PURPOSE: In the WHO classification of breast carcinoma, invasive ductal carcinoma with predominant intraductal component (IDC with PIC) has been defined as carcinomas in which the component of ductal carcinoma in situ amounts to four times more than the invasive element in area. This study was designed to evaluate the clinicopathological significance of IDC with PIC. METHODS: Five hundred and seventy nine patients with breast cancer (154 IDC with PIC and 425 with T1 invasive ductal carcinomas) treated with mastectomy or breast conserving surgery between 1989 and 1998 at the Asan Medical Center were divided into two study groups (IDC with PIC and T1 IDC) and compared the clinicopathological characteristics and survival of both groups. RESULTS: By comparison with the T1 IDC, the IDC with PIC has several distinct features including younger mean age of occurrence (45.3 years vs 48.3 years, p=0.002), larger mean tumor size (3.5 cm vs 1.6 cm, p<0.001), lower incidence of axillary lymph node metastasis (15.7% vs 31.3%, p<0.001) and estrogen receptor positivity (45.7% vs 59.2%, p=0.03), higher incidence of low histologic grade (78.7% vs 61.7%, p=0.002) and cancer detection rate by screening without symptom (21.6% vs 11.5%, p=0.003) or clinical manifestation of nipple discharge (17.3% vs 4.3%, p<0.001) and microcalcification with or without mass on mammography (58.7% vs 30.2%, p<0.001). There were no significant difference in the cumulative 5-year overall and disease-freesurvival rates (93.1% vs 90.1%, p=0.78; 89.5% vs 86%, p=0.23). In the IDC with PIC group, tumors larger than 2 cm in size were more frequently metastasized to axillary lymph nodes than tumors smaller than 2 cm, but this finding was not significant (p=0.07). CONCLUSION: Invasive ductal carcinoma with predominant intraductal component showed less invasive and more low-grade malignant characteristics than T1 invasive ductal carcinoma. Survival was not statistically different.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating ; Chungcheongnam-do ; Classification ; Estrogens ; Humans ; Incidence ; Lymph Nodes ; Mammography ; Mass Screening ; Mastectomy ; Mastectomy, Segmental ; Neoplasm Metastasis ; Nipples

PURPOSE: In the WHO classification of breast carcinoma, invasive ductal carcinoma with predominant intraductal component (IDC with PIC) has been defined as carcinomas in which the component of ductal carcinoma in situ amounts to four times more than the invasive element in area. This study was designed to evaluate the clinicopathological significance of IDC with PIC. METHODS: Five hundred and seventy nine patients with breast cancer (154 IDC with PIC and 425 with T1 invasive ductal carcinomas) treated with mastectomy or breast conserving surgery between 1989 and 1998 at the Asan Medical Center were divided into two study groups (IDC with PIC and T1 IDC) and compared the clinicopathological characteristics and survival of both groups. RESULTS: By comparison with the T1 IDC, the IDC with PIC has several distinct features including younger mean age of occurrence (45.3 years vs 48.3 years, P=0.002), larger mean tumor size (3.5 cm vs 1.6 cm, P<0.001), lower incidence of axillary lymph node metastasis (15.7% vs 31.3%, P<0.001) and estrogen receptor positivity (45.7% vs 59.2%, P=0.03), higher incidence of low histologic grade (78.7% vs 61.7%, P=0.002) and cancer detection rate by screening without symptom (21.6% vs 11.5%, P=0.003) or clinical manifestation of nipple discharge (17.3% vs 4.3%, P<0.001) and microcalcification with or without mass on mammography (58.7% vs 30.2%, P<0.001). There were no significant difference in the cumulative 5-year overall and disease-free survival rates (93.1% vs 90.1%, P=0.78; 89.5% vs 86%, P=0.23). In the IDC with PIC group, tumors larger than 2 cm in size were more frequently metastasized to axillary lymph nodes than tumors smaller than 2 cm, but this finding was not significant (P=0.07). CONCLUSION: Invasive ductal carcinoma with predominant intraductal component showed less invasive and more low-grade malignant characteristics than T1 invasive ductal carcinoma. Survival was not statistically different.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating ; Chungcheongnam-do ; Classification ; Disease-Free Survival ; Estrogens ; Humans ; Incidence ; Lymph Nodes ; Mammography ; Mass Screening ; Mastectomy ; Mastectomy, Segmental ; Neoplasm Metastasis ; Nipples

