Nowadays shoulder ultrasound is commonly used in the assessment of shoulder diseases and is as accurate as magnetic resonance imaging in the detection of several pathologies. Operator dependence is the main disadvantage of shoulder ultrasound. After adhering to a strict examination protocol, good knowledge of normal anatomy and pathologic processes and an awareness of common pitfalls, it can be used as a focused examination providing rapid, real-time diagnosis, and treatment by ultrasound-guided interventions in desired clinical situations. Also shoulder ultrasound can help the surgeon decide whether treatment will be surgical or nonsurgical. If arthroscopy is planned, sonographic findings help to counsel patients regarding surgical and functional outcomes. If a nonsurgical approach is indicated, ultrasound can be used to follow patients. This review article presents the examination techniques, the normal sonographic appearances and the main pathologic conditions found in shoulder ultrasound. And also addresses a simplified approach to scanning and ultrasound-guided intervention. Knowledge of optimal techniques, normal anatomy, dynamic maneuvers, and pathologic conditions is essential for optimal performance and interpretation of images.
Arthroscopy ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Pathologic Processes ; Pathology ; Shoulder* ; Ultrasonography*

No abstract available.
Giant Cell Arteritis*

Pneumomediastinum is a relatively uncommon, infrequently reported entity, In the evaluation of these entity, it is important to exclude pathological causes, including Boerhaave's syndrome which carries a high mortality. Spontaneous pneumomediastinum is related to excessive intraalveolar pressure leading to rupture of perivascular alveoli in the setting of a Valsalva maneuver without communication to gut material. So, it has a benign self-limited course and rarely requires medical intervention. On the contrary, secondary pneumomediastinum caused by instrumental, traumatic, and spontaneous perforation of esophagus. Although the prognosis have been improved since the advent of broad-spectrum antibiotics and nutritional support, pneumomediastinum due to esophageal perforation still has a high morbidity and mortality. The most important prognostic factor is the time interval between perforation and initiation of therapy, and an awareness and a high clinical suspicion is critical in the early diagnosis and treatment. Recently, we have experienced 2 cases of pneumomediastinum, one case was spontaneous pneumomediastinum and the other may be caused by instrumental esophageal perforation. We report the clinical course of the patients with a current literature review.
Anti-Bacterial Agents ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Fibrinogen ; Humans ; Mediastinal Emphysema* ; Mortality ; Nutritional Support ; Prognosis ; Rupture ; Valsalva Maneuver

The posterior cruciate ligament is an anatomically and biomechanically complex structure. PCL injuries are reported to occur in 1-40% of acute knee injuries, with isolated PCL tear, less common than PCL tears combined with other Iigament injuries. Controversy exists concerning the geatment of the PCL injures. Recently, arthroscopic techniques of PCL reconstruction are becoming nore refined and reproducible. Between July 1993 and May 1995, 25 operations for PCL rupture were performed in our hospital. At the follow-up examinations we noted mild to moderate posterior instablilty which was not noted at the time of operation and during the immediate postoperative period. We reviewed type (if injuries, amplitude of initial posterior tibia1 translation, surgical techniques, which seemcd to be in relation ivith the postoperative instabilities. At final follow-up, the mean Lysholm knee score was 86 points, and the posterior tibial translation 6.5mm on posterior stress radiographs. The ligament augmentation device provided no benefit. The ideal positioning and fixation of the graft and protection of the graft from abrasion seemed to be important to get a good results.
Follow-Up Studies ; Knee ; Knee Injuries ; Ligaments ; Patellar Ligament* ; Posterior Cruciate Ligament ; Postoperative Period ; Rupture ; Transplants*

