Purpose: Breast cancer is the second most common malignancy in Korean women, and its incidence has increased rapidly. The purpose of this study was to evaluate the treatment outcomes of patients with breast cancer treated at a low volume center. Methods: We retrospectively analyzed 401 patients with stage I-III breast cancer at Chosun University Hospital from January 1998 to December 2013. We reviewed medical records including clinical information and pathologic reports. Results: We found 401 cases of newly diagnosed breast cancer, including 5 (1.2%) male breast cancer patients. According to histological features, there were 43 cases (ductal carcinoma in situ (DCIS): 35 cases [8.7%], lobular carcinoma in situ (LCIS): 8 cases [2.0%]) of non-invasive carcinoma, 350 cases (87.3%) of invasive carcinoma, 2 cases (0.5%) of Paget’s disease, 1 case (0.2%) of malignant phyllodes tumor, 3 cases (0.7%) of sarcoma, and 2 cases (0.5%) of other types. With respect to disease stage, 117 (29.2%) patients were in stage I, 176 (43.9%) in stage II, and 78 (19.4%) in stage III. The type of surgical approaches were breast-conserving surgery (153, 38.2%), modified radical mastectomy (243, 60.6%), wide excision (4, 1.0%), and others (1, 0.2%). Five-year disease-free survival rates were 100% (stage 0), 95.4% (stage I), 91.4% (stage IIa), 75% (stage IIb), 78% (stage IIIa), 50% (stage IIIb), and 59.2% (stage IIIc). Overall survival rates were 100% (stage 0), 96.2% (stage I), 94.3% (stage IIa), 85.4% (stage IIb), 84.8% (stage IIIa), 50% (stage IIIb), and 55.5% (stage IIIc). Conclusion Although the patients were treated at a low-volume center, their favorable survival outcomes are notable. Further multicenter (low-volume centers) research is warranted.

PURPOSE: A papillary thyroid microcarcinoma (PTMC) measures 1 cm or less in diameter. The diagnosis, and thus the apparent incidence, of PTMC has recently increased owing to an increase in the detection of subclinical small and low-risk carcinomas with ultrasonography and fine needle aspiration cytology. However, central neck lymph node metastasis (CLNM) can occur in patients with PTMC. We evaluated the factors influencing CLNM in patients with PTMC. METHODS: We reviewed medical records including clinical information and pathologic reports, and analyzed 622 patients with PTMC who underwent thyroid surgery from January 2002 to December 2012. RESULTS: CLNM was detected in 119 patients (19.1%) of the 622 with PTMC. Lymph node metastasis occurred more frequently in males (P=0.025), and those with bilateral tumors (P=0.016), more than two tumors (P=0.035), tumor size greater than 5 mm (P<0.001), and lymphovascular invasion (P=0.024). There were no statistically significant differences in age and capsular invasion. Multivariate analysis showed that significant factors affecting lymph node metastasis included age at operation (odds ratio [OR]=0.647, 95% confidence interval [CI]=0.422∼0.990, P=0.045), sex (OR=0.489, 95% CI=0.268∼0.891, P=0.020), tumor size (OR=3.034, 95% CI=1.761∼5.224, P<0.001), and lymphovascular invasion (OR=15.036, 95% CI=1.450∼155.911, P=0.023). CONCLUSION: Age less than 45 years, male sex, tumor size greater than 5 mm, and lymphovascular invasion were risk factors associated with CLNM.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Humans ; Incidence ; Lymph Nodes* ; Male ; Medical Records ; Multivariate Analysis ; Neck* ; Neoplasm Metastasis* ; Risk Factors ; Thyroid Gland* ; Ultrasonography