PURPOSE: In spite of improved local control and adjuvant therapy in breast cancer, many patients after a modified radical mastectomy suffer from locoregional or systemic failure. The purpose of this study was to assess both the patterns of failure following a mastectomy and the predictive factors affecting the risks of locoregional or systemic failure. METHODS: The study population consisted of 195 patients who developed locoregional or systemic failure from among 1,187 patients treated by using a modified radical mastectomy between July 1989 and October 1998 at the Asan Medical Center's Breast Clinic. The median follow-up time following the mastectomy was 41 months (range; 1-119 months). RESULTS: Isolated locoregional recurrence (LRR) developed in 46 patients (24%), LRR with distant metastasis in 43 (22%), and only distant metastasis in 106 (54%). The sites of LRR were as follows: the chest wall, 52%; the ipsilateral supraclaviclar node, 22%; and the axillary node, 15%; etc. The first sites of distant metastasis were as follows: bone, 46%; lung, 38%; liver, 12%; brain, 6%; and pleura, 6%; etc. Local or systemic failure appeared within the first 3 years following the mastectomy in 75-82% of the patients, and within 5 years in 95-98%. Multivariate analysis showed that increasing initial tumor size, increasing number of involved nodes, negative progesterone receptor, and increasing histologic grade were significant factors for increased risks of LLR or distant metastasis. CONCLUSION: Half of the locoregional recurrences following a mastectomy are isolated. T-stage, nodal status, progesterone receptor, and histo logic grade may help to identify patients at risk for locoregional or systemic failure after a mastectomy.
Brain ; Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Follow-Up Studies ; Humans ; Liver ; Logic ; Lung ; Mastectomy* ; Mastectomy, Modified Radical ; Multivariate Analysis ; Neoplasm Metastasis ; Pleura ; Receptors, Progesterone ; Recurrence ; Risk Factors* ; Thoracic Wall

The bleeding pseudoaneurysm is a rare condition but one of the lethal complications in patients with chronic pancreatitis. Early diagnosis and emergent intervention can reduce mortality and promise better outcomes. We experienced a case of a bleeding pseudo- aneurysm in a chronic pancreatitis patient. The 44-year-old male was suffering from con- tinuous, vague epigastric pain and black tarry stool. An abdominal CT scan revealed a homogeneously enhancing round mass in the pancreatic pseudocyst, and celiac angi- ography found that a pseudoaneurysm had originated from the pancreaticoduodenal artery. The patient was treated with Whipple's operation and was later discharged, having improved in his condition.
Adult ; Aneurysm ; Aneurysm, False* ; Arteries ; Early Diagnosis ; Hemorrhage ; Humans ; Male ; Mortality ; Pancreatic Pseudocyst ; Pancreatitis, Chronic* ; Tomography, X-Ray Computed

