Invasive micropapillary carcinoma is a recently defined unusual variant of invasive breast carcinoma characterized by the formation of micropapillae within clear spaces separated by delicate fibrocollagenous stroma. This study was designed to examine clinicopathologic features of invasive micropapillary carcinoma of the breast. Sixteen cases of invasive micropapillary carcinoma were retrieved from the files of the Department of Pathology, Yeungnam University College of Medicine. We evaluated their clinicopathologic findings including patients' age, tumor size, nuclear grade, vascular invasion, axillary lymph node status, presence of extensive intraductal carcinoma, estrogen and progesterone receptors, p53, c-erbB-2, MIB-1 labelling index and follow-up data and compared this results with those of 292 cases of invasive ductal carcinoma, not otherwise specified. The incidence of invasive micropapillary carcinoma was 4.2% of all invasive breast carcinoma, and the mean age of the patients was 46 years. Nine cases were pure form (over 75% of micropapillary growth pattern in the tumor) and seven cases were mixed form. The results of clinicopathologic findings, except vascular invasion and axillary lymph node status, of the 16 cases of invasive micropapillary carcinoma were not different from those of the 292 cases of invasive ductal carcinoma, not otherwise specified (p>0.05). However, the rate of vascular invasion and axillary lymph node metastasis was significantly higher in invasive micropapillary carcinoma (p <0.05). Of 16 cases, five cases had distant metastasis during follow-up period, and one patient died of cancer. Although the mechanism of higher vascular invasion and lymph node metastasis in micropapillary growth pattern could not be determined, we propose that invasive micropapillary carcinoma should be recognized as a separate entity with increased risks of vascular invasion and axillary lymph node metastsis.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Estrogens ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Pathology ; Receptors, Progesterone

The prefabrication by vascular induction into random patterned flaps is a method creating axial donor flap by implantation of nourishing pedicles prior to harvesting random patterned flaps. The purpose of this study was to evaluate the viability of a thin prefabricated flap prepared by the subdermal implantation of fasciovascular pedicles without subcutaneous tissue or muscular layer, by comparing with the prefabrication by the subpanniculus carnosus implantation of vascular pedicles, which is well known to a predictable survival rate by many authors. In the left abdomen of 40 Sprague-Dawley rats, the fasciovascular pedicles were implanted in the subdermal layer in group I(n=20) and sub panniculus carnosus layer in group II(n=20), respectively. 5 weeks later, 4 x 6 cm sized abdominal flap was elevated with implanted vascular pedicle as an island and reposed immediately. At the same time, in the right abdomen, conventional island flap was elevated and reposed. After 3 days later, the evaluation of the survival area was carried out in each side, in both groups. The mean proportions of the survival areas in group I were 74.2 and 91.8% in the prefabricated and conventional flap, respectively. And those in group II were 76.4 and 91.2% in the prefabricated and conventional flap, respectively. These results showed that there is no difference in the proportion of survival area between two types of prefabrication. In conclusion, it is possible to prefabricate a thin axial-patterned fascioutaneous flap without subcutaneous tissue and the viability of this prefabricated flap is reliable as much as that of other prefabricated flaps having subcutaneous or muscular tissue.
Abdomen ; Humans ; Rats, Sprague-Dawley ; Subcutaneous Tissue ; Survival Rate ; Tissue Donors

BACKGROUND: Through the control of tuberculosis at 22 public health centers under the National Tuberculosis Control Program, this study is purposed to examine the situation of the tuberculous patients and the characteristics of the therapeutic regimens. METHODS: The data was obtained from 8091 medical records of pulmonary tuberculous patients who were registered for treatment at public health center in Seoul during the year of 1993. It was comparatively analysed by the general characteristics(gender, age, chest X-ray findings, sputum results, treatment results, side effects, combined diseases and accompanied extra-pulmonary tuberculosis) according to various regimens of the tuberculosis. RESULTS: The male patients were 5144, the female were 2947. 34.1% of patients were between 21 and 30years of age. Short course regimen was 97.1% and long course regimen was 2.9%. According to chest X-ray findings minimal 53.5%, moderately advanced 41.2%, far advanced 5.3%. Sputum AFB negative was 52.2% and positive was 47.8%. Therapeutic efficiency was high in short course regimen. Among the side effects, dermatologic problems was high and at the regimen of EHRZ side effects were developed highly. Combined diseases were liver diseases(5.2%), DM(4.2%). Accompanied extrapulmonary tuberculosis were pleurisy(5.4% ), superficial lymphadenitis(0.4% ). CONCLUSIONS: There was great effects in the treatment of tuberculosis with short course regimen in the National Tuberculosis Control Program. But only 38% among the expected patients were treated in this country. So the greater efforts were needed to find and treat more patients effectively.
Female ; Humans ; Liver ; Male ; Medical Records ; Public Health* ; Seoul* ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

