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Dong Ho SHIN ; Han Seung KANG ; Young Cheol KIM ; Ji Soo KIM ; Dong Young NOH ; Yeo Kyu YOON ; Kuk Jin CHOE ; Seung Keun OH

Journal of the Korean Surgical Society.1998;55(3):350-356.

One of the most important issues in breast cancer is the possibility of developing a new second carcinoma in the opposite breast. In order to evaluate the clinical and histopathologic characteristics of bilateral breast cancer, we retrospectively reviewed the clinical records of 23 bilateral breast cancer patients from among the 1136 women with invasive breast cancer treated in our Departmentbetween January 1989 and December 1995. Tumors were grouped into those simultaneously detected or detected within 6 months of each other, in both breasts (synchronous, 8/23) and those detected more than 6 months (metachronous, 15/23). The mean interval in the metachronous cancers was 55 months. Among the previously reported risk factors for bilateral breast cancer, such as onset at an early age, lobular histology, family history, and multicentricity, family history was the only statistically significant factor in our study(p<0.01). The most frequent histologic type of tumor was an invasive ductal carcinoma and the most frequent tumor location was the outer upper quadrant, as in unilateral breast cancer. The concordance rate of the histologic types and the location of both tumors was 60.9% and 39.1%, respectively. According to the AJCC classification, the most common pathologic stage was IIA. For tumors detected by mammography alone, the pathologic stage of the tumors was lower and the percentage of in situ lesions was higher than for those detected by physical examination. In conclusion, in breast cancer patients with a family history of breast cancer, the possibility of contralateral breast cancer should be considered more carefully, and close mammographic follow up and the concept of mirror image may be helpful in early detection of contralateral breast cancer.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Classification ; Female ; Follow-Up Studies ; Humans ; Mammography ; Physical Examination ; Retrospective Studies ; Risk Factors

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A Clinical Analysis of Parotid Tumors.

Tae Seon KIM ; Dong Young NOH ; Yeo Kyu YOUN ; Seung Keun OH ; Kuk Jin CHOE

Journal of the Korean Surgical Society.1998;55(3):332-340.

A clinical analysis was done for 141 patients with parotid tumors who had been admitted to and treated at the Department of Surgery, Seoul National University Hospital over a period of 15 years from January 1981 to December 1995. Of these 141 cases, there were 123 cases of benign tumors and 18 cases of malignant tumors. The results were as follows ; 1) Sex distribution revealed a preponderance of females with a ratio of 1.4 : 1. When only malignant tumors were considered, males were predominant with a ratio of 1.6 : 1. 2) Benign tumors were prevalent in the 3rd & the 4th decades while malignant tumors were prevalent in the 4th & the 5th decades. 3) The chief complaint was a palpable mass in all the cases and facial nerve palsy was accompanied with 22% of malignant cases. 4) The mean size of the mass was 3.5 cm in diameter. 5) The mean duration of illness was 4.9 years with a duration of 1 year being seen in 28% of the benign tumor cases and in 44% of the malignant tumor cases. 6) The most commonly performed operative procedures were a superficial lobectomy(56%) for benign tumors and a total parotidectomy(67%) for malignant cases. And 76% of all benign tumors and 89% of all malignant tumors were treated with a superficial lobectomy or a more extensive operation. 7) According to the histopathological findings, benign tumors were present in 123 cases(87%) and malignant tumors in 18 cases(13%). The most common benign tumor was pleomorphic adenoma(80%) and the most common malignant tumor was mucoepidermoid carcinoma(50%). 8) In the 5 recurrent cases, previous operations were enucleation(4 cases) and biopsy only(1 case). 9) The postoperative complications developed in 51 cases(36%), including 33 cases(23%) of facial nerve palsy and 9 cases(6%) of Frey's syndrome. Facial palsy was permanent in 7 cases(5%). 10) Of the 94 follow-up cases, recurrences developed in 6 cases(7%) of benign tumors and 6 cases (50%) of malignant tumors.
Biopsy ; Facial Nerve ; Facial Paralysis ; Female ; Follow-Up Studies ; Humans ; Male ; Paralysis ; Postoperative Complications ; Recurrence ; Seoul ; Sex Distribution ; Surgical Procedures, Operative ; Sweating, Gustatory

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Effect of External Beam Irradiation on Intimal Hyperplasia in Autografted Femoral Artery of Dog.

Song Ok LEE ; Chang Yong SOHN ; Kwan Gyu PARK ; Ok Bae KIM ; Won Hyun CHO

Journal of the Korean Surgical Society.1998;55(3):324-331.

