PURPOSE: The Mammotome(R) biopsy is a relatively new surgical technique that is a minimally invasive image-guided procedure, requiring a small incision that produces a barely noticeable scar. The technique is a useful method for the surgical biopsy of properly selected patients. We reviewed the pathology of the biopsies for the proper selection of a mammotome biopsy in patients with re-excised breast tumors. METHODS: During a 24-month period, we performed vacuumassisted breast biopsies for 277 likely benign breast lesions using ultrasound and fine-needle aspiration cytology or a core needle biopsy, in 203 patients. The age of the patients ranged from 15 to 67 yr (average age 36.6 yr), and the average size of the lesions was 2.39+/-1.06 cm (minimum size 0.5 cm, maximum size 5.0 cm). We retrospectively analyzed the pathological findings of the re-excised breast lesions. RESULTS: The pathology of ultrasound-guided vacuum biopsies of the benign-appearing breast lesions were fibroadenomas (69.7%), intraductal papillomas (6.1%), fibrocystic disease (7.9%), phyllodes tumors (2.9%), malignant tumors (1.4%), ductal hyperplasia (2.9%), and other benign diseases (9.1%). Re-excision by a conventional method was performed for nine patients. Reasons for re-excision were the presence of five proven malignancies (a malignant phyllodes tumor in 2 cases, a tubular carcinoma in 1 case, a papillary carcinoma in 1 case and a ductal carcinoma in situ [DCIS] in 1 case), a possible atypical ductal hyperplasia (ADH) malignancy, two marginal involvement in phyllodes tumors and the possible extension of a lesion as an atypical papilloma. In the re-excised specimens, residual tissues were noticed in eight cases. An ADH lesion was proven as a DCIS. CONCLUSION: A case of suggested marginal involvements and/or a possible malignancy should be re-excised because of the high possibility of remnant lesions being present after the mammotome biopsy. The cytological and pathological review must be performed precisely before performing the mammotome procedures with considering of the clinical and radiological findings.
Adenocarcinoma ; Biopsy* ; Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Breast Neoplasms ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Papillary ; Cicatrix ; Fibroadenoma ; Humans ; Hyperplasia ; Papilloma ; Papilloma, Intraductal ; Pathology ; Phyllodes Tumor ; Retrospective Studies ; Ultrasonography ; Vacuum

Paraduodenal hernias are a rare congenital malformation, but they are the most common internal hernias. They develop secondary to a failure in midgut rotation, which may lead to small bowel obstruction or other clinical manifestations. The authors recently experienced a case of a left paraduodenal hernia presenting with unusual symptoms of left flank pain and vomiting.
Adult ; Hernia/*complications/*diagnosis/pathology/surgery ; Humans ; Intestinal Obstruction/*etiology/surgery ; Male

Glycogen-rich clear cell carcinoma of the breast is a very rare malignancy whose incidence is about 1~3% of the total breast cancers. Histologic features are usually those of ductal carcinoma, but it contains the cells that is characterized by the abundant cytoplasm and centrally-located nuclei. We report a case of glycogen-rich clear cell carcinoma of the breast. The case is a 63-year-old woman with a palpable lump of the right breast. The operation is partial mastectomy with axillary lymph node dissection. The tumor consists of round or polygonal cells. The cell membranes are distinct, and the cytoplasm is clear. Most of the nulcei are centrally-located and hyperchromatic. The tumor cells are PAS positive and D-PAS negative. Immunohistochemically, the tumor cells are positive to the epithelial membrane antigen (EMA), and negative to vimentin, smooth muscle actin, desmin. Estrogen receptors are positive, but progesterone receptors are negative.
Actins ; Breast* ; Carcinoma, Ductal ; Cell Membrane ; Cytoplasm ; Desmin ; Female ; Humans ; Incidence ; Lymph Node Excision ; Mastectomy, Segmental ; Middle Aged ; Mucin-1 ; Muscle, Smooth ; Receptors, Estrogen ; Receptors, Progesterone ; Vimentin

An adenomyoepithelioma (AME) is an uncommon neoplasm characterized by proliferation of both epithelial and myoepithelial cells in the salivary gland, skin, lung and breast. AMEs can recur, progress to malignancy and metastasize. A 68-year-old woman presented a large mass occupying her whole right breast. The mass had grown slowly for about 20 years and the preoperative biopsy of the mass was chondroid syringoma. The mass was completely resected and the postoperative biopsy revealed malignant AME with a negative resection margin. The patient didn't receive any adjuvant therapy and has been free of recurrence or metastasis up to now. We report herein a case of a malignant AME that was diagnosed in the largest breast mass reported to date. This mass grew slowly and without metastasis. Clinicians should consider this rare disease entity in the differential diagnosis of a breast mass and remember the importance of complete excision of this tumor.
Adenoma, Pleomorphic ; Adenomyoepithelioma ; Aged ; Amphotericin B ; Biopsy ; Breast ; Diagnosis, Differential ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Rare Diseases ; Recurrence ; Salivary Glands ; Skin

