PURPOSE: Current evidence indicates that ultrasonography of the breast is an important adjunct to mammography and clinical examination in the diagnosis of palpable breast abnormalities. An assessment of the value of office-based ultrasonography of a palpable breast mass performed by a breast surgeon was the aim of this work. METHODS: A 7.5 MHz linear probe was used to perform office-based ultrasonography in 109 consecutive female patients having a palpable solid breast mass between August 1998 and December 1999. Breast masses diagnosed histologically as fibroadenomas or breast cancer were included in this study. The clinical impression from the physical examination (PE), the result of officed-based ultrasonography done by a surgeon (OUSG), and comprehensive judgement engaging both PE and OUSG (PEUSG) were recorded in each patient's hospital record as benign or malignant at the first visit. The diagnostic values of PE, OUSG, PEUSG, mammography (MMG), and ultrasonography done by a radiologist (USG) were compared. RESULTS: Of 109 masses, a fibroadenoma was diagnosed in 73 patients while a carcinoma was established in 36 patients. The sensitivity, the specificity, the accuracy rate, and the kappa coefficient were 91.7%, 89.0%, 89.9%, and 0.780 for PE; 100%, 90.4%, 93.6%, and 0.862 for OUSG; 97.2%, 97.3%, 97.2%, and 0.938 for PEUSG; 90.4%, 89.4%, 90%, and 0.630 for MMG; and 88.9%, 90.9%, 90% and 0.798 for USG. The diagnostic accuracy of PEUSG was significantly higher than those of PE and MG (p<0.05). CONCLUSION: These data suggest that office-based ultrasonography of the breast performed by a surgeon is a useful adjunct to clinical evaluation of the breast mass and permits timely and cost-effective patient care.
Breast Neoplasms ; Breast* ; Diagnosis* ; Female ; Fibroadenoma ; Hospital Records ; Humans ; Mammography ; Patient Care ; Physical Examination ; Prospective Studies* ; Sensitivity and Specificity ; Ultrasonography*

To evaluate the potential contribution of high resolution ultrasonography(US) and 99mTc scintigraphy in the routine diagnosis of thyroid nodules, we performed thyroid function tests, US, thyroid scintigraphy, and fine-needle aspiration cytology (FNAC) in all 54 patients who initially visit our surgical department for thyroid masses from March 1995 to February 1996. The final diagnoses were made by either repeated FNAC (n=39) or thyroid operations (n=15). Final diagnoses were adenomatous goiters (n=41), simple cysts (n=3), follicular adenoma (n=1), papillary carcinomas (n=8), follicular carcinoma(n=1). The diagnostic impacts of US and 99mTc scintigraphy in all 54 patients were assessed and scored according to the following criteria: when the information provided by either test supported or confirmed (and/or gave some other information for management of thyroid nodules) the final diagnosis, it received a scores of 2 or 3 respectively, while a score 1 was given when the test itself was useless for the differential diagnosis. The scores of US were higher than those of scintigraphy in the diagnoses of adenomatous goiters, cysts, adenomas and carcinomas. However, after statistical analysis with Wilcoxon's signed rank test, US was statistically superior to scintigraphy only in diagnosing adenomatous goiters. These results indicate that current findings in US for differential diagnosis of thyroid nodules are not absolutely superior to those in scintigraphy, but have some benefits in detection of occult nodules in malignancy and differential diagnosis of adenomatous goiters.