PURPOSE: In the present study we analyzed the leading diseases causing epiretinal membrane and compared the prognosis after epiretinal membrane peeling. METHODS: We enrolled 158 (160 eyes) patients diagnosed with epiretinal membrane who underwent epiretinal membrane peeling from January 2005 to January 2014. The medical records including age, underlying ocular disease, and pre-operative symptoms of patients from Chonbuk National University Hospital were analyzed retrospectively. Additionally, we evaluated the changes in central macular thickness and visual acuity after the epiretinal membrane peeling. RESULTS: Idiopathic epiretinal membrane was the most common type of disease (44.4%, 71/160). The causes of secondary epiretinal membrane were diabetic retinopathy (20.6%, 33/160), retinal tear, and retinal hole (18.1%, 29/160). Other causes were post retinal detachment surgery, traumatic epiretinal membrane, retinal vein occlusion and uveitis; 6.9% (11/160), 4.4% (7/160), 3.8% (6/160), and 1.9% (3/160), respectively. The changes in central macular thickness after surgery did not differ significantly between the idiopathic epiretinal membrane and secondary epiretinal membrane patients after adjusting for age (p = 0.958, based on analysis of variance (ANOVA). Additionally, the visual acuity did not differ significantly after the surgery even after adjusting for age (p = 0.118, analysis of covariance [ANCOVA]). CONCLUSIONS: Various ocular diseases can be the leading causes of epiretinal membrane, but the leading disease does not affect the degree of central macular thickness changes after surgery or change the prognosis of post-surgical visual acuity.
Diabetic Retinopathy ; Epiretinal Membrane* ; Humans ; Jeollabuk-do ; Medical Records ; Prognosis* ; Retinal Detachment ; Retinal Perforations ; Retinal Vein Occlusion ; Retrospective Studies ; Uveitis ; Visual Acuity

PURPOSE: There has been controversy of the lobectomy for well differentiated thyroid cancer (WDTC). Current guidelines recommend total thyroidectomy for the cancer over 1cm, despite previous report suggesting that the lobectomy provides similar excellent outcomes. The purpose of our study is to report our experience of WDTC treated by thyroid lobectomy. METHODS: We retrospectively analyzed 284 patients with WDTC treated by thyroid lobectomy at department of Surgery in Chosun University Hospital from January 2002 to December 2010. Overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method. Factors predictive of recurrence by univariate and multivariate analysis were determined using the χ2 test and Cox proportional hazard model respectively. RESULTS: With a mean follow-up of 60.4 months, OS and RFS for all patients were 97.9% and 96.5% respectively. No patient died due to WDTC. Univariate analysis showed statistically significant differences in recurrence by tumor size (P=0.013) and presence of invasion (P=0.039). However, Multivariate analysis showed no significant difference in local recurrence. CONCLUSION: Patients with WDTC confined to one lobe can be safely treated by lobectomy.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Methods ; Multivariate Analysis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Cyclin D1, cytokeratin(CK)7, CK20 and vimentin play an important role in tumorigenesis and tumor progression. Our aim was to investigate the expression of cyclin D1, CK7, CK20 and vimentin in 138 papillary thyroid cancer and relationship with clinicobiological factors. We also tried to evaluate the value of those as prognostic factors. METHODS: We performed an immunohistochemical assay for cyclin D1, CK7, CK20, and vimentin in 138 papillary thyroid cancer tissue specimens. The correlation between these factors and the clinicobiological parameters was analyzed. RESULTS: In 138 papillary thyroid carcinoma specimens, the expression of cyclin D1, CK7, CK20 and vimentin was seen in 118 cases (85.5%), 133 cases (96.4%), 2 cases (1.4%) and 119 cases (86.2%), respectively. In our cases, there was a significant association among the expressions of cyclin D1, gender and lymph node metastasis. However, no obvious correlation was found between those proteins, age, tumor size, tumor amount, lymph node status and the TNM stage. CONCLUSION: Our results suggested increased cyclin D1 expression was seen in female gender and it may be a useful marker for evaluating lymph node metastasis. However, the clinical utility of cyclin D1, CK7, CK20 and vimentin in thyroid cancer patients has to be further defined by prospective studies with larger sample sizes.
Carcinogenesis ; Cyclin D1* ; Cyclins* ; Female ; Humans ; Keratin-20* ; Keratin-7* ; Keratins* ; Lymph Nodes ; Neoplasm Metastasis ; Prospective Studies ; Sample Size ; Thyroid Gland* ; Thyroid Neoplasms* ; Vimentin*

