BACKGROUND: Lymphatic malformation (LM) is a form of congenital vascular malformation with a low incidence. Although LM has been studied, no consensus has emerged regarding its cause or treatment. METHODS: In this study, we retrospectively evaluated 40 patients who visited our vascular anomalies center for the treatment of cervicofacial LM, which is a common manifestation of LM. The medical records of patients over a period of 12 years were reviewed and analyzed for commonalities regarding the diagnosis and the results of treatment. RESULTS: Suspected cervicofacial LM was confirmed through imaging studies. No difference in incidence was observed according to sex, and 73% of patients first presented with symptoms before the age of two years. The left side and the V2-V3 area were most commonly affected. No significant differences in incidence were observed among the macrocystic, microcystic, and combined types of LM. A total of 28 out of 36 patients received sclerotherapy as the first choice of treatment, regardless of the type of lesion. Complete resolution was achieved in only 25% of patients. CONCLUSIONS: LM is important to confirm the diagnosis early and to choose an appropriate treatment strategy according to the stage of the disease and each individual patient's symptoms. When treatment is delayed or an incorrect treatment is administered, patient discomfort increases as the lesion gradually spreads. Therefore, more so than is the case for most other diseases, a team approach on a case-by-case basis is important for the accurate and appropriate treatment of LM.
Consensus ; Diagnosis ; Humans ; Incidence ; Lymphangioma ; Lymphatic Abnormalities ; Medical Records ; Retrospective Studies* ; Sclerotherapy ; Vascular Malformations

PURPOSE: To assess the appropriateness of radiotherapy volume for patients receiving breast-conserving treatment (BCT) through analysis of recurrence pattern and factors affecting recurrence. METHODS: From 1991 to 1996, 362 patients who received BCT were retrospectively evaluated. The radiation volume was the involved breast alone in the patients with less than 4 positive axillary lymph nodes (LNs), and breast and supraclavicular fossa in patients with 4 or more positive axillary LNs. The median follow-up period was 123 months (range, 3-169 months). RESULTS: Ten-year overall, disease-free, local recurrence-free, and regional recurrence-free survival rates were 86.2%, 82.2%, 95.9%, and 95.2%, respectively. Among 310 patients receiving radiotherapy on the breast alone, 15 (4.8%) had regional recurrence. In particular, patients with inner quadrant lesions had high regional recurrence rates (11/98, 11.2%) (p<0.001). CONCLUSION: These low local recurrence rates may reveal that the current radiotherapy technique was successful. However, in cases of inner quadrant lesions, there were a considerable number of regional recurrences, even in N0 cases. This may suggest a potential role for irradiation on regional LNs in this group.
Breast ; Breast Neoplasms ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mastectomy, Segmental ; Recurrence ; Retrospective Studies ; Survival Rate

Synovial fluid (SF) aspiration cytology is a useful diagnostic tool. For patients with gouty arthritis, the diagnosis is confirmed by the presence of monosodium uric acid (MSU) crystals in the SF, and these crystals are long, pointed ended and needle-shaped and they show strongly negative birefringence. Sometimes, it is difficult to diagnosis between gouty arthritis and other type of inflammatory arthritis. We experienced two unusual cases of gouty arthritis that we performed SF analysis for. The first patient was a 35 year old male who presented with relatively typical clinical symptoms with hyperuricemia, but the SF showed acute inflammatory cells without crystals on light microscopy. Only a few suspected crystals of MSU were identified on polarizing microscopy. The second patient was a 45 year old male who presented with atypical symptoms and pain and swelling of the left ankle and knee joint for 3 weeks. The uric acid level in the serum and urine was increased, but not over the normal limit. However, on light and polarizing microscopy, there were numerous MSU crystals in the SF. Conclusively, in some cases of gouty arthritis, the crystals are not identified on light microscopy or the uric acid level is not dramatically increased. So, the polarizing microscopy, the clinical information and the laboratory findings are all included in the work-up when evaluating the SF cytology of arthritis patients.
Animals ; Ankle ; Arthritis ; Arthritis, Gouty ; Birefringence ; Gout ; Humans ; Hyperuricemia ; Knee Joint ; Light ; Male ; Microscopy ; Synovial Fluid ; Uric Acid

Excess dietary fat intake is associated with many chronic diseases. This crosssectional study determines the differences in nutritional status and diet-related psychosocial factors by accuracy levels of dietary fat intake perceptions among adults. A total of 202 Universiti Putra Malaysia staff (20-55 years old) volunteered to participate in the study. Dietary fat accuracy levels (under-estimate, accurate and over-estimate) were determined by assessing actual fat intake through 24-hour diet recall and self-rated fat intake. Diet-related psychosocial factors assessed were perceived risks, intention to change, outcome expectancies and perceived barriers. About half (49.5%) of the respondents were classified as accurate estimators, while 35.6% and 14.9% were under-estimators and over-estimators, respectively. Dietary fat intake differed significantly between the dietary fat accuracy groups with under-estimators having the highest amount of dietary fat intake (F=17.10; p<0.001) and percentage of fat calories (F=103.99 + 0.533%, p<0.001). Over-estimators had the highest mean BMI (F=3.11, p<0.05) compared to other groups. Among the fat accuracy groups, under-estimators reported the least barriers to eating low fat foods (F= 3.671, p<0.05). There were no significant differences in waist circumference, energy intake, perceived disease risks, intention to change and outcome expectancies among the dietary fat accuracy groups. These findings suggest that inaccurate perceptions of dietary fat intake should not be overlooked as one of the cognitive barriers to dietary change and factors that influence nutritional status among adults.

OBJECTIVE: Paclitaxel is one of the most effective antineoplastic drugs. HPV-related cervical lesions have only managed with invasive procedure. Topical drug administration with temperature sensitive copolymer gels are useful approaches to clinical situation. In this study, we evaluated the activity of multiblock copolymers of PEG/PLA (poly(L-lactic acid)/polyethylene glycol) gels with paclitaxel (PTX) formulation administered by topical treatment to mice bearing human cervical cancer cell lines (HeLa). METHODS: We have synthesized gels of PEG/PLLA (poly(L-lactic acid)/polyethylene glycol) multiblock copolymers containing Paclitaxel which have temperature-sensitivecharacteristics. This Paclitaxel-containg copolymers has the sol-gel-sol transition temperature at body temperature. The efficacy of PTX in PEG/PLA mutiblock copolymer micelle were conducted in HeLa-tumor bearing Balb/c Nu/Nu athymic mice at an equivalent paclitaxel dose of 10 mg/kg with 48 hr interval. The inhibition of tumor growth was evaluated after 8 days of treatment. Tumors were harvested at day 10 and stained with hematoxylin and eosine to measure tumor. RESULTS: PTX-containing PEG/PLA mutiblock copolymer significantly decreased tumor growth at day 8, as measured by tumor size; ie, PEG/PLA mutiblock copolymer only goup ; 1.43+/-0.26 m versus intraperitoneal treatment of Paclitaxel : 0.75+/-0.07 mm and topical treatment of PTX-containing PEG/PLA copolymer containing Paclitaxel : 0.28 mm (Min; 0.1 mm-Maxu0.8 mm). CONCLUSION: This demonstration that PTX-containing PEG/PLA mutiblock copolymer have a useful topical drug deliversy system carrying temperature sensitive characetersitics in HPV-related