In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient’s pathology, the treatment plan should be carefully decided and individualized. At the authors’ institution, the treatment plan is made individually based on each patient’s symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient’s pathophysiology, optimal outcomes can be achieved. Depending on each patient’s pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient’s pathology, the treatment plan should be carefully decided and individualized. At the authors’ institution, the treatment plan is made individually based on each patient’s symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient’s pathophysiology, optimal outcomes can be achieved. Depending on each patient’s pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

The required adjustments precipitated by the coronavirus disease 2019 crisis have been challenging, but also represent a critical opportunity for the evolution and potential disruptive and constructive change of medical education. Given that the format of medical education is not fixed, but malleable and in fact must be adaptable to societal needs through ongoing reflexivity, we find ourselves in a potentially transformative learning phase for the field. An Association for Medical Education in Europe ASPIRE Academy group of 18 medical educators from seven countries was formed to consider this opportunity, and identified critical questions for collective reflection on current medical education practices and assumptions, with the attendant challenge to envision the future of medical education. This was achieved through online discussion as well as asynchronous collective reflections by group members. Four major themes and related conclusions arose from this conversation: Why we teach: the humanitarian mission of medicine should be reinforced; what we teach: disaster management, social accountability and embracing an environment of complexity and uncertainty should be the core; how we teach: open pathways to lean medical education and learning by developing learners embedded in a community context; and whom we teach: those willing to take professional responsibility. These collective reflections provide neither fully matured digests of the challenges of our field, nor comprehensive solutions; rather they are offered as a starting point for medical schools to consider as we seek to harness the learning opportunities stimulated by the pandemic.

PURPOSE: Spirituality is an important domain and is related with physical and psychological symptoms in terminal cancer patient. The aim of this study is to examine how patients' spirituality is associated with their physical and psychological symptoms as it has been explored by few studies. METHODS: In this cross sectional study, 50 patients in the palliative ward of a tertiary hospital were interviewed. Spiritual well-being, depression, anxiety and pain is measured by Functional Assessment of Chronic-Illness Therapy-Spirituality (FACIT-Sp), hospital anxiety and depression scale (HADS) and the Korean version of the Brief Pain Inventory (BPI-K). The correlations between patients' spiritual well-being and anxiety, depression and pain were analysed. The association between spiritual well-being and age, gender, palliative performance scale (PPS), religion, mean pain intensity, anxiety, depression were assessed by univariate and multivariate regression analyses. RESULTS: Spiritual well-being was negatively correlated with the mean pain intensity (r=-0.283, P<0.05), anxiety (r=-0.613, P<0.05) and depression (r=-0.526, P<0.05). In multivariate regression analysis, spiritual well-being showed negative association with anxiety (OR=-1.03, 95% CI=-1.657~-0.403, P=0.002) and positive association with the existence of religion (OR=9.193, 95% CI=4.158~14.229, P<0.001). CONCLUSION: In this study, patients' anxiety and existence of religion were significantly associated with spiritual well-being after adjusting age, gender, PPS, mean pain intensity, depression. Prospective studies are warranted.
Anxiety ; Depression ; Humans ; Pilot Projects ; Spirituality ; Terminally Ill ; Tertiary Care Centers

An 87-yr-old woman was diagnosed with AML with myelodysplasia-related changes (AML-MRC). The initial complete blood count showed Hb level of 5.9 g/dL, platelet counts of 27x10(9)/L, and white blood cell counts of 85.33x10(9)/L with 55% blasts. Peripheral blood samples were used in all the tests, as bone marrow examination could not be performed because of the patient's extremely advanced age and poor general health condition. Flow cytometric analysis, chromosome analysis, FISH, and reverse transcriptase-PCR (RT-PCR) results indicated AML-MRC resulting from t(3;21) with the RUNX1-MECOM fusion gene. To our knowledge, this is the second most elderly de novo AML patient associated with t(3;21) to be reported.
Aged, 80 and over ; Blood Cells/pathology ; Chromosomes, Human, Pair 21 ; Chromosomes, Human, Pair 3 ; Female ; Humans ; Karyotyping ; Leukemia, Myeloid, Acute/complications/*diagnosis/genetics ; Multiplex Polymerase Chain Reaction ; Myelodysplastic Syndromes/complications/*diagnosis/genetics ; Oncogene Proteins, Fusion/*genetics ; Sequence Analysis, DNA ; *Translocation, Genetic