PURPOSE: The definition of locally advanced breast cancer (LABC) includes stage III breast cancer. In order to investigate the factors influencing on the final outcome we analysed the data of LABC patients that received neoadjuvant chemotherapy prior to definitive surgery. METHODS: 122 LABC patients, who underwent neoadjuvant chemotherapy between 1980 and 1997, were included for the analysis. Clinical responses to neoadjuvant chemother apy were classified as complete response (CR), partial response (PR), and no response (NR). Overall survival (OS), Loco-regional relapse free survival (LRRFS), and distant relapse free survival (DRRFS) probabilities were investigated according to initial clinical stage, clinical response to neoadjuvant chemotherapy, and pathologic stage after neo adjuvant chemotherapy. Statistical analyses were performed with chi2-test, Kaplan-Meier, and Cox-regression methods using SPSS. RESULTS: The mean age at diagnosis was 47 years old (range 31~73) and median follow-up period was 61.6 months (range 3~227 months). Among 122 LABC patients, 69 (56.6%) were included in stage IIIA, 37 (30.3%) in stage IIIB, and 16 (13.1%) in IIIC at diagnosis. 10 patients (8.2%) have shown CR, 85 (69.7%) patients PR, and the remaining 27 (22.1%) patients showed NR. The overall response rate to neoadjuvant chemotherapy was 77.5%. However, only 51 (41.8%) were demonstrated to have pathologically down-staged results. There were 32 loco-regional recurrences and 59 distant metastases. All of the initial clinical stage, clinical response to neoadjuvant chemotherapy, and pathologic stage influenced the final outcome of 10 year OS, LRRFS, DRFS. However, in multivariate analysis pathologic stage after neoadjuvant chemotherapy was the most influencing factor on the final outcome. CONCLUSION: Pathologic stage after neoadjuvant chemotherapy could be the most important prognostic factor of the LABC.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Diagnosis ; Drug Therapy* ; Follow-Up Studies ; Humans ; Middle Aged ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence

PURPOSE: A phyllodes tumor is a rare disease of the breast, which shows various clinicopathological aspects. However, there is some controversy over its clinical behavior, pathologic characteristics, and local recurrence rates. Therefore, the clinicopathological characteristics of phyllodes tumor and the risk factor that influence a local recurrence after surgery were analyzed. METHODS: The medical records of 56 patients with a phyllodes tumor who had undergone surgery at the Department of Surgery, Yonsei University, from 1986 to 1998, were analyzed retrospectively. The median follow up period was 57.2 months (12~245 months). The microscopic slides were re-examined and the pathologic criteria analyzed were cellular atypia, stromal cellularity, pleomorphism, necrosis, differentiation, tumor margin, and number of mitoses. The malignancy was reclassified using the histological criteria reported by Pietruszka et al. (benign was 0~4 mitoses/10 high- power fields, borderline 5~9 mitoses, and malignant more than 10 mitoses). The clinical features evaluated included age, preoperative diagnosis, tumor size, surgical methods, and local recurrence. RESULTS: The mean age was 41 years 14~69 years) and the mean tumor size was 4.5 cm (1~12 cm). Only 9 cases (16.1%) were preoperatively diagnosed as having a phyllodes tumor. The most commonly performed surgical procedures were local or wide excision (46 cases, 82.1%), and a mastectomy in 10 cases (17.9%). Out of 56 cases reviewed, 43 (76.8%) were confirmed as being a benign, 7 (12.5%) as being a borderline, and 5 (1.8%) as being a malignant phyllodes tumor. Cellular atypia was minimal in 40 cases (71.4%) and prominent in 14 cases (25.0%). The stromal cellularity was minimal in 32 cases (57.1%) and prominent in 23 cases (41.1%). Pleomorphism and necrosis were represented in only 1 case (1.8%). The tumor margin was infiltrating in 11 cases (19.6%) and pushing in 43 cases (76.8%). A local recurrence developed in 9 cases (16.1%). There were no dependable histopathological features to predict a local recurrence except for cellular atypia, stromal cellularity, and an infiltrating tumor margin. CONCLUSION: From the above results, the strong prognostic factors that can be used to predict a local recurrence appear to be cellular atypia, stromal cellularity, and an infiltrating tumor margin.
Breast ; Diagnosis ; Follow-Up Studies ; Humans ; Mastectomy ; Medical Records ; Mitosis ; Necrosis ; Phyllodes Tumor* ; Rare Diseases ; Recurrence* ; Retrospective Studies ; Risk Factors*

