PURPOSE: Oncoplastic breast conserving surgery is a new concept in breast cancer surgery. We performed immediate latissimus dorsi flap reconstruction after breast conserving surgery (BCS) to get an adequate resection margin and a good cosmetic results. The aim of this study is to evaluate the effect of immediate latissimus dorsi flap reconstruction after BCS. METHODS: From January to December, 2007, we performed BCS and immediate latissimus dosi myocutaneous flap reconstruction for 44 breast cancer patients. We evaluated the status of the post operative resection margin, the complications and the cosmetic results. The cosmetic results were evaluated with paying particular attention to the symmetry of the breasts, the breast shape, the location of the nipple and the post-operative scar by a three person panel that consisted of one doctor and two nurses. RESULTS: Reoperation was performed in 3 patients out of 44 (6.8%) because of positive resection margin. Flap complications didn't occurred and donor-site complications such as seroma occurred in only 3 cases. The mean score for the overall cosmetic outcome by the panel was 7.03 (SD=1.36) out of 10 and the cosmesis was deemed to be fair for 52% and, good for 48%. The mean subjective score by the patients was 6.5 (SD=2.29) out of 10 and the cosmesis was deemed to be poor for 14%, fair for 46% and, good for 40%. The most influential factors for the overall cosmetic results were breast symmetry and shape, and the breast scar in descending order (p<0.05). CONCLUSION: BCS with immediate latissimus dorsi flap reconstruction allows an adequate resection margin and good cosmetic results without serious complications.
Breast ; Breast Neoplasms ; Cicatrix ; Cosmetics ; Female ; Humans ; Mammaplasty ; Mastectomy, Segmental ; Nipples ; Reoperation ; Seroma

PURPOSE: PET/CT is useful in preoperative evaluation of invasive breast cancer (IBC) to predict axillary metastasis and staging workup. The usefulness is unclear in cases of ductal carcinoma in situ (DCIS) diagnosed at biopsy before surgery, which sometimes is upgraded to IBC after definitive surgery. The aim of this study is to find out the usefulness of PET/CT on DCIS as a preoperative evaluation tool. METHODS: We investigated 102 patients preoperatively diagnosed with DCIS who subsequently underwent definitive surgery between 2010 and 2015. The uptake of 18F-fluorodeoxyglucose was graded by visual and semiquantitative methods. We analyzed the maximum standardized uptake value (SUVmax) of each patient with clinicopathologic variables. We determined optimal cutoff values for SUVmax by receiver operating characteristic curve analysis. RESULTS: Fifteen cases out of 102 cases (14.7%) were upgraded to IBC after surgery. The SUVmax was higher in patients upgraded to IBC (mean: 2.56 vs. 1.36) (P = 0.007). The SUVmax was significantly higher in patients who had symptoms, palpable masses, lesions over 2 cm in size and BI-RAD category 5. Both visual and semiquantitative analysis were significant predictors of IBC underestimation. SUVmax of 2.65 was the theoretical cutoff value in ROC curve analysis in predicting the underestimation of IBC. The underestimation rate was significantly higher in patients with SUVmax >2.65 (P < 0.001), over the moderate enhanced uptake on visual analysis (P < 0.001). CONCLUSION: PET/CT can be used as a complementary evaluation tool to predict the underestimation of DCIS combined with the lesion size, palpable mass, symptomatic lesion, and BI-RAD category.
Biopsy ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Neoplasm Metastasis ; Positron-Emission Tomography and Computed Tomography ; ROC Curve

Epidemiological studies typically examine the causal effect of exposure on a health outcome. Standardization is one of the most straightforward methods for estimating causal estimands. However, compared to inverse probability weighting, there is a lack of user-centric explanations for implementing standardization to estimate causal estimands. This paper explains the standardization method using basic R functions only and how it is linked to the R package stdReg, which can be used to implement the same procedure. We provide a step-by-step tutorial for estimating causal risk differences, causal risk ratios, and causal odds ratios based on standardization. We also discuss how to carry out subgroup analysis in detail.

PURPOSE: To evaluate the effect of corneal flap thickness on visual prognosis and complications in LASIK. METHODS: A total of 251 eyes of 129 patients who had been followed up for 6 months or more after LASIK were evaluated retrospectively. The eyes were classified into two groups: group A of 34 eyes with corneal flap thickness of 100 m or less and group B of 217 eyes with corneal flap thickness of more than 100 m. Clinical outcomes, including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), spherical equivalent (SE), myopic regression and complications, were compared between the two groups. RESULTS: In groups A and B, UCVA improved from 0.08 +/- 0.04 and 0.08 +/- 0.02 before surgery to 0.84 +/- 16 and 0.88 +/- 21 6 months after surgery, and SE changed from -6.36 +/- 2.46D and 6.07 +/- 2.81D to 0.29 +/- 0.72D and -0.17 +/- 0.81D 6 months after surgery, respectively, but there were no statistically significant differences between the two groups. BCVA, myopic regression and the incidence of complications also did not show any statistical difference. CONCLUSIONS: LASIK can be performed safely under thin corneal flaps of 100 m or less to leave enough residual corneal thickness.
Humans ; Incidence ; Keratomileusis, Laser In Situ* ; Prognosis ; Retrospective Studies ; Visual Acuity

