A palpable breast lump is the most frequent symptom of breast cancer. At the same time, metastatic lymph nodes can be palpable in the axilla. Breast cancer can sometimes present as an isolated axillary adenopathy without any clinically detectable breast tumor. The incidence of an occult primary tumor with axillary metastases is very low, 0.4% of the breast cancer patients in the collective data. A metastatic carcinoma found in an axillary node should be treated as a breast cancer, because the breast is the most common primary site and because breast cancer is a curable disease with proper management. Between July 1993 and June 1996, 523 breast cancer patients underwent surgery in Asan Medical Center. Among them, 7 patients (1.3%, 7/523) presented with metastatic axillary lymphadenopathy without clinical evidence of a breast tumor or any other primary tumor. The median age of these 7 patients was 49 years (range 39~62 years). The mean size of palpable lymph nodes was 3.7 cm. A histological diagnosis of metastatic adenocarcinoma was obtained by excision in 5 patients and by fine needle aspiration cytology in 2 cases. The findings of the preoperative mammography was normal in 5 patients showed a dense breast in one patient was suspicious in one patient (14%, 1/7). Preoperative ultrasonography detected a suspicious tumor in two patients (28%, 2/7). The primary treatment was a modified radical mastectomy in 6 patients and an axillary dissection with whole breast radiotherapy in one patient. A breast cancer was found in the mastectomy specimen of 4 of 6 patients (66%): one invasive ductal, one invasive lobular, one DCIS, and one LCIS tumor. No tumor was found in two mastectomy samples.The median number of involved metastatic lymph nodes was 2 (range 1~25). The staging was IIA (TxN1M0, T0N1M0) in 4 patients, IIB (T2N1M0) in 2 patients, and IIIA (TxN2M0) in one patient. Four patients were positive for hormone receptors, 2 were negative, and one was unknown. All the patients were treated with postoperative adjuvant chemotherapy, radiotherapy or hormone therapy; no recurrence has been found in these patients to date. We conclude that axillary metastases without clinical evidence of a primary breast tumor represents a unique clinical entity of breast cancer, and it should be treated as a breast cancer to avoid unnecessary labaratory or radiological efforts to find the primary site.
Adenocarcinoma ; Axilla ; Biopsy, Fine-Needle ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Diagnosis ; Humans ; Incidence ; Lymph Nodes* ; Lymphatic Diseases ; Mammography ; Mastectomy ; Mastectomy, Modified Radical ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Ultrasonography

It has been recognized that angiogenesis has a profound effect on growth of tumors in various animal models. Recently, it was suggested that tumor microvessel density may be an independent prognostic factor in breast cancer and other human tumors. This study was designed to define the correlation between tumor microvessel density and survival in breast cancer. Pathological parameters of 60 patients with breast cancer were analyzed: stage, nodal status, histologic grade, vascular invasion, and p53 expression. Tumor microvessels were stained by the immunohistochemical method in formalin-fixed, paraffin-embedded tissues by using the anti-CD31 monoclonal antibody (JC/70A, DAKO) and were counted with in a 10 objective field (about 0.74 mm2) in the area of the most intense neovascularization. The microvessel density (MVD) of the tumor was compared with other prognostic factors and 5-year survival rate. The mean MVD of the 60 breast cancers was 36.5 15.3 (range: 17~112). The MVD did not correlate with the stage, the node metastasis, the histologic grade, the vascular invasion, or the p53 expression. The MVD was graded by the number of microvessels as grade 1 (MVD 17~32), grade 2 (MVD 33~48), and grade 3 (MVD>49). The 5-year survival rate of patients with MVD grade 1 was 69.0%, and those of grades 2 and 3 were 58.2% and 29.6%, respectively, which was statistically significant (p=0.004). By univariate analysis, the stage (p<0.001), the axillary nodal status (p<0.001), the MVD (p=0.004), and the p53 expression (p=0.041) had a significant correlation with survival. In 25 patients with node-negative breast cancer, the MVD was the single significant prognostic factor (p=0.047). These results suggest that tumor microvessel density is a significant prognostic factor in invasive breast cancer and that it may be a prognostic factor in node-negative breast cancer.
Breast Neoplasms* ; Breast* ; Humans ; Microvessels* ; Models, Animal ; Neoplasm Metastasis ; Prognosis* ; Survival Rate

1136 breast cancer patients admitted to and treated at the Department of Surgery, Seoul National University Hospital, between Jan. 1989 and Dec. 1995 were analysed retrospectively. We compared this group of patients with another group of 802 breast cancer patients between Jan. 1970 and Dec. 1988. The results are as follows. Neither the mean age (46.9 years), prevalent age group (5th decade) or common location of the tumor (outer upper quadrant) showed any difference between the two groups. The common presenting symptoms of patients, breast lump (89.0%) and bloody discharge (3.0%), also did not change significantly. However, the number of patients with microcalcification or abnormal mass density on mammography without specific symptoms and signs increased in this period. According to the AJCC staging system, more than half of thepatients were stage II (59.2%) followed by stage I (20.5%), stage III (13.2%), stage 0 (4.7%) and stage IV (2.3%). The proportion of patients with early breast cancer increased from 62.0% for the early-time group to 84.4% for the later-time group, while that of patients with advanced breast cancer decreased significantly from 38.0% to 15.5% (p<0.0001). Invasive ductal carcinoma,NOS (81.7%) and modified radical mastectomy (84.5%) was still the most common histologic type and type of operation performed respectively. Although the most common type of operation performed did not change significantly, a number of patients, 113 patients, underwent breast conservation surgeries during the later-time period. Quadrantectomy and axillary dissection was the most common type of breast conservation surgery. In summary, no obvious differences in age distribution, tumor location, or common histologic type were found between the two groups. However, the number of asymptomatic patients detected by mammography, the number of breast conservation surgery performed, and the proportion of early breast cancer were markedly increased remarkably in later-time group.
Age Distribution ; Breast Neoplasms* ; Breast* ; Humans ; Mammography ; Mastectomy, Modified Radical ; Retrospective Studies ; Seoul

In consideration of the potential deleterious effects of blood transfusion, the effect of acute anemia on the healing of both small (SI) and large intestinal (LI) anastomoses was evaluated. Thirty-six white rabbits underwent resection of both the mid-ileum and the distal colon with primary anastomosis of each. One and two weeks post operation, all anastomoses were assessed by anastomotic bursting pressure (ABP) and histologic evaluation utilizing a modified Erhlich/Hunt scale with grading of the WBC influx, blood vessel ingrowth, fibroblast proliferation, and collagen deposition. Results were analyzed using oneway analysis of variance (ANOVA) and the Chi-Square approximation with p<0.05 being considered significant. The SI ABP, reported in mmHg SE, of the anemic rabbits was decreased at one week vs. the controls (234 mmHg 17 vs. 201 mmHg 16), reaching significance at two weeks (190 mmHg 6 vs. 257 mmHg 17). A decreased LI ABP was found at one week, though not quite reaching singnificance (p=0.06). Recovery to control values occurred by two weeks. Histologic assessment (anemia vs. control) demonstrated a uniform decrease in WBC infiltration, reaching significance in the LI group at two weeks. Blood vessel ingrowth was likewise depressed, but did not achieve significance. The collagen contents of both the SI and the LI groups at two weeks decreased, as were the SI fibroblast proliferation at one week (p<0.05). This study demonstrates that severe, acute anemia in rabbits undergoing intestinal anastomoses severely alters histologic parameters in both the SI and the LI anastomoses while decreasing the overall strength of the SI anastomoses.
Anemia* ; Blood Transfusion ; Blood Vessels ; Collagen ; Colon ; Fibroblasts ; Rabbits*

No abstract available.
Appendicitis* ; Child ; Humans

Long-term venous access devices have become an important part of the stantard care for children with malignant disease requiring chemotherapy. Totally implantable venous access system(TIVAS) gained widespread use and acceptance in the management of children with cancer in whom frequent and prolonged venous access is required. We analysed our experiences of insertion and use of totally implantable venous access device in 70 pediatric patients(79 devices), between April 1991 and April 1996. Median age of patients was 6 years and 10 months old. Median duration of utilization was 320 days(range 7-1449 days). Access vein was right external jugular vein(46.8%), left external jugular vein(21.5%), right internal jugular vein(11.4%), left internal jugular vein(3.8%), right subclavian vein(1.3%), left subclavian vein (7.6%), right cephalic vein(2.5%), left cephalic vein(5.1%). Complications related to surgical factors included: wound dehiscence(3 cases), hematoma(1 case), malposition of catheter(1 case). Complications not related to surgical factors included: occlusion of catheter(12 cases), wound infection(7 cases), sepsis(6 cases), leakage(3 cases), hematoma(3 cases), thrombosis of vein (1case). Many complications resolved spontaneously or with medical threatment and 14 cases(17.7%) required removal of system. We conclude that with long-term usage of totally implantable venous access system making it a safe and viable alternative for patients requiring long-term intravenous therapy.
Child ; Drug Therapy ; Humans ; Infant ; Subclavian Vein ; Thrombosis ; Veins ; Wounds and Injuries

Clinical analysis was performed on 660 cases of the intussusception treated at the Masan Fatima Hospital from January 1981 to December 1995. Also the frequency of the intussusception in the central area of Kyung Nam province from January 1991 to December 1995 was studied. The results were as follows. 1) The intusssusception was most commonly occured between 6 months to 9 months of age(28.6%). Male to female ratio was 2.06 : 1. 2) The frequent symptoms and signs were abdominal pain(80.9%), bloody stool(68.3%), vomiting(63.9%), and palpable abdominal mass(43.6%). 3) The incidence of types of intussusception were ileo-colic(50.0%), ileo-ileo-colic(41.2%), ileo-cecal(6.3%), colo-colic(2.1%) and ileo-ileal(0.4%) in order. 4) The chance of intestinal resection was increased in the case of symptom duration over 24 hours(P<0.01). 5) Barium reduction was attempted in 660 cases(100%) and achieved successful reduction in 364 cases(55.2%). Operative treatment was performed in 296 cases(44.8%), of which manual reduction was carried out in 267 cases(90.2%), intestinal resection in 17 cases(5.8%) and spontaneous reduction was noted in 12 cases(4.0%). 6) Wound infection developed in 12 cases(4.0%) was the most commonly observed postoperative complication. 7) The recurrent rates of the barium enema and operation were 9.1% and 7.1%, resepctively. 8) The operative mortality was 0.2%. 9) The incidence of intussusception in Kyung Nam central area from 1991 to 1995 were as followings : 5.55/1000 live birth in 1991, 5.65/1000 live birth in 1992, 5.03/1000 live birth in 1993, 5.00/1000 live birth in 1994 and 4.03/1000 live birth in 1995.
Barium ; Child* ; Enema ; Female ; Humans ; Incidence* ; Infant* ; Intussusception* ; Live Birth ; Male ; Mortality ; Postoperative Complications ; Wound Infection

This article consists of a clinical analysis of 171 cases of intussusception treated at the Department of General Surgery and Pediatrics of Pusan Adventist Hospital, during a five year period from Jan. 1991 to Dec. 1995. The results were as follows ; 1) On the age and sex distribution, the age incidence under 1 year old was the most common(73.1%), and male to female ratio was 1.48 : 1. 2) The seasonal variation was Autumn(35.1%), Spring(32.1%), Summer(19.9%), and Winter(12.9%). 3) On the hematologic laboratory finding, 68% were revealed leukocytosis above 10,000/mm3 in serum. 4) In etiology, idiopathic type was common(98.5%), and Meckel's diverticulum was rare(1.5%). 5) The frequent Symptoms and signs were abdominal pain and irritability(84.2%), bloody stool(83.6%), vomiting(80.7%), palpable abdominal mass(48.5%). 6) On comparison of barium reduction to methods of the operation in relation to duration of symptoms, within 12 hours was 81.4% : 15.7% and above 24 hours was 49% : 51% 7) The common anatomical type of intussusception was ileo-colic type (36.9%), and the common types of bowel resection were ileoileo type and ileoileocolic type(80%). 8) The methods of the operation were manual reduction(53.8%), bowel resection(30.8%), and spontaneous reduction(15.4%). 9) Postoperative complications occurred in 10 cases ; febrile convulsion 3 cases, wound infection 2 cases, and wound dehiscence, intestinal obstruction, pulmonary complication each 1 case. 10) The overall recurrence rate was 5.3% (8 cases); 6.6% (7 cases) were after barium reduction, and 1.5% (1 case) was after manual reduction.
Abdominal Pain ; Barium ; Busan ; Child* ; Female ; Humans ; Incidence ; Infant* ; Intestinal Obstruction ; Intussusception* ; Leukocytosis ; Male ; Meckel Diverticulum ; Pediatrics ; Postoperative Complications ; Recurrence ; Seasons ; Seizures ; Seizures, Febrile ; Sex Distribution ; Wound Infection ; Wounds and Injuries

No abstract available.
Esophageal Atresia* ; Tracheoesophageal Fistula*

A retrospective analysis was performed on 69 follow-up cases of ducal carcinoma in situ(DCIS) treated from Jan. 1981 to Dec. 1995 at Department of Surgery, Seoul National University Hospital. The results are as follows. The mean age was 45.4 years that ranged from 28 to 68. The proportion of DCIS to breast cancer was increased from 1.3% to 7.2% for 15 years. Clinical presentations of DCIS were mass, nipple discharge and suspicious mammographic findings. Patients presenting mass were decreased, while mammographically detected DCIS were increased. In 49.3% of cases, the tumor size was smaller than 2cm and in 21.3% of the cases, the tumor was not palpable. Treatment modality was changed to more conservative procedures. All of the patients survived well without local recurrence or distant metastasis for a mean follow-up of 36.3 months(range 7 to 146). Histopathologic review was also performed on 52 cases of which paraffin blocks were saved, by one pathologist and diagnosis was confirmed. Pure DCIS composed 16 cases(30.8%), and DCIS with microinvasion was 36 cases(69.2%). Clinical presentation of DCIS, such as age, nipple discharge, calcification on mammography and mass size were not related to the microinvasion, but mass palpability was related to microinvasion(p=0.018). There was no histopathologic features to predict progression to invasive carcinoma, regardless of comedo type, histologic grade and nuclear grade. The expression of cathepsin-D, nm23, p53 and c-erbB-2 protein, was also evaluated using immunohistochemical methods. The relationship between expression of immunohistochemical antibodies and prognostic variables such as tumor size, histologic grade, nuclear grade, and microinvasion was assessed. The overexpression of c-erbB-2 protein was associated with lower nuclear grade(p=0.033), and a strong correlation was seen between tumor size and cathepsin-D and p53 protein(p=0.035, p=0.016). In this study, we conclude that the fine classification and analysis of DCIS subtype, not only by histopathologic but also by immunohistochemical study can be helpful to predict biological behaviour of DCIS and decide the modality of treatment.
Antibodies ; Breast ; Breast Neoplasms ; Carcinoma in Situ* ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Mammography ; Neoplasm Metastasis ; Nipples ; Paraffin ; Receptor, erbB-2 ; Recurrence ; Retrospective Studies ; Seoul