Adenoma ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Diagnosis, Differential ; Goiter ; Humans ; Radionuclide Imaging* ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Nodule*

In the light of experimental results, two case-control studies and one cohort study in a population of ginseng cultivation area were conducted to confirm whether ginseng has any anticarcinogenic effect on human cancers. All participants were interviewed using a standardised questionnaire to obtain the information on demographics, cigarette smoking, alcohol consumption and ginseng intake. In 905 pairs case-control study, 62% had a history of ginseng intake compared to 75% of the controls, a statistically significant difference (p<0.01). The odds ratio (OR) for cancer in relation to ginseng intake was 0.56. In extended case-control study with 1987 pairs, the ORs for cancer were 0.37 in fresh ginseng extract users, 0.57 in white ginseng extract users, 0.30 in white ginseng extract users, 0.30 in white ginseng powder users, and 0.20 in red ginseng users. Those who took fresh ginseng slices, fresh ginseng juice, and white ginseng tea, however, did not show decrease in the risk. Overall, the risk decreased as the frequency and duration of ginseng intake increased. With respect to the site of cancer, the ORs for cancers of the lip, oral cavity, pharynx, esophagus, stomach, colorectum, liver, pancreas, larynx, lung and ovary were significantly reduced by ginseng intake. Smokers with ginseng intake showed lower ORs for cancers of lung, lip, oral cavity and pharynx and liver than those without ginseng intake. In 5 yr follow- up cohort study conducted in the ginseng cultivation area, Kangwha-eup, ginseng intakers had significantly lower risk than non-intakers. As for the type of ginseng, cancer risk significantly decreased among intakers of fresh ginseng extract, alone or together with other ginseng preparations. Among 24 red ginseng intakers, no cancer death occurred during the follow-up period. The risk for stomach and lung cancers was significantly reduced by ginseng intake, showing a statistically significant dose-response relationship in each follow-up year. In conclusion, Panax ginseng C.A. Meyer has been established as non-organ specific cancer preventive, having dose response relationship. These results warrant that ginseng extracts and its synthetic derivatives should be examined for their preventive effect on various types of human cancers.
Antineoplastic Agents, Phytogenic/*therapeutic use ; Case-Control Studies ; Cohort Studies ; Human ; Korea/epidemiology ; Neoplasms/epidemiology/*prevention & control ; *Panax ; Plant Roots ; Population Surveillance

PURPOSE: Several reports have suggested that the expressing of COX-2 is related to carcinogenesis and the prognosis of cancer. The aim of this study was to discover the relationship between the prognostic factors of a differentiated thyroid carcinoma (DTC) and the rate of COX-2 expression. METHODS: We performed immunohistochemical staining on well conditioned thyroid cancer paraffin specimens obtained from the patients that had undergone a thyroidectomy at the Department of Surgery, Chungbuk National University Hospital during 1994. The specimens were composed of papillary carcinomas (n=23), follicular carcinomas (n=9) and follicular adenomas (n=4). We analyzed the expressions of COX-2 in relation to age, distant metastasis, invasion to extrathyroidal tissue, mass size and risk group. A statistical analysis was performed using the Chi-square, Fishers Exact, and Mantel- Haenszel Chi-Square tests on the PC SAS system. RESULTS: COX-2 was expressed in 82% of the papillary carcinomas (19/23), 33% of the follicular carcinomas (3/9) and none of the follicular adenomas (0/4). There were no significant differences between the expression of COX-2 in all the items compared (P-value>0.05): i.e. age, distant metastasis, invasion to extrathyroidal tissues, mass size or risk group. CONCLUSION: COX-2 was expressed in 82, and 33% of the papillary and follicular carcinomas, respectively. The papillary carcinomas had a higher rate of expression than the follicular carcinomas, but this was not significantly correlated with the clinical and prognostic parameters. These results suggested that COX-2 might not be a prognostic factor in DTC.
Adenoma ; Carcinogenesis ; Carcinoma, Papillary ; Chungcheongbuk-do ; Cyclooxygenase 2* ; Humans ; Neoplasm Metastasis ; Paraffin ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Gastric emptying after a gastric resection has been studied in early gastric cancer. Most reports are retrospective and show that gastric emptying after gastroduodenal reconstruction is faster than normal. This study was designed to evaluate the gastric-emptying pattern after a gastroduodenal reconstruction with preservation of the truncal vagus nerve had been performed on a patient whose preoperative gastric-emptying time had been normal. METHODS: From July 1996 to February 1998, we performed a distal gastrectomy with gastroduodenal reconstruction with preservation of the truncal vagus nerve in 11 patients (9 patients with early gastric cancer, 1 patient with advanced gastric cancer, and 1 patient with high-grade dysplasia) whose preoperative gastric-emptying times was normal. To evaluate the gastric emptying after the gastrectomy and gastroduodenal reconstruction, we analyzed the lag time (when 10% of food is delivered to the duodenum), T1/2 (when 50% of food is delivered to the duodenum), and the residual food in the stomach after 100 minutes (%) by means of radionuclide scintigraphy using a single-head gamma camera after ingestion of an 99mTc-tin-colloid steamed egg. We defined the delayed gastric emptying as T1/2 longer than the mean of the preoperative value by 2 standard deviation. RESULTS: Among the 11 patients with gastroduodenal reconstruction, gastric emptying was normal in 4 patients and delayed in 7 patients; only one of the delayed cases has GI symptoms such as early satiety. There were no rapid gastric emptying cases. CONCLUSION: Rapid gastric emptying after gastroduodenal recon struction with preservation of the truncal vagus nerve was rare.
