PURPOSE: Although breast reconstruction provides some advantages for women following mastectomy, few Korean breast cancer patients currently receive such reconstruction. Routine provision of breast reconstruction requires simplicity and easy availability for the procedure. This paper reports the possibility of performing breast reconstruction by insertion of a tissue expander by the breast surgeon. METHODS: We studied 22 cases of breast cancer patients who were treated in the Breast service of KangNam Cha Hospital. Nine cases were the group of immediate expander insertion and 13 were the group of MRM only. We evaluated age, histopathologic stage, starting time of chemotherapy, operation time, drainage amounts and periods, medication periods, time of discharge and depression score. RESULTS: The mean age of the expander insertion group was 41, which was younger than that of the MRM only group by 3 years. Histopathologic state was better in the expander insertion group and the time for chemotherapy start was almost the same between the two groups. Mean operation time in the expander insertion group was 2 hours and 41 minutes, and it was longer than the MRM only group by 1 hour, but it included additional wasting time to check the results of frozen biopsy. Periods for drainage were longer and amounts were larger, but this only delayed the medication period and time for discharge by two days. There were no other complications and mental suffering was alleviated. CONCLUSION: Tissue expander insertion for breast reconstruction could be offered on a routine basis by breast surgeons without problems. Breast reconstruction will become a more essential process for breast cancer patients to improve the quality of life. It is ideal if the same surgeon participates in both oncology and reconstruction surgery.
Biopsy ; Breast Neoplasms* ; Breast* ; Depression ; Drainage ; Drug Therapy ; Female ; Humans ; Mammaplasty* ; Mastectomy* ; Quality of Life ; Stress, Psychological ; Tissue Expansion Devices*

PURPOSE: To evaluate the vascular pattern of lymph nodes, and the usefulness of color Doppler sonogaphy indifferentiating benign from malignant superficial lymphadenopathy. MATERIALS AND METHODS: Twenty-six patientswere pathologically and clinically confirmed to be suffering from benign reactive lymphadenitis and tuberculosis(n=16) or lymphoma and malignant lymphadenitis (n=10). Lymph node shape was assessed by the ratio of longitudinaldiameter to transverse diameter(L/T), and patients were thus assigned to one of two groups : L/T >or =2, or L/T<2.The hilar vascular pattern of lymph node was assessed by color Doppler sonography and classified as central,eccentric, or absent. On the basis of peripheral vascularity, patients were divided into three groups according tocircumferental linear vascularity. An absence of peripheral vascularity was classified as grade 0. If less thanhalf the periphery was covered by linear vascularity, a patient was assigned to as grade I, and if more than halfwas covered by a vessel, the classification was grade II. RESULTS: Statistically significant differences in L/Tratio were noted between malignant and benign node (p<.001). Of the 16 benign reactive nodes, 13 showed L/T >or =2,and 3 L/T<2. while in nine of the ten malignant nodes, L/T<2 was noted. Among 16 benign reactive nodes, hilarvascularity was central in 13, eccentric in one, and absent in two. Among the ten malignant nodes, thecorresponding totals were nil, four, and Six. The hilar vascular pattern showed statistically significantdifferentiation between malignant and benign node (p<.05). Among 16 benign reactive nodes, 13 were grade 0, twowere grade I, and one was grade II, while among ten malignant nodes, two were grade 0 and eight were grade I. Onthe basis of vascular pattern, the difference between benign and malignant nodes was statistically significant(p<.05). CONCLUSION: L/T ratio<2, absent or eccentric hilar vascularity, and the presence of peripheralvascularity are suggestive of malignant lymph node. The shape of LN and pattern revealed by an analysis of nodalvascularity using color Doppler sonography are useful in differential diagnosis of benign and malignantlymphadenopathy.
Classification ; Diagnosis, Differential ; Humans ; Lymph Nodes ; Lymphadenitis ; Lymphatic Diseases* ; Lymphoma

