PURPOSE: Since the publication of the 5th edition of the AJCC cancer staging manual in 1997 (old stage), significant developments have occurred in the field of breast cancer diagnosis and management; therefore, it was revised at 2002 (new stage). There are few reports comparing the changes in prognosis in relation to the changes in the staging system. The aims of this study were to evaluate the changes in patient distribution and prognosis according to the changes in the staging system and to elucidate the efficacy of new staging system. METHODS: The records of 1, 275 patients who underwent an operation for breast cancer at Yeung-Nam University Hospital between 1987 and 2003 were reviewed. The pathological stage was assigned retrospectively according to the 5th and the 6th AJCC staging criteria. The patient distributions by stage, nodal status, 5-year relapse free survival (RFSR) and overall survival rates (OSR) were retrospectively compared. RESULTS: Five hundred and five of 616 stage II patients according to the 1997 classification system were also stage II according to the 6th AJCC staging system. The number of patients with stages IIA and IIB decreased from 370 and 246 (old stage) to 342 and 165 (new stage), respectively. Conversely, the number of patients with stage III increased from 158 (old stage) to 271 (new stage). The five-year RFSR for patients with stage I, IIA, IIB, and IIIA were 94.2, 87.1, 74.3, and 48.8% according to the old stage (P<0.0001), and 95.2, 87.8, 81.7, and 66.8%, respectively, according to the new stage (P<0.0001). The five-year OSR for patients with stage I, IIA, IIB, and IIIA were 98.7, 94.3, 86.1, and 63.5% according to the old stage (P<0.0001), and 98.7, 95.7, 96.5, and 72.9%, respectively, according to the new stage (P<0.0001). The RFSR and OSR for stage IIIC were 42.0 and 59.5%, respectively. There was significant difference in the five-year OSR for stages IIB and IIIA (P=0.0308 and P=0.0132, respectively). CONCLUSION: In our study, the 6th AJCC staging system shifted poorer prognostic cohort of each stage toward a higher stage compared to the 1997 version. Therefore, the survival rate for any one stage assigned by 2002 staging system was also improved. In conclusion, it is imperative that careful attention is devoted to this effect so that accurate conclusions regarding the efficacy of new treatment can be drawn.
Breast Neoplasms* ; Breast* ; Classification ; Cohort Studies ; Diagnosis ; Humans ; Joints* ; Neoplasm Staging ; Prognosis ; Publications ; Recurrence ; Retrospective Studies ; Survival Rate

Among many adverse effects of docetaxel, fluid retention is a well recognized, cumulative side effect, but severe fluid retention is rare. We report here on a case of docetaxel-induced severe fluid retention with peripheral edema, pleural effusion, severe ascites and pericardial effusion in a 41-year-old woman. She had been treated with 3 cycles of docetaxel 9 days previously and she was admitted to our hospital due to abdominal distention and mild dyspnea. Radiologic studies revealed pleural effusion, severe ascites and a small pericardial effusion. Diuretics were given for 21 days. The pleural effusion was resolved after treatment with diuretics for 2 days, but the ascites wasn't resolved until 14 days of diuretics. After treatment with diuretics for 21 days, all the symptoms of the patient were completely resolved. Early detection is mandatory and diuretics are very effective for patient suffering with docetaxel-induced severe fluid retention.
Adult ; Ascites ; Breast ; Breast Neoplasms ; Diuretics ; Dyspnea ; Edema ; Female ; Fluid Shifts ; Humans ; Pericardial Effusion ; Pleural Effusion ; Retention (Psychology) ; Stress, Psychological ; Taxoids

Spontaneous spinal subdural hematoma is reported at a rare level of incidence, and is frequently associated with underlying coagulopathy or those receiving anticoagulant or antiplatelet agents; some cases accompany concomitant intracranial hemorrhage. The spontaneous development of spinal subdural hemorrhage (SDH) is a neurological emergency; therefore, early diagnosis, the discontinuation of anticoagulant, and urgent surgical decompression are required to enable neurological recovery. In this report, we present a simultaneous spinal subdural hematoma and cranial subarachnoid hemorrhage, which mimicked an aneurysmal origin in a female patient who had been taking warfarin due to aortic valve replacement surgery.
Aneurysm ; Aortic Valve ; Decompression, Surgical ; Early Diagnosis ; Emergencies ; Female ; Hematoma, Subdural ; Hematoma, Subdural, Spinal* ; Humans ; Incidence ; Intracranial Hemorrhages ; Platelet Aggregation Inhibitors ; Subarachnoid Hemorrhage* ; Warfarin