PURPOSE: In order to study the effect of body mass index (BMI) on the risk and the prognosis of breast cancers, we analyzed the BMI and clinico-pathological data of the breast cancer patients. We compared the BMIs of breast cancer patients to those of normal women and investigated the association of the BMI with the clinico-pathological data. Then the overall and disease-free survial probabilities were analyzed according to the BMI groups. METHODS: 1,201 breast cancer patients were available for the analysis of BMI and the BMI of the normal control women was adopted from the report of the National Health, Nutrition Survey of 1998. We classified the BMI groups by he World Health Organization classification as follows; BMI under 18.5 as under-weight group, 18.5-24.9 as the normal weight group, 25-30 as the overweight group, and over 30 as the obesity group. BMI was compared between the patient group and the control group by age, while the correlation between BMI and the clinico-pathological characteristics and the recurrence and survival rates for each BMI group were comparatively analyzed. The statistical analysis were performed using x2 test, one-way ANOVA, independent T-test, and one sample T test, and the survival probabilities were generated by Kaplan-Meier methods. RESULTS: The means of BMI increased by aging in both the patients and the control group. The means of BMI of the 30s and 50s were significantly lower in breast cancer patients than those of normal women (P=0.001, 0.002). However, those of 60s and 70s were higher in breast cancer patients with marginal significance (P=0.159). In the pre- menopausal patient group, BMI was associated with the tumor size (P=0.012) and the tumor stage (P=0.018). In the post-menopausal patients, on the other hand, BMI had positive relationship with well-differentiation of the tumor (P=0.025), and also showed a marginal association with estrogen receptor positivity (P=0.074). BMI did not influence on the outcome of premenopausal breast cancer patients but lower BMI (underweight group) showed poorer outcome in postmenopausal patients in terms of overall survival (P= 0.278), locoregional relapse-free survival (P=0.581), and distant relapse-free survival (P=0.040). CONCLUSIONS: As a breast cancer risk factor, BMI seems to have a different association by the age. Higher BMI for the 60s and 70s but lower BMI for the younger age group seems to be a risk factor for the breast cancer development. In terms of the relationship with the clinico-pathological characteristics, BMI has different association by the menopausal status. BMI did not influence on the outcome of premenopausal breast cancer patients but lower BMI (underweight group) showed significantly poorer outcome in postmenopausal patients.
Aging ; Body Mass Index* ; Breast Neoplasms* ; Breast* ; Classification ; Estrogens ; Female ; Hand ; Humans ; Nutrition Surveys ; Obesity ; Overweight ; Prognosis ; Recurrence ; Risk Factors ; Survival Rate ; World Health Organization

PURPOSE: The use of mammographic screening has led to the early detection of breast cancers as well as the increasing incidence of ductal carcinoma in situ (DCIS) and DCIS with microinvasion (MI). The biologic behaviors and management of DCIS and DCIS with MI remain uncertain and controversial. We designed this study to investigate the differences in clinical behavior and association with pathological parameter of both DCIS and DCIS with MI. METHODS: DCIS with MI was defined as DCIS with and invasive area of 1 mm or less in greatest dimension. We analyzed and compared the clinico-pathological features and treatment outcomes of 155 DCIS patients and 73 DCIS with MI patients. Chi-square test, student t-test and Kaplan-Meier method using SPSS 9.0 for MS-windows were used to verify the statistical significance. RESULTS: Both DCIS with MI and DCIS were most prevalent in women in the fifth decade, and the mean ages of the two groups were 45.0 and 46.8 years old, respectively. The primary tumors of DCIS with MI were more palpable (72.6% vs. 56.8%, P=0.032) upon physical examination and larger (3.1+/-0.21 cm vs. 2.6+/-0.12 cm, P=0.037) than those of the DCIS group. The rate of axillary lymph node metastasis was higher in the DCIS with MI group (8.3% vs. 0.7%, P=0.003). The DCIS with MI group was more commonly associated with high nuclear grade (50% vs. 28%, P=0.028). The DCIS with MI group was also linked with comedo type, although not to a statistically significant degree (67.6% vs. 52.6%, P=0.095). In terms of hormone receptor, there was no significant difference between the groups. There were three systemic metastases in DCIS patients and two DCIS with MI patients (P>0.05). There were no local-regional recurrences in either groups. The 8-year disease-free survival rates of the DCIS and DCIS with MI groups were 98.1% and 95.8% respectively (P>0.05). CONCLUSION: DCIS with MI has several clinical-pathological characterisitcs: more palpable on physical examination, larger in size, higher incidence of lesions with comedo necrosis and high nuclear grade. Examination of the axillary lymph node with less invasive techniques may be necessary in cases with suspicious invasion. Since DCIS with MI is thought to be a transitional disease entity between DCIS and invasive ductal carcinoma and has a metastatic potential, a careful histologic evaluation is necessary for the diagnosis of DCIS.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Diagnosis ; Disease-Free Survival ; Female ; Humans ; Incidence ; Lymph Nodes ; Mass Screening ; Necrosis ; Neoplasm Metastasis ; Physical Examination ; Recurrence