PURPOSE: Papillary thyroid microcarcinomas (PTMC), which are not palpable and have no clinical symptoms are 1.0 cm or less in diameter. The optimal extent of thyroid tumor resection has been controversial. We investigated clinicopathological findings of PTMC of 5 mm or less in diameter for reasonable therapeutic approach. METHODS: From, Jan. 2002 to Dec. 2006, 366 patients underwent thyroidectomy for thyroid papillary carcinoma at our institution. Among these patients, 62 patients with a mass measuring less than 5 mm and 103 patients with a mass 5 mm to 1.0 cm were selected. We retrospectively reviewed their medical records. RESULTS: There was no significant difference on the clinical characteristics except multifocality. We performed more unilateral lobectomy, near total thyroidectomy with or without neck node dissection in patients with PTMC of less than 5 mm (P=0.13). In permanent biopsy, lymph node metastasis more frequently occurred in patients with PTMC of less than 5 mm (P=0.03). There were no differences in capsular invasion, distant metastasis or recurrence. CONCLUSION: In papillary thyroid microcarcinoma less than 0.5 cm, it is very uncommon for capsular invasion, distant metastasis and locoregional metastasis to exist. The extent of tumor resection may be limited less than near total thyroidectomy for suitable cases, because there was no locoregional metastasis or distant metastasis in the follow-up period. Longer follow-up periods would be required to confirm that limited surgery is sufficient for tumors less than 0.5 cm in size.
Biopsy ; Carcinoma ; Carcinoma, Papillary ; Follow-Up Studies ; Humans ; Lymph Nodes ; Medical Records ; Neck ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

PURPOSE: To identify the clinical manifestations and risk factors for poor visual outcome, as well as antibiotic susceptibility of isolates in bacterial keratitis. METHODS: A total of 128 eyes in 128 patients with bacterial keratitis, who were diagnosed by smears and cultures from January 2000 to December 2007 were reviewed retrospectively. Sex, age, previous ocular disease, trauma history, pre-treatment duration, previous ocular surgery, clinical manifestation, causative bacteria, pre- and post-treatment visual acuity, and treatment results were evaluated. An initial univariate and multivariate logistic regression analysis was performed to identify and select the main prognostic factors. The antibiotic susceptibility was evaluated in 2 consecutive 4-year periods. RESULTS: The mean age of the 128 patients was 59.0+/-18.2 years; 67 (52.3%) patients were male. The most common risk factor was ocular trauma (40.6%). The most prevalent isolate was coagulase-negative Staphylococcus (43.7%). Large size (p < 0.001) and previous ocular disease (p < 0.001) were significant prognostic factors in the multivariate logistic regression model. Resistance of cefazolin and aminoglycoside antibiotics that were commonly used as a combination therapy increased over the 8 years, but there was no significant difference in the 2 time periods tested (all p > 0.05). Among the fluoroquinolone antibiotics, susceptibility of ciprofloxacin was 75.7%. CONCLUSIONS: In patients with bacterial keratitis, a large ulcer size and the presence of previous ocular disease were risk factors for poor visual outcome. Gentamicin, cefazolin, and ciprofloxacin should be avoided as primary monotherapy for bacterial keratitis.
Anti-Bacterial Agents ; Bacteria ; Cefazolin ; Ciprofloxacin ; Eye ; Gentamicins ; Humans ; Keratitis ; Logistic Models ; Male ; Retrospective Studies ; Risk Factors ; Staphylococcus ; Ulcer ; Visual Acuity

