Purpose: Breast cancer is the second most common malignancy in Korean women, and its incidence has increased rapidly. The purpose of this study was to evaluate the treatment outcomes of patients with breast cancer treated at a low volume center. Methods: We retrospectively analyzed 401 patients with stage I-III breast cancer at Chosun University Hospital from January 1998 to December 2013. We reviewed medical records including clinical information and pathologic reports. Results: We found 401 cases of newly diagnosed breast cancer, including 5 (1.2%) male breast cancer patients. According to histological features, there were 43 cases (ductal carcinoma in situ (DCIS): 35 cases [8.7%], lobular carcinoma in situ (LCIS): 8 cases [2.0%]) of non-invasive carcinoma, 350 cases (87.3%) of invasive carcinoma, 2 cases (0.5%) of Paget’s disease, 1 case (0.2%) of malignant phyllodes tumor, 3 cases (0.7%) of sarcoma, and 2 cases (0.5%) of other types. With respect to disease stage, 117 (29.2%) patients were in stage I, 176 (43.9%) in stage II, and 78 (19.4%) in stage III. The type of surgical approaches were breast-conserving surgery (153, 38.2%), modified radical mastectomy (243, 60.6%), wide excision (4, 1.0%), and others (1, 0.2%). Five-year disease-free survival rates were 100% (stage 0), 95.4% (stage I), 91.4% (stage IIa), 75% (stage IIb), 78% (stage IIIa), 50% (stage IIIb), and 59.2% (stage IIIc). Overall survival rates were 100% (stage 0), 96.2% (stage I), 94.3% (stage IIa), 85.4% (stage IIb), 84.8% (stage IIIa), 50% (stage IIIb), and 55.5% (stage IIIc). Conclusion Although the patients were treated at a low-volume center, their favorable survival outcomes are notable. Further multicenter (low-volume centers) research is warranted.

OBJECTIVE: Stenotrophomonas maltophilia has been emerging as an important nosocomial pathogen in recent years in patients with impaired host- defense mechanism or who has been exposed to large amount of inocula. This organism is usually resistant to multiple (commonly used) antimicrobial agents, particularly to those of the beta-lactam class. To evaluate the clinical feature of Stenotrophomonas maltophilia infection and in vitro anti- microbial susceptibility, we performed a retrospective study. METHODS: We analyzed the result of in vitro antimicrobial susceptibility test for 200 isolates of S. maltophilia and the annual isolation rate during the period between January 1990 and December 1994 in our institution, and performed a retrospective study for the available records of 165 cases among them. The data were obtained with only the first isolation of the organism for each patients. RESULTS: Total of 165 initial isolates, the isolates were from wounds in 50(30.3%), urine in 47(28.5%), the respiratory tract in 37(22.4%), blood in 9(5.5%), bile in 6(3.6%), and miscellaneous sources in 16(9.7%). The 84.2% of isolates were hospital-acquired isolate and 58.3% of these patients had received antecedent antibiotic therapy: polymicrobial growth was demonstrated in 61.9% of the cases. In vitro antimicrobial susceptibiiity test, ofloxacin was active against the isolates in 89.2%, moxalactam in 85.9%, ciprofloxacin in 83.9%, TMP-SMX(trimethoprim-sulfamethoxazole) in 64.2%, As expected, S. maltophilia isolates were, in general, not susceptible to cephalosporins, penicillins. The annual isolation rate at Kyung Hee University hospital was not increased significantly from 1990 to 1994, 19.53 per 10,000 patients dismissals in 1990, 13.56 in 1994. The major underlying diseases of patients were malignancy(17.6%), cerebrovascular disorder(17%), diabetic mellitus(13.3%). Mortality rate is 10.3%. CONCLUSION: S. maltophilia has been emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy. And this organism is resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class. When antimicrobial treatment is necessary, the clinician should be guided by results of in vitro susceptibility testing because of the notable in vitro resistance of S. maltophilia to commonly used antibiotics. And when S. maltophilia has been recovered from a patient, wound and contact isolation is warranted.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bile ; Cephalosporins ; Ciprofloxacin ; Humans ; Immunocompromised Host ; Mortality ; Moxalactam ; Ofloxacin ; Penicillins ; Respiratory System ; Retrospective Studies ; Stenotrophomonas maltophilia ; Stenotrophomonas* ; Wounds and Injuries

