PURPOSE: To investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients. MATERIALS AND METHODS: This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. We performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method. RESULTS: Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline (p<0.05 for both). Duration from onset to surgery and duration of myofascial pain syndrome in the good responder group were significantly shorter than in the bad responder group (p<0.05). Patients did not report any complications related to the procedure or serious adverse events attributable to the treatment. CONCLUSION: In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.
Adult ; Aged ; Anesthetics, Local/administration & dosage/therapeutic use ; Female ; Humans ; Injections, Intramuscular/methods ; Lidocaine/administration & dosage/therapeutic use ; Mastectomy ; Middle Aged ; Muscle, Skeletal/drug effects/ultrasonography ; Myofascial Pain Syndromes/drug therapy ; Pectoralis Muscles/drug effects/*ultrasonography ; Trigger Points/*ultrasonography

As breast-conserving surgery (BCS) has become the most common type of breast surgery, oncoplastic BCS has developed in response to improve cosmetic outcomes. Acellular dermal matrix (ADM) has been used as an adjunct to enhance cosmetic outcomes in partial breast reconstruction. This study aimed to evaluate postoperative complications, cosmetic satisfaction, and oncologic safety over a short-term follow-up period. Methods: This retrospective study included 26 patients who underwent BCS at Myongji Hospital between April 2019 and April 2021. All procedures were performed by three surgeons. We reviewed demographic data, histologic grades, tumor-node-metastasis stages, treatment modalities, and survival data based on patient medical records. Results: Of the 26 total patients, 5 developed seromas, which was the most common complication, and one patient experienced red breast syndrome. The incidence of complications per surgeon was less than 25%. The mean satisfaction score for the cosmetic outcome on a 10-point scale was 7.6 ( ± 2.1) as scored by patients and 8.8 ( ± 0.9) as scored by surgeons. Responses regarding cosmetic satisfaction revealed no significant differences among surgeons (p= 0.444). Of the 26 patients, four were lost to follow-up, and the mean follow-up period was 35.2 months. Two patients experienced recurrence, both of whom had regional recurrence with no local recurrence. Conclusion: ADM replacement is a favorable alternative to oncoplastic BCS, in terms of the ease of surgical procedures, minimal complications, and low rates of local recurrence.

PURPOSE: Polypoid lesions of the gallbladder have a range of causes. A problem exists in the selection of patients for surgery. This study examined the usefulness of laparoscopic cholecystectomy, suspected risk factors and plan of patients with gallbladder polyps. METHODS: This study examined 57 patients who underwent laparoscopy cholecystectomy with gallbladder polyps. All patients had been diagnosed preoperatively by ultrasound and abdominal computed tomography between October 2001 and October 2010. Preoperative radiologic diagnosis, age, gender, symptoms, size of polyps, number, concurrent gallstones and histological diagnosis of the polyps as well as the postoperative complications were reviewed retrospectively. The operation indications were polyps >10 mm, age above 55 years, symptomatic polyps, coincidence of a stone, focal thickening of gallbladder wall and detection during other operations. RESULTS: The number of each type of polyp lesion of the gallbladder was as follows: 26 cases (45.6%) had cholesterol polyps, 2 cases (3.6%) inflammatory polyps, 1 case (1.7%) mucosal lymphoid follicles, 12 cases (21.1%) adenomatous polyps, 1 case (1.7%) adenocarcinoma. Non-neoplastic and neoplastic polyps accounted for 50.9% and 22.8%, respectively. Forty-eight cases had an accepted operative indication and underwent surgery. The nine other cases also underwent surgery. Among those with operative indications, 27.1% had neoplastic polyps. Of the patients who had non-indication operative surgery or polyps <5 mm in size, there were non neoplastic polyps in any cases. Two of the patients developed complications; wound infection (1 case), and common bile duct obstruction (1 case). CONCLUSION: Observation and careful surgery is necessary for patients with polyps <5 mm in size, and who do not have accepted operative indications. Laparoscopic cholecystectomy can be considered an adequate treatment for patients with accepted operative indications.
Adenocarcinoma ; Adenomatous Polyps ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholesterol ; Common Bile Duct ; Gallbladder ; Gallstones ; Humans ; Laparoscopy ; Polyps ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Wound Infection