PURPOSE: To report a case of corneal ulcer due to Alcaligenes faecalis in a patient with a preexisting corneal ulcer. CASE SUMMARY: A 58-year-old male patient presented with a corneal ulcer without a history of any trauma. The patient had a history of corneal ulcer 9 months earlier. The patient had previously been diagnosed with diabetic retinopathy and neovascular glaucoma, and his visual acuity was no light perception. Corneal scraping and culture yielded Alcaligenes faecalis susceptible to most antibiotics in the antibiotic susceptibility test. After treatment with empirical systemic antibiotics and eyedrops, his eye improved with a remaining corneal scar. CONCLUSIONS: Alcaligenes faecalis should be considered as a causal pathogen of corneal ulcer in patients with suspicious compromised ocular surface, such as previous corneal ulcer.
Alcaligenes ; Alcaligenes faecalis ; Anti-Bacterial Agents ; Cicatrix ; Corneal Ulcer ; Diabetic Retinopathy ; Eye ; Glaucoma, Neovascular ; Humans ; Light ; Male ; Middle Aged ; Ophthalmic Solutions ; Visual Acuity

PURPOSE: Surgical site infection (SSI) is the most common nosocomial infection in surgical patients, and this accounts for 38% of all patients with nosocomial infections. Despite the advances in techniques and knowledge to prevent infection, SSI remains a significant source of postoperative morbidity and mortality, and it results in a prolonged hospital stay and increased cost. This study aims to assess the incidence of SSI and to identify the risk factors associated with SSI for patients who undergo abdominal operation. METHODS: The data on 347 abdominal operations that were done under general anesthesia from 1 August 2005 to 31 July 2006 was collected and reviewed. RESULTS: The overall incidence of SSI was 4.9%. Comorbidity was the independent risk factor for the development of SSI (P=0.011). The development of SSI was related with the American Society of Anesthesiologists (ASA) preoperative assessment score (P=0.025). The duration of the operation had a statistically significant association with an increased risk of SSI on univariate analysis. The wound classification was not associated with SSI. Staphylococcus aureus was the most frequently isolated organism, and all of the cases were methcillin-resistant Staphylococcus aureus. CONCLUSION: This study demonstrate that comorbidity is a significant independent risk factor for SSI.
Anesthesia, General ; Comorbidity ; Cross Infection ; Humans ; Incidence ; Length of Stay ; Risk Factors ; Staphylococcus ; Staphylococcus aureus

PURPOSE: This study investigated the clinical features of patients with thyroid nodule combined with Hashimoto's thyroiditis, and the latter was incidentally detected after surgery. METHODS: The authors retrospectively evaluated 43 patients who were diagnosed with Hashimoto's thyroiditis after thyroidectomy between January 2001 and December 2006 at Chosun University Hospital. RESULTS: All patients underwent ultrasonography for the diagnosis of thyroid nodules. Ultrasonography revealed 16 calcified nodules with ill-defined margins, and these nodules were suspicious for malignancy. On performing preoperative fine needle aspiration, 37 cases were suspicious for malignancy or they were diagnosed as malignancies. All the thyroid nodules were taken for frozen section examination during surgery. On the frozen sections, 19 cases that were suspicious for malignant tumors underwent near total or total thyroidectomy along with central lymph node dissection, whereas 24 cases that were diagnosed as benign tumors underwent near total thyroidectomy or thyroid lobectomy. Based on the histopathological findings, 21 cases were diagnosed as Hashimoto's thyroiditis associated with papillary cancer; the nodules of these 21 cases were on average 0.75 cm, Twenty two cases were diagnosed as Hashimoto's thyroiditis associated with benign tumors, and the nodules of these cases measured on average 1.6 cm. CONCLUSION: Hashimoto's thyroiditis may present with a variety of clinical features, atypical ultrasonographic findings and a high false positive rate on fine needle aspiration. For the cases where Hashimoto's thyroiditis is suspected before surgery, serum antibody tests, ultrasonography and fine needle aspiration should be performed for making the accurate diagnosis of Hashimoto's thyroiditis. For the cases of suspicious malignant tumors, frozen section examination should be performed during surgery to decide on the correct operative procedure.
Biopsy, Fine-Needle ; Frozen Sections ; Humans ; Lymph Node Excision ; Retrospective Studies ; Surgical Procedures, Operative ; Thyroid Gland ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis