BACKGROUND: Breast cancer is the most frequent malignant neoplasm among women in the Orient. This cancer is also increasing in Korea due to westernization of the living pattern, increased recognition among the general population, and improved methods for early detection. In the surgical treatment of breast cancer, cosmetic conservation of the breast has drawn the patients' attention so that conservative surgery is increasing nowadays. The purpose of this study is to describe the current status of breast cancer management at our institution and to identify the survival and the recurrence rates according to the stage and the surgical method used. METHODS: We reviewed the medical records of 150 patients diagnosed as having breast cancer on pathologic examination at the Department of General Surgery, EulJi College of Medicine, from January 1991 to December 1996 and evaluated the clinical findings, the diagnostic method, operation, and the prognosis. RESULTS: The mean age of the patients was 49.1 years, and 34.0% of the patients was in the fifth decade. A palpable mass in the breast was the most frequent clinical symptom and sign (80.7%). The interval between symptom onset and diagnosis was about 6 months in 76.0% of patients. The size of the mass was 2~5 cm in 51.3% of the patients. A modified radical mastectomy was the most frequently employed surgical method (74.0%), but conservative surgery has increased lately. Seventy-ight patients (52.0%) were in stage II. The five-ear survival rates for stages I, II, III were 100%, 82.9%, and 55.0% (p=0.00006). The five-ear survival rates for 0, 1~3, 4~9, and more than 10 axillary-ode metastases were 85.9%, 55.3%, 53.6%, and 21.1%, respectively (p=0.0007). The five-ear survival rates for breast-conserving surgery and a modified radical mastectomy, for both stage of I and II, were 90.9% and 89.3% (p=0.8114), respectively, and the recurrence rates were 17.9% and 23.8% (p=0.88). CONCLUSIONS: The authors may conclude that breast-onserving surgery may offer an effective alternative to a modified radical mastectomy for patients with stage I & II breast cancer.
Breast Neoplasms* ; Breast* ; Diagnosis ; Female ; Humans ; Korea ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Survival Rate

PURPOSE: Phyllodes tumor is a rare fibroepithelial tumor of the breast, first described by Johannes Muller in 1838. Much has been written about phyllodes tumor, but very few widely accepted conclusions about its clinical behavior, treatment modality, and prognosis have been reached. This study aims to analyze the clinical, radiological, and pathological characteristics of phyllodes tumor of the breast. METHODS: The medical records of 41 patients with phyllodes tumor who had been treated between February 1982 and August 1998 at the Department of Surgery, Seoul National University Hospital, were retrospectively reviewed for clinical, radiological and pathological findings, treatment modalities, and follow-up results. RESULTS: Of these 41 cases, there were 28 cases (68.3%) of benign tumors and 13 cases (31.7%) of malignanat tumors. All patients were females, and the mean ages of onset were 33.2 years for benign tumors and 40.8 years for malignant tumors. Most patients, 100% of benign and 92.3% of malignant, presented with a papable mass in the breast. The median duration of illness was 2 months for malignant tumors and 8 months for benign tumors. The tumor size was greater than 10 cm in diameter in 5 cases (38.5%) of malignant tumors and in 3 cases (10.7%) of benign tumors. Only 4 cases were preoperatively diagnosed as having a phyllodes tumor by using radiological and fine needle aspiration cytology. Out of the 10 malignant cases reviewed, 5 cases were confirmed as malignant, and 5 cases were confirmed as borderline phyllodes tumors. Cellularity was moderate or above in all 5 malignant and 5 borderline cases. Atypism above moderate degree was found in 4 of 5 (80%) malignant tumors, in 3 of 5 (60%) borderline tumors, and in 4 of 24 (16.7%) benign tumors. Mitotic counts in all 5 malignant cases were 5 or more per 10 high power field while those in the 5 borderline tumors were 2-5 mitoses per 10 high power field. The most commonly performed operative procedures were a simple mastectomy (50%) for malignant tumors and a simple excision (64.3%) for benign tumors. Post-operative adjuvant therapy was done for 4 cases; out of these, 1 case had been initially diagnosed as a malignant phyllodes tumor, but the diagnosis was changed to a benign phyllodes tumor upon review. Of the 27 follow-up cases, recurrences developed in 3 cases (16.7%) of benign tumors. CONCLUSION: From the above results, there were no specific clinical features for differentiating benign from malignant phyllodes tumor preoperatively; therefore, we cannot help depending on the pathologic findings. Pathologic reviews showed that among several criteria, atypism, cellularity, and mitotic count were the most definite pathologic characteristics in differentiating benign from malignant phyllodes tumor. But much more experience and long-term follow-up may be needed to define optimal treatments and to analyze the prognosis for phyllodes tumors of the breast.
Biopsy, Fine-Needle ; Breast* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Mastectomy, Simple ; Medical Records ; Mitosis ; Phyllodes Tumor* ; Prognosis ; Recurrence ; Retrospective Studies ; Seoul ; Surgical Procedures, Operative