PURPOSE: The purpose of this study was to evaluate the HRCT findings of bronchial asthma during maintenance bronchodilator therapy and to determine whether there were irreversible bronchial changes occurred in pediatric patients with this condition. MATERIALS AND METHODS: HRCT findings of the lung in 21 asthmatic children [14 boys and 7 girls aged between 3.5 and 13.8 (mean : 7.7) years] who were receiving maintenance bronchodilator therapy were retrospectively studied. At the time of CT examination, 16 were receiving nonsteroid bronchodilator therapy only, and five were receiving both bronchodilator and steroid therapy. Thirteen patients were defined as allergic and eight were nonallergic. The clinical severity of chronic asthma was graded as severe in seven cases, and moderate in 14. The duration of the disease ranged from 4 months to 6 years (mean 3.2 years). HRCT was performed in 19 cases for evalvation of the atelectasis, hyperinflation, and prominent bronchovascular bundles seen on plain radiographs, and in two cases for evaluation following acute exacerbation. A CT W-2000 scanner (Hitachi Medical Co. Tokyo, Japan) was used during the end inspiratory phase, and in addition, ten patients were scanned during the expiratory phase. Scans were reviewed for evidence of bronchial thickening, bronchiectasis, emphysema, abnormal density, mucus plugs, and other morphological abnormalities. The presence of bronchial wall thickening or air trapping was evaluated according to the duration, severity and type of asthma. RESULTS: Among the 21 patients, 7(33.3%) had normal HRCT findings, while in 14 (66.7%), bronchial wall thickening was demonstrated. Eleven of the 14 patients with bronchial wall thickening (78.6%) also had air trapping. No patient was suffering from bronchiectasis or emphysema. There were no statistically significant correlations between the presence of bronchial wall thickening or air trapping and the duration of the disease, its severity, or type of asthma. There was, however, a statistically significant correlation between bronchial wall thickening and air trapping (p < . 0 5 ). CONCLUSION: In asthmatic children who were under maintenance therapy, the most frequent HRCT findings were bronchial wall thickening and air trapping, with significant correlation between the presence of these two phenomena. No destructive lesion such as bronchiectasis or emphysema was found in these asthmatic children, however, and this is probably due to the short duration of the disease, and different disease processes.
Asthma ; Bronchiectasis ; Child* ; Emphysema ; Female ; Humans ; Lung ; Mucus ; Pulmonary Atelectasis ; Retrospective Studies

BACKGROUND: Early detection of breast cancer is important because it can reduce morbidity and mortality. Mammography is widely used for clinical and screening purposes and was contributed to the early detection of breast cancer, even tumors less than 1 cm in size and microcalcifications without lumps. METHODS: We retrospectively analyzed the clinical records of 340 patients with clinically evident breast cancer and 55 patients with clinically occult breast cancer who were treated at the Department of Surgery, Samsung Medical Center. Preoperative mammography, ultrasonography, and cytology, as well as operative method and postoperative pathology, were compared to evaluate the clinical features of clinically occult cancer. Preoperative marking was performed in suspected lesions by means of hookwire insertion or, in case of breast conservation surgery, by means of tattooing. RESULTS: Based on mammography, malignancy was suspected in 39 out of 42 cases (92.8%). Micro calcifications were seen on the mammography in 19 patients (45.2%), a mass in 17 (40.5%), a mass with microcalcifications in 4 (9.5%), and an asymmetric increased density in 2 (4.8%). Microcalcifications were major findings in comparing with clinically evident cases (16.9%) (p=0.001). Ultrasonography detected a malignancy in 10 patients (76.9%) and a core biopsy under ultrasonography was performed in 9 of them. Among the 39 patients with a mammographically suspected malignancy, a stereotactic core biopsy was performed in 12 patients, an ultrasonography-guided core biopsy in 9, fine needle aspiration cytology in 10, and localization & excisional biopsy in 3; the remaining 5 cases underwent surgery without additional evaluation. Breast conservation surgery was performed in 23 patients (41.8%) and modified radical mastectomy in 31 (56.4%). In the breast conservation surgery, 19 patients were localized by using mammographic needle localization and 4 patients by using ultrasonographically tattooing preoperatively. A ductal carcinoma in situ (DCIS) was more frequently found in the group with clinically occult breast cancer (10 patients, 18.2%) than in the group with clinically evident breast cancer (2.6%, p<0.001). Postoperative staging was earlier in patient with clinically occult cancers than in those with clinically presenting masses (p<0.001). CONCLUSION: By using mammography and ultrasonography, breast cancer can be diagnosed before it becomes palpable, and thus it can be treated with conservative surgical procedures.
Biopsy ; Biopsy, Fine-Needle ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Mammography ; Mass Screening ; Mastectomy, Modified Radical ; Mortality ; Needles ; Pathology ; Retrospective Studies ; Tattooing ; Ultrasonography ; Ultrasonography, Mammary

