No Abstract Available.
Fatigue Syndrome, Chronic* ; Fatigue* ; Prevalence*

PURPOSE: Modified radical mastectomy is the most commonly performed operative treatment because of extensive microcalcifications, multicentric tumors, early pregnancy, and patient preference, despite of the eligibility of many women for breast-conserving surgery. Various modifications of this operation have been described, including preservation of the pectoralis minor, resection of the pectoralis minor, and division of the origin of the pectoralis minor. The purpose of this study was to identify the indications of Scanlon's technique by evaluating the benefit of complete axillary dissection and the cosmetic results of chest walls in patients who had undergone a modified radical mastectomy (MRM) for breast cancer. METHODS: In fifty nine patients who had undergone MRM for infiltrating breast cancer from January 1992 to December 1997 and performed follow-up study of CT of chest walls, we examined operative techniques, dissected & involved axillary lymph nodes (ALNs) retrospectively and atrophy of pectoralis muscles by clinical examination and CT findings of chest walls. RESULTS: We analyzed all the results of aforementioned study, based on various operative techniques. The largest groups were Auchincloss of 63.6% in stage IIA, Scanlon of 50% in stage IIB and Patey of 28.6% in stage IIIA. The mean numbers of harvested ALNs were 20.4 in Scanlon, 20 in Patey and 15 in Auchincloss. The largest groups were Auchincloss of 77.3% in the harvested ALNs of 10-19, Scanlon of 40% in the harvested ALNs of 20-29 and Patey of 14.3% in the harvested ALNs of 30-39. The mean numbers of involved ALNs were 4.4 in Patey, 2.6 in Scanlon and 0.9 in Auchincloss. The largest groups were Auchincloss of 63.6% in the non-involved ALNs, Auchincloss of 31.8% in the involved ALNs of 1-3, Scanlon of 20% in the involved ALNs of 4-9 and Patey of 28.6% in the involved ALNs of 10 or more. Through the clinical examinations and CT studies of chest wall, such changes of chest walls were found, as suggestive of injury of medial pectoral nerve of 2 cases (9.1%) and of lateral pectoral nerve of 1 case (4.5%) inAuchincloss, of injury of medial pectoral nerve of 1 case (3.3%) in Scanlon and of injuries of medial pectoral nerve of 3 cases (42.9%) and of lateral pectoral nerve of 1 case (14.3%) in Patey. Postoperative complications were arm lymphedema of 1 case in each technique and anemia of 4 cases (13.3%) in Scanlon. CONCLUSION: We conclude that in the MRM for patients with resectable breast cancer, Scanlon's technique is superior to Auchincloss or Patey in preventing axillary recurrence and atrophies of pectoralis muscles by successful complete axillary dissection with preservation of medial and lateral pectoral nerve in cases of more advanced stage over stage IIB with involved ALNs of one to nine. However Patey's technique seems to be necessary in cases of metastasis of the interpectoral node or the subclavicular node regardless of poor results of cosmesis.
Anemia ; Arm ; Atrophy ; Breast Neoplasms* ; Breast* ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphedema ; Mastectomy, Modified Radical* ; Mastectomy, Segmental ; Neoplasm Metastasis ; Patient Preference ; Pectoralis Muscles ; Postoperative Complications ; Pregnancy ; Recurrence ; Retrospective Studies ; Thoracic Nerves ; Thoracic Wall ; Thorax

PURPOSE: The purpose of this study was to analyze the clinical results of patients with scaphoid nonunions treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation. METHODS: We retrospectively reviewed 20 patients with a scaphoid nonunions which was treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation from November 2008 to July 2012. Time from injury to treatment was 74 months (range, 3-480 months) in average. Functional outcome was evaluated using the modified Mayo wrist score and visual analogue scale (VAS) for pain, which were measured before operation and at the last follow up. RESULTS: All nonunions were healed successfully. The average radiologic union time was 9.7 weeks (range, 7-14 weeks). The average VAS score improved from 6.3 (range, 4-8) preoperatively to 1.6 (range, 0-3) at the last follow up. The average modified Mayo wrist score increased from 62.5 preoperatively to 85.7 at the last follow-up. CONCLUSION: Arthroscopically assisted bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion. It may provide more biological environment than open surgery as a minimally invasive procedure.
Arthroscopy ; Bone Transplantation* ; Follow-Up Studies ; Humans ; Retrospective Studies ; Wrist