The aim of this study was to investigate relationships between acute exacerbation and Forced Expiratory Volume 1 second (FEV1) improvement after treatment with combined long-acting beta-agonist (LABA) and inhaled corticosteroid (ICS) in patients with chronic obstructive pulmonary disease (COPD). A total of 137 COPD patients were classified as responders or nonresponders according to FEV1 improvement after 3 months of LABA/ICS treatment in fourteen referral hospitals in Korea. Exacerbation occurrence in these two subgroups was compared over a period of 1 yr. Eighty of the 137 COPD patients (58.4%) were classified as responders and 57 (41.6%) as nonresponders. Acute exacerbations occurred in 25 patients (31.3%) in the responder group and in 26 patients (45.6%) in the nonresponder group (P=0.086). FEV1 improvement after LABA/ICS treatment was a significant prognostic factor for fewer acute exacerbations in a multivariate Cox proportional hazard model adjusted for age, sex, FEV1, smoking history, 6 min walk distance, body mass index, exacerbation history in the previous year, and dyspnea scale.Three-month treatment response to LABA/ICS might be a prognostic factor for the occurrence of acute exacerbation in COPD patients.
Adrenal Cortex Hormones/*therapeutic use ; Adrenergic beta-2 Receptor Agonists/*therapeutic use ; Bronchodilator Agents/*therapeutic use ; Budesonide/therapeutic use ; Drug Therapy, Combination ; Female ; Fluticasone/therapeutic use ; Forced Expiratory Volume/drug effects/*physiology ; Formoterol Fumarate/therapeutic use ; Humans ; Male ; Pulmonary Disease, Chronic Obstructive/*drug therapy/physiopathology ; Recurrence ; Republic of Korea ; Salmeterol Xinafoate/therapeutic use ; Smoking ; Spirometry ; Treatment Outcome

BACKGROUND: Although the association of hyperuricemia with an increased risk of mortality has been demonstrated in the context of acute exacerbation of chronic obstructive pulmonary disease (COPD), the long-term outcomes of hyperuricemia have not been studied in the case of stable COPD.METHODS: We retrospectively analyzed baseline data of 240 men with stable COPD enrolled in the Korea Obstructive Lung Disease cohort. We evaluated associations between serum uric acid levels and clinical parameters, risk factors for all-cause mortality, and acute exacerbation of COPD.RESULTS: The mean age of subjects was 66.4 ± 7.7 years, and the median follow-up time was 5.9 years. We identified no significant difference in terms of lung function or laboratory findings between patients with hyperuricemia and those without. Serum uric acid level was negatively associated with systemic inflammation indicated by neutrophil–lymphocyte ratio (r = −0.211, P = 0.001). Univariate Cox regression analysis revealed hyperuricemia to not be associated with an increased risk of all-cause mortality in men with stable COPD (hazard ratio [HR], 0.580; 95% confidence interval [CI], 0.250–1.370; P = 0.213). In the multivariate Cox regression model, hyperuricemia was not an independent predictor of acute exacerbation (HR, 1.383; 95% CI, 0.977–1.959; P = 0.068).CONCLUSION: Among men with stable COPD, hyperuricemia is not an independent predictor of all-cause mortality or future acute exacerbation of COPD. These results differ from those of previous studies on patients with acute exacerbation of COPD.
Cohort Studies ; Follow-Up Studies ; Humans ; Hyperuricemia ; Inflammation ; Korea ; Lung ; Lung Diseases, Obstructive ; Male ; Mortality ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Uric Acid

BACKGROUND: Although the association of hyperuricemia with an increased risk of mortality has been demonstrated in the context of acute exacerbation of chronic obstructive pulmonary disease (COPD), the long-term outcomes of hyperuricemia have not been studied in the case of stable COPD. METHODS: We retrospectively analyzed baseline data of 240 men with stable COPD enrolled in the Korea Obstructive Lung Disease cohort. We evaluated associations between serum uric acid levels and clinical parameters, risk factors for all-cause mortality, and acute exacerbation of COPD. RESULTS: The mean age of subjects was 66.4 ± 7.7 years, and the median follow-up time was 5.9 years. We identified no significant difference in terms of lung function or laboratory findings between patients with hyperuricemia and those without. Serum uric acid level was negatively associated with systemic inflammation indicated by neutrophil–lymphocyte ratio (r = −0.211, P = 0.001). Univariate Cox regression analysis revealed hyperuricemia to not be associated with an increased risk of all-cause mortality in men with stable COPD (hazard ratio [HR], 0.580; 95% confidence interval [CI], 0.250–1.370; P = 0.213). In the multivariate Cox regression model, hyperuricemia was not an independent predictor of acute exacerbation (HR, 1.383; 95% CI, 0.977–1.959; P = 0.068). CONCLUSION Among men with stable COPD, hyperuricemia is not an independent predictor of all-cause mortality or future acute exacerbation of COPD. These results differ from those of previous studies on patients with acute exacerbation of COPD.

Cough is the most common respiratory symptom that can have various causes. It is a major clinical problem that can reduce a patient’s quality of life. Thus, clinical guidelines for the treatment of cough were established in 2014 by the cough guideline committee under the Korean Academy of Tuberculosis and Respiratory Diseases. From October 2018 to July 2020, cough guidelines were revised by members of the committee based on the first guidelines. The purpose of these guidelines is to help clinicians efficiently diagnose and treat patients with cough. This article highlights the recommendations and summary of the revised Korean cough guidelines. It includes a revised algorithm for the evaluation of acute, subacute, and chronic cough. For a chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered in differential diagnoses. If UACS is suspected, first-generation antihistamines and nasal decongestants can be used empirically. In cases with CVA, inhaled corticosteroids are recommended to improve cough. In patients with suspected chronic cough due to symptomatic GERD, proton pump inhibitors are recommended. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, intake of angiotensin-converting enzyme inhibitor, intake of dipeptidyl peptidase-4 inhibitor, habitual cough, psychogenic cough, interstitial lung disease, environmental and occupational factors, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and unexplained cough can also be considered as causes of a chronic cough. Chronic cough due to laryngeal dysfunction syndrome has been newly added to the guidelines.

Cough is the most common respiratory symptom that can have various causes. It is a major clinical problem that can reduce a patient’s quality of life. Thus, clinical guidelines for the treatment of cough were established in 2014 by the cough guideline committee under the Korean Academy of Tuberculosis and Respiratory Diseases. From October 2018 to July 2020, cough guidelines were revised by members of the committee based on the first guidelines. The purpose of these guidelines is to help clinicians efficiently diagnose and treat patients with cough. This article highlights the recommendations and summary of the revised Korean cough guidelines. It includes a revised algorithm for the evaluation of acute, subacute, and chronic cough. For a chronic cough, upper airway cough syndrome (UACS), cough variant asthma (CVA), and gastroesophageal reflux disease (GERD) should be considered in differential diagnoses. If UACS is suspected, first-generation antihistamines and nasal decongestants can be used empirically. In cases with CVA, inhaled corticosteroids are recommended to improve cough. In patients with suspected chronic cough due to symptomatic GERD, proton pump inhibitors are recommended. Chronic bronchitis, bronchiectasis, bronchiolitis, lung cancer, aspiration, intake of angiotensin-converting enzyme inhibitor, intake of dipeptidyl peptidase-4 inhibitor, habitual cough, psychogenic cough, interstitial lung disease, environmental and occupational factors, tuberculosis, obstructive sleep apnea, peritoneal dialysis, and unexplained cough can also be considered as causes of a chronic cough. Chronic cough due to laryngeal dysfunction syndrome has been newly added to the guidelines.

Social welfare services for respiratory-disabled persons in Korea are offered based on the respiratory impairment grade, which is determined by 3 clinical parameters; dyspnea, forced expiratory volume in 1 second (FEV1), and arterial oxygen tension. This grading system has several limitations in the objective assessment of respiratory impairment. We reviewed several guidelines for the evaluation of respiratory impairment and relevant articles. Then, we discussed a new grading system with respiratory physicians. Both researchers and respiratory physicians agreed that pulmonary function tests are essential in assessing the severity of respiratory impairment, forced vital capacity (FVC), FEV1 and single breath diffusing capacity (DLco) are the primarily recommended tests. In addition, we agreed that arterial blood gas analysis should be reserved for selected patients. In conclusion, we propose a new respiratory impairment grading system utilizing a combination FVC, FEV1 and DLco scores, with more social discussion included.
Blood Gas Analysis ; Disability Evaluation ; Dyspnea ; Forced Expiratory Volume ; Humans ; Korea ; Oxygen ; Pulmonary Diffusing Capacity ; Respiratory Function Tests ; Respiratory System ; Social Welfare ; Spirometry ; Vital Capacity