PURPOSE: We studied this study to see the effect of hearing music on response to pain during needling. We hypothesized that music would reduce pain in newborns. METHODS: Twenty term and near-term newborns were enrolled for the study. They were admitted to neonatal intensive care unit of Hanyang University Guri Hospital from May 1, 2011 to September 30, 2011. We evaluated pain response to needling, such as arterial puncture or heel prick, by using Neonatal Infant Pain Scale (NIPS; facial expression, crying, breathing patterns, arms, legs, state of arousal) and duration of crying through video recording. We started video recording when the newborns were stable with 0 score of NIPS, and continued for 3 minutes after needling. Each newborn took video-recordings in 2 separate periods. One was done with hearing music (Music group) and the other without music (Control group). Two observers reviewed the videotapes and gave final scores in agreement. T-test was done for comparisons of pain scale and duration of crying between music and control groups. RESULTS: Mean age and hospital days at test of the subjects were 6+/-5 days of life (1-16 days of life) and 3+/-2 days, respectively. Twenty-one of 40 needlings (52.5%) for blood sample were from radial arterial puncture and 19 (47.5%) from heel prick. The music group had lower NIPS score than the controls (5.6+/-1.1 vs 6.5+/-0.7, P=0.006). Among the NIPS parameters, the music group had lower scores in crying and arm (crying, 1.6+/-0.5 vs 1.9+/-0.3, P=0.028; arm, 0.3+/-0.5 vs 0.7+/-0.5, P=0.01) parameters. The remaining parameters such as facial expression, leg, breathing patterns and state of arousal, and duration of crying were not significantly different in 2 groups. CONCLUSION: c reduced pain response to needling in newborns. Music could be one of modalities to relieve pain during routine medical procedures in newborns.
Arm ; Arousal ; Crying ; Facial Expression ; Hearing* ; Heel ; Humans ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Korea ; Leg ; Music* ; Punctures ; Respiration ; Video Recording ; Videotape Recording

PURPOSE: We wanted to evaluate the clinical utility of performing bilateral whole breast US as a subsequent diagnostic method along with mammography in asymptomatic women. MATERIALS AND METHODS: From May 2002 to Dec 2004, we conducted 3998 examinations on 3638 patients with negative findings on the clinical examination and negative mammographic results, and those breast tissues having a BI-RADS category 2, 3, or 4 density were further evaluated by performing bilateral whole breast US. The patients' age distribution ranged from 24 to 66 years (mean age: 43.6 yrs). The abnormalities were compared with core or vacuum assisted core biopsy, operations, and follow up US. For the normal cases, we used the clinical notes and the statistical data from the Korean Central Cancer Registry. RESULTS: For 3998 examinations of 3638 women who were examined with bilateral whole breast US, pathologic confirmations were available for 433 patients and follow-up data were available for 35 patients. The sensitivity, specificity, the positive predictive value and the cancer detection rate of using additional whole breast US were 50, 92.6, 0.6 and 0.5, respectively. The two cancers that were detected only on US were minimal breast cancer. CONCLUSION: Although all the breast cancers that were detected only on US were minimal breast cancers, performing bilateral whole breast US revealed a low cancer detection rate and a high false positive. Therefore, further studies will be needed to investigate the role of US as a screening tool.
Age Distribution ; Biopsy ; Breast Neoplasms ; Breast* ; Female ; Follow-Up Studies ; Humans ; Mammography ; Mass Screening ; Sensitivity and Specificity ; Vacuum

No abstract available.
Incidence*

PURPOSE: Infiltrating lobular carcinomas (ILC) represent 5-10% of all breast cancers. Compared to infiltrating ductal carcinomas (IDC), ILC has a trend to be a more indistinct and multicentric form of cancer, thus, they are detected later and are less frequently treated using breast conserving surgery. The objective of this study was to determine the difference between ILC and IDC and the utility of using breast conserving surgery for ILC. METHODS: We studied 26 ILC and 319 IDC patients surgically treated at the Department of Surgery, Samsung Medical Center. Age, size of tumor, mammographic findings, operative method and pathologic findings were analysed retrospectively. For the microvessel count, tumor sections were immunohistochemically stained using CD31 monoclonal antibody, and microvessels were counted at 200 magnification in three separate fields selected from areas of highest vascularity. RESULTS: There were no differences between patients with ILC and IDC with respect to the mean age (45.4 and 47), the mean size of the tumors (2.59 cm and 2.63 cm), the malignant findings on mammography (13/15 (86.6%) and 203/237 (85.7%)(p=0.636)), and the number of breast conservaing surgeries (10/26 (38.5%) and 103/311 (33.1%)(p=0.361)). Axillary nodal metastasis was slightly more common in patients with ILC (15/25, 60%) than in those with IDC (141/284, 9.6%)(p=0.217) but there was no difference in TNM staging. More frequent estrogen receptor expression and less frequent P53 mutations were found in ILC than in IDC. Unlike IDC, there was no association between tumor microvessel density and pathologic stagings in ILC. CONCLUSION: ILC was found in patients of similar age, and the size was not different from that of IDC. The mammographic accuracy in diagnosing malignancy was about the same in ILCas in IDC. Breast conserving surgery can be performed in ILC patients at the same rate as in IDC patients. Microvessel density was not a prognostic factor in ILC patients.
Breast* ; Carcinoma, Ductal* ; Carcinoma, Lobular* ; Estrogens ; Humans ; Mammography ; Mastectomy, Segmental ; Microvessels ; Neoplasm Metastasis ; Neoplasm Staging ; Retrospective Studies

