No abstract available.

PURPOSE: c-erbB2 encodes 185 kDa oncoprotein with tyrosine kinase activity and has homology to the epidermal growth factor receptor. c-erbB2 proto-oncogene is found to be overexpressed in approximately 20 to 30% of primary breast cancer and has been associated with poor prognosis and lower response to conventional chemotherapy. MATERIALS AND METHODS: We perfonned a study on 40 infiltrating ductal breast cancers treated with primary surgery and adjuvant chemotherapy. We investigated c-erbB2 expression by immunohistochemistry in paraffin-embedded tissue using polyclonal antipeptide antibody(DAKO). We evaluated the relationships between its expression and the results after over 6 cycles of adjuvant chemotherapy including cyclophosphamide, methotrexate and 5-FU. RESULTS: The median age at diagnosis was 43 years and the median follow-up time was 47.3 months. Thirteen(32.1%) of 40 patients showed the c-erbB2 overexpression in the external domains of protein. There were no correlations among c-erbB2 amplification and other prognostic factors such as hormonal receptors, histologic grade and tumor size. Estrogen receptor and progesterone receptor showed tendency of inverse correlation with c-erbB2 overexpression but it was not statistically significant(p>0.05). c-erbB2 positive patients showed shorter disease free survival compared to c-erbB2 negative patients in univariate analysis(p<0.05)(Kaplan Meire analysis). The patients without c-erbB2 overexpression seemed to survive longer but had no significant survival benefit(p>0.05). CONCLUSION: These findings suggest that overexpression of c-erbB2 may be a marker of poor response to adjuvant chemotherapy with CMF regimen and may be an indicator of more aggressive therapy.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Estrogens ; Fluorouracil ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Methotrexate ; Prognosis ; Protein-Tyrosine Kinases ; Proto-Oncogenes ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone

PURPOSE: The axillary lymph node status is the most important prognostic factor in breast cancer. The axillary node dissection is done are usually performed in infiltrating breast cancer for the information of therapeutic decision and prediction of prognosis. But this procedure results in lymphedema of affected upper extremity nearly about 25%, increased axillary drainage, sensory abnormality and pain. Many researches are focussed to find the patients group who do not need axillary dissection according to the status of tumor size, patient age, hormonal receptor and histologic grade. MATERIAL AND METHODS: We evaluated the axillary lymph node status related with tumor size less then 2 cm in and the correlation of other prognostic factor. We reviewed 127 women with histologically diagnosed infiltrating ductal carcinoma of breast who were treated by one surgeon at YongDong Severance Hospital, Yonsei University College of medicine between 1991 and 1996. RESULTS: Five patients (3.9%) had T1a lesion (< 5 mm), 24 patients (18.9%) had T1b tumors (6-10 mm), and 98 cases (77.2%) had T1c lesion (11-20 mm). The average numbers of dissected axillary lymph nodes were 14.2 We found that small tumor size, good histologic grade, estrogen receptor positivity, old age (over 50 years) showed tendency of decreased axillary node metastasis but without statistical significance. CONCLUSIONS: There are possibility of finding subset with low risk of axillary lymph node metastasis in small size tumor with addition of good prognostic indicators such as good histologic grade, hormonal receptors and old age.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Drainage ; Estrogens ; Female ; Humans ; Lymph Nodes* ; Lymphedema ; Neoplasm Metastasis* ; Prognosis ; Upper Extremity

Venous thrombosis is uncommon in young individuals. Hypereosinophilia is a rare cause of thrombosis that usually involves the heart and small vessels like retinal vessels. We report a case of massive deep vein thrombosis that developed in a young patient with hypereosinophilia who was successfully treated with continuous local infusion of urokinase.
Eosinophilia* ; Heart ; Humans ; Retinal Vessels ; Thrombosis ; Urokinase-Type Plasminogen Activator* ; Venous Thrombosis*