Chronic kidney disease (CKD) is associated with a higher prevalence of vascular calcification (VC) and cardiovascular disease. VC in CKD patients showed different pathophysiological features from those of the general population. The pathogenesis of VC in CKD is a highly organized process, and prior studies have suggested that patients with CKD have their own specific contributors to the phenotypic change of vascular smooth muscle cells (VSMCs), including uremic toxins, CKD-mineral and bone disease (CKD-MBD), inflammation, and oxidative stress. For the diagnosis and monitoring of VC in CKD, several imaging modalities, including plain radiography, ultrasound, and computed tomography have been utilized. VC in CKD patients has distinct clinical features and implications. CKD patients revealed a more intense and more prevalent calcification on the intimal and medial layers, whereas intimal calcification is predominantly observed in the general population. While a higher VC score is clearly associated with a higher risk of all-cause mortality and cardiovascular events, a greater VC score in CKD patients does not fully reflect the burden of atherosclerosis, because they have more calcification at equal volumes of atheromatous plaques. The primary goal of VC treatment in CKD is the prevention of VC progression, and the main management is to control the biochemical components of CKD-MBD. Cinacalcet and non-calcium-containing phosphate binders are the mainstay of VC prevention in CKD-MBD management. VC in patients with CKD is an ongoing area of research and is expected to advance soon.

Epithelial-myoepithelial carcinoma and basal cell adenocarcinoma are uncommon, low-grade malignant epithelial neoplasms of salivary gland. They occur predominantly in the parotid glands with frequent recurrences and occasional distant metastases. We report an unusual case of combined epithelial-myoepithelial carcinoma and basal cell adenocarcinoma within the same mass of the parotid gland in a 32-year-old woman. To the best of our knowledge, this is the first such a combined carcinoma case.
Adenocarcinoma* ; Adult ; Carcinoma ; Female ; Humans ; Neoplasm Metastasis ; Parotid Gland* ; Recurrence ; Salivary Glands

By November 2013, a total of 125 clinical practice guidelines (CPGs) have been developed in Korea. However, despite the high burden of diseases and the clinical importance of CPGs, most chronic diseases do not have available CPGs. Merely 83 CPGs are related to chronic diseases, and only 40 guidelines had been developed in the last 5 yr. Considering the rate of the production of new evidence in medicine and the worsening burden from chronic diseases, the need for developing CPGs for more chronic diseases is becoming increasingly pressing. Since 2011, the Korean Academy of Medical Sciences and the Korea Centers for Disease Control and Prevention have been jointly developing CPGs for chronic diseases. However, priorities have to be set and resources need to be allocated within the constraint of a limited funding. This study identifies the chronic diseases that should be prioritized for the development of CPGs in Korea. Through an objective assessment by using the analytic hierarchy process and a subjective assessment with a survey of expert opinion, high priorities were placed on ischemic heart disease, cerebrovascular diseases, Alzheimer's disease and other dementias, osteoarthritis, neck pain, chronic kidney disease, and cirrhosis of the liver.
Chronic Disease ; *Disease Management ; Expert Testimony ; Female ; Health Priorities ; Humans ; Male ; *Practice Guidelines as Topic ; Primary Health Care ; Republic of Korea ; Surveys and Questionnaires

Patients treated by extracorporeal shock wave lithotripsy are usually evaluated by excretory urography within 1 month after treatment to determine the clearance of stone debris and rule out asymptomatic obstruction. In an attempt to obtain more precise functional information, we used 99m-Tc-DTPA renal scan as the initial follow-up study after ESWL in 10 patients. GFR checked by renal scan shows no difference in pre and post ESWL. Our experience suggests that follow up after ESWL by radionuclide renal imaging studies provides specific functional information and also particular value in the management of patients with obstructing stone debris and diminished renal function. Radionuclide renal imaging studies may also reveal unexpected obstruction and functional impairment after ESWL of stones, and is recommended as routine follow-up study after ESWL.
Follow-Up Studies* ; Humans ; Lithotripsy* ; Shock* ; Urography