PURPOSE: To evaluate the CT findings and clinical significance of colonic edema in liver cirrhosis. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 221 cases of clinically diagnosed liver cirrhosis in 173 patients. In 30 of these [23 men and six women aged between 35 and 67 (mean, 54) years], colonic edema was present. We evaluated its distribution (ascending, transverse or descending colon), analysed serum albumin and bilirubin levels, and in both the colonic edema and non-colonic edema group, determined whether ascites was present. Thus, we sought correlation between the presence of colonic edema, the severity of liver cirrhosis, and each parameter. RESULTS: CT revealed colonic edema in 30 of 221 cases (14 %). Of the 30, 13 cases (43 %) were diffuse colonic edema and 17 (57 %) were regional edema. Among these 17 cases, 12 (71 %) were seen only in the ascending colon, while five (29 %) were seen in both the ascending and transverse colon. In the group with colonic edema, the mean level of serum albumin was 2.6 g/dl, and that of serum bilirubin was 4.9 mg/dl; 20 patients ( 67 %) had ascites. In the group without colonic edema, mean levels of serum albumin and serum bilirubin were 3.0 g/dl and 4.1 mg/dl, respectively ; 43 patients (30 %) had ascites. There was no significant statistical difference in serum albumin and bilirubin levels between the colonic edema and non-colonic edema group (p>0.05), though ascites was more common among the former group. CONCLUSION: In cases of liver cirrhosis, CT evidence of colonic edema is not uncommon. The ascending colon is most frequently involved, though disease severity does not vary significantly according to site. When CT reveals the presence of colonic edema, further diagnostic evaluation is not necessary if there is no evidence of clinical symptoms.
Ascites ; Bilirubin ; Colon* ; Colon, Ascending ; Colon, Transverse ; Edema* ; Female ; Humans ; Liver Cirrhosis* ; Liver* ; Male ; Retrospective Studies ; Serum Albumin ; Tomography, X-Ray Computed

PURPOSE: The relationship of the age at diagnosis and the prognosis in breast carcinoma remains controversial. However, it is a widely held belief that breast cancer in young women especially women in the twenties is a disease more lethal than that found in older patients. We attempted to determine whether young age could be a poor prognostic factor for breast cancer. METHODS: A retrospective study was conducted of all women age 30 or younger who had undergone a definite operation from September 1994 to December 1999 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the older group. RESULTS: There were 30 cases (75%) of infiltrating ductal carcinomas in the twenties, which was relatively less than that in the older group (84.8%)(p=0.001). Ductal carcinomas in situ and special types such as mucinous, secretory, and medullary carcinomas and phyllodes tumors were noted more and infiltrating lobular carcinomas less in the younger group than in the older group. Patients in the twenties had smaller tumors (p=0.001) and fewer axillary lymph node metastases (p=0.018) than those in the older group. There were no significant differences between the groups of age 30 or younger and older in terms of the extensive intraductal component (EIC), histologic and nuclear grades, hormonal receptors, p53 mutation rates, and TNM staging (p>0.05). The Nottingham Prognostic Index used to assess the prognosis in breast cancer patients failed to prove the young age as a poor prognostic factor (p=0.133). CONCLUSION: Breast cancer in our study population of women in the twenties did not have a poor prognostic factor. We conclude that age itself is not a poor prognostic factor in patients with breast cancer.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular ; Carcinoma, Medullary ; Diagnosis ; Female ; Humans ; Lymph Nodes ; Mucins ; Mutation Rate ; Neoplasm Metastasis ; Neoplasm Staging ; Phyllodes Tumor ; Prognosis* ; Retrospective Studies