PURPOSE: We performed 3-channel single incision laparoscopic cholecystectomy (SILC) in earlier period of this study and modified our method to 4-channel SILC using a snake retractor for better operative field in later period. This study has been designed to evaluate the risk factors for prolonged operative time in SILC. METHODS: From April 2010 to August 2014, 323 cases of 3-channel SILC (Konyang standard method [KSM] group) and 399 cases of 4-channel SILC (modified KSM [mKSM] group) using a snake retractor were performed. RESULTS: The clinical characteristics were not significantly different between KSM and mKSM group except preoperative percutaneous transhepatic gallbladder drainage (PTGBD) treatment (9.6% vs. 16.5%, P < 0.007). The mean operation time was longer in mKSM group than KSM group (55.8 +/- 19.7 minutes vs. 51.7 +/- 20.1 minutes, P = 0.006). The estimated blood loss of KSM group was more than mKSM group (24.6 +/- 54.1 mL vs. 16.9 +/- 27.0 mL, P = 0.013). According to the histopathologic findings, acute cholecystitis or empyema were confirmed more in mKSM group as compared with KSM group (28% vs. 14.0%, P = 0.025). In multivariate analysis, the risk factors for prolonged operation time were drainage insertion, histopathologic findings (acute cholecystitis or empyema), surgeons' technical expertise, body mass index > 30 kg/m2 as well as the 4-channel SILC. CONCLUSION: Among patients with these risk factors, conventional laparoscopic cholecystectomy could be considered as well although SILC might be safe and feasible modality for benign gallbladder disease.
Body Mass Index ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Empyema ; Gallbladder ; Gallbladder Diseases ; Humans ; Laparoscopy ; Multivariate Analysis ; Operative Time* ; Professional Competence ; Risk Factors* ; Snakes

OBJECTIVE: To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on neurological and functional recovery in patients with central cord syndrome (CCS) involving the upper extremities between the treated and non-treated sides of the treated group and whether the outcomes are comparable to that of the untreated control group. METHODS: Nineteen CCS patients were treated with high-frequency (20 Hz) rTMS over the motor cortex for 5 days. The stimulation side was randomly selected, and all the subjects received conventional occupational therapy during the rTMS-treatment period. Twenty CCS patients who did not receive rTMS were considered as controls. Clinical assessments, including those by the International Standard for Neurological Classification of Spinal Cord Injury, the Jebsen-Taylor Hand Function Test, and the O'Connor Finger Dexterity Test were performed initially and followed up for 1 month after rTMS treatment or 5 weeks after initial assessments. RESULTS: The motor scores for upper extremities were increased and the number of improved cases was greater for the treated side in rTMS-treated patients than for the non-treated side in rTMS-treated patients or controls. The improved cases for writing time and score measured on the Jebsen-Taylor Hand Function Test were also significantly greater in number on the rTMS-treated side compared with the non-treated side and controls. There were no adverse effects during rTMS therapy or the follow-up period. CONCLUSION: The results of the application of high-frequency rTMS treatment to CCS patients suggest that rTMS can enhance the motor recovery and functional fine motor task performance of the upper extremities in such individuals.
Central Cord Syndrome ; Classification ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Motor Cortex ; Occupational Therapy ; Spinal Cord Injuries ; Task Performance and Analysis ; Transcranial Magnetic Stimulation ; Upper Extremity ; Writing

Objective: To investigate the comprehensive outcomes in aphasic patients, including their cognitive and functional status after ischemic or hemorrhagic stroke. It also aimed to clarify whether aphasia is a prognostic factor for cognitive and functional improvements in stroke patients. Methods: Sixty-seven ischemic or hemorrhagic stroke patients in the subacute stage who had been diagnosed with aphasia using the Korean version of Frenchay Aphasia Screening Test (K-FAST) were included in the study. Forty-six stroke patients without aphasia were used as controls. All patients were examined with the Korean version of the Western Aphasia Battery (K-WAB). Cognitive and functional assessments of the patients including the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of Modified Barthel Index (K-MBI) were performed during admission and 4 weeks after the initial assessments. Results: The initial and follow-up total K-MMSE and K-MBI scores were significantly lower in aphasic patients than in non-aphasic controls. The K-WAB scores highly correlated with the total K-MMSE scores at the follow-up stage in all aphasic stroke patients. The K-WAB scores moderately correlated with the follow-up scores of the K-MBI in ischemic stroke patients but not in hemorrhagic stroke patients. Conclusion Aphasia influences the cognitive and functional status of stroke patients and has a greater impact on cognitive improvement. Aphasia severity can be one of the prognostic factors for cognitive status in aphasic patients with stroke.