Meningioma is one of the most common tumors of the central nervous system. However, primary extra cranial meningioma is rare as it consists 1%-2% of meningioma. It is very rare in paranasal sinus and accounts for about 0.1% of the paranasal sinus tumor. The treatment of choice is complete surgical excision of the tumor. Herein, with a review of the literature, we report a rare case of primary extra cranial meningioma in a 38-year-old male.

Small cell carcinoma (SmCC) is a type of neuroendocrine tumor commonly originating in the lung, with only about 2-4% of cases arising at extrapulmonary sites. Extrapulmonary SmCC of the head and neck has a poor prognosis and a high rate of distant metastasis. The paranasal sinus is a rare location for extrapulmonary SmCC and only a few related papers have been published to date. We report a rare case of SmCC originating from the sphenoid sinus in a patient with a recurrent pituitary tumor with a literature review.

Small cell carcinoma (SmCC) is a type of neuroendocrine tumor commonly originating in the lung, with only about 2-4% of cases arising at extrapulmonary sites. Extrapulmonary SmCC of the head and neck has a poor prognosis and a high rate of distant metastasis. The paranasal sinus is a rare location for extrapulmonary SmCC and only a few related papers have been published to date. We report a rare case of SmCC originating from the sphenoid sinus in a patient with a recurrent pituitary tumor with a literature review.

Leptin serves an important role in suppressing appetite in mice and is known to be elevated in chronic renal failure (CRF) patients. But clinical significance of leptin as an appetite-reducing uremic toxin, remains to be determined. So we studied the relationship between plasma leptin and nutritional status in 46 chronic hemodialysis (HD) patients. Pre HD leptin was measured and divided by body mass index (BMI) to give adjusted leptin levels. KT/Vurea (K, dialyzer urea clearance; T, duration of HD; V, volume of distribution of urea), C-reactive protein (CRP), plasma insulin and nutritional parameters such as serum albumin, normalized protein catabolic rate (nPCR), subjective global assessment (SGA), BMI and mid-arm muscle circumference (MAMC) were also measured. Mean plasma leptin levels were 8.13+/-2.91 ng/mL (male 3.15+/-0.70; female 14.07+/-6.14, p<0.05). Adjusted leptin levels were positively correlated with nPCR (male r=0.47, p<0.05; female r=0.46, p<0.05), SGA (male r=0.43, p<0.05; female r=0.51, p<0.05) and MAMC (male r=0.60, p<0.005; female r=0.61, p<0.05). They did not correlate with KT/Vurea, serum albumin, hematocrit, bicarbonate, insulin and CRP. Presence of DM and erythropoietin therapy had no effect on leptin levels. These results suggest that leptin is a marker of good nutritional status rather than a cause of protein energy malnutrition in chronic HD patients.
Adult ; Biological Markers/blood ; Cross-Sectional Studies ; Female ; Human ; Kidney Failure, Chronic/therapy ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/blood* ; Leptin/blood* ; Male ; Middle Age ; Nutrition Disorders/etiology ; Nutrition Disorders/diagnosis ; Nutritional Status* ; Obesity/metabolism ; Obesity/etiology ; Renal Dialysis*/adverse effects ; Sex Factors