Two cases of human Echinostoma hortense infection were found in Seoul Paik Hospital. Their stools revealed echinostomatid eggs. After treatment with praziquantel (single does of 10-12 mg/kg) and purgation with magnesium salt, total 21 flukes were collected in one case. The flukes were 5.9-7.5 mm long, had 27-28 collar spines around their head, laterally deviated ovary and two tandem testes. They were identified as E. hortense Asada, 1926. The cases are 38-year and 20-year old men residing in Seoul, whose hometown is Chungsong-gun and Seungju-gun, Kyongsangbuk-do respectively. They had eaten raw flesh of various kinds of fresh water fishes (both cases) and/or salamander (latter case), which are considered possible sources of this fluke infection. They experienced abdominal discomfort and/or diarrhea. Hematology revealed 22 percent eosinophilia in the latter case, but it became 5 percent after the treatment. Echinostomatid eggs were not found after the treatment in both cases. These are the 4th and 5th human cases of E. hortense infection in Korea.
parasitology-helminth-trematoda ; Echinostoma hortense ; case report ; praziquantel ; intestine

PURPOSE: Mucinous carcinoma of the breast is relatively rare among the malignant breast lesions. It has distinctive pathological and behavioral characteristics to separate from other types of breast cancers. Accoding to the WHO definition, mucinous carcinoma of the breast is a carcinoma containing large amounts of extracellular epithelial mucus, sufficient to be visible grossly, and recognizable microscopically surrounding and within tumor cells. Mucinous carcinoma shows the characteristic features clinically and histologically because of the mucus production by the tumor. MATERIALS AND METHODS: We reviewed 29 cases of mucinous carcinoma that had been treated from 1985 to 1996 in the Department of General Surgery, Yonsei University College of Medicine. RESULTS: The results were as follows: The prevalent age group was the fifth decade (37.9%). The 27 cases were female and 2 were male. The most common sign and symptom was a palpable mass (100%). The most patients visited the hospital within 2 months of onset (55.2%). Most frequent tumor size was 2-3 cm in diameter, found in 10 cases (34.5%), and 13.8% of cases was more than 5 cm in diameter. The most frequent site of tumor was the upper outer quadrant in 16 cases (55.2%). The operations performed were as follows: Modified radical mastectomy (Auchincloss or Patey) in 24 cases (82.8%), quadrantectomy with axillary lymph node dissection in 4 cases (13.8%), simple mastectomy with lower axillar dissection in 1 cases (3.4%). Axillary lymph node metastasis was present in 3 cases (10.3%). The most common stage at diagnosis was stage IIa in 13 cases (44.8%). CONCLUSION: This study shows some characteristics of mucinous carcinoma of breast distinict from those previously proposed Further studies are needed to identify clinical parameters which characterize mucinous carcinoma of the breast.
Adenocarcinoma, Mucinous* ; Breast Neoplasms ; Breast* ; Diagnosis ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Mastectomy, Modified Radical ; Mastectomy, Simple ; Mucins* ; Mucus ; Neoplasm Metastasis