PURPOSE: In about 1% of cases, incidental gallbladder cancers (iGBC) are found after routine cholecystectomy. The aim of this study is to compare clinical features of iGBC with benign GB disease and to evaluate factors affecting recurrence and survival. METHODS: Between January 1998 and March 2014, 4,629 patients received cholecystectomy and 73 iGBC patients (1.6%) were identified. We compared clinical features of 4,556 benign GB disease patients with 73 iGBC patients, and evaluated operative outcomes and prognostic factors in 56 eligible patients. RESULTS: The iGBC patients were older and concomitant diseases such as hypertension and anemia were more common than benign ones. And an age of more than 65 years was the only risk factor of iGBC. Adverse prognostic factors affecting patients' survival were age over 65, advanced histology, lymph node metastasis, and lymphovascular invasion on multivariate analysis. Age over 65 years, lymph node involvement, and lymphovascular invasion were identified as unfavorable factors affecting survival in subgroup analysis of extended cholecystectomy with bile duct resection (EC with BDR, n = 22). CONCLUSION: Prior to routine cholecystectomy, incidental GB cancer should be suspected especially in elderly patients. And advanced age, lymph node metastasis, and lymphovascular invasion are important prognostic factors in EC with BDR cohorts.
Aged ; Anemia ; Bile Ducts ; Cholecystectomy* ; Cohort Studies ; Gallbladder Neoplasms* ; Gallbladder* ; Humans ; Hypertension ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors

PURPOSE: To evaluate of the role in carcinogenesis of p53 over-expression and bcl-2 inhibition in early gastric and advanced gastric cancers, we investigated the immunohistochemical tissue status of 31 primary early gastric-cancer patients and 31 primary advanced gastric-cancer patients. METHODS: DO7, the monoclonal antiserum to the P53 protein, and clone 124, the monoclonal antibody to the bcl-2 protein, were used for the immunohistochemical analysis of the 31 surgically resected primary early gastric cancer specimens and the 31 surgically resected advanced gastric-cancer specimens. The expressions were scored and divided into negative, positive, low expression, and overexpression. RESULTS: The clinicopathologic parameter; tumor depth of invasion, histologic type, and differentiation, were not related with the expression status of p53 or bcl-2. Of the 31 primary early gastric-cancer patients, 14 exhibited p53 overexpression and 16 showed negative the bcl-2 expression; 5 cases had both p53 overexpression and negative bcl-2 expression. Of the 31 advanced gastric cancer patients, 19 showed the p53 overexpression, and negative bcl-2 expression, 15 exhibited both p53 overexpression and negative bcl-2 expression. CONCLUSION: These results suggest that cell cycle alteration and apoptosis control by p53 and bcl-2 may play roles in the carcinogenesis of gastric cancer. However, there are many other mediators that may facilitate carcinogenesis. This study proved that bcl-2 is a valuable prognostic factor.
Apoptosis ; Carcinogenesis ; Cell Cycle ; Clone Cells ; Humans ; Stomach Neoplasms*

Acinic cell carcinoma is a rare malignant tumor that accounts for 2%–3% of salivary gland tumors. Acinic cell carcinoma arising from the breast is extremely rare, with only approximately 70 cases reported to date. Owing to its rarity, previous studies have primarily focused on pathological findings. Herein, we present the clinical and radiological features of acinic cell carcinoma of the breast in a 33-year-old woman.

Acinic cell carcinoma is a rare malignant tumor that accounts for 2%–3% of salivary gland tumors. Acinic cell carcinoma arising from the breast is extremely rare, with only approximately 70 cases reported to date. Owing to its rarity, previous studies have primarily focused on pathological findings. Herein, we present the clinical and radiological features of acinic cell carcinoma of the breast in a 33-year-old woman.

Acinic cell carcinoma is a rare malignant tumor that accounts for 2%–3% of salivary gland tumors. Acinic cell carcinoma arising from the breast is extremely rare, with only approximately 70 cases reported to date. Owing to its rarity, previous studies have primarily focused on pathological findings. Herein, we present the clinical and radiological features of acinic cell carcinoma of the breast in a 33-year-old woman.