BACKGROUNDS: It is well known that intimal hyperplasia is one of the most important cause of vascular graft failure in angioplasty, autogenous venous graft and prosthetic bypass graft. Clinical trials of drugs including antiplatelet agents, anticoagulant, corticosteroid, cyclosporine and prostaglandin were not satisfactory in suppressing intimal hyperplasia. Seeding of endothelial cell also have been done for this purpose with some success. There are several reports that endovascular low dose irradiation and external beam irradiation might reduce the amount of proliferative neointima after arterial injury. METHODS: In order to evaluate the effect of external beam irradiation on intimal hyperplasia in grafted vessel, femoral artery autografts using external jugular vein were performed in dogs, and studied the morphological finding under microscope and compared intimal hyperplasia between control and radiated groups. Group I (control) was not irradiated after graft. But experimental groups were irradiated with 6 Mev electron: Group II, 800 cGy on day 1; Group III, 400 cGy on day 1 and day 4 each; and Group IV, 800 cGy on day 4. Radiation efficacy on intimal hyperplasia was histologically assessed by measuring neointimal thickness at the proximal and distal site of grafted vessel at 6 weeks after graft. RESULTS: Mean neointimal thickness in all irradiated groups were significantly lesser than control group (p<0.05) and not related with irradiating time: Group I (Control), 0.41+/-0.11 mm; Group II, 0.16+/-0.10 mm; Group III, 0.19 0.10 mm; Group IV 0.15+/-0.08 mm. There was no difference in intimal hyperplasia between proximal and distal anastomotic site of grafted vessels in both control and irradiated groups: Control, 0.42+/-0.11 mm vs 0.40+/-0.10 mm; Radiated groups, 0.17+/-0.10 mm vs 0.16+/-0.09 mm; (p>0.05). CONCLUSION: These data suggest that low dose external beam irradiation might suppress intimal hyperplasia in grafted vessel, but further study will be necessary to determine optimal dose and timing of radiation delivery, and its efficacy in long segment bypass graft.
Angioplasty ; Animals ; Autografts* ; Cyclosporine ; Dogs* ; Endothelial Cells ; Femoral Artery* ; Hyperplasia* ; Jugular Veins ; Neointima ; Platelet Aggregation Inhibitors ; Transplants

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Comparative Experimental Analysis on Several Anastomotic Techniques of the Colon.

Kang Hong LEE ; Chang Sik YU ; Han Il LEE ; Wan Soo KIM ; Chang Nam KIM ; Youn CHOI ; Gyeong Hoon KANG ; Mee Ra CHOO ; Sang Kyu PARK ; Jin Cheon KIM

Journal of the Korean Surgical Society.1998;55(3):314-324.

BACKGROUND: Although the stapled anastomotic technique has achieved efficacy in gastrointestinal surgery, there are only a few experimental results comparing the physical properties of the anastomotic site, pathologic features of the healing process, and physiologic change after the operation. Moreover, there have been no comparative study among various stapled anastomotic techniques. The purpose of this study was to evaluate the safety of various stapled anastomotic techniques by comparing the physical properties of the anastomotic site, pathologic features of the healing process and physiologic change observed for the classical hand-sewn anastomotic technique with those observed for various stapled anastomotic techniques in the normal porcine colon and rectum. METHODS: Twelve male pigs were grouped into 4 according to the anastomotic techniques; standard Albert-Lembert two-layer hand-sewn anastomosis, stapled end-to-end anastomosis, stapled end-to-side anastomosis, and stapled side-to-side anastomosis. Each anastomotic technique was applied at 3 sites (ascending colon, transverse colon, and rectum). Groups of animals underwent a second surgery on the 4th week postoperatively, and the anastomotic properties were assessed with respect to the first day of defecation, bursting pressure, tensile strength, gross scar formation, microscopic inflammatory cell infiltration, telangiectasia, lymphangiectasia, foreign-body reaction, granulation and fibrosis. RESULTS: No significant difference among the respective anastomotic techniques was found with respect to the first day of defecation, bursting pressure, tensile strength, microscopic inflammatory cell infiltration, telangiectasia, and lymphangiectasia. However, more scar formation, foreign-body reaction, granulation and fibrosis were observed in the hand-sewn anastomosis. There was no significant difference among the groups of various stapled anastomotic techniques. CONCLUSION: According to this animal study, various stapled anastomoses were superior to the standard Albert-Lembert two-layer hand-sewn anastomosis with less scar formation, foreign-body reaction,granulation and fibrosis. In colorectal surgery, various stapled anastomotic techniques can be safely applied in accordance with the respective purpose and the anatomical characteristics.
Animals ; Breast Neoplasms* ; Breast* ; Cicatrix ; Colon* ; Colon, Transverse ; Colorectal Surgery ; Defecation ; Fibrosis ; Foreign-Body Reaction ; Humans ; Lymphatic Vessels ; Male ; Mastectomy ; Mastectomy, Radical ; Mastectomy, Segmental* ; Neoplasm Metastasis ; Rectum ; Recurrence ; Retrospective Studies ; Swine ; Telangiectasis ; Tensile Strength

