PURPOSE: This retrospective study was conducted to compare early preliminary results of breast conservation therapy (BCT) with mastectomy in early breast cancer. MATERIALS AND MEHTODS: We evaluated 171 women with AJCC stage I and II breast cancer who had been treated at Kangnam St. Mary's Hospital from March 1989 to August 1996. Eighty-eight patients underwent mastectomy and 85 patients did conservative surgery with breast irradiation. In the BCT group, all patients received whole breast irradiation to a total dose of 45~50 Gy/5~6 wks, followed by a boost to the original tumor site at least 60 Gy. Chemotherapy was administered to 29 (34.1%) patients in BCT and 40 (45.5%) in mastectomy, with various sequencing of surgery and/or radiation. We compared survival rate, patterns of failure in each treatment group and the prognostic factors that had a significant effect on treatment failure. The median follow-up time was 63 months (19~111 months). Log rank test was used to estimate the prognostic factors for treatment failure. RESULTS: Overall survival, disease free survival, locoregional recurrence and distant metastasis rates were not significantly different between the two treatment groups. During the follow-up period, 11 patients (12.5%) in the mastectomy group and 10 patients (11.8%) in the BCT group were failed. Six local recurrences occurred after mastectomy and 5 after BCT. Five patients failed at distant site in mastectomy and 4 in BCT. Of the local recurrence cases, five of 6 mastectomy patients and 3 of 5 BCT patients were alive with no evidence of disease after salvage surgery and/or chemoirradiation. Our results indicated that the major influence on survival was distant metastasis. Unfortunately, control of distant metastasisis was not frequently achieved. Even with salvage systemic therapy or radiotherapy, most of distant metastasis patients died or had uncontrolled disease in both treatment groups: only one of 4 BCT patients and none of mastectomy patients were alive without disease. There was no apparent difference in the incidence rate of contralateral breast cancer and non-breast 2nd primary tumor between the two treatment groups. Univariate Log-rank test identified the N stage and the involved axillary LN number as distinct prognostic factors that were highly predictive of treatment failure in both treatment groups. Additionally, marginal status in BCT and histologic nuclear grade in the mastectomy group were risk factors for treatment failure (p<0.05). CONCLUSION: Although further careful follow-up is necessary to confirm the trends evident in this series, it would appear that patterns of failure and survival rate following conservative surgery and radiotherapy in early breast cancer are similar to those following mastectomy. The great majority of patients with local recurrence had an exellent salvage rate in both treatment groups. Therefore, these preliminary short term results support BCT as an equally effective management for early breast cancer as an alternative to mastectomy.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Mastectomy* ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate* ; Treatment Failure

Authors report a case of intractable temporal lobe epilepsy recorded by the foramen ovale electrode and underwent standard temporal lobectomy including amygdalohippocampectomy. The foramen ovale electrode for analysis of seizures provides good neurophysiological information in candidates for resective surgery. Also the foramen ovale elctrode is a relatively simple free hand procedure and relatively nontraumatic to the brain. In conclusion, the foramen ovale electrode recording in the presurgical evaluation of intractable temporal lobe epilepsy might provide sufficient information to select a candidates for temporal lobectomy or selective amygdalohippocampectomy.
Brain ; Electrodes* ; Epilepsy, Temporal Lobe* ; Foramen Ovale* ; Hand ; Seizures ; Temporal Lobe*

Neuronal intestinal dysplasia in pediatric patients has similar clinical symptoms and often similar radiologic findings to those of Hirschsprung's disease. Yet neuronal intestinal dysplasia shows hyperplasia of the myenteric plexus for the pathology, and it requires different treatment compared with Hirschsprung disease. This disease has been reported many times in Europe but, to date, only one case has been reported in the radiologic literatures in Korea. We report here on a case of neuronal intestinal dysplasia that involved the entire colon in a two-month-old boy, and we include the radiographic findings.
Colon ; Europe ; Hirschsprung Disease ; Humans ; Hyperplasia ; Infant* ; Korea ; Male ; Myenteric Plexus ; Neurons* ; Pathology