Severe sepsis and septic shock are the main causes of death in critically ill patients. Early detection and appropriate treatment according to guidelines are crucial for achieving favorable outcomes. Endotoxin is considered to be a main element in the pathogenic induction of gram-negative bacterial sepsis. Polymyxin B hemoperfusion can remove endotoxin and is reported to improve clinical outcomes in patients with intra-abdominal septic shock, but its clinical efficacy for pneumonic septic shock remains unclear. Here, we report a case of a 51-year-old man with pneumonic septic shock caused by Pseudomonas aeruginosa, who recovered through polymyxin B hemoperfusion.
Cause of Death ; Critical Illness ; Gram-Negative Bacteria* ; Hemoperfusion* ; Humans ; Middle Aged ; Polymyxin B* ; Polymyxins* ; Pseudomonas aeruginosa ; Sepsis ; Shock, Septic*

From January 1988 to December 1991, 39 fractures of the lateral condyle of humerus in children were treated at the Department of Orthopaedic Surgery, Sung-Ac General Hospital. It was possible to follow up from one year to four years and eleven months. The authors have analyzed the method of treatment on the basis of the degree of displacement in the change of Carrying angle and Baumann's angle. The results were as follows; 1. Of the 39 cases, the age incidence was confined to 2 to 12 years of age and the average age of the patients were 5 years. 2. Most fractures were Milch type II (29 cases) in contrast to Milch type I (10 cases). 3. According to the initial displacement of the fracture, 8 cases were Jokob's stage I, 21 cases of stage II & 10 cases of stage III. 4. There were no significant difference in the range of change of Carrying angle and Baumann's angle according to initial displacement of fracture site. However, significant difference in outcome were noticed from open reduction and internal fixation in comparison to closed reduction and percutaneous pinning. 5. In all 39 cases, lateral condylar overgrowth (10 cases), cubitus varus (1 cases) and cubitus valgus (3 cases) were noticed as complications but clinical significance was not noted. 6. The above results suggest that internal fixation is recommended for firm fixation although displacement is not severe. In case of Jakob's stage III, anatomical reduction is required in order to reduce additional damage on articular surface and epiphyseal plate caused by excessive manipulation.
Child ; Clinical Study ; Follow-Up Studies ; Growth Plate ; Hospitals, General ; Humans ; Humerus ; Incidence ; Methods

Congenital fibrosarcoma of neonate is a very rare malignant tumor prone to behave aggressively with a tendency to local recurrence without metastasis. It is characteristically composed of collagenous fibroblasts and herringbone pattern in histology. We experienced a case of congenital fibrosarcoma on the left thigh and report this case with some review in literature with 1½ year follow up.
Collagen ; Fibroblasts ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Infant, Newborn ; Neoplasm Metastasis ; Recurrence ; Thigh

The authors analyzed ultrasonographic findings of 112 cases of trophoblastic disases which were confirmed byD&E or hysterectomy at Wallace Memorial Baptist Hospital from September 1980 to December 1984. The results were asfollows; 1. Of all 112 cases, hydatidiform moles were 99 cases, invasive moles were 3 cases and choriocarcinomas were 10 cases. 2. 81 cases (72%) occurred in 3rd decades. 3. The sized of uterus was large for gestational weeksin 65 cases(56%) and smaller in 13 cases(13%). 4. The contour of uterus was globular in 59 cases(53%), diffuse in49 cases(44%) and nodular in 4 cases(3%). 5. The internal echopatterns of uterus revealed numerous small vesicular snowstorm patterns in all cases, and revealed internal degeneration in 67 cases(60%). 6. Uterine walls in 89 cases(79%) were well delineated but uterine walls in 23 cases(21%) were poor delineated. 7. Multiseptated ovarian thecalutein cysts were seen in 36 cases (32%). 8. Invasive trophoblastic disease(invasive moles 3 cases andchoriocarcinomas 10 cases) revealed similiar ultrasonographic findings with H-mole, but more irregular internalechoes and irregular echoes in uterine wall. 9. Diagnostic accuracy was diagnostic in 98 cases (88%) , nonspecificin 11 cases (10%) and error in 3 cases(2%).
Choriocarcinoma ; Female ; Hydatidiform Mole ; Hydatidiform Mole, Invasive ; Hysterectomy ; Pregnancy ; Protestantism ; Trophoblasts ; Uterus