The etiology of neural tube defects, a category encompassing spina bifida, anencephaly and encephalocele, remains highly controversial and unclear, However, there is overwhelming evidence supporting a multifactorial etiology for this group of defects. Recent studies have shown that folic acid supplements taken periconceptionally can reduce a woman's risk of having a child with a neural tube defect. Qenetic screening could identify women who will require folic acid supplements periconceptionally to reduce their risk of having a child with a neural tube defects. Recently, we encountered two cases of recurrent anencephaly that had occurted in a same pregnant woman in our hospital. We report these two cases with brief review of the literatures.
Anencephaly* ; Child ; Encephalocele ; Female ; Folic Acid ; Humans ; Mass Screening ; Neural Tube Defects ; Pregnant Women* ; Spinal Dysraphism

Purpose: After periodontal surgery, studies have found that the use of periodontal wound dressing reduces the risk of wound infection and increases healing. The purpose of this study is to evaluate the effect of attachable periodontal wound dressing on the healing and patient satisfaction after periodontal flap surgery. Materials and Methods: Twenty-eight patients requiring periodontal surgery underwent periodontal flap surgery on both quadrants of maxilla or mandible. Postoperative pain, bleeding, dietary discomfort and hypersensitivity in relation to attachable periodontal wound dressing was assessed using Visual Analogue Scale (VAS). Additional survey on frequency of burning sensation and overall satisfaction rates were assessed. Results: VAS mean values for pain, bleeding, and dietary discomfort depending on the presence and absence of attachable wound dressing were; pain: 2.82, 3.96 (P = 0.002), bleeding: 1.61, 2.54 (P = 0.008), dietary discomfort: 2.82, 4.18 (P < 0.001), respectively. Test groups with attachable wound dressing reported significantly lower rates of discomfort. No significant difference was observed in burning sensation and hypersensitivity related with wound dressing. Satisfaction was higher in 75% of patients who received wound dressing. Conclusion According to the results of this study, patients who received attachable periodontal wound dressing reported less postoperative pain, bleeding, and dietary discomfort. There was no statistical significance related to the use of wound dressing with burning sensation and hypersensitivity.

PURPOSE: Reduced growth and microvascular complications have been recognized as consequences of type 1 diabetes mellitus (T1DM). We assessed the effect of T1DM on growth and factors associated with the development of microvascular complications. METHODS: We conducted a retrospective longitudinal evaluation of 154 patients above 16 years of age. We analyzed factors which affect final height standard deviation scores (SDS) and development of microvascular complications. RESULTS: Final height SDS was -0.11+/-1.15 (-0.26+/-1.33 in females, 0.04+/-0.91 in males). Final height SDS was significantly lower than midparental height SDS and height SDS at diagnosis. There was no difference in final height SDS according to age at onset, existence or nonexistence of complications, or average HbA1C. Height SDS at onset of puberty, midparental height SDS and pubertal growth gain affected final height SDS. The number of patients with complications was 37 (24 percent). Microvascular complications developed at a younger age and after longer duration of diabetes in patients with a prepubertal onset of T1DM compared to patients with pubertal onset. Patients with complications had a higher level of average HbA1C than patients without complications. Patients whose microalbuminuria regressed had lower levels of average HbA1C, systolic BP, second 24h urine microalbumin than patients with persistant or progressed microalbuminuria. CONCLUSION: The results suggest that degrees of glycemic control don't affect final height, but various factors associated with T1DM can impair growth potential. Additionally, the degrees of glycemic control and puberty affect the development of microvascular complications.
Adolescent ; Diabetes Mellitus, Type 1* ; Diagnosis ; Female ; Humans ; Puberty ; Retrospective Studies

PURPOSE: To report some early experiences of ultrasonography-guided mammotome biopsy for solid breast lesions. MATERIALS AND METHODS: Sixty seven solid breast lesions in 59 patients aged 25 -77 (mean, 44.5) years were biopsied under ultrasound-guidance using an 11 gauge mammotome. The size and depth of the lesions, diagnostic accuracy achieved, complications, and merits and demerits of the device were evaluated. RESULTS: The lesions ranged in size from 0.5 to 8 (mean, 1.6)cm, and at their center the mean depth was 1.4 cm. For every lesion at least seven biopsies were performed, and the mean weight of extracted tissue was 0.44 gm. The lesions were located mainly at the at 12 o'clock area and upper inner quadrant of the left breast (n=10 for each area); they were also found in other regions fo both breasts, including subareolar areas. The histopathologic diagnosis was malignant in 26 lesions and benign in 39, and in one case, atypical ductal hyperplasia was diagnosed. One lesion contained no tumor cells. Twenty-four malignant lesions were surgically excised, and in 21 invasive ductal/lobular carcinomas and one ductal carcinoma in situ (DCIS) (91.7%) the initial and subsequent diagnosis correlated. One lesion diagnosed as DCIS and one whose invasiveness could not be initially determined were confirmed as invasive ductal carcinomas (8.3%). Follow-up ultrasonography involved six benign lesions and showed that five of these had become smaller. The complications noted were severe pain in three patients and a moderate amount of bleeding in two, but in all cases good control was achieved by interrupting the procedure or applying compression. The merits of the mammotome biopsy compared with the conventional core biopsy technique are higher diagnostic accuracy due to the larger amount of tissue extracted by suction and the large caliber of the needle, multiple biopsies achieved by one needle insertion, and less possibility of severe complications such as pneumothorax. Drytapping was a demerit of the device. Very small lesions could be extracted completely, and this may be a merit for benign lesions and a demerit for malignant lesions. For the latter, clips could be used. CONCLUSION: Ultrasonography-guided mammotome biopsy is a very accurate and safe method for the diagnosis of various breast lesions.
Biopsy* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Hyperplasia ; Needles ; Pneumothorax ; Suction ; Ultrasonography

