In this study of 64 cases of breast cancer with a clinical follow-up period of more than 5 years, several prognostic factors were evaluated. The purpose of this study was to determine whether any one parameter or group of parameters serves as adequate predictors of tumor behavior and patient's prognosis. Several prognostic factors included clinicopathological variables (patient's age, histologic grade, status of lymph node (LN) metastasis, and tumor size), expression of estrogen receptor (ER), progesterone receptor (PR), p53, bcl-2 and CD44 by immunohistochemistry, and DNA ploidy pattern. The results showed that the expression of ER and PR had a significant inverse correlation with the histologic grade (ER, p=0.05; PR, p<0.05). The expression of p53 protein showed a significant relationship with high histologic grade of tumor (p<0.05). The expression of bcl-2 protein was preferably seen in low histologic grade of tumor (p<0.05) and significantly associated with ER positive or PR positive tumors (ER, p<0.05; PR, p<0.05). This results suggest that bcl-2 protein might play significant roles in ER and PR. The CD44 expression showed a significant relationship with tumor size (p<0.05). The large size and aneuploidy pattern of tumor had a tendency to be associated with shorter patient survival. Cox's multivariate analysis showed that overall survival was affected by LN metastasis because of the shorter survival in patients with LN metastasis. In conclusion, tumor size, DNA ploidy pattern, and LN metastasis were themselves significant predictors of breast cancer survival rate.
Aneuploidy ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; DNA* ; Estrogens ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Ploidies* ; Prognosis ; Receptors, Progesterone ; Survival Rate

The retinoblastoma (Rb)/cyclin D1/p16 pathway is an important constituent of cell cycle regulation. Perturbations in this pathway due to a variety of genetic aberrations have been reported in many human cancers including breast cancer. We examined the significance of immunoexpression of p16 protein, cyclin D1 protein, Rb protein (pRb), and p53 protein in 128 cases of invasive breast carcinoma. The results were correlated with survival rate and clinicopathological variables, including age, histologic grade, lymph node status, tumor size, estrogen receptor (ER), and progesterone receptor (PR) content. Abnormal expressions of p16 and pRb which were defined as negative staining were seen in 21% and 43% of tumors, respectively. There was a significant inverse relationship between p16 and pRb expression. There was no correlation between p16 staining and any other parameters, including survival rate, cyclin D1, p53, and clinicopathologic variables. Surprisingly, there was a trend for tumors which were positive for pRb to be grade III ductal carcinomas. Cyclin D1 positivity was noted in 46% of cases. The expression of cyclin D1 protein was significantly higher in lower histologic grade, higher ER and PR expression. The expression of p53 protein showed a significant correlation with high tumor grade. In a Cox multivariate analysis, neither p16, pRb, cyclin D1 nor p53 was an independent predictor, but tumor size and lymph node status were independent predictors of patient outcome.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Cell Cycle ; Cyclin D1* ; Cyclins* ; Estrogens ; Humans ; Lymph Nodes ; Multivariate Analysis ; Negative Staining ; Receptors, Progesterone ; Retinoblastoma ; Retinoblastoma Protein ; Survival Rate

PURPOSE: We aimed to verify the pattern of recurrences or metastases after a curative resection for primary colorectal cancer. METHODS: From the prospective colorectal cancer database of Asan Cancer Center, 2,810 paitents who underwent a curative resection for primary colon (1,295) or rectal (1,515) cancer between October 1995 and December 2003 were studied retrospectively. Patients were followed for more than three years or until disease recurrence. Risk factors considered were age, gender, site of primary tumor, stage, histologic differentiation, and lymphovascular invasion. The mean follow-up duration was 60+/-29 months. RESULTS: Overall recurrence occurred in 546 patients (19.4%). According to stage, the recurrence rates were 4.7% (20/423) in stage I, 10.8% (128/1,185) in stage II, and 33.1% (398/1,202) in stage III. More than 70% of the recurrences occurred within 2 years of surgery. The most common metastatic site was the liver in colon cancer and the lung in rectal cancer. In colon cancer, recurrence was more common in left than in right colon cancer (P=0.012). In rectal cancer, local recurrence was the most common in lower rectal cancer and was more common in patients receiving abdominoperineal resection than in those receiving a sphincter-preserving operation. The liver was the most common site of metastasis within 2 years postoperatively, but metastasis to lung was significantly increased after the second postoperative year. Factors such as sex, T category, N category, and location of the primary tumor were identified to be independent risk covariates for recurrence. CONCLUSIONS: Patterns of recurrences differed according to the characteristics of the primary tumor and varied with the follow-up period.
Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Prospective Studies ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Risk Factors

PURPOSE: This study was undertaken to determine the adequate cutoff value of the neonatal screening test to decrease recall and false-positive rates. METHODS: During the period of January 1999 through December in Asan Medical Center, newborn screening tests for phenylketonuria, congenital hypothyroidism, congenital adrenal hyperplasia, and galactosemia were performed in 3,775, 3,707, 3,783, and 3,806 newborns respectively using commercial ELISA kits. We reviewed and analyzed the recall rate at currently used cutoff values. RESULTS: 1)In neonatal screening test for congenital hypothyroidism, using a current cutoff value, 17 microIU/mL, the recall rate was 0.9% and using a 99.7% cutoff value, 21.3 microIU/mL, the predictive recall rate was 0.4%. There were no significant differences in the other reports that suggest adequate recall rate. 2)In neonatal screening test for phenylketonuria, using a current cutoff value, 3.6 mg/dL, the recall rate was 1.5% which was no significant difference compared with expected presumptive positive rate, 1.44%. 3)In neonatal screening test for congenital adrenal hyperplasia and galactosemia, the recall rate was high when using current cutoff value. But all results were within normal limits in reevaluation. CONCLUSION: The cutoff values of screening test which are currently recommended by manufacturers of commercial kits for congenital hypothyroidism, congenital adrenal hyperplasia and galactosemia, are needed to be reset to decrease the recall rate by false-positive results on the basis of data from an individual newborn screening laboratory.
Adrenal Hyperplasia, Congenital ; Chungcheongnam-do ; Congenital Hypothyroidism ; Enzyme-Linked Immunosorbent Assay ; Galactosemias ; Humans ; Infant, Newborn ; Mass Screening ; Neonatal Screening* ; Phenylketonurias

Wilson's disease is a familial disease characterized by coarsely nodular cirrhosis of the liver, sometimes associated with progressive damage to the nervous system, and the appearance of a coloured ring in the cornea. Wilson's disease is an inborn error of copper metabolism in which the synthesis of ceruloplasmin, with which copper forms a table compound in the blood, is diminished and there is an increased absorption of copper from the gastrointestinal tract together with an increased output in the urine. The Kayser-Fleischer ring is originally described by Kayser(1902) and later by Fleischer(1903). The colours of Kayser-Fleischer ring is seen, varing from rub by red to bright green or an 1lltramarine blue. sometimes interspersed with yellow or smoky shade of brown. The ring starts dose to the limbus as a sharp line just where the endothelial pattern begins to be seen distinctly, extends over a breadth of I to 3mm.. and gradually fades away towards the center of the cornea. Harry et al(1970) described that electron microscopy showed the presence of electron dense deposits of varing size lying mainly in Descmet's membrane and confirmed that the deposits were copper. A 14 year old korean boy with Wilson's disease was found to have Kayser-Fleischer ring in the cornea(ou) and greenish brown pigments on the anterior surface of the lens (ou). In about 16 months after the administration of penicillamine(chelating agent), greenish brown pigments on the anterior surface of the lens (ou) were disappeared remaining Kayser Fleischer ring unchanged.
Absorption ; Adolescent ; Ceruloplasmin ; Copper ; Cornea ; Deception ; Fibrosis ; Gastrointestinal Tract ; Hepatolenticular Degeneration* ; Humans ; Liver ; Male ; Membranes ; Metabolism ; Microscopy, Electron ; Nervous System

Carcinoma of the lids has the highest incidence of any malignant ocular tumor. It is most frequent in men over 50 years of age. The majority of lid carcinoma are of the basal cell type, the remaining consist of squamous cell carcinomas and meibomian gland carcinomas. Basal cell carcinoma is much more common in the lower lid; squamous cell carcinoma in the upper lid. Squamous cell carcinoma grows slowly and painlessly, and may be present for months before it is noted. It may occlude meibomian ducts and produce an inflammatory element which may confuses the clinical picture. A 57 years old man with bronchogenic carcinoma was referred for eye consultation and found to have a small painless nodule on right upper lid that was thought to be chalazion. Palpation of preauricular, submaxillary or cervical node was negative. This small nodule was excised radically for microscopic examination to rule out a probable metastatic lesion from bronchogenic carcinma. Histopathologically, this tumor was reported not to be a secondary but to be a primary squamous cell carcinoma on right upper lid.
Carcinoma, Basal Cell ; Carcinoma, Bronchogenic ; Carcinoma, Squamous Cell* ; Chalazion* ; Eyelids* ; Humans ; Incidence ; Male ; Meibomian Glands ; Middle Aged ; Palpation

Over the physiologic range of heart rate, the duration of electrical systole(QT) is shorter than that of electromechanical systole(QS2), which reflects direct physiologic link between electrical repolarization and mechanical events of the cardiac cycle. The present study designed to test usefulness of systolic time intervals and QT-QS2(QT minus QS2) value as complication predictors, which may predict prognostic status of myocardial infarction. The studied subjects were consisted of 33 healthy adults as control(22 men, 11 women) and 35 patients with myocardial infarction. And studied patients were divided into 3 groups; group I of 14 patients with or without complication in acute stage, group II of 11 uncomplicated patients under recovery of chronic status, group III of 10 complicated patients under recovery or chronic status. The observation periods were 3 to 13 days in group I, 5 to 96 weeks in group II and III after their onset. The results were follows; 1) The normal ranges were defined as mean+/-2 standard deviations of the measured values of control, that of QTc were shorter than 431ms of man and 458ms of woman, that of QS2 I were longer than 503ms of man and 514ms of woman, that of PEP/LVET ratio was less than 0.40, that of QT-QS2 value was less than 0 ms respectively. 2) QTc of all patient groups were significantly prolonged compared with that of control, and that of group III was significantly longer than that of group II(481+/-25 vs 432+/-32, p<0.005). 3) The changes of QS2 I were not significant in all patient groups compared with QS2 I of control. 4) QT-QS2 value showed QT>QS2 in group I and III. and QTQS2 had positive predictive value of 82% for predicting probability of previous complicated status. We concluded that QT-QS2 value, including PEP/LVET ratio and QTc, could be used as complication predictors. But it is necessary to examine these indicators prospectively to confirm its clinical applicability.
Adult ; Female ; Heart Rate ; Humans ; Male ; Myocardial Infarction* ; Reference Values ; Sensitivity and Specificity ; Systole*

Tracheo-innominate artery fistula (TIF) is a life-threatening complication of tracheostomy that manifests with acute and massive bleeding. We present a patient who deveoloped a TIF and underwent a division of the fistula, interrupting the innominate artery. Successful management of a patient with TIF requires the rapid institution of specific resuscitative and operative measures. The patient arrived at the emergency room with acute massive tracheal bleeding, respiratory difficulty, decreased consciousness and ensuing cardiac arrest. After the tracheal cuff was fully inflated, cardiopulmonary resuscitation was started. Fortunately, the bleeding was stopped and heart rate and blood pressure were normalized. Before performing the cerebral angiography, the patient was intubated orally for rebleeding. The patient was admitted to the intensive care unit and stayed for 29 days due to weaning failure from the ventilator. After repair of tracheal stenosis, a permanent tracheostomy was instituted. The patient had no respiratory difficulty or massive tracheal bleeding during the 2 months after discharge except one episode of minor bleeding.
Arteries* ; Blood Pressure ; Brachiocephalic Trunk ; Cardiopulmonary Resuscitation ; Cerebral Angiography ; Consciousness ; Emergency Service, Hospital ; Fistula* ; Heart Arrest ; Heart Rate ; Hemorrhage ; Humans ; Intensive Care Units ; Tracheal Stenosis ; Tracheostomy* ; Ventilators, Mechanical ; Weaning

