PURPOSE: It is well established that the presence of axillary nodal metastases is the most important prognostic factor in primary operable breast cancer. However, it has also been shown that 15-30% of patients without lymph node metastases as assessed by light microscopy have recurrence within 10 years. In this study, our aim was first to investigate the diagnostic value of immunohistochemical staining in detecting micrometastases and secondly to correlate their presence with prognosis (recurrence and survival) MATERIALS AND METHODS: We retrospectively analyzed 492 axillary nodes from 49 consecutive node-negative invasive breast cancers treated at Kyung-Hee University Hospital from 1991 to 1995 with average follow-up of 60.2 (21-100) months. An additional section of original paraffin blocks was cut and stained by immunohistochemical chemical technique using monoclonal antibodies (AE 1/3 and No.7) to cytokeratin. RESULTS: Micrometastases with individual cell and cell clusters were readily detected by this technique in 27% of the cases. These were no predictors of micrometastses among the clinicopathological data of patient. The presence of micometastases wes not associated with disease-free and overall survival but loco-regional recurrence rate. CONCLUSIONS: A combination of immunohistochemistry and serial sectioning of axillary lymph node would help evaluate the significance of occult axillary metastases. Patients with node-negative disease may relapse after many years and prolonged follow-up is required to establish the role of mirometastases. Such an approach, together with a search for bone marrow micrometastases and epidemiologic, clinical, pathologic and/or biochemical prognostic factors, may serve to identify high risk patients in the presumed node-negative group. It would provide a rational basis for the selective use of adjuvant therapy.
Antibodies, Monoclonal ; Bone Marrow ; Breast Neoplasms* ; Breast* ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Lymph Nodes ; Microscopy ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Paraffin ; Prognosis ; Recurrence ; Retrospective Studies*

Neurocutaneous melanosis is a very rare congenital syndrome characterized by the presence of large or multiple congenital melanocytic nevi and benign or malignant melanotic tumors of the central nervous system. We report herein a case of neurocutaneous melanosis with leptomeningeal melanosis and a malignant melanoma of the right temporal lobe in a 46-year old man. The case is exceptional as regards the late onset of symptoms and death. Even without a malignant melanoma, the symptomatic neurocutaneous melanosis has a fatal course. The syndrome is rare but lethal, so the dermatologist should be aware of this syndrome when evaluating the patients with large or numerous congenital melanocytic nevi so as to watch for the usual signs of increased intracranial pressure and to take prompt palliative measures.
Central Nervous System ; Humans ; Intracranial Pressure ; Melanoma ; Melanosis* ; Nevus, Pigmented ; Temporal Lobe

Background/Aims: Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events, including endocrine dysfunctions, which can have serious consequences on patient health and quality of life. The clinical course and characteristics of immune-related hypophysitis (irH) are not well established. This study aimed to analyze the clinical course and characteristics of irH. Methods: This single-center, retrospective study analyzed data from electronic medical records of Asan Medical Center, spanning January 2017 through June 2021. It included adult patients with solid tumors who underwent thyroid and adrenal function tests, along with gonadotropin and/or growth hormone evaluations, following the initiation of ICI treatment within the same period. The study explored the clinical characteristics of ICI-treated patients with and without irH, the incidence of irH, the time to irH onset, and the associated hormonal changes. Results: Twenty-one patients were included in this analysis. Clinical characteristics did not differ significantly between the irH (n = 13) and non-irH (n = 8) groups. Deficiency rates in the irH group were 23.1% for thyroid-stimulating hormone (n = 3), 76.9% for adrenocorticotropic hormone (n = 10), 61.5% for gonadotropin (n = 8), and 15.4% for growth hormone (n = 2). The overall incidence was 0.9 per person-year, with 6-month and 1-year cumulative incidences of 38.8% and 57.1%, respectively. The median time from ICI initiation to irH diagnosis was 7.7 months. Time to levothyroxine replacement was shorter in the irH group. Conclusions The findings provide evidence that could facilitate the prediction of ICI-induced irH based on clinical course and characteristics.

Background/Aims: Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events, including endocrine dysfunctions, which can have serious consequences on patient health and quality of life. The clinical course and characteristics of immune-related hypophysitis (irH) are not well established. This study aimed to analyze the clinical course and characteristics of irH. Methods: This single-center, retrospective study analyzed data from electronic medical records of Asan Medical Center, spanning January 2017 through June 2021. It included adult patients with solid tumors who underwent thyroid and adrenal function tests, along with gonadotropin and/or growth hormone evaluations, following the initiation of ICI treatment within the same period. The study explored the clinical characteristics of ICI-treated patients with and without irH, the incidence of irH, the time to irH onset, and the associated hormonal changes. Results: Twenty-one patients were included in this analysis. Clinical characteristics did not differ significantly between the irH (n = 13) and non-irH (n = 8) groups. Deficiency rates in the irH group were 23.1% for thyroid-stimulating hormone (n = 3), 76.9% for adrenocorticotropic hormone (n = 10), 61.5% for gonadotropin (n = 8), and 15.4% for growth hormone (n = 2). The overall incidence was 0.9 per person-year, with 6-month and 1-year cumulative incidences of 38.8% and 57.1%, respectively. The median time from ICI initiation to irH diagnosis was 7.7 months. Time to levothyroxine replacement was shorter in the irH group. Conclusions The findings provide evidence that could facilitate the prediction of ICI-induced irH based on clinical course and characteristics.

