BACKGROUND: Generally, it has been thought that the prognosis of breast cancer in young women is worse than that in their older counterparts. This, however, remains controversial. The purpose of this study was to evaluate the clinicopathological characteristics and the prognosis of breast cancer in the young age group. METHODS: One hundred and thirty-three patients under 35 years of age (younger group) at the time of diagnosis were selected from among the of total 936 female breast-cancer patients treated at the Breast Cancer Clinic of Asan Medical Center from July 1989 to December 1996, and they were compared with the 803 patients over 35 years of age (older group). RESULTS: Inadequately diagnosed cases of breast cancer, including a dense breast on mammography, were more frequent among the younger group (p=0.0005). The median tumor size of invasive ductal carcinomas was larger (3.0 cm vs 2.4 cm). The rate of lymph-node metastasis was high (58.6% vs 46.1%). The rate of early breast cancer (stage 0 and I) was lower (25.3% vs 42.6%). The 5-year disease-free survival rate was less (56.6% vs 73.7%, p=0.037), but no differences in operative methods, 5-year overall survival rate, and disease-free survival rate based on the different stages were observed between the two groups. CONCLUSIONS: This study showed that in the younger group (under 35 years of age), the breast cancer was more advanced, the lymph-node metastasis rate was higher, and the 5-year disease-free survival rate was significantly lower, but the 5-year overall survival rate was not significantly different from that in the older group.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Chungcheongnam-do ; Diagnosis ; Disease-Free Survival ; Female ; Humans ; Mammography ; Neoplasm Metastasis ; Prognosis* ; Survival Rate

No abstract available.
Aneurysm* ; Hydrocephalus* ; Hypothalamus* ; Subarachnoid Hemorrhage*

PURPOSE: This study was performed to show the several clinical variables before and after the surgery that need to be considered for patient selection and whether there is an increased possibility of recurrence after surgery and whether this possibility can be reduced when adjuvant treatment is applied. METHODS: The outcome of SSM with immediate breast reconstruction, using follow-up data of cases performed at Asan Medical Center between September, 1996 and December, 2002, were retrospectively assessed and pathologically advanced breast cancer patients (stage III) were analyzed separately. RESULTS: 191 patients had undergone SSM with immediate reconstruction during the study period. The percentage of cases stage III was 15.2% (29 cases). Among these patients, 6 (20.7%) were suspected of being in the early stages of breast cancer prior to the surgery. The mean age of the advanced breast cancer patients was 37 years. Immediate breast reconstruction consisted of a pedicled TRAM flap (n=24), a insertion of tissue expander (n=4) or direct implant (n=1). Radiotherapy was performed in 16 patients (53.3%) and chemotherapy was conducted without delay in all case. With a median length of follow-up of 36.1 months for 22 patients, who under went the operation until December, 2001, local recurrence was 4.5% (1/22) with successful local treatment, and distant metastasis was 13.7% (3/22). There was no difference in the disease free survival compared to that of the non-reconstruction group (P=0.093). CONCLUSION: SSM with immediate reconstruction seems safe and effective for patients with advanced breast cancer. However an accurate preoperative assessment of the extent of the disease and discussion for the planning of treatment between surgeon and patient is required.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Mammaplasty* ; Mastectomy* ; Neoplasm Metastasis ; Patient Selection ; Radiotherapy ; Recurrence ; Retrospective Studies ; Tissue Expansion Devices

STUDY DESIGNS: Retrospective analysis of the surgical treatment in patients of thoracolumbar spine fractures. OBJECTIVES: To measure by modified Cobb method the correction angle of thoracolumbar vertebral fractures and to comparison the difference between short segment pedicular fixation with fractured vertebra(group A) and without fractured vertebra (group B). SUMMARY OF LITERATURE REVIEW: The major treatment of thoracolumbar spine fractures is surgical correction of kyphotic angle by posterior decompression and posterolat. fusion at one level or more. MATERIALS AND METHODS: The materials are the patients who visited due to trauma beween 1991.1 and 2000.12. and treated by post. decompression and short segment posterolat. fusion with iliac bone graft. The number were A group, 28 persons and B group, 15 persons. The method of radiologic measurement is done by the modified Cobb method. The follow up time is till 2001.7. and the duration are minimal 6 months and maximal 77 months. The age was between 17 old and 60 old. The neurologic abnormalities in patients are 12 persons. The fractures were classified by the Denis classification. There are compressive fracture are 3 persons and bursting fracture type A are 18 persons, type B are 22 persons. The materials were confirmed by radiologic union and excluded if more than one vertebra fusion is needed. RESULTS: The most fractures were due to falldown injury. The most fracture site was T-L level (T12-L3). The one case was complicated by deep infection and treated and the other case was reduction loss due to metallic failure. The results of the loss of correction were A group, 5.3 degree and B group, 6.2 degree. (P>0.05). The relative correction loss were A group, 42%, and B group, 54%. (P<0.05). CONCLUSION: The mean correction angle and loss of correction are more good results in the group of short segment pedicular fixation with fracture vertebra. But to get more good results, our study do more long term follow-up and rule out other statistical errors and consecutive radiologic follow-up.
Classification ; Decompression ; Follow-Up Studies ; Humans ; Retrospective Studies ; Spine* ; Transplants