PURPOSE: This study was conducted to assess the frequency and severity of upper extremity injuries in Korea through a retrospective epidemiological study. METHODS: For this study, we retrospectively reviewed nation-wide upper extremity injury data compiled from 2001 to 2003 from the National Injury Database, which includes the National Health Insurance Corporation (NHIC), Car Insurance, and Industry Insurance. NHIC consists of the medical aid population, the self-employed insured population and the employer-insured population. Data was standardized in terms of demographic characteristics, region and socioeconomic status by NHIC. To assess the degree of the injuries, we used the International Classification of Disease-10 (ICD-10) code and the Modified Abbreviated Injury Scale (MoAIS). Afterwards, we classified the degree of the severity into 4-four categories-mild, moderate, severe and critical- using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS). RESULTS: Frequency of cases of upper extremity injuries per 1,000,000 persons was 58,663, and the incidence rate is 26.9% of total injuries. In fact, the incidence rate remained stable. Yet, there was a steady increase in total injuries from 2001 to 2003. Injuries in men outnumbered women regardless of the severity. In terms of severity, mortality was higher for the elderly aged 60 and over. The Seoul and Kyeonggi-areas showed the highest incidence rate while Jeju was the lowest. Furthermore, injuries were more frequent among the medical aid population. The daily incidence rate for non-critical cases was higher in the months of June, September and October. CONCLUSION: The data indicated that upper extremity injuries comprised a major portion of all injuries. Moreover, the result were affected by differences in gender, location and socioeconomic status. All in all, it is critical that sophisticated research and clinical data be compiled in order to develop more effective prevention strategies.
Abbreviated Injury Scale ; Aged ; Female ; Humans ; Incidence ; Injury Severity Score ; Insurance ; Korea ; Male ; National Health Programs ; Retrospective Studies ; Social Class ; Upper Extremity

PURPOSE: Metaplastic carcinomas of the breast (MCBs) are rare diseases. The aim of this study is to evaluate the clinicopathologic characteristics of MCBs and to compare them with those of infiltrating ductal carcinoma (IDC). METHODS: Thirty-eight patients who underwent surgery at Seoul National University Hospital from May 1982 to December 2002 were retrospectively analyzed on the basis of the medical records and the pathology reports. These patients were compared with 3578 IDC patients that we experienced during the same period. RESULTS: The histologic subtypes of MCBs were 7 squamous, 6 matrix-producing, 7 sarcomatous, 4 mixed, 1 osteogenic, and 13 unclassified tumors. The mean tumor size was 4.4+/-3.1 cm. The operations' methods were a modified radical mastectomy in 26 patients, breast conserving surgery in 11 patients and only an incisional biopsy in one patient. Lymph node metastases and distant metastases were detected in 11 (29.7%) and 5 (13.2%) patients respectively. Lymph node metastases of MCBs were significantly lower than that for the IDC group (p = 0.030). Otherwise, the distant metastases were significantly higher than that of the IDC group (p = 0.019). The MCBs group also showed a significantly higher nuclear grade and histologic grade than did the IDC group (p = 0.001, p = 0.001). Estrogen receptor and progesterone receptor positivity was 5.3% and 5.3% respectively, which were significantly lower than that for the IDC group (p < 0.001, p = 0.002). The overall 5 year survival rate was 65% and the 5 year disease-free survival rate was 68%. After exclusion of patients with distant metastasis, the overall survival rates were not significantly different between the two groups (p = 0.291). CONCLUSION: MCB is a rare pathological entity. Compared with IDC, MCB displays a larger size, less lymph node metastasis, more distant metastasis, a higher histologic grade, and less hormone receptor expression. MCB has a poorer overall survival rate, which is probably due to its frequent distant metastasis.
Biopsy ; Breast* ; Carcinoma, Ductal ; Disease-Free Survival ; Estrogens ; Humans ; Lymph Nodes ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Medical Records ; Metaplasia ; Neoplasm Metastasis ; Pathology ; Prognosis ; Rare Diseases ; Receptors, Progesterone ; Retrospective Studies ; Seoul ; Survival Rate