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Breast-Conserving Surgery With or Without Radiation Therapy for Early Breast Cancer.

Soon Gi HONG ; Jee Hyun LEE ; Sung Kong LEE ; Sei Ok YOON

Journal of the Korean Surgical Society.1998;55(3):314-349.

Breast conserving surgery (BCS) with radiation therapy (RT) has been considered an alternative to a radical mastectomy in the surgical treatment of early breast cancer. Breast-conserving therapy (BCT) can achieve a more favorable cosmetic outcome than a mastectomy in patients with early breast cancer. However, it is widely recognized that RT following BCS is an impediment to improve the cosmetic outcome of a BCT-treated breast. If the local recurrence (LR) rate is acceptable and LR can be controlled with salvage surgery, an appropriate conservative surgical procedure without RT will be a reasonable option for some patients with early breast cancer. Between 1990 and 1996, 60 patients were enrolled in a retrospective study to examine whether or not RT could be avoided following conservative surgery in patients with early breast cancer. There was no significant difference in local recurrence rate between the RT and the non-RT groups (6.3% vs 10.7%). The characteristics of suitable BCS without RT would be negative axillary lymph-node metastasis, low nuclear grade, a 1 cm negative resection margin and no lymphatic vessel involvement. In conclusion, breast-conserving surgery without RT is a reasonable option for some patients with early breast cancer.
Animals ; Breast Neoplasms* ; Breast* ; Cicatrix ; Colon* ; Colon, Transverse ; Colorectal Surgery ; Defecation ; Fibrosis ; Foreign-Body Reaction ; Humans ; Lymphatic Vessels ; Male ; Mastectomy ; Mastectomy, Radical ; Mastectomy, Segmental* ; Methods ; Neoplasm Metastasis ; Rectum ; Recurrence ; Retrospective Studies ; Swine ; Telangiectasis ; Tensile Strength

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The Correlations between the Expression of Cyclin E and Clinical Features of the Primary Breast Cancer.

Jae Woo PARK ; Keun Ho YANG ; Byung Noe BAE ; Ki Hwan KIM ; Hong Joo KIM ; Young Duck KIM ; Hong Yong KIM ; Kyeong Mee PARK ; Se Hwan HAN

Journal of the Korean Surgical Society.2002;63(5):372-377.

PURPOSE: Cyclin E is a key regulatory protein in the G1-S transition during the cell cycle. The correlations between cyclin E protein and the clinical features of breast cancer were investigated in order to evaluate its clinical utility in invasive breast cancer. METHODS: An immunohistochemical assay for cyclin E was performed in 101 consecutive invasive breast cancers. The correlation between cyclin E expression and the clinicobiological parameters including patient survival was analyzed. RESULTS: Cyclin E expression was observed in 50 patients (49.5%). The scoring of the cyclin E expression level was divided into low (<25%) and high (>or=25%). In high nuclear grade tumors, cyclin E overexpression was much higher than that in low nuclear grade tumors (P=0.049). In the younger age group (<50 yrs), cyclin E expression was significantly higher than the older age group (P= 0.016). No significant correlation was observed between cyclin E and the tumor size, lymph node status, hormonal receptor status, histological grade, mitotic index and Ki67. In multivariate analysis, only the lymph node status was significantly associated with the patients' outcome (P= 0.002). CONCLUSION: Cyclin E overexpression did not have prognostic impact on the patients' survival rate in invasive breast cancer. In high nuclear grade tumors, the cyclin E expression level was much higher. The definite value of cyclin E as a clinicobiologic marker should be further investigated by prospective studies with other cell regulatory proteins.
Breast Neoplasms* ; Breast* ; Cell Cycle ; Cell Proliferation ; Cyclin E* ; Cyclins* ; Humans ; Lymph Nodes ; Mitotic Index ; Multivariate Analysis ; Prognosis ; Survival Rate

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99mTc-tetrofosmin, 131I Whole Body Scan and Thyroglobulin in Detecting Differentiated Thyroid Carcinoma Metastases.