PURPOSE: We conducted the immunoassay of pertussis according to ages, in order to evaluate protective immunity against pertussis in Korean populations. METHODS: Healthy subjects were enrolled at four university hospitals in Korea. The subjects were grouped as seven age groups (every 10 years). Antibodies against pertussis toxin (PT) in sera were measured by enzyme linked immunosorbent assay (ELISA) kits. Geometric mean concentrations (GMC) of antibodies and the ratios of the subjects with seroprotective antibody levels were determined. The subjects with antibody titers > or =24.0 EU/mL were considered to seroprotective as the manufacturer's protocol. RESULTS: Total 1,605 subjects (age: 2 months-65 years) participated in this study, and their GMC was 56.16+/-50.54 EU/mL. Among seven age groups, age group <11 year showed the highest GMC (64.78+/-53.24 EU/mL) (P<0.001). In the analysis of the ratios of the subjects with seroprotective antibody titers, 68.2% of the subjects were proven to seroprotective, and age group <11 year also showed the highest ratio (76.5%) (P<0.001). CONCLUSIONS: We found that adolescences or adults (age group > or =11 year) showed lower levels of antibody against pertussis and lower ratio of the subjects with seroprotective antibody titers than children (age group <11 year).
Adult ; Antibodies ; Child ; Enzyme-Linked Immunosorbent Assay ; Hospitals, University ; Humans ; Immunization ; Immunoassay ; Korea ; Pertussis Toxin ; Whooping Cough

Varicella-zoster virus (VZV) infection is common in HIV seropositive patients, but disseminated VZV infection with pneumonia is rare in adult HIV seropositive patients. We report a case of disseminated VZV infection in a 28 year-old female patient with acquired immunodeficiency syndrome. The patient presented with dyspnea and disseminated cutaneous lesions. Chest radiograph showed multiple patchy lesions on the whole lung field. VZV was isolated from vesicular fluid of the cutaneous lesions. The patient was successfully treated with intravenous acyclovir.
Acquired Immunodeficiency Syndrome ; Acyclovir ; Adult ; Dyspnea ; Female ; Herpesvirus 3, Human* ; HIV ; Humans ; Lung ; Pneumonia* ; Radiography, Thoracic

PURPOSE: This study evaluated the benefit of radiation therapy in high-risk breast cancer patients who have received immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. The evaluation involved examining the effect of radiation therapy on postmastectomy flap fat necrosis and tumor recurrence. METHODS: A retrospective review was performed on 102 patients who underwent mastectomy and immediate TRAM flap reconstruction between 1996 and 2001 at the Asan Medical Center (Seoul, Korea). The mean patient age was 41 years, and the median follow-up time was 33 months. Skin-sparing mastectomy was con ducted in 82 patients (80.4%) and classical mastectomy in 20 patients (19.6%). Of the 21 high-risk patients needing postmastectomy radiation therapy, nine received it. RESULTS: Moderate or severe TRAM flap fat necrosis occurred more frequently in patients receiving radiation therapy than those not receiving radiation therapy (55.6% vs. 19.4%, P=0.026). In the group with high-risk patients, two tumor recurrences occurred (one-locoregional and one-systemic). Among the 102 patients, thirteen had recurrences, including only two high-risk patients, with almost of them being systemic recurrences except four locoregional recurrences. CONCLUSION: Our findings showed that radiation therapy increased flap fat necrosis in high-risk patients underwent immediate TRAM flap reconstruction. Such necrosis can result in poor outcomes for reconstruction. We recommend careful consideration prior to using radiation therapy on high-risk breast cancer patients after immediate TRAM flap reconstruction, where clinicians need to balance the possible positive effects on recurrence with the possible negative effects on flap tissue.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Fat Necrosis* ; Follow-Up Studies ; Humans ; Mastectomy* ; Necrosis ; Rectus Abdominis ; Recurrence ; Retrospective Studies