Background/Aims: Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events, including endocrine dysfunctions, which can have serious consequences on patient health and quality of life. The clinical course and characteristics of immune-related hypophysitis (irH) are not well established. This study aimed to analyze the clinical course and characteristics of irH. Methods: This single-center, retrospective study analyzed data from electronic medical records of Asan Medical Center, spanning January 2017 through June 2021. It included adult patients with solid tumors who underwent thyroid and adrenal function tests, along with gonadotropin and/or growth hormone evaluations, following the initiation of ICI treatment within the same period. The study explored the clinical characteristics of ICI-treated patients with and without irH, the incidence of irH, the time to irH onset, and the associated hormonal changes. Results: Twenty-one patients were included in this analysis. Clinical characteristics did not differ significantly between the irH (n = 13) and non-irH (n = 8) groups. Deficiency rates in the irH group were 23.1% for thyroid-stimulating hormone (n = 3), 76.9% for adrenocorticotropic hormone (n = 10), 61.5% for gonadotropin (n = 8), and 15.4% for growth hormone (n = 2). The overall incidence was 0.9 per person-year, with 6-month and 1-year cumulative incidences of 38.8% and 57.1%, respectively. The median time from ICI initiation to irH diagnosis was 7.7 months. Time to levothyroxine replacement was shorter in the irH group. Conclusions The findings provide evidence that could facilitate the prediction of ICI-induced irH based on clinical course and characteristics.

Background/Aims: Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events, including endocrine dysfunctions, which can have serious consequences on patient health and quality of life. The clinical course and characteristics of immune-related hypophysitis (irH) are not well established. This study aimed to analyze the clinical course and characteristics of irH. Methods: This single-center, retrospective study analyzed data from electronic medical records of Asan Medical Center, spanning January 2017 through June 2021. It included adult patients with solid tumors who underwent thyroid and adrenal function tests, along with gonadotropin and/or growth hormone evaluations, following the initiation of ICI treatment within the same period. The study explored the clinical characteristics of ICI-treated patients with and without irH, the incidence of irH, the time to irH onset, and the associated hormonal changes. Results: Twenty-one patients were included in this analysis. Clinical characteristics did not differ significantly between the irH (n = 13) and non-irH (n = 8) groups. Deficiency rates in the irH group were 23.1% for thyroid-stimulating hormone (n = 3), 76.9% for adrenocorticotropic hormone (n = 10), 61.5% for gonadotropin (n = 8), and 15.4% for growth hormone (n = 2). The overall incidence was 0.9 per person-year, with 6-month and 1-year cumulative incidences of 38.8% and 57.1%, respectively. The median time from ICI initiation to irH diagnosis was 7.7 months. Time to levothyroxine replacement was shorter in the irH group. Conclusions The findings provide evidence that could facilitate the prediction of ICI-induced irH based on clinical course and characteristics.

Percutaneous transluminal coronary angioplasty(PTCA) has been widely applied in patients with coronary artery disease since 1977. Although coronary angioplasty has beeb shown to be safe and effective treatment strategy, acute closure & restenosis remain as major limitations of PTCA. Acute occlusion due to intracoronary thrombus accumulation during or immediately after coronary angioplasty is serious complication of PTCA, also, Intracoronary urokinase has been used to treat acute occlusion by intracoronary thrombus that complicated in PTCA and proved to be effective in restoring vessel preventing acute myocardial infarction. We report a case in which embolism of left anterior descending artery was complicated during angioplasty of left circumflex artery and managed with intracoronary infusion of urokinas.
Angioplasty* ; Arteries* ; Coronary Artery Disease ; Embolism ; Humans ; Myocardial Infarction ; Thrombocytosis ; Thromboembolism* ; Thrombosis ; Urokinase-Type Plasminogen Activator

OBJECTIVE: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by increased production of cytokines, proliferation of fibroblast-like synoviocytes (FLS) and joint destruction. It is well known that the involved joints in RA are hypoxic. Hypoxia may play a role in the pathogenesis of RA. We thought that hypoxia might alter the production of cytokines by FLS and these changes could affect the biologic behaviors of FLS. Based on that, we investigated whether hypoxia affects the production of cytokines in FLS and the effect of these changes on matrix metalloproteinases (MMPs) expression. METHODS: Fibroblast-like synoviocytes from human rheumatoid synovial tissue obtained duringjoint replacement surgery were cultured in vitro. Hypoxic culture was performed by incubating cells in BBL? Gaspak pouchTM anaerobic system. After incubation under hypoxic condition for 24 hr, the concentrations of various cytokines in culture supernatants were determined by ELISA. To determine the effect of highly expressed cytokines on MMP expression, we performed ELISA of MMP-1, MMP-2 and MMP-3 in cultured FLS, after stimulation with respective cytokines. RESULTS: In hypoxic state, IL-6, IL-8 and vascular endothelial growth factor (VEGF) concentrations were significantly increased compared to those in normoxic condition. However, there were little differences in IL-1, IL-2, IL-4, TNF-alpha and TGF-beta. Stimulation of FLS with IL-6 and IL-8 showed the increased concentrations of MMP-1, MMP-2 and MMP-3. CONCLUSION: Hypoxic environment of rheumatoid synovium might affect FLS to produce proinflammatory and proangiogenic cytokine such as IL-6 and IL-8. These cytokines again could stimulate MMPs production in FLS leading to joint destruction.
Anoxia* ; Arthritis, Rheumatoid ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interleukin-1 ; Interleukin-2 ; Interleukin-4 ; Interleukin-6 ; Interleukin-8 ; Joints ; Matrix Metalloproteinases ; Synovial Membrane ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha ; Vascular Endothelial Growth Factor A

BACKGROUND: Management of primary aldosteronism has undergone dramatic changes in the past 40 years. This retrospective study was carried out to review our surgical experience and postoperative outcome and to identify the clinical charateristics of primary aldosteronism. METHODS: Twenty-five patients who underwent an adrenalectomy for primary aldosteronism from 1983 to 1997 were included in the study. All patients were operated on at the Department of Surgery, School of Medicine, Kyung-Hee University. We reviewed the records of 18 women and 7 men, ranging in age from 22 to 59 years. Data examined included clinical presentation, biochemical results, hormonal evaluation, localization studies, operative results, pathologic details, and postoperative outcome. The diagnosis of primary aldosteronism was based on a demonstration of hypertension, hypokalemia, elevated plasma aldosterone concentration, and suppressed plasma renin activity. Localization studies, including computed tomography (CT) and ultrasonography (US) were performed in all patients. A follow-up study was conducted by either reviewing clinical records, telephone contact, or examination of patients during return visits. RESULTS: Hypertension and hypokalemia were present in all patients. Serum potassium ranged from 1.4 to 3.2 mEq/L (2.3+/-0.5; mean+/-standard deviation {SD}mEq/L), and hypokalemia was considered an important diagnostic clue. We found the accuracy rate for CT results in our patients to be 96.0% (24 patients). An adrenal venous sampling was performed in one patient whose CT results were not confirmatory. A unilateral adrenalectomy was performed through posterior (22 patients), an anterior transabdominal (1 patient), or a lateral transabdominal laparoscopic (2 patients) approach. A laparoscopic adrenalectomy will minimize postoperative pain and hospital stay. The histological findings were 23 aldosterone-producing adenomas and 1 nodular hyperplasia. During a mean follow-up of 31.6 months, 22 (91.7%) of the 24 patients required no further antihypertensive treatment. CONCLUSION: Primary aldosteronism due to an aldosterone-producing adenoma can be diagnosed and localized expeditiously, and surgical treatment can be performed safely.
Adenoma ; Adrenalectomy ; Aldosterone ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Hyperaldosteronism* ; Hyperplasia ; Hypertension ; Hypokalemia ; Length of Stay ; Male ; Pain, Postoperative ; Plasma ; Potassium ; Renin ; Retrospective Studies ; Telephone ; Ultrasonography

OBJECTIVES: To analyse the characteristics of occupational COPD (Chronic obstructive pulmonary disease) cases that were evaluated by the Occupational Safety and Health Research Institute (OSHRI) of the Korea Occupational Safety & Health Agency (KOSHA). METHODS: Using the OSHRI database from KOSHA, we collected 13 cases of occupational COPD that had been evaluated from 1998 to 2007. RESULTS: Four cases had been evaluated as occupational COPD: 1) a nonsmoking road sweeper exposed to automobile exhaust gases and trash dust; 2) an oxygen welding worker exposed to cadmium fumes; 3) a cotton mill air conditioner cleaning worker exposed to cotton dust; and 4) a foundry grinding worker exposed to dust, gases, vapors and fumes. Nine cases had been evaluated as non-occupational COPD: 1) 4 cases in which smoking was determined to be the main cause rather than occupational exposure; 2) 1 case that was evaluated as another respiratory disease (severe tuberculosis sequelae); 3) 1 case that had been misdiagnosed as COPD; 4) 2 cases in which the exposure levels in the workplace environments were too low; and 5) 1 case that had developed before the employment. Among these 13 cases, a shipyard grinding worker had been evaluated in 2006 as having had a low occupational hazard, but a similar case (a foundry grinding worker) was evaluated as having had a high hazard in 2007. CONCLUSIONS: Proper evaluation of occupational COPD demands an accurate diagnosis of COPD itself and also the exclusion of other respiratory diseases that have similar symptoms; an investigation of the relevant occupatioonal hazards and the amount of the exposure; and a consideration of smoking history. The evaluation should also take into account any substantial loss of life due to occupational hazards as well as any disease-free periods.
Academies and Institutes ; Cadmium ; Dust ; Employment ; Gases ; Korea ; Occupational Exposure ; Occupational Health ; Oxygen ; Pulmonary Disease, Chronic Obstructive ; Smoke ; Smoking ; Tuberculosis ; Vehicle Emissions ; Welding ; Workers' Compensation