24-hour Holter ambulatory ECG monitoring has been examined for the cardiac evaluation during ordinary activities in 81 subjects with suspected or propostmyocardial infarction (PMI), 12-lead ECG and the 24-hour ECG tape showed similar basic rhythm, heart rates and conduction patterns, but ventricular premature contractions (VPCs) were more frequently recorded on the 24-hour tape. Of 17 PMI patients, one or more VPCs in 14 cases (82.4%), multifocal VPCs in 3 cases (17.6%) and bigeminy or paired VPCs in 5 cases (29.4%) and transient runs of ventricular tachycardia in 1 case (5.9%) were observed on the 24-hour monitoring. 2) Of 30 patients with typical or atypical chest pain, 20 examinees had changes in the ST segment and/or T wave, but 10 examinees did not have any pathological changes in the ST segment or in the T wave. 3) Of 26 patients with dizziness and palpitation during waking periods, sinus rates were 76.4+/-12.8/min. and the ranges were 134.1+/-15.1/min. and 58.7+/-9.1/min. Average sinus rates observed during sleeping periods were 61.6+/-10.3/min., the ranges were 92.7+/-11.4/min. and 51.5+/-8.7/min. In general, longer PR interval, QTc interval, QRS duration and high R amplitude were observed during sleeping periods than waking periods. 4) Of 64 patients without PMI, all subjects had episodes of normal sinus rhythm and brady-and-tachycardia syndrome in 5 cases, VPCs in 23 cases, APCs in 2 cases, AV block in 4 cases and W.P.W. syndrome in 2 cases were observed during 24-hour Holter ECG monitoring.
Atrioventricular Block ; Chest Pain ; Dizziness ; Electrocardiography* ; Heart Rate ; Humans ; Infarction ; Tachycardia, Ventricular

Purpose: This study aims to oncologic outcomes of the watch-and-wait (WW) strategy compared with radical resection (RR). Methods: Patients with rectal cancer who received neoadjuvant chemoradiotherapy (nCRT) and achieved ≤ycT2 between 2008 and 2016 were included. The mean follow-up time was 61 months (range, 0–168 months). Recurrence-free survival (RFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were compared. A total of 446 patients were included, and WW was adopted for 34 patients. Results: WW patients were older (P = 0.022) and less advanced initial cT stage (P = 0.004). Ten patients in the WW group (29.4%) experienced local regrowth. Later, distant metastases occurred in 7 of these patients. The 5-year RFS (74.1% vs. 79.5%), DMFS (74.1% vs. 81.6%), and OS (90.4% vs. 87.7%) for the WW and RR groups were not statistically different.However, LRFS in the WW group was significantly lower (65.1% vs. 97.0%, P < 0.001). The initial cT stage was associated with RFS (P = 0.019) and LRFS (P = 0.037). WW was an independent risk factor for LRFS (P < 0.001) and DMFS (P = 0.024).After 1:4 propensity score matching between the WW and RR groups, there was no difference in RFS and OS. However, the 5-year LRFS (67.5% vs. 96.5%) and DMFS (73.2% vs. 86.4%) demonstrated a statistically significant difference between the groups. Conclusion By appointing the WW strategy, oncologic safety was not ensured. The WW strategy must be implemented with caution in patients with ≤ycT2 stage, particularly those with advanced initial cT stage.