Neuronal intestinal dysplasia in pediatric patients has similar clinical symptoms and often similar radiologic findings to those of Hirschsprung's disease. Yet neuronal intestinal dysplasia shows hyperplasia of the myenteric plexus for the pathology, and it requires different treatment compared with Hirschsprung disease. This disease has been reported many times in Europe but, to date, only one case has been reported in the radiologic literatures in Korea. We report here on a case of neuronal intestinal dysplasia that involved the entire colon in a two-month-old boy, and we include the radiographic findings.
Colon ; Europe ; Hirschsprung Disease ; Humans ; Hyperplasia ; Infant* ; Korea ; Male ; Myenteric Plexus ; Neurons* ; Pathology

Recent research has led to the discovery and characterization of a hormone secreted by the atria that has powerful vasopressive and natriuretic properties. Various atrial natriuretic peptides(ANP) were isolated and synthetized, and the effects were investigated by many workers. This study was attempted to access the effects of high dose morphine anesthesia on the plasma ANP level, renin activity and renal function in patients with cardiac surgery. Anesthesia was induced with morphine and maintained with 50% nitrous oxide in oxygen. Supple-mentary dose of morphine was given during the anesthesia according to responses of patients. The results were as follows: 1) The blood pressure and heart rate were not chaged significantly during anesthesia compared with the control values. 2) There was no statistically signigicant difference of plasma ANP level compared with the control values. 3) The plasma concentration of renin was markedly elevated after 30 minutes of induction time and sustained it during the anesthesia. Recovery to normal range of plasma renin concentration was observed after 2 days of surgery. This change is much the same as the other anesthetic methods. 4) Tendency of decreasing urine volume was shown just after the induction period but restored to control level immediately. 5) The renal excretory rate of sodium chloride and fractional excretion of sodium was significantly decreased during anesthesia and restored to control level after surgery. These results show that morphine anesthesia dose not produce significant alteration of both ANP and renin-angiotensin system.
Anesthesia* ; Atrial Natriuretic Factor* ; Blood Pressure ; Heart Rate ; Humans ; Morphine* ; Nitrous Oxide ; Oxygen ; Plasma* ; Reference Values ; Renin* ; Renin-Angiotensin System ; Sodium ; Sodium Chloride ; Thoracic Surgery*

Pernicious anemia is a macrocytic anemia that is caused by vitamin B12 deficiency, itself a result of the absence of intrinsic factors due to autoimmune destruction of parietal cells. We report here the case of a 43-year-old female with spontaneous remission of pernicious anemia. The patient presented with fatigue. Her serum vitamin B12 level was low, hemoglobin level was 7.6 g/dL, and serologic tests for anti-intrinsic factor and anti-parietal cell antibodies were positive. We diagnosed her with pernicious anemia, but did not administer vitamin B12 because her hemoglobin level increased spontaneously. Since then, the patient's hemoglobin and serum vitamin B12 levels have been within the normal range.
Adult ; Anemia, Macrocytic ; Anemia, Pernicious* ; Antibodies ; Fatigue ; Female ; Humans ; Intrinsic Factor ; Rabeprazole ; Reference Values ; Remission, Spontaneous* ; Serologic Tests ; Vitamin B 12 ; Vitamin B 12 Deficiency

Histoacryl(R) (n-butyl-2-cyanoacrylate) has been used successfully for the treatment of gastric variceal bleeding. The reported complications of Histoacryl(R) injection therapy include bleeding, perforation, stenosis and embolism. Here we describe a case of splenic infarction as an unusual complication of Histoacryl(R) injection. A 51-year-old male patient with liver cirrhosis was admitted due to acute gastric varix bleeding. Sclerotherapy was successfully carried out using Histoacryl(R) mixed with lipiodol (2.6 mL). 4 days later, he complained left upper quadrant pain and developed a fever of 38.2degrees C. Abdominal CT showed wedge-shaped hypodense area in the spleen compatible with infarction. He was treated conservatively. The fever and abdominal pain gradually subsided and he was discharged without significant problems.
Abdominal Pain ; Constriction, Pathologic ; Embolism ; Esophageal and Gastric Varices* ; Ethiodized Oil ; Fever ; Hemorrhage* ; Humans ; Infarction ; Liver Cirrhosis ; Male ; Middle Aged ; Sclerotherapy ; Spleen ; Splenic Infarction* ; Tomography, X-Ray Computed