BACKGROUND: Viral myocarditis is considered as a cause of dilated cardiomyopathy. At present, two pathogenic mechanisms may be involved in the pathogenesis of viral myocarditis and subsequent cardiomyopathy. First, the virus infection of myocyte may directly lead to either cell death or persistent metabolic dysfunction. Second, virus-induced immune or autoimmune mechanism may play a role. METHODS: To test the therapeutic efficacy of immunosuppression with cyclophophamide(CYP) on coxsackievirus B3(CB3) myocarditis, 10-14 week-old Balb/c mice were inoculated with 4000 plaque-forming units of CB3. In experiment 1, CYP (100mg/kg/day subcutaneous injection, s.c) was administrated daily on days 1-7(group 2, n=16). In experiment 2, CYP 30mg/kg/day s.c(group 3, n=32) or CYP 100mg/kg/day s.c(group 4, n=32) were administrated on days 8-14. The animals of infected controls(group 1, n=26) and group 2, 3, 4 were dissected at days 4, 7, 15, 22 and spleen, heart, thymus and body weights were measured. RESULTS: In experiment 1. survival rate in group 2 on day 7, 15 were low compared with group 1(85%, 0% vs 100%, p<0.05). and myocardial virus titers in group 2 on day 4 was 50 times, and on day 7, 1000 times higher compared with group 1, Histologically, on day 7, focal cellular infiltrations were prominent findings in group 1, but diffuse myocardial necrosis without cellular infiltration were observed in group 2. In experiment 2, survival rate, cardiac histopathology myocardial virus titer and serum neutralizing antibody titers did not differ among groups 1, 3 and 4. In experiment 1 and 2, the spleen-to-body-weight and thymus-to-body-weight ratios were significantly lower in CYP treated groups than those in controls and marked cellular depletions in spleens and thymus were observed in CYP treated groups. CONCLUSIONS: As the results of above, it can be concluded that the immunosuppression during viremic phase of murine viral myocarditis aggravated the myocardial necrosis, and during aviremic phase, the administration of CYP didnot affect the process of viral myocarditis. Thus, direct viral mechanisms in the production of cardiomyocyte injury in CB3-infected mice appear to bo more important than cell mediated immune mechanism. To understand relevant pathogenic mechanisms of clinical myocarditis and dilated cardiomyopathy resulting from viral infection, the experimental study expanding into nonmurine animals and into various models using other infectious agents may be required.
Animals ; Antibodies, Neutralizing ; Body Weight ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cell Death ; Cyclophosphamide* ; Heart ; Immunosuppression ; Injections, Subcutaneous ; Mice ; Muscle Cells ; Myocarditis* ; Myocytes, Cardiac ; Necrosis ; Spleen ; Survival Rate ; Thymus Gland ; Viral Load

Various options have been introduced for the selection of implant overdenture attachments. Attachment wear due to the repeated insertion and removal of dentures has caused problems such as decreased retention and the requirement for suprastructure remanufacturing. In these cases, a Locator bar system was applied using the drill and tapping technique to achieve total retrievability. In a 55-year-old female patient who showed three degrees of mobility in most of her teeth due to severe alveolar bone loss, a complete denture in the maxilla and an implant supported type overdenture in the mandible were planned after extracting all the remaining teeth. Six implants were placed from canine region to the distal molar region, and the locator was connected to the milled bar using the drill and tapping technique. For a 61-year-old female edentulous patient who complained of poor retention with old denture, a complete denture in the maxilla and an implant-tissue supported type overdenture in the mandible were planned. Four implants were placed in front of mental foramen, and the Locator was also connected to the Hader bar using the drill and tapping technique. With this technique, female parts can be easily replaced, and retention can be continuously maintained.
Alveolar Bone Loss ; Denture, Complete ; Denture, Overlay ; Dentures ; Female ; Humans ; Mandible ; Mandrillus ; Maxilla ; Middle Aged ; Molar ; Retention (Psychology) ; Tooth

OBJECTIVE: There was no abundance of data on the use of anticoagulant in patients with previous high risk of thromboembolic conditions under a newly developed intracranial hemorrhage in Korean society. The purpose of this study was to evaluate the safety of discontinuance and suggest the proper time period for discontinuance of anticoagulant among these patients. METHODS: We reviewed the medical records of 19 patients who took anticoagulant because of thromboembolic problems and were admitted to our department with newly developed anticoagulation associated intracranial hemorrhage (AAICH), and stopped taking medicine due to concern of rebleeding from January 2008 to December 2012. Analysis of the incidence of thromboembolic complications and proper withdrawal time of anticoagulant was performed using the Kaplan-Meier method. RESULTS: Our patients showed high risk for thromboembolic complication. The CHA2DS2-VASc score ranged from two to five. Thromboembolic complication occurred in eight (42.1%) out of 19 patients without restarting anticoagulant since the initial hemorrhage. Among them, three patients (37.5%) died from direct thromboembolic complications. Mean time to outbreak of thromboembolic complication was 21.38+/-14.89 days (range, 8-56 days). The probability of thromboembolic complications at 7, 14, and 30 days since cessation of anticoagulation was 0.00, 10.53, and 38.49%, respectively. CONCLUSION: Short term discontinuance of anticoagulant within seven days in patients with AAICH who are at high embolic risk (CHA2DS2-VASc score >2) appears to be relatively safe in Korean people. However, prolonged cessation (more than seven days) may result in increased incidence of catastrophic thromboembolic complications.
Cerebral Hemorrhage ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhages* ; Medical Records ; Methods