Sang Hyun SONG ; Heung Kyu PARK ; Yeon Ho PARK ; Jeong Nam LEE ; Jong Ho KIM ; Young Don LEE

Journal of the Korean Surgical Society.2002;63(5):366-371.

PURPOSE: The purpose of this study was to assess the detectability of differentiated thyroid carcinoma metastases by 99mTc-tetrofosmin and to compare these results with a 131I whole body scan (131I WBS). The results of two scans were also compared with the T4 off-thyroglobulin (Tg) concentration. METHODS: A prospective study was performed on 43 patients (40 females, 3 males) with differentiated thyroid carcinomas (41 papillary, 2 follicular) having undergone a total thyroidectomy, and received 100~200 mCi (3,700~7,400 MBq) of radioiodine for ablation of residual thyroid tissue, or treatment of metastasis. All patients (n=43) had a 99mTc- tetrofosmin scan, and a 131I WBS following the discontinuation of thyroid hormone replacement. The T4 off-Tg level was checked immediately prior to the radioiodine therapy, with T4 off-Tg levels above 20 ng/ml defined as positive for metastasis or a remnant disease. RESULTS: Cervical metastases were considered in 6 patients and distant metastases in 7, based on the clinical, radiological, and histopathological findings. The 131I WBS (70.2%) was much more sensitive than the 99mTc-tetrofosmin scan (29.8%) in demonstrating the residual thyroid tissue following surgery. The 131I WBS revealed cervical metastases in 3 of the 6 patients, but only 2 of the 6 were revealed by the 99mTc-tetrofosmin scan. Of the 3 patients with negative 131I WBS, two were detected by the 99mTc-tetrofosmin scan. The sensitivities of the 131I WBS and 99mTc-tetrofosmin scan in diagnosing distant metastases were comparable (71%, and 57% respectively), but in 2 patients with negative 131I WBS, the 99mTc-tetrofosmin revealed distant metastases. The specificities of the 131I WBS and 99mTc-tetrofosmin scan were not comparable (100%, 97%, respectively) in the diagnosis distant metastases. The mean T4 off-Tg level of the patients with cervical or distant metastases was 317 ng/ml, with a sensitivity and specificity of 100%, and 83% respectively. In the patients with a T4 off-Tg level above 50 ng/ml, the two scans and clinical studies could not reveal any metastases in 3 of the patients. CONCLUSION: Although the specificity of the 99mTc-tetrofosmin scan was slightly lower than that of the 131I WBS, it is a useful tool for detecting cervical or distant metastases in differentiated thyroid carcinomas and does not require prior withdrawal from thyroid hormones. Therefore the concomitant use of a 99mTc-tetrofosmin scan, a 131I WBS and Tg, is more effective in detecting metastases in differentiated thyroid carcinomas.
Diagnosis ; Female ; Humans ; Neoplasm Metastasis* ; Prospective Studies ; Sensitivity and Specificity ; Thyroglobulin* ; Thyroid Gland* ; Thyroid Hormones ; Thyroid Neoplasms* ; Thyroidectomy ; Whole Body Imaging*

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Ischemia-reperfusion Injury after Canine Liver Allo-transplantation: The Effect of Gadolinium Chloride.

Ku Yong CHUNG ; Soon Hee SUNG ; Gyu Young JEONG ; Soo Youn OH ; Yu Seun KIM ; Baik Hwan CHO ; Kum Ja CHOI ; Yong Man CHOI

Journal of the Korean Surgical Society.2002;63(5):360-365.

PURPOSE: The effective suppression of Kupffer cell function is believed to contribute to the prevention of preservation/ reperfusion injury. In this study, the effect of Gadolinium, a synthetic Kupffer cell suppressor, on the reperfusion injury was examined using a canine partial liver transplant model. METHODS: About 70% of the liver was harvested and reimplanted in a mongrel recipient dog weighing 20~25 kg. Gadolinium Chloride (10 mg/kg) was infused via the cephalic vein 24 hour before harvesting the partial liver (Gadolinium group, n=5). Serum Aspartate Aminotransferase (AST) Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH), and morphological grading of the graft were compared with the control group (n=5). Statistical analysis was done with an independent T-test. RESULTS: The total ischemic time was 4 hours and 27 minutes on average. One hour after reperfusion, there were no significant differences in the AST, ALP and LDH level, and the pathologic scores. At 48 hours after reperfusion, the AST (P=0.03) and LDH (P=0.05) levels were significantly lower in Gadolinium group. CONCLUSION: Kupffer cell blockage using the Gadolinium chloride might be an effective way of reducing ischemia reperfusion injury. However, this effect was not evident in the early stages of reperfusion.
Alkaline Phosphatase ; Animals ; Aspartate Aminotransferases ; Dogs ; Gadolinium* ; L-Lactate Dehydrogenase ; Liver* ; Reperfusion ; Reperfusion Injury* ; Transplants ; Veins

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Outcome of Curative Resection in Patients with Completely Obstructing Colorectal Cancer.