PURPOSE: While pediatric observation units (POU) have become a common practice in hospitals throughout developed countries, there has been no report about POUs in Korea so far. The aims of this study were to analyze our one-year's experience of the POU and to decide which disease entities are suitable for the POU. METHODS: All children admitted from March 2006 to February 2007 to the POU at the Department of Pediatrics in Our Lady of Mercy Hospital were included in this study. Data were collected from retrospective reviews of their medical records. RESULTS: There were a total of 1,076 POU admissions. Median age of patients was 2.4 years and median length of hospital stay 14.0 hours. The most common diagnoses were gastroenteritis (42.7%), pharyngotonsillitis (19.1%), bronchiolitis (7.8%), pneumonia (5.5%) and febrile seizure (5.2%). Overall, 7.5% of the POU patients required subsequent inpatient admissions due to hospital stays of longer than 48 hours. The disease entities that were most likely to require inpatient admission were pneumonia (17.0%), febrile seizure (12.5%) and asthma (11.5%). Diseases that allowed successful discharge from the POU were gastroenteritis (4.6%), upper respiratory tract infection (5.8%), such as otitis media and pharygnotonsillitis and seizure disorder (6.4%). Compared with the previous year when the POU was not in operation, there was a statistically significant reduction in the average length of hospital stays (from 4.69 to 3.75 days), as well as a rise in the bed turnover rate (from 78.8 to 98.2 patients/ bed). CONCLUSION: Our study shows that the POU is efficient for the management of children with certain acute illnesses. Based on this study, we suggest that the POU be used as a new modality which links between the outpatient, inpatient, and emergency departments in the field of pediatrics in Korea.
Asthma ; Bronchiolitis ; Child ; Day Care, Medical ; Developed Countries ; Diagnosis ; Emergency Service, Hospital ; Epilepsy ; Gastroenteritis ; Humans ; Inpatients ; Korea* ; Length of Stay ; Medical Records ; Otitis Media ; Outpatients ; Pediatrics ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies ; Seizures, Febrile

PURPOSE: Infiltrating lobular carcinoma (ILC) represents approximately 10% of all breast cancers. Its detection and staging for appropriate surgical planning may be difficult on account of its unique growth pattern, including a linear file arrangement of the tumor cells and a planar growth pattern and the resulting low density of the lesions. The purpose of this study was to evaluate the clinicopathological features of an ILC of the breast including multifocality, the preoperative accuracy of the pathological diagnostic tools, and its impact on the surgical procedure. METHODS: Between 1997 and 2003 at the Asan Medical Center, a group of 63 patients with a pathologically proven invasive lobular carcinoma who had undergone surgery were included. They were all in stage I~III, and their medical records, mammographic and sonographic results, and pathologic findings were reviewed retrospectively. RESULTS: Of the 63 patients with a mean age of 48 years (range 35 to 70), multifocal lesions were identified in 27.0% by a pathological examination. For a preoperative evaluation of a multifocal lesion, the sensitivity and positive prediction value were 21.4% and 50% by mammography, and 92.9% and 52.0% by ultrasonography, respectively. Only 27.0% of all patients were confirmed as having an ILC preoperatively; surgical excision or incision biopsies 75%, core-needle biopsy 36.4%, frozen biopsy 22.7%, FNA 5.9%. Conservative surgery was performed in only 14.3% and a mastectomy was performed on 85.5%. The mean tumor size was 3.0 cm, and according to the TNM stage, stage I was found in 22.2%, stage II in 58.7%, stage III in 19.1%. ER-positive was found in 83.9% and PR-positive was found in 74.2%. Seven out of 11 patients, who underwent the planed conserving surgery, had a positive resection margin, 1 case had re- excision, 2 cases underwent mastectomies, and 4 cases underwent radiation therapy without additional surgery. CONCLUSION: Since invasive lobular carcinomas have more often multifocal lesions and a preoperative accurate evaluation may be difficult pathologically or radiologically, a careful evaluation of the accurate tumor extent as well as the multifocal lesion is needed particularly for patients with an ILC considering conserving surgery.
Biopsy ; Breast* ; Carcinoma, Lobular* ; Chungcheongnam-do ; Diagnosis* ; Humans ; Mammography ; Mastectomy ; Medical Records ; Retrospective Studies ; Ultrasonography

Diphtheria-tetanus-acellular pertussis (DTaP) vaccination must currently be administered three times starting at 2 months of age, at intervals of two months, with the first and second boosters administered at 15 to 8 months and 4 to 6 years of age. A high rate of vaccination is maintained, but studies of the efficiency and safety of booster vaccination are lacking. This study evaluated the immunogenicity and safety of the DTaP booster vaccine. Seventy-two infants who had been vaccinated with the first booster and 78 children who had been vaccinated with the second booster were enrolled in this study. Local and systemic adverse reactions after vaccination were recorded. Sera obtained before and 1 month after booster vaccination were analyzed for antibodies to diphtheria and tetanus toxoid, and anti-pertussis toxin. Diphtheria: The GMT was increased. Tetanus: The geometric mean antibody titer (GMT) was increased. Pertussis: The GMT was increased by 13.72 times and 14.37 times after the first and the second additional vaccination, respectively. Although the seroconversion rate was low prior to the first booster, the average amount of anti-pertussis toxin antibodies before the first additional vaccination was 143.37 EU/mL, which rose to 261.88 EU/mL after the vaccination. The seroconversion rate also increased to 100%. Adverse reactions showed spontaneous resolution within a few days after vaccination. After the second additional vaccination, there was a statistically significant increase in the manifestation of myalgia compared to after the first additional vaccination. In conclusion, DTaP booster vaccination was effective in Korean children, demonstrating that modifications to the current regimen would be unnecessary.
Antibodies ; Child ; Diphtheria ; Diphtheria-Tetanus-acellular Pertussis Vaccines ; Humans ; Immunization, Secondary ; Infant ; Tetanus Toxoid ; Vaccination ; Whooping Cough