This study was performed to determine the effects of dietary calcium (Ca) intake, milk and dairy product intake, and serum vitamin D level on bone mineral density. The survey data from the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES) for adults (3,819 males, 5,625 females) aged > 20 years were examined; osteoporosis was defined according to the standards for Asian populations (T-score < -2.5). The risk for osteoporosis significantly decreased as Ca intake increased; this effect persisted (quartile 4 vs. quartile 1 of Ca intake: odds ratio [OR] 0.66; 95% confidence interval [CI]: 0.50-0.87) even after adjustment for gender, age, and other factors (body mass index, serum vitamin D, menstruation, female hormone intake, menopausal status, and the number of days per week of muscular strength exercise). Additionally, the risk for osteoporosis significantly decreased as the Ca/P ratio increased (quartile 4 vs. quartile 1: OR 0.76; 95% CI: 0.58-0.98). The degree of risk was 0.96 (0.66-1.38) in those who consumed < 1 portion of milk or dairy products daily, and 0.71 (0.53-0.96) in those who consumed > 1 portion per day, compared with those who had zero intake. The risk for osteoporosis significantly decreased as the serum 25(OH) vitamin D level increased. From these results, we advocate an increase in Ca, milk, and dairy product intake, and that serum 25(OH) vitamin D levels be maintained within the normal range, for the maintenance of bone health and the prevention of osteoporosis in adults.
Adult ; Aged ; Asian Continental Ancestry Group ; Bone Density ; Calcium ; Calcium, Dietary ; Dairy Products ; Female ; Humans ; Korea ; Male ; Menstruation ; Milk ; Nutrition Surveys ; Odds Ratio ; Osteoporosis ; Reference Values ; Vitamin D ; Vitamins

From January l, l990 to June 30, l992, tota1 1,067 epidural anesthesia were evaluated retrospectively for physical status, level of anesthesia, agents of 1ocal anesthetics, complication and poatoperative pain control. The reaults were as follows: 1) Annual numbers of epidural aneathesia were 272 cases in 1990. 392 cases in 1991 and 403 cases in 1992 respectively. The number of epidural anesthesia was increaeing with years. 2) The most common site of epidural puncture level wae L(3-4) intervertebral space and mean depth from skin to epidural space was 4.88 cm. 3) The local anesthetics that used during epidural anesthesia were lidocaine(1%, 1.5%, 2%) and bupivacaine(0.25%, 0.375%. 0.5%). 4) The most common sensory level which were blocked by epidural anesthesia waa T(10) and most common complication was hypotension. 5) Postoperative pain control with epidural anestheaia was managed with continuous drug infusor after 1991, and it was managed with single bolus injection before 1991. In conclusion, epidural anesthesia is a safe regional anesthesia that will reduce the incidence of hypotension provided that careful control of the aensory level to be anesthetiaed is taken under consideration along with the age, physical status, site of operation, volume of local anesthetics and it is effective for the postoperative pain control with continuous infusion of morphine sulfate and local anesthetic through catheter.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Catheters ; Epidural Space ; Hypotension ; Incidence ; Infusion Pumps ; Morphine ; Pain, Postoperative ; Punctures ; Retrospective Studies ; Skin

OBJECTIVE: Although heterotopic pregnancy is a rare disorder, it is on an increasing tendency due to frequent use of intrauterine device, pelvic inflammatory disease, ovulation induction, assisted reproductive technology. This study was performed the clinical experiences of seven patients with heterotopic pregnancy. METHODS: Seven patients diagnosed as heterotopic pregnancy were analyzed by various factors such as age, symptoms, beta-hCG levels, gestational age at the time of diagnosis, postoperative course, sites of ectopic pregnancy, use of assisted reproductive technology, multiple pregnancy, and mode of surgery. RESULTS: The mean age of patients was 29.1 years, and chief complaint was abdominal pain. Laparotomy was done in 5 patients, and laparoscopy was done in 2 patients. Four of seven patients delivered at term, two were twins, two singletones. CONCLUSION: In heterotopic pregnancy, identification of intrauterine pregnancy without confirmation of ectopic pregnancy is associated with poor prognosis for both mother and fetus, and hence early dignosis and careful examination are need. Ectopic pregnancy should be removed and intrauterine pregnancy should be maintained.
Abdominal Pain ; Diagnosis ; Female ; Fetus ; Gestational Age ; Humans ; Intrauterine Devices ; Laparoscopy ; Laparotomy ; Mothers ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic* ; Pregnancy, Multiple ; Prognosis ; Reproductive Techniques, Assisted ; Twins