PURPOSE: Hemodialysis remains the most important support for patients with end stage renal disease, and vascular access is an essential component for their life. Since 1966, internal arteriovenous fistula (AVF) has been used widely today. If vessels were not available for AVF, the alternative would be used such as prosthetic graft. But in 1997, the National Kidney Foundation-Dialysis Outcome and Quality Initiative (DOQI) recommended increased use of native arteriovenous fistula to improve overall patency and curtail angioaccess costs. This retrospective study is to review our experience and to evaluate the overall patency rate and the influencing factors on the patency of the AVF. METHOD: From March 1995 through October 2000, 111 fistulas were created of 111 patients in Eulji university hospital. Among them, 106 cases were able to follow up survey. The statistical analysis used by SPSS package. RESULT: The male versus female ratio was 1.22:1 and the age distribution was occurred on from 3rd decade to 9th decade. the common causes of renal failure was hypertension, glomerulonephritis and diabetes (62.1%). the autogenous graft fistulas were performed in 101 cases (wrist/antecubital fossa. 101/3), Goretex graft fistula were 7 cases. The early graft failures were 12 cases (11.4%) and the causes was thrombosis or stricture, and immaturation, psudoaneurysm, venous hypertension in order of frequency. At 12, 24, 36 months, the assisted patency rates of AVF were 80.4, 76.5, 71.3%, respectively. CONCLUSION: We could get higher patency rate of AVF due to liberal use of native veins and aggressive intervention of the failing AVF as recommendation of DOQI.
Age Distribution ; Arteriovenous Fistula* ; Constriction, Pathologic ; Female ; Fistula ; Follow-Up Studies ; Glomerulonephritis ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Male ; Polytetrafluoroethylene ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Thrombosis ; Transplants ; Veins

PURPOSE: This study was to investigate the effect of music therapy as intervention on peripheral neuropathic pain and anxiety of gynecologic cancer patients who were undergoing paclitaxel chemotherapy. METHODS: Hospitalized 62 patients were assigned to an experimental group (n=30) and a control group (n=33) in this quasi-experimental study. The experimental group participated in music therapy that includes listening, singing and song writing during 1 hour. The peripheral neuropathic pain, anxiety and depression were examined as pre-intervention evaluation by using pain scale, anxiety scale (20 questions) and depression scale (20 questions) in both groups. There were no further treatments for the control group while the experimental group involved in music therapy. The peripheral neuropathic pain and anxiety were evaluated in both groups as post-intervention evaluation. RESULTS: Outcomes were verified through hypothesis testing. The level of peripheral neuropathic pain and anxiety in the experimental group was decreased, compared to the control group. CONCLUSION: According to the study, music therapy is a beneficial intervention that reduces peripheral neuropathic pain and anxiety in gynecologic cancer patients. These findings are encouraging and suggest that music therapy can be applied as an effective intervention for minimizing chemotherapy related symptoms.
Anxiety ; Depression ; Humans ; Music ; Music Therapy ; Neuralgia ; Paclitaxel ; Singing ; Writing

BACKGROUND AND OBJECTIVE: Although the endovascular method of treating abdominal aortic aneurysms (AAA) shows good early results and benefits, the late outcome of this treatment remains uncertain. This study evaluated the late outcome following an endovascular AAA repair. SUBJECTS AND METHODS: Thirty-three patients that had undergone an endovascular AAA repair at our institute were evaluated. The results of the treatment were evaluated by an angiography, taken just after the completion of the procedure, and by contrast-enhanced CT scans at 1, 3, 6 and 12 months, and annually thereafter. RESULTS: The patient's characteristics were as follows: 29 (88%) were male, 19 (58%) had coronary artery disease and 7 (21%) had renal insufficiency. A technical success was achieved in 31 patients (94%), with primary endoleaks in two. Two patients (6.1%) died within 1 month of the procedure, both at an elderly age, with high risk. There was 1 (3%) incidence of early complications that required treatment. During the 28 month follow-up period, 6 patients (20%) needed a secondary procedure. Endoleaks remained in 4 patients, and the size of aneurysm increased in 3 patients. Four patients died during follow-up, and two had an endoleak. The cause of death was not related to cardiovascular diseases in the other two patients. The event free survival at 24 months was 72%. CONCLUSION: The late outcome after an endovascular AAA repair was favorable. However, a secondary procedure was needed, and endoleaks observed, in half of the patients that died during follow-up. Therefore, regular evaluation of aneurysms and the management of endoleaks are very important for a favorable late outcome in endovascular AAA repair patients.
Aged ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal* ; Cardiovascular Diseases ; Cause of Death ; Coronary Artery Disease ; Disease-Free Survival ; Endoleak ; Follow-Up Studies ; Humans ; Incidence ; Male ; Renal Insufficiency ; Tomography, X-Ray Computed