BACKGROUND: Serum uric acid (UA) and anemia could be a valid and useful prognostic marker of chronic heart failure (CHF). We investigated the relationship of anemia and UA with clinical outcomes in CHF patients. METHODS: We analyzed 109 patients with congestive heart failure between August 2001 and October 2002 (age 67 +/- 15 years, follow-up 14 +/- 5 months). We distributed the patients into 3 groups according to hematocrit (Hct) level [Hct group 1 (Hct <30%, n=21), Hct group 2 (Hct 30~38%, n=49), Hct group 3 (Hct >38%, n=39)] and into 3 groups according to serum uric acid (UA) level [UA group I (UA <5.2 mg/dL, n=20), UA group II (UA 5.2~7.5 mg/dL, n=25), UA group III (UA >7.5 mg/dL, n=20)]. Primary end point were rehospitalization resulting from aggravation of CHF and all-cause of death. RESULTS: Among the groups according to Hct level, readmission rates were 57.1%, 28.6%, 15.4%, respectively (p<0.05). Among men, readmission rates were 82.3%, 22.2%, 14.3%, respectively (p<0.05). No significant difference in death rate was observed among the 3 groups. Among the groups according to UA level, there was no significant difference in readmission rates. Death rates were 5%, 8%, 35%, respectively (p<0.05) and there was significant difference in death rate especially among male patients. CONCLUSION: In male patients, lower hematocrit level was associated with higher readmission rate and higher serum uric acid level was associated with death rate.
Anemia* ; Estrogens, Conjugated (USP)* ; Follow-Up Studies ; Heart Failure* ; Hematocrit ; Humans ; Male ; Mortality ; Uric Acid*

BACKGROUND: LB03002[somatropin(rDNA origin) for injectable suspension] is a sustained release formulation of human growth hormone to be administered by once-a-week subcutaneous injections. Less frequent administration could provide a considerable improvement on compliance and convenience. OBJECTIVE: To determine the efficacy and safety of a LB03002 administered in children with GHD once weekly for 6 months. DESIGN: Open-label, active-controlled, randomised, parallel group, phase II study. PATIENTS: A total of forty-two naive or previously treated, pre-pubertal children with GHD, confirmed by two different GH provocation tests, were randomised and received either LB03002(0.3 or 0.5 mg/kg/week) or Eutropin(TM)(daily rhGH, 0.3 mg/ kg/week divided 6 times a week) for 6 months. RESULTS: The pre-treatment(HV0) and 6-month annualised height velocity(HV6) are shown(mean+/-SD) in the table below: ----------------------------------------------------------------------- LB03002 LB03002 EutropinTM 0.3 mg/kg/week 0.5 mg/kg/week 0.3 mg/kg/week ----------------------------------------------------------------------- N 10 13 13 HV0 3.1+/-1.0 3.9+/-1.5 3.0+/-1.1 HV6 9.3+/-2.3 10.2+/-2.3 11.1+/-2.5 ----------------------------------------------------------------------- Mean IGF-I and IGFBP-3 levels were significantly elevated from baseline values in all the study groups. LB03002 at all dose groups was safe and well tolerated. No clinically relevant adverse events or abnormal laboratory parameters were observed and there were no remarkable differences between groups or changes over time within groups regarding parameters for glucose and lipid metabolism including fasting glucose and haemoglobin A1c. Injection site reactions were mostly mild to occasionally moderate and resolved within 2 to 3 days post-dose without intervention. CONCLUSIONS: Treatment with LB03002 by weekly administration of the doses tested in the study resulted in comparable safety and efficacy to daily rhGH in pre-pubertal children with GHD.
Child* ; Compliance ; Fasting ; Glucose ; Growth Hormone* ; Human Growth Hormone* ; Humans* ; Injections, Subcutaneous ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Lipid Metabolism