Eating ; Gamma Cameras ; Gastrectomy ; Gastric Emptying ; Humans ; Ovum ; Radionuclide Imaging ; Retrospective Studies ; Steam ; Stomach ; Stomach Neoplasms ; Vagus Nerve*

A Radical gastrectomy can affect the dumping syndrome, reflux gastritis, injury of the autonomic nervous system and the small capacity syndrome and can cause some problems in the quality of life for post-gastrectomy patients. To minimize these complications in the treatment of early gastric cancer (EGC), various gastric-reduced operations have been discussed by gastric surgeons. A pylorus preserving gastrectomy (PPG) is a kind of reduced-gastric operation which preserves the distal portion (1.5 cm) of the gastric antrum and reduces postoperative complications such as the dumping syndrome and reflux esophagitis. However, a limitation of this operation is that complete lymph node dissection of the suprapyloric lymph node is undesirable for preservation of the pyloric branch of the vagus nerve. Nowadays, some reports state that this operation may be applicable in EGC confined to the mucosa and located at the gastric mid-body. (Purpose) This study was designed to evaluate the gastric function after PPG by using solid foods to obtain the gastric emptying time. (Materials and Method) From June 1995 to December 1995, we performed PPGs on 7 patients (4 patients with mucosal cancer, 2 patients with gastric ulcer and 1 patient with a leiomyoma) and Billroth I reconstruction in 7 patients (5 patients with mucosal cancer, 1 patient with advanced gastric cancer and 1 patient with gastric ulcer). To compare the gastric function between these two subgroups, we analyzed the lag time, T1/2 and the residual food after 100 min using 99mTc-tin-colloid-steamed eggs to obtain the gastric emptying time for the PPG group (n=7), the Billroth I reconstruction group (n=7), and the normal control group (n=7). A statistical analysis was done by using the Kruskal-Wallis test (Chi-square approximation). (Results) There were no differences in the amount of transfusion, the hospital stay, the operation time, and the body weight loss after operation between the PPG group and the Billroth I reconstruction group. The severe dumping syndrome and reflux esophagitis were found in one of the patients after Billroth I reconstruction, but were not found in PPG group. Statistically, there was no difference in T1/2 between the Billroth I reconstruction group and the PPG group; however, both lag times were longer than that of the normal control group. We also found that the residual food 100 min after oral intake was greater in both the Billroth I reconstruction and the PPG groups than in the normal control group. (Conclusion) Though both PPG and Billroth I reconstruction showed delayed gastric emptying, we found that PPG is superior to Billroth I reconstruction in lag time and in the amount of residual food after 100 min. We conclude that PPG is superior to Billroth I reconstruction in gastric motility, and if this operation is applied in indicated gastric cancer patients, post-operative complications, such as the dumping syndrome and reflux esophagitis can be reduced and the quality of life in post-gastrectomy patients can be increased.