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. METHODS: The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). RESULTS: The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index <0.70). CONCLUSIONS: The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.
APACHE* ; Calibration ; Cohort Studies ; Comorbidity ; Critical Care ; Discrimination (Psychology) ; Hospital Mortality ; Intensive Care Units ; Korea ; Mortality* ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; Risk Factors ; ROC Curve ; Tertiary Care Centers* ; Triage

PURPOSE: This retrospective study was performed to evaluate the effect of postoperative adjuvant radiation therapy of breast cancer on survival, failure patterns and to identify unfavorable prognostic factors. MATERIALS AND METHODS: Seventy-seven patients were analysed retrospectively. Median follow up period was 72 months. According to AJCC system, fifty-eight patients (75%) were advanced than Stage IIb. Among 77 patients, 66 patients (86%) received mastectomy and axillary LN dissection and the other 11 patients (14%) received partial mastectomy and axillary LN dissection. Postoperative radiation therapy with 6 MV X-ray was given to the chest wall and regional lymphatics with total dose of 50 to 55 Gy. Fifty-five patients (71%) received CMF or CAF chemotherapy prior to or after radiation therapy. RESULTS: The 5 year and 10 year survival rate were 64.4% and 51.3%, respectively and 5 year and 10 year disease free survival rate were 57.6% and 47.5%, respectively. Median survival duration was 91 months. Of the 77 patients, 59 patients were evaluable for pattern of failure. Of these, eighteen patients (31%) failed. Initial failure pattern was as follow: 7 (12%) at locoregional, 3 (5%) in distant metastasis, 8 (14%) with locoregional and distant metastasis. But the pattern of final failure at the time of last follow up was contrasted. Distanf failure was the predominant pattern of failure with 29% of patients. Overall survival and disease free survival was significantly influenced by 6 factors with univariated analysis (p<0.05): AJC Stage, T stage, N Stage, number of involved axilliary LN, SCL LN mets, failure pattern. By multivariate analysis the survival difference continued to be significant in 3 factors : T stage, number of involved axillary LN, failure pattern. CONCLUSION: These data demonstrate high locoregional control and survival rate using the combination of surgery and radiotherapy for the patients with locally advanced breast cancer. But predominant failure pattern was distant dissemination. Therefore more effective systemic therapy is needed to improve overall survival.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Mastectomy ; Mastectomy, Segmental ; Multivariate Analysis ; Neoplasm Metastasis ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Thoracic Wall

PURPOSE: We undertook this study to evaluate the usefullness of radiologic placement of subcutaneous infusion ports (SIP). MATERIALS AND METHODS: Between August 1999 and May 2000 we performed 45 implantations of SIP in radiologic suite. Both sonography and fluoroscopy were used for venipuncture and to guide port insertion. We prospectively evaluated 45 systems in 45 patients with solid tumors. RESULTS: Median follow-up time was 189 days (61~352 days). Technical success rate is 100% without any venipuncture-related complications. Early complication rate within 30 days of procedure was 4.4%, including wound dehiscence (n=1) and pocket hematoma and local infection (n=1). Catheter-related infection rate was 6.7% and catheter-related venous thrombosis rate was 4.4%. Mean duration of catheter use was 208 96 days (total, 9,381 days). Overall port survival rate was 38.5%, and four systems (8.9%) were prematurely removed because of catheter tunnel infection (n=1), pocket infection (n=1), and central venous thrombosis (n=2). CONCLUSION: Radiologic placement of SIP had higher success rate and equal or lower complication rate compared with reported conventional surgical technique using anatomical landmarks. Moreover, clinical convenience, resulting from ease of scheduling could make it replace surgical method.
Catheter-Related Infections ; Catheters ; Fluoroscopy ; Follow-Up Studies ; Hematoma ; Humans ; Infusions, Subcutaneous* ; Phlebotomy ; Prospective Studies ; Survival Rate ; Venous Thrombosis ; Wounds and Injuries