BACKGROUND: The aim of this study is to evaluate the clinical outcomes between anti-thymocyte globulin (ATG) and basiliximab induction in deceased donor kidney transplantation (DDKT). METHODS: Between May 2006 and February 2015, 40 patients underwent DDKT at our institution. Three cases (7.5%) of them were lost during the following-up schedule. In this study, ATG induction criteria were donor age >50 years old or donor creatinine level >1.3 mg/dL except hepatitis B virus positive and hepatitis C virus positive recipients. Recipients were divided into two groups: the ATG group (n=20) and the basiliximab group (n=17). RESULTS: The 1-year patient survival in the ATG group was 89.4% compared to 93.8% in the basiliximab group (P=0.989). Graft survival for a 1 year in the ATG and the basiliximab group was 89.1% and 93.8%, respectively (P=0.967). Incidences of acute rejection episodes were more prevalent in the basiliximab group (15.0% vs. 29.4%, P=0.428). The glomerular filtration rate level by period of recipients was not different in both group (12th month, 64.60+/-16.17 mg/dL vs. 68.51+/-18.60 mg/dL, P=0.544). The overall complications during the follow-up were not significantly different in both groups (90.0% vs. 76.5%, P=0.383). CONCLUSIONS: The results showed that there was no difference in the patient survival and graft survival between induction of ATG and basiliximab of the DDKT were not different. Therefore, use of both induction agents led to a good patient and graft survival and ATG might be a safe and preferable agent for relatively poor renal function of donor in kidney transplantation.
Antilymphocyte Serum* ; Appointments and Schedules ; Creatinine ; Follow-Up Studies ; Glomerular Filtration Rate ; Graft Survival ; Hepacivirus ; Hepatitis B virus ; Humans ; Incidence ; Kidney Transplantation* ; Tissue Donors*

OBJECTIVES: Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ. MATERIALS AND METHODS: Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level. RESULTS: BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and ‘responder group’ and ‘non-responder group,’ but there was no significant difference with the ‘worsened group.’ In addition, the age of the patients was a relative factor with BRONJ stage. CONCLUSION: With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.
Bisphosphonate-Associated Osteonecrosis of the Jaw* ; Busan ; Creatinine ; Diphosphonates ; Filtration ; Holidays ; Human Body ; Humans ; Kidney ; Oral and Maxillofacial Surgeons ; Osteomyelitis ; Renal Insufficiency, Chronic

BACKGROUND: Patent foramen ovale (PFO) is increasingly being recognized in stroke patients. The capability of transcranial Doppler (TCD) to detect a PFO has been established. We studied the frequency of PFO in patients with ischemic stroke. METHODS: Eighty-nine patients with ischemic stroke (62 men, mean age: 56.5) consecutively underwent a contrast-enhanced TCD with monitoring of the bilateral middle cerebral arteries (MCA). The contrast solution, which consisted of 8 ml of normal saline, 1 ml of air, and 0.2 ml of patient's blood, was injected twice during normal breathing and the Valsalva maneuver. High intensity transient signals (HITS) were counted for 30 seconds after the injection. RESULTS: Patent foramen ovale was detected in 19 patients (21%). The mean age was similar in those with (55 years) and those without (57 years) PFO. Patent foramen ovale was more frequent among men (26%) than women (11%). There were no differences in the frequency of PFO among stroke subtypes (large artery atherosclerosis, 18%; small artery occlusion, 27%; cardioembolic, 27%; undetermined cause, 11%). CONCLUSIONS: Patent foramen ovale is common in patients with ischemic stroke of all subtypes.
Arteries ; Atherosclerosis ; Female ; Foramen Ovale, Patent* ; Humans ; Incidence* ; Male ; Middle Cerebral Artery ; Respiration ; Stroke* ; Valsalva Maneuver

This correction is being published to correct the approval number of the Institutional Review Board in this article.

OBJECTIVES: Aeromonas species is a gram-negative, facultative anaerobe of the family Vibrionaceae. The organism has been recognized as a pathogen associated with illness in human, such as acute gastroenteritis, cellulitis, septicemia, and other rare diseases. METHODS: To evaluate the clinical significance of Aeromonas bacteremia in Korea and it's susceptibility of antibiotics, we evaluated the 17patients with Aeromonas bacteremia. Identification was done by use of API 20E system and antibiotic susceptibility was tested with disk diffusion method. RESULTS: Male to female ratio was 11:6, and mean age was 54.1years(8-85years) old. Liver cirrhosis was the most common underlying disease(10cases of 17patients, 58.8%a). Other underlying diseases were as follows: gallstone in 2cases, cholangiocarcinoma in 2cases, and aplastic anemia in 1case, cerebral infarction in 1case. But one had no underlying disease. So Aeromonas bacteremia were occurred in 14immunocompromised patients(82.3%), and in 10patients with hepatobiliary diseases, A. hydrophila was most commonly isolated(13cases, 764%), and the A sobria(4cases, 23.5%) was infrequently isolated. The overall fatality was 47%, and there had no significant difference in fatality between A. hydrophila and A sobria All Aeromonas species had resistance to ampicillin and carbenicillin. CONCLUSION: Because Aeromonas bacteremia may occur through water-borne route, especially in immunocompromised host. We should pay attention to immunocompromised patients, espacially having hepatobiliary disease.
Aeromonas* ; Ampicillin ; Anemia, Aplastic ; Anti-Bacterial Agents ; Bacteremia* ; Carbenicillin ; Cellulitis ; Cerebral Infarction ; Cholangiocarcinoma ; Diffusion ; Female ; Gallstones ; Gastroenteritis ; Humans ; Immunocompromised Host ; Korea ; Liver Cirrhosis ; Male ; Rare Diseases ; Sepsis ; Vibrionaceae