PURPOSE: Magnetocardiography (MCG) has been proposed as a noninvasive, diagnostic tool for risk-stratifying patients with acute myocardial infarction (AMI). This study evaluated whether MCG predicts long-term prognosis in AMI. MATERIALS AND METHODS: In 124 AMI patients (95 males, mean age 60±11 years), including 39 with ST-elevation myocardial infarction, a 64-channel MCG was performed within 2 days after AMI. During a mean follow-up period of 6.1 years, major adverse cardiac events (MACE) were evaluated. RESULTS: MACE occurred in 31 (25%) patients, including 20 revascularizations, 8 deaths, and 3 re-infarctions. Non-dipole patterns were observed at the end of the T wave in every patients. However, they were observed at T-peak in 77% (24/31) and 54% (50/93) of patients with and without MACE, respectively (p=0.03). Maximum current, field map angles, and distance dynamics were not different between groups. In the multivariate analysis, patients with non-dipole patterns at T-peak had increased age- and gender-adjusted hazard ratios for MACE (hazard ratio 2.89, 95% confidence interval 1.20–6.97, p=0.02) and lower cumulative MACE-free survival than those with dipole patterns (p=0.02). CONCLUSION: Non-dipole patterns at T-peak were more frequently observed in patients with MACE and were related to poor long-term prognosis. Thus, repolarization heterogeneity measured by MCG may be a useful predictor for AMI prognosis.
Follow-Up Studies ; Humans ; Magnetocardiography* ; Male ; Multivariate Analysis ; Myocardial Infarction* ; Population Characteristics* ; Prognosis*

OBJECTIVE: To compare quantitative and qualitative image quality parameters in pediatric abdominopelvic dual-energy CT (DECT) using noise-optimized virtual monoenergetic image (VMI) and conventional VMI at different kiloelectron volt (keV) levels. MATERIALS AND METHODS: Thirty-six consecutive abdominopelvic DECT scans were retrospectively included. Noise-optimized VMI and conventional VMI were reconstructed at seven energy levels, from 40 keV to 100 keV at 10 keV intervals. The contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) of the liver, pancreas, and aorta were objectively measured and compared. Image quality was evaluated subjectively regarding image noise, image blurring of solid organ, bowel image quality and severity of beam-hardening artifacts. Optimal monoenergetic levels in keV for both algorithms were determined based on overall image quality score. RESULTS: The maximal CNR and SNR values for all investigated organs were observed at 40 keV in noise-optimized VMI (CNR and SNR of liver, pancreas, aorta in order [CNR; 20.93, 17.34, 46.75: SNR; 37.39, 33.80, 63.21]), at 60–70 keV and at 70 keV in conventional VMI (CNR; 8.12, 5.67, 15.97: SNR; 19.57, 16.66, 26.65). In qualitative image analysis, noise-optimized VMI and conventional VMI showed the best overall image quality scores at 60 keV and at 70 keV, respectively. Noise-optimized VMI at 60 keV showed superior CNRs, SNRs, and overall image quality scores compared to conventional VMI at 70 keV (p < 0.001). CONCLUSION: Optimal energy levels for noise-optimized VMI and conventional VMI were 60 keV and at 70 keV, respectively. Noise-optimized VMI shows superior CNRs, SNRs and subjective image quality over conventional VMI, at the optimal energy level.
Aorta ; Artifacts ; Liver ; Noise ; Pancreas ; Retrospective Studies ; Signal-To-Noise Ratio

BACKGROUND AND OBJECTIVES: Identifying the critical isthmus of slow conduction is crucial for successful treatment of scar-related ventricular tachycardia. Current 3D mapping is not designed for tracking the critical isthmus and may lead to a risk of extensive ablation. We edited the algorithm to track the delayed potential in order to visualize the isthmus and compared the edited map with a conventional map. SUBJECTS AND METHODS: We marked every point that showed delayed potential with blue color. After substrate mapping, we edited to reset the annotation from true ventricular potential to delayed potential and then changed the window of interest from the conventional zone (early, 50-60%; late, 40-50% from peak of QRS) to the edited zone (early, 80-90%; late, 10-20%) for every blue point. Finally, we compared the propagation maps before and after editing. RESULTS: We analyzed five scar-related ventricular tachycardia cases. In the propagation maps, the resetting map showed the critical isthmus and entrance and exit sites of tachycardia that showed figure 8 reentry. However, conventional maps only showed the earliest ventricular activation sites and searched for focal tachycardia. All of the tachycardia cases were terminated by ablating the area around the isthmus. CONCLUSION: Identifying the channel and direction of the critical isthmus by a new editing method to track delayed potential is essential in scar-related tachycardia.
Tachycardia ; Tachycardia, Ventricular*