Primary aortoenteric fistula (PAEF) is a rare disease with a high mortality rate due to massive hemorrhaging and diagnostic difficulties. Although hemorrhagic regions can be identified by endoscopy, it is difficult to diagnose PAEF by this method. If PAEF is suspected, endoscopic procedure should be terminated and abdominal CT should be performed. Overlooking the herald bleeding of PAEF can lead to massive bleeding and death. An 85-year-old previously healthy male presented with a complaint of melena. Gastrointestinal endoscopy identified a hemorrhagic site in the third portion of the duodenum and endoscopic hemostasis was performed. However, during the procedure, it became apparent that the hemorrhage was probably not the result of a simple duodenal ulceration and abdominal CT was performed immediately. An aortic aneurysm connected to the duodenum was identified, confirming the diagnosis of PAEF. However, the patient died of massive hemorrhaging before an operation could be performed.
Aged, 80 and over ; Aortic Aneurysm, Abdominal/*diagnosis/pathology ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Fibrin Tissue Adhesive/therapeutic use ; Fistula/*diagnosis/pathology ; Gastrointestinal Hemorrhage/diagnosis/therapy ; Humans ; Male ; Tomography, X-Ray Computed

OBJECTIVE: To determine whether characteristics of sperm motility obtained by computer-assisted sperm analysis (CASA) could predict pregnancy after intrauterine insemination (IUI) in couples with unexplained infertility. METHODS: Three hundred eighty-three cycles of intrauterine insemination with superovulation were retrospectively analyzed. Semen analysis was performed with CASA before and after swim-up and the parameters were compared between pregnant and non-pregnant women. RESULTS: The pregnancy rate per cycle was 14.1%. Pregnant and non-pregnant women were comparable in terms of age, infertility duration, the number of dominant follicles. While sperm concentration, motility, and parameters such as average path velocity (VAP) and percentage rapid (RAPID) before semen preparation were significantly different between the pregnancy and non-pregnancy groups, there were no differences in sperm parameters when comparing the two groups after preparation. Using a receiver operating characteristic curve to measure sensitivity and specificity, the optimal threshold value for the predictors of pregnancy was revealed to be a concentration of > or =111x10(6)/mL, a motility of > or =51.4%, and RAPID > or =30.1% before preparation for IUI. CONCLUSION: Sperm parameters including concentration, motility, and RAPID before sperm preparation could have predictive value for pregnancy outcome after intrauterine insemination with superovulation in couples with unexplained infertility, and would be helpful when counseling patients before they make the decision to proceed with IVF/ICSI-ET.
Counseling ; Family Characteristics ; Female ; Humans ; Image Processing, Computer-Assisted ; Infertility ; Insemination ; Insemination, Artificial ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; ROC Curve ; Semen ; Semen Analysis ; Sensitivity and Specificity ; Sperm Motility ; Spermatozoa ; Superovulation

OBJECTIVE: To determine whether characteristics of sperm motility obtained by computer-assisted sperm analysis (CASA) could predict pregnancy after intrauterine insemination (IUI) in couples with unexplained infertility. METHODS: Three hundred eighty-three cycles of intrauterine insemination with superovulation were retrospectively analyzed. Semen analysis was performed with CASA before and after swim-up and the parameters were compared between pregnant and non-pregnant women. RESULTS: The pregnancy rate per cycle was 14.1%. Pregnant and non-pregnant women were comparable in terms of age, infertility duration, the number of dominant follicles. While sperm concentration, motility, and parameters such as average path velocity (VAP) and percentage rapid (RAPID) before semen preparation were significantly different between the pregnancy and non-pregnancy groups, there were no differences in sperm parameters when comparing the two groups after preparation. Using a receiver operating characteristic curve to measure sensitivity and specificity, the optimal threshold value for the predictors of pregnancy was revealed to be a concentration of > or =111x10(6)/mL, a motility of > or =51.4%, and RAPID > or =30.1% before preparation for IUI. CONCLUSION: Sperm parameters including concentration, motility, and RAPID before sperm preparation could have predictive value for pregnancy outcome after intrauterine insemination with superovulation in couples with unexplained infertility, and would be helpful when counseling patients before they make the decision to proceed with IVF/ICSI-ET.
Counseling ; Family Characteristics ; Female ; Humans ; Image Processing, Computer-Assisted ; Infertility ; Insemination ; Insemination, Artificial ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; ROC Curve ; Semen ; Semen Analysis ; Sensitivity and Specificity ; Sperm Motility ; Spermatozoa ; Superovulation

