.with a fractionated external beam radiotherapy under the impression of cystic astrocytoma in the left frontoparietal region. After 6 months, she developed a headache, nausea and vomiting, dysphagia, and secondary generalized seizure. A follow-up brain MRI showed a high signal mass lesion in a T2 weighted image and a fluorodeoxyglucose PET revealed hypometabolism in the left frontoparietal lobe, suggesting radionecrosis. It was confirmed as radionecrosis with an expanding edema by open biopsy. We report a cerebral radiation necrosis mimicking recurrent brain tumor.
Astrocytoma ; Biopsy ; Brain ; Brain Neoplasms* ; Deglutition Disorders ; Edema ; Female ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Imaging ; Nausea ; Necrosis* ; Radiotherapy ; Recurrence ; Seizures ; Vomiting