OBJECTIVE: To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery. METHODS: We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb. RESULTS: All of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups. CONCLUSION: The results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball.
Arteriovenous Fistula* ; Blood Flow Velocity ; Exercise* ; Extremities ; Forearm* ; Hand Strength* ; Hand* ; Humans ; Pinch Strength ; Renal Dialysis ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Resistance Training ; Ultrasonography ; Veins

Leber's hereditary optic neuropathy (LHON) is a disease due to mitochondrial DNA mutations. We report a man with LHON, who presented with four episodes of respiratory failure. In the last episode, he had a loss of the automatic component of the respiratory drive but retained the voluntary component. Brain MRI showed lesions in the midbrain, pons, and medulla oblongata, involving the neuroanatomic areas of the medullary respiratory center. Our patient provides a further example of the broad manifestations of mitochondrial disease.
Brain ; DNA, Mitochondrial ; Humans ; Magnetic Resonance Imaging ; Medulla Oblongata ; Mesencephalon ; Mitochondrial Diseases ; Optic Atrophy, Hereditary, Leber* ; Pons ; Respiratory Center ; Respiratory Insufficiency*

PURPOSE: To report a case of squamous cell carcinoma of lacrimal sac which has never been reported in Korea so far to our knowledge. METHODS: A 55-year-old male who had a history of epiphora for three years and palpable mass along the inferomedial aspect of the right medial canthus for 3months underwent surgical excision of the mass and dacryocystorhinostomy, and postoperative adjuvant radiation therapy was followed after surgical excision. RESULTS: Pathologic diagnosis of the excised mass was well differentiated squamous cell carcinoma. There is no evidence of recurrence until postoperative 9 months and the patient shows good clinical course with normal visual acuity. CONCLUSIONS: Despite its lower incidence, primary tumor of the lacrimal sac is usually malignant with high tendency of recurrence and fatality. Clinician should have a high suspicion of this disease on the patients who have epiphora and lacrimal sac mass, and perform early surgical excision and pathologic diagnosis. In this study, we experienced a rare case of squamous cell carcinoma of lacrimal sac.
Carcinoma, Squamous Cell* ; Dacryocystorhinostomy ; Diagnosis ; Humans ; Incidence ; Korea ; Lacrimal Apparatus Diseases ; Male ; Middle Aged ; Recurrence ; Visual Acuity

OBJECTIVE: We describe a systematic review and meta-analysis of the performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting metastasis in ovarian cancer. METHODS: MEDLINE and Embase were searched for diagnostic accuracy studies that used 18F-FDG PET or PET/CT for pre-treatment staging, using surgical findings as the reference standard. Sensitivities and specificities were pooled and plotted in a hierarchic summary receiver operating characteristic plot. Potential causes of heterogeneity were explored through sensitivity analyses. RESULTS: Eight studies with 594 patients were included. The overall pooled sensitivity and specificity for metastasis were 0.72 (95% confidence interval [CI]=0.61–0.81) and 0.93 (95% CI=0.85–0.97), respectively. There was considerable heterogeneity in sensitivity (I2=97.57%) and specificity (I2=96.74%). In sensitivity analyses, studies that used laparotomy as the reference standard showed significantly higher sensitivity and specificity (0.77; 95% CI=0.67–0.87 and 0.96; 95% CI=0.92–0.99, respectively) than those including diagnostic laparoscopy (0.62; 95% CI=0.46–0.77 and 0.84; 95% CI=0.69–0.99, respectively). Higher specificity was shown in studies that confirmed surgical findings by pathologic evaluation (0.95; 95% CI=0.90–0.99) than in a study without pathologic confirmation (0.69; 95% CI=0.24–1.00). Studies with a lower prevalence of the FDG-avid subtype showed higher specificity (0.97; 95% CI=0.94–1.00) than those with a greater prevalence (0.89; 95% CI=0.80–0.97). CONCLUSION: Pre-treatment 18F-FDG PET/CT shows moderate sensitivity and high specificity for detecting metastasis in ovarian cancer. With its low false-positive rate, it can help select surgical approaches or alternative treatment options.
Electrons* ; Fluorodeoxyglucose F18 ; Humans ; Laparoscopy ; Laparotomy ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Population Characteristics ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Prevalence ; ROC Curve ; Sensitivity and Specificity

No abstract available.
Nystagmus, Congenital ; Turner Syndrome

No abstract available.
Stroke ; Subclavian Artery