BACKGROUND: Tranilast is an anti-allergic drug that suppresses the release of cytokines. An antioxidant, probucol, prevents endothelial dysfunction and oxidation of low density lipoprotein and also inhibits the secretion of interleukin-1 by macrophages. In several studies, both the tranilast and probucol with multivitamins have been shown to decrease the frequency of angiographic restenosis after PCI. METHODS: We analyzed clinical events and restenosis at 6 months following percutaneous coronary angioplasty in 93 patients with 113 coronary arterial lesions after coronary stenting at Soonchunhyang University Hospital between Jan 2001 and Apr 2003. The patients were assigned to following three groups: 39 patients who didn't receive tranilast and antioxidants (control group, M 29, F 10, 61 +/- 10 years) ; 25 patients who received probucol (500 mg), vitamin C (1,000 mg), vitamin E (400 mg) (antioxidant group, M 19, F 6, 62 +/- 10 years) ; 29 patients who received tranilast (400 mg) (Tranilast group, M 18, F 11, 59 +/- 9 years). RESULTS: The restenosis per lesion between three groups was not different significantly (control group, 32.7%; antioxidant group, 26.7%; Tranilast group, 20.6%). At follow-up, minimal luminal diameter (MLD) was not different significantly between three groups (control group, 1.8 +/- 1.07 mm; antioxidant group, 2.1 +/- 1.18 mm; Tranilast group, 2.1 +/- 0.94 mm). Target lesion revascularization was lower in Tranilast group (3.4%) as compared with control group (25.6%) and antioxidant group (16%, p<0.05). CONCLUSION: Neither probucol combined with vitamin C and E nor tranilast did not improve significantly the angiographic restenosis rate. But tranilast had reduced the target lesion revascularization rate as compared with control group and antioxidant group.
Angioplasty ; Antioxidants ; Ascorbic Acid ; Cytokines ; Follow-Up Studies ; Humans ; Interleukin-1 ; Lipoproteins ; Macrophages ; Percutaneous Coronary Intervention* ; Phenobarbital ; Probucol* ; Stents ; Vitamin E ; Vitamins

PURPOSE: In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. MATERIALS AND METHODS: Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. RESULTS: Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast- conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I, and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. CONCLUSION: Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.
Breast Neoplasms* ; Breast* ; Education ; Geography ; Humans ; Incidence ; Korea* ; Mastectomy, Radical ; Mastectomy, Segmental ; Radiotherapy

PURPOSE: This study was conducted to construct traffic-accident-related injury pyramid based on the New Injury Severity Score (NISS). METHODS: We constructed injury episodes to use the Traffic Accident Insurance database (1997~2001) and calculated the NISS by Abbreviated Injury Scale (AIS). All episodes were classified into three groups by using the NISS: minor group (1~10), moderate group (11~25), and severe group (25~75). Seventy-five points were assigned to all death episodes. We constructed a traffic-accident-related injury pyramid by using an NISS criterion. We compared frequencies and percentiles of episodes in the NISS-based injury pyramid. RESULTS: The number of episodes was 2,012,135. Of these, 1,331,599 episodes involved males, and the other 680,536 episodes involved females. The number of death episodes was 2,091 in 1997, 1,971 in 1998, 2,430 in 1999, 2,546 in 2000 and 141 in 2002. The mean NISS was 6.89+/-6.31, and the percents for the minor group, the moderate group, and the severe group were 85.58%, 13.39%, and 1.03%, respectively. The percent of males in the severe group was higher than that of females by 2.43 times. The percent of older persons (>46 yrs) in the severe and moderate groups was higher than that of young adults (16-45 yrs) The percents of belt-unattached episodes, pedestrian episodes, and separated-car accident episodes in the severe group were higher than those of bet-attached episodes, passenger or driver episodes, and car-to-car accident episodes. The mean out-patient-department follow-up period and the mean loss rate of labor ability increased from the minor group through the moderate group to the severe group. CONCLUSION: We confirmed the characteristics of the traffic-accident-related injury pyramid.
Abbreviated Injury Scale ; Accidents, Traffic* ; Female ; Follow-Up Studies ; Humans ; Injury Severity Score* ; Insurance ; Male ; Young Adult