PURPOSE: In newborns from mothers with Graves' disease, neonatal transient hyperthyroidism or hypothyroidism may develop early in life. We evaluated the incidence and prognosis of neonatal thyroid dysfunction in neonates born to mothers with hyperthyroidism during pregnancy. METHODS: We measured blood T4, T3, TSH levels and TSH-R-Ab titer in 48 hyperthyroid mothers and their babies between 1988 and 1994. RESULTS: The mean birth weight was 3.21+/-0.49kg and gestational age was 39+5 weeks and three neonates(6%) were small for gestational age and two(4%) were premature whose mother had hyperthyroidism during pregnancy. Eight of the neonates showed high levels of thyroid hormone and four showed low levels of thyroid hormone but none had symptom or sign. The neonatal thyroid function was not affected by maternal antithyroid medication and maternal TSH-R-Ab level. The positive rate of TSH-R-Ab was 44 percent in neonates. In the neonates with low T4 level, the mean TSH-R-Ab was 38.1+/-19.6%, which was higher than those in euthyroid(14.7+/-9.7%) or hyperthyroid(8.4+/-6.2%) neonates(p<0.05). The neonatal blood TSH-R-Ab levels was correlated with maternal TSH-R-Ab levels(r=0.50, p<0.05). Neonatal T4 didn't show any correlation with maternal TSH-R-Ab but showed negative correlation with neonatal TSH-R-Ab(r=-0.43, p<0.05). Neonates with high T4 showed normal thyroid function within 35 days(10-54days) in average. Neonates with low T4 showed normal thyroid function within 29 days(7-61days) in average. One of neonate with low T4 was given thyroid hormone for 1 month. No one with initial abnoraml thyroid function showed clinical problem through follow-up. CONCLUSIONS: It is likely that hyperthyroid mothers have more tendency of small babies for gestational age or premature babies. Neonates born to hyperthyroid mothers should be closely monitored because of possible abnormal thyroid function, as shown by this study. It is likely that TSH-R-Ab from hyperthyroid mother usually consists of blocking antibody, rather than stimulating antibody, which might cause hypothyroidism in the neonates.
Birth Weight ; Follow-Up Studies ; Gestational Age ; Graves Disease ; Humans ; Hyperthyroidism* ; Hypothyroidism ; Incidence ; Infant, Newborn* ; Mothers* ; Pregnancy ; Prognosis ; Thyroid Gland*

PURPOSE: This study evaluated the prevalence of the metabolic syndrome (MetS) and risk factors for metabolic derangement in young adults with childhood-onset hypopituitary growth hormone deficiency (ACOHGHD). METHODS: Thirty patients with ACOHGHD who were treated with hormone-replacement therapy, aged 18 to 29 years, who visited the Seoul National University Children's Hospital between September 2009 and February 2010 were enrolled. Height, weight, waist circumference, hip circumference, and blood pressure were measured, and the clinical and hormonal features were reviewed retrospectively. We evaluated measures of metabolic derangement in the enrolled patients and in the data of healthy adults aged 20 to 29 years taken from the 2005 Korean National Health and Nutrition Examination Survey (KNHANES) as part of the National Cholesterol Education Program-the Adult Treatment Panel III. RESULTS: Compared with the KNHANES participants, patients with ACOHGHD had significantly large waist circumference (men and women), high systolic blood pressure (BP) (women) and diastolic BP (men), and high serum triglyceride levels (women). The duration of illness correlated significantly with central obesity (r2=0.546, P=0.003). The prevalence of MetS was 10% in patients with ACOHGHD and 2.3% in KNHANES participants. The prevalence of central obesity and MetS was higher in patients with ACOHGHD than in KNHANES participants (P<0.001 and P=0.042, respectively). CONCLUSION: Abdominal obesity correlated with the duration of illness in patients with ACOHGHD. Waist circumference should be measured in the clinic to prevent MetS, particularly in patients with a long history of ACOHGHD, regardless of age or sex.
Adult ; Aged ; Blood Pressure ; Child ; Cholesterol ; Growth Hormone ; Hip ; Humans ; Hypopituitarism ; Nutrition Surveys ; Obesity, Abdominal ; Prevalence ; Retrospective Studies ; Risk Factors ; Waist Circumference ; Young Adult