Autonomic Nervous System ; Body Weight ; Dumping Syndrome ; Eggs ; Esophagitis, Peptic ; Gastrectomy ; Gastric Emptying ; Gastritis ; Gastroenterostomy ; Humans ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Mucous Membrane ; Ovum ; Postgastrectomy Syndromes* ; Postoperative Complications ; Pyloric Antrum ; Pylorus ; Quality of Life ; Stomach Neoplasms ; Stomach Ulcer ; Vagus Nerve

The failure to improve the five-year survival rate of cancer patients, from one in three in the 1960s to one in two in the 1970s, stimulated awareness of the importance of primary prevention of cancer. Korean investigators carried out extensive long-term anticarcinogenicity experiments with 2000 newborn mice to investigate whether Panax ginseng C.A. Meyer inhibited carcinogenesis induced by several chemical carcinogens in 1978. There was a 22% decrease (p<0.05) in the incidence of urethane induced lung adenoma by the combined use of red ginseng extract. In the group sacrificed at 56 weeks after the treatment with aflatoxin B1, the incidence of hepatoma significantly decreased to 75% by the addition of red ginseng extract (p<0.05). The result showed that natural products can provide hope for human cancer prevention. By the newly established '9 week medium-term anticarcinogenicity test model of lung tumors in mice' (Yun's model), we confirmed significant anticarcinogenic effects of powders and extracts of the 6- yr-old dried fresh ginseng, 5- and 6-yr old white ginsengs, and 4-, 5-, and 6-yr old red ginseng. We also demonstrated that the anticarcinogencity of ginseng was more prominent in aged or heat treated extracts of ginseng and red ginseng made by steaming. To investigate the active components for cancer prevention, several fractions of 6-yr old fresh ginseng and red ginseng, four semi-synthetic ginsenoside Rh1, Rh2, Rg3 and Rg5, major saponin components in red ginseng, were prepared. Among the ginsenosides, Rg3 and Rg5 showed statistically significant reduction of lung tumor incidence and Rh2 had a tendency of decreasing the incidence. Ginsenoside Rg3, Rg5 and Rh2 were found to be active anticarcinogenic compounds. Rg3, Rg5 and Rh2 are active components in red ginseng, and they prevent cancer either singularly or synergistically.
Animal ; *Anticarcinogenic Agents ; Disease Models, Animal ; Fractionation ; Human ; Korea ; Mice ; Molecular Structure ; *Panax/chemistry/growth & development ; Plant Extracts/analysis ; Time Factors

PURPOSE: Cyclooxygenase (COX) enzymes catalyze the ratelimiting step in arachidonate metabolism. COX-1 is expressed constitutively in many cell types. However COX-2 is an inducible enzyme responsible for prostaglandin production at site of inflammation. Recently, there has been increasing evidence that COX-2 involves in development and progression of human tumors. The aim of the present investigation is to evaluate the antiproliferative effect of NS-398, a selective COX-2 inhibitor, and its mechanism in a papillary thyroid cancer cell line, TPC-1. METHODS: We used TPC-1 cell line, NS-398 and EGF. COX-2 expression was detected by RT-PCR and western blot. We used MTT assay to evaluate antiproliferative effect of NS- 398. The mechanisms of growth inhibition were evaluated by apoptosis assay and cell cycle analysis using flow cytometry. RESULTS: COX-2 expression was identified by both RT-PCR and western blot in TPC-1 cells and it was upregulated by serum, EGF (10 ng/ml), and NS-398 (50 mM). NS-398 induced a dose-dependent inhibition of cell proliferation but did not increases apoptotic cell population significantly in the TPC-1 cell line. EGF treatment (10 ng/ml) for 72 hours did not seem to change the antiproliferative effect of NS-398. The proportion of G0/G1 cell cycle was increased by 10% compared with control after 36 hours of treatment with NS-398. CONCLUSION: TPC-1 cells expressed COX-2 constitutively and its expression was upregulated by serum, EGF, and NS-398. The selective COX-2 inhibitor, NS-398 inhibited cell proliferation in TPC-1 cell line rather by cell cycle arrest at G₀/G₁ phase than by inducing apoptosis.