Kang Hong LEE ; Chang Sik YU ; Hee Cheol KIM ; Jung Rang KIM ; Young Min KIM ; Jung Sun KIM ; Jin Cheon KIM

Journal of the Korean Surgical Society.2004;66(3):199-204.

PURPOSE: A large bowel obstruction as a result of primary colorectal cancer has a poor outcome. A retrospective study was designed to verify the recurrence patterns and to determine the prognostic factors after a curative resection in patients with a completely obstructing colorectal cancer. METHODS: Eight hundred patients with stage II and III colorectal adenocarcinomas (37 patients with a complete obstruction and 763 patients without an obstruction) underwent curative surgery between 1989 and 1996 at the Asan Medical Center. The median follow-up period was 55 (3~107) months. RESULTS: Clinicopathologic variables, i.e. sex, serum carcinoembryonic antigen (CEA), Borrmann type, differentiation, and tumor stage in the two groups were similar. Patients with obstructing colorectal cancer were significantly older than those without an obstruction (61+/-14 vs. 56+/-12 years, P=0.02). Rectal cancers were more frequent in the non-obstructing cancers than in the obstructing cancers (P=0.02). The recurrence rate in the two groups was similar (obstructing vs. non-obstructing cancer, 27.0% vs. 28.0%). Ten patients with 12 recurrences were identified in 37 obstructing colorectal cancer patients, three with local recurrences (8.1%) and nine with distant metastasis (24.3%). The 5-year survival rate between the same stages was not different between the two groups (77.8% vs. 85.3% in stage II, 65.1% vs. 60.4% in stage III). Among the various clinicopathologic variables, neural invasion was strongly associated with a poor prognosis in obstructing colorectal cancer on multivariate analysis (P<0.05). CONCLUSION: Because the obstructing cancers and the non-obstructing colorectal cancers had a similar outcome, curative surgery appears to offer the best chance of a cure in stage II and III obstructing colorectal cancer.
Adenocarcinoma ; Carcinoembryonic Antigen ; Chungcheongnam-do ; Colorectal Neoplasms* ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Survival Rate

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Detection of Micrometastasis in Draining Vein before & after Manipulation and Peritoneal Cavity in Colorectal Cancer by Reverse Transcriptase-Polymerase Chain Reactions for Cytokeratin 20 and Carcinoembryonic Antigen.

Jai Kyun JOO ; Ji Hee LEE ; Young Kyu PARK ; Seong Yeob RYU ; Dong Yi KIM ; Young Jin KIM

Journal of the Korean Surgical Society.2004;66(3):194-198.

PURPOSE: Micrometastasis is known as a significant predictor of prognosis in colorectal cancer patients. Recently, reverse transcriptase polymerase chain reaction (RT-PCR) has been applied to detecting micrometastasis. The drainage vein and peritoneum were examined and the micrometastases assessed in a series of colorectal cancer patients. METHODS: 22 patients, who were histologically diagnosed with colorectal cancer, and 8 patients of serosal and peritoneal brushing, were examined using RT-PCR to amplify the mRNAs for two epithelial markers, carcinoembryonic antigen (CEA) and cytokeratin 20 (CK-20). RESULTS: Among the 22 colorectal cancer patients, the positive rates of CK-20 and CEA mRNAs in the drainage vein were 10 (45%) and 7 (32%), and those of the serosal and peritoneal brushing were 6 (75%) and 5 (63%), respectively. CONCLUSION: These results suggest that the "no touch isolation technique" might be useful for operations in advanced colorectal cancer patients, and the brushing of the serosal or Douglas pouch can represent the micrometastasis status.
Carcinoembryonic Antigen* ; Colorectal Neoplasms* ; Douglas' Pouch ; Drainage ; Humans ; Keratin-20* ; Keratins* ; Neoplasm Micrometastasis* ; Peritoneal Cavity* ; Peritoneum ; Prognosis ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger ; Veins*

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