PURPOSE: To determine the activity and toxicities of PEF (Cisplatin, Etoposide, 5-Fluorouracil) chemotherapy for stomach cancer. MATERIALS AND METHODS: Patients with previously untreated metastatic stomach cancer were treated with PEF regimen which consisted of cisplatin (20 mg/m2 i.v. days 1~5), etoposide (100 mg/m2 i.v. days 1, 3, 5), and 5-fluorouracil (5-FU)(800 mg/m2 i.v. infusion for 12 hours days 1~5). Chemotherapy was repeated every 3 weeks until disease progressed or toxicities were intolerable. RESULTS: Between May 1989 and July 1990, 40 patients were enrolled in this protocol. Twelve patients were lost to follow up after one cycle of chemotherapy and inevaluable. After 2~8 cycles (median 3) of chemotherapy, 20 out of 28 evaluable patients showed objective responses without any complete response, making the response rate 71% (95% confidence interval: 54~89%). The responses lasted from 4+ to 39 weeks (median: 38 weeks). The overall survival of total evaluable patients was 4+ ~50+ weeks (median 38 weeks). Among total 109 cycles of chemotherapy, cycles were delayed or doses were reduced in 48 cycles (44%) because of leukopenia (in 61 cycles: 56%) and/or thrombocytopenia (in 14 cycles: 13%). However, there was no treatment-related death. Nausea/vomiting and alopecia were experienced in most of patients. The stomatitis was experienced in 7 patients (25%) but completely reversible. In contrast, the peripheral neuropathy which developed in 4 patients (14%) after 5 cycles of chemotherapy was not reversible. CONCLUSION: The PEF regimen was active and tolerable in stomach cancer.
Alopecia ; Cisplatin ; Drug Therapy* ; Etoposide* ; Fluorouracil* ; Humans ; Leukopenia ; Lost to Follow-Up ; Peripheral Nervous System Diseases ; Stomach Neoplasms* ; Stomach* ; Stomatitis ; Thrombocytopenia

PURPOSE: Bcl-2 and p53 are known to act as a regulator of apoptosis in breast cancer and we evaluated the significance of these gene expressions and correlation with prognostic factors in breast cancer. MATERIALS AND METHODS: In order to investigate the expression of Bcl-2 and p53, we analyzed immunochemistry staining from paraffin blocks in a series of 80 women with breast cancer. Expression was then compared with the established indicators of prognosis. RESULTS: Bcl-2 positivity was 45% and p53 was 32.2%. No relationships could be observed between bcl-2 and node status,tumor size and also between p53 and node status, differentiation,tumor size. Strong positive relationships were seen between bcl-2 and estrogen receptor (ER) (p<0.0001), progesterone receptor (PR) (p<0.001). p53 also showed relationships with ER and PR (p<0.05) Histologic (p<0.05) and nuclear grade (p<0.05) showed relationships with bcl-2 but not with p53. Inverse relationship was noted between p53 and ER, PR (p<0.05). Inverse relationship was also found between bcl-2 and p53 expression (p<0.001). CONCLUSION: This study suggest that there may be a possibility that bcl-2 and p53 expressions can affect tumor growth and prognosis in breast cancer patients.
Apoptosis ; Breast Neoplasms* ; Breast* ; Estrogens ; Female ; Gene Expression ; Humans ; Immunochemistry ; Immunohistochemistry* ; Paraffin ; Prognosis ; Receptors, Progesterone

Recently, with the remarkable theoretical progress made in anesthesiology these years, reports are being made on the results of the study on the complications, minor or major, caused by previous general anesthesia. However, .the reports on incidence vary according to the reporters. According to Riding, the recent development of anesthesiology, anesthetic inatruments, knowledge of physiology, anesthetics, induction agents and muscle relaxants are said to have reduced the incidence of complications to a great extent. Riding, Gold and Dyrberg report that the factors capable of influencing the incidence of complication, in the post-operative period include age, sex, premedicants for anesthetics, inhalation method of anesthetics, time of anesthesia, muscle relaxant, use of induction agent, acid-base imbalance and developed knowledge of physioloy, operation site, mental state of patients before operation, general condition, anesthetic technique, and. adequate selection of medicine. Working for Department of Anesthesiology, Hanyang University, from October 1976 to August 1977, we selected, out of the patients who received general anesthesia, 523 males and 372 females, totalling 895, who showed no abnormal symptoms in their respiratory systems, circulatory systems and metabolic systems and observed the incidence of complication in the light of sex, age and operation site, the factors supposed to affect the incidence. An hour prior to the general anesthesia, the patients were given intramuscular injection with premedicants atropine 0. 01 mg per kg, Valium 0. 2 mg or Demerol 1 mg per kg of body weight. For induction of anesthesia, Epontol 10 mg per kg and succinylcholine 1 mg per kg of body weight were injected in the veins, then ventilation was made for a minute with mask and then endotracheal tubes were inserted. and then a minimum amount of air was injected. into the cuff of the endotracheal tube, and the ventilation was done in a semi-closed system. During the period of maintenance, anesthesia was administered in a semi-closed system with 0. 5~l. 0% halothane, 3 L/min of nitrous oxide, 2 L/min of oxygen; and if need be, muscle relaxant was injected into the vein. In case a nondenolarizing agent was used in the course of maintenance, atropine 0. 5~1. 0 mg and neostigmine 2.0 ~ 4.0 mg were injected into the vein for reversion at the recovery time. After the patient was completely recovered, the endotracheal tube was cautiously removed, so as not to give trauma to the throat. As for method of observations, 24 hours after the patient had recovered, we visited the patient in the ward, first observing the existence or nonexistence of incidence of minor complications, and then calculating the incidence by the distribution of sex, age and operation site. The outcome of the observation of the above results by statistics and by chi square test is as follows; 1) the incidence of complications after general anesthesia was high in females. 2) Age has not affected the incidence of complications. 3) The incidence of nausea was highest in the patients with abdominal operation. 4) The incidence of sore throat was highest in the head and neck patients. 5) The incidence of fever was highest in the abdomen patients. 6) The incidence of headache was highest in the head and neck patients.
Abdomen ; Acid-Base Imbalance ; Anesthesia ; Anesthesia, General* ; Anesthesiology ; Anesthetics ; Anesthetics, Inhalation ; Atropine ; Body Weight ; Diazepam ; Female ; Fever ; Halothane ; Head ; Headache ; Humans ; Incidence ; Injections, Intramuscular ; Male ; Masks ; Meperidine ; Methods ; Nausea ; Neck ; Neostigmine ; Nitrous Oxide ; Oxygen ; Pharyngitis ; Pharynx ; Physiology ; Propanidid ; Respiratory System ; Succinylcholine ; Veins ; Ventilation

The treatment of infertile women with polycystic ovary syndrome (PCOS) has not yet been established. Before any intervention is initiated, lifestyle modification with diet and exercise leading to weight loss should be emphasized in overweight women. The recommended first-line treatment for ovulation induction remains clomiphene citrate. If clomiphene citrate use fails to result in ovulation or pregnancy, the recommended second-line intervention is exogenous gonadotropins. The use of exogenous gonadotropins is related to an increased risk for multiple pregnancies, and, therefore, intense ovarian response monitoring is required. Laparoscopic ovarian surgery is an alternative to gonadotropin therapy because this surgery is as effective as gonadotropin in pregnancy rate or live birth rate. However, the surgery may require additional ovulation induction drug and should be performed by well-trained surgeon, its use solely to induce ovulation is unwarranted. Recommended third-line treatment is in vitro fertilization (IVF). IVF reduces the risk of multiple pregnancies by using single-embryo transfer in women with PCOS. The use of metformin alone as first-line infertility therapy or in combination with clomiphene is surrounded by controversies. Aromatase inhibitors appear to be as effective as clomiphene citrate for induction of ovulation, but the drug is currently not approved for treatment of infertility. Further studies should demonstrate the efficacy and long term safety.
Aromatase Inhibitors ; Clomiphene ; Diet ; Female ; Fertilization in Vitro ; Gonadotropins ; Humans ; Infertility ; Life Style ; Live Birth ; Metformin ; Overweight ; Ovulation ; Ovulation Induction ; Polycystic Ovary Syndrome ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Weight Loss

PURPOSE: We investigated the clinical characteristics of breast cancers and its significance. MATERIAL AND METHOD: We evaluated the clinical characteristics of 500 women with breast cancer who were diagnosed and treated by one surgeon between March 1991 and August 1996. RESULTS: The median age was 46.7 years and the most common age group was 40's. The presenting symptoms for most patients were palpable mass (75.2%) followed by abnormal mammographic findings (8.4%), pain (6.3%) and nipple discharges (4.7%), and the duration of symptoms was less than 1 month in 41.4%. Fifty three percent of the 500 cases had T2 lesion (size; 2 to 5 cm). With the increase of tumor size, overall and disease free survival rates (OS, DFS) were decreased. Surgical treatment consisted of modified radical mastectomy (52.8%) and partial mastectomy (33.6%) The most common stage was II (42.3%) and the early breast cancer (stage 0, I, II) was 388cases (78.1%) and the stage were inversely correlated with DFS and OS. The positivity of axillary lymph node was 39.3% and the number of the metastatic lymph nodes was inversely correlated with DFS and OS. The pathologic types were infiltrating ductal carcinoma (83.0%), ductal carcinoma in situ (12.8%), infiltrating lobular carcinoma (1.2%), lobular carcinoma in situ (0.4%) and Paget's disease (2.0%). ER positivity was 48.9% and PR 46.9%. ER positive patients showed survival benefit compared to ER negative patients. The common sites of distant metastases were lung, bone and liver. CONCLUSIONS: Our patients with breast cancer were younger than those of western and showed the impacts on survival according to the lymph node status,tumor size.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Disease-Free Survival ; Female ; Humans ; Liver ; Lung ; Lymph Nodes ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Neoplasm Metastasis ; Nipples ; Survival Rate

PURPOSE: To evaluate the relationship between nuclear DNA contents and prognostic factors and survival in breast cancer patients. MATERIALS AND METHODS: We determined nuclear DNA content from 91 paraffin-embedded malignant breast tumors and evaluated relationship between DNA nuclear content and well-known prognostic indicators of breast cancer and the survival of the patients by statistical analyses. RESULTS: Twenty nine (34.5%) of the 91 tumors examined were diploid, and the remainder (65.5%) contained one or more aneuploid clones. S-phase fraction (SPF) ranged from 1.4 to 68.3% (median 11.2%) and it was higher in aneuploidy tumors than in diploid tumors (p<0.05). Positive axillary lymph nodes were found in 72.7% of the patients who had a tumor with a high SPF (above the median 11.2%) and in 27.3% of those with tumor with low SPF (below median) (p<0.05). The overall survival rate was 96.1% in DNA diploid and 87.6% in DNA aneuploid tumors, showing that DNA ploidy had no prognostic significance in breast cancers. The actuarial survival rates were 96.4% and 86.3% for low and high SPF, respectively (p=0.28). The patients with high SPF showed high disease free survival rate compared to the patients with low SPF but the difference had no statistical significance. CONCLUSION: Our results indicate DNA aneuploid tumors were more prevalent in breast cancer patients with high SPF or lymph node metastasis and larger patient accumulation with longer follow-up period will be helpful to identifiy the relationship between flow- cytometrical analysis and prognosis.
Aneuploidy ; Breast Neoplasms* ; Breast* ; Clone Cells ; Diploidy ; Disease-Free Survival ; DNA* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Ploidies ; Prognosis ; Survival Rate