Apoptosis ; Blotting, Western ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Line* ; Cell Proliferation ; Cyclooxygenase 2 ; Epidermal Growth Factor ; Flow Cytometry ; Humans ; Inflammation ; Metabolism ; Prostaglandin-Endoperoxide Synthases ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: This study was performed to investigate the effects of environmental factors, genetic polymor phisms of cytochrome P450 2E1 (CYP2E1) and N-acetyltransferase 2 (NAT2), and their interactions on mutations of p53 and Ki-ras genes in Korean stomach cancer. METHODS: One hundred nine stomach cancer patients and 211 age- and sex-matched controls were enrolled in this study. Direct interview with a structured questionnaire was performed to get informations on the level of exposure to environmental factors. For genotyping of the metabolic enzymes, PCR-RFLP methods were used. RT-PCR and direct sequencing were carried out to detect mutations in the p53 and the Ki-ras genes of stomach cancer tissue. To evaluate the risk of stomach cancer, we calculated odds ratios for environmental and genetic factors, and their combinations. RESULTS: Past medical histories of gastritis, diabetes and asthma allergic rhinitis were significant risk factors for stomach cancer. Fried potatoes, squid and octopus, welsh onions and chestnuts and gingkonuts had protective effects against stomach cancer. On the contrary, chicken, soybean paste stew, and soybean milk were significantly related to an increased stomach cancer risk. The NAT2 rapid acetylator turned out to be a marginally significant risk factor for gastric cancer. Mutations of the p53 and the Ki-ras genes were detected in 27.5% and 10.7% of stomach cancer tissues, respectively. Frizzled rice, potato, beef, lard, pickled fish, chicken stew, anchovies, tempura, Welsh onions, eggs, bean-curd, Qing-style soybean paste stew, and ice cream were protective against p53 mutation whereas yogurt was a risk factor for p53 mutation in stomach cancer tissue. Ki-ras mutation was associated with less intake of pears and persimmons, melons, strawberries, grapes and milk and with more intake ofsoybean paste stew. In a multiple logistic analysis including genetic polymorphism, past medical history and diet intake, past history of gastritis, chicken, soybean paste stew, and soybean milk were significant risk factors for stomach cancer whereas past history of diabetes, squid and octopus, and Welsh onions were protective factors against stomach cancer. CONCLUSION: These results suggest that past medical history and diet are more important risk factors for stomach cancer than genetic polymorphism and that mutations of the p53 and the Ki-ras genes would be induced by the respective risk factors.
Asthma ; Carcinogenesis* ; Carcinogens, Environmental* ; Chickens ; Cucurbitaceae ; Cytochrome P-450 CYP2E1* ; Decapodiformes ; Diet ; Diospyros ; Eggs ; Fragaria ; Gastritis ; Genes, ras ; Humans ; Ice Cream ; Milk ; Octopodiformes ; Odds Ratio ; Onions ; Ovum ; Polymorphism, Genetic* ; Pyrus ; Surveys and Questionnaires ; Rhinitis ; Risk Factors ; Solanum tuberosum ; Soybeans ; Stomach Neoplasms ; Vitis ; Yogurt

Since 1970's, Tamoxifen has been used as an antiestrogen agent for adjuvant hormonal therapy, targeting hormone receptor positive breast cancer. Tamoxifen has adverse side effects such as menopausal hot flush, vaginal discharge, irregular menses, thromboembolism, and uterine endometrial carcinoma. Tamoxifen has structure and side effects similar to amphiphilic cationic agents like chlorpromazine, thorazine, amiodarone, and chloroquine. With long period use in high dose, tamoxifen can cause ocular side effects such as retinal crystalline deposition, macular edema, whorl-like corneal opacities, posterior subcapsular lens opacities, optic neuritis, and affected EOG. Recently several reports showed that ocular side effect could happen even in low dose standard treatment. We experienced a case of keratopathy of corneal opacity without disorder of retina, lens, and optic nerve in low dose tamoxifen therapy for breast cancer.
Amiodarone ; Breast Neoplasms* ; Breast* ; Cataract ; Chloroquine ; Chlorpromazine ; Corneal Opacity* ; Crystallins ; Electrooculography ; Endometrial Neoplasms ; Estrogen Receptor Modulators ; Female ; Humans ; Macular Edema ; Optic Nerve ; Optic Neuritis ; Retina ; Retinaldehyde ; Tamoxifen* ; Thromboembolism ; Vaginal Discharge