PURPOSE: Sentinel lymph node (SLN) biopsy has emerged as a substitute for a conventional axillary lymph node (ALN) dissection in early breast carcinomas. We evaluated SLN biopsy in breast carcinoma using a gamma-detection probe in order to identify its accuracy as a staging procedure for lymph node status. METHODS: Fifty-one patients with breast carcinomas who underwent a SLN biopsy followed by an ALN dissection between June 1999 and January 2001 were evaluated. Tc 99m antimony trisulfide colloid was used as a tracer and SLN biopsy using a gamma-detection probe was done following breast lymphoscintigraphy. Intraoperative imprint cytology (II C) was done for each SLN. If a SLN biopsy was free of metastasis by permanent hematoxylin and eosin (H&E) staining, immun ohistochemical (IHC) staining using pan-cytokeratin was do ne to detect micrometastasis. RESULTS: ALN metastases were identified in 21.6% of pa tients and the resection rate of SLN was 94.1%. The mean number of resected SLN was 1.8, all located at the axilla. IIC had a sensitivity of 72.7% and a spe cificity of 100%. The false-negative rate of SLN biopsy was 12.5% when SLNs were evaluated by H&E staining alone. However, the false-negative rate improved up to 0% when IHC staining was added. CONCLUSION: SLN biopsy using a gamma-detection probe proved to be a very sensitive method to detect SLN in breast carcinoma patients. Frozen biopsy should be added to im prove the outcomes of intraoperative examination of SLN. If permanent biopsy revealed that SLN was free of tumorthe by H&E staining, IHC staining should be done to improve false-negative rate of SLN biopsy.
Antimony ; Axilla ; Biopsy* ; Breast Neoplasms* ; Breast* ; Colloids ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Lymph Nodes ; Lymphoscintigraphy ; Neoplasm Metastasis ; Neoplasm Micrometastasis

PURPOSE: Sentinel lymph node (SLN) biopsy has emerged as a substitute for a conventional axillary lymph node (ALN) dissection in early breast carcinomas. We evaluated SLN biopsy in breast carcinoma using a gamma-detection probe in order to identify its accuracy as a staging procedure for lymph node status. METHODS: Fifty-one patients with breast carcinomas who underwent a SLN biopsy followed by an ALN dissection between June 1999 and January 2001 were evaluated. Tc 99m antimony trisulfide colloid was used as a tracer and SLN biopsy using a gamma-detection probe was done following breast lymphoscintigraphy. Intraoperative imprint cytology (II C) was done for each SLN. If a SLN biopsy was free of metastasis by permanent hematoxylin and eosin (H&E) staining, immun ohistochemical (IHC) staining using pan-cytokeratin was do ne to detect micrometastasis. RESULTS: ALN metastases were identified in 21.6% of pa tients and the resection rate of SLN was 94.1%. The mean number of resected SLN was 1.8, all located at the axilla. IIC had a sensitivity of 72.7% and a spe cificity of 100%. The false-negative rate of SLN biopsy was 12.5% when SLNs were evaluated by H&E staining alone. However, the false-negative rate improved up to 0% when IHC staining was added. CONCLUSION: SLN biopsy using a gamma-detection probe proved to be a very sensitive method to detect SLN in breast carcinoma patients. Frozen biopsy should be added to im prove the outcomes of intraoperative examination of SLN. If permanent biopsy revealed that SLN was free of tumorthe by H&E staining, IHC staining should be done to improve false-negative rate of SLN biopsy.
Antimony ; Axilla ; Biopsy* ; Breast Neoplasms* ; Breast* ; Colloids ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Lymph Nodes ; Lymphoscintigraphy ; Neoplasm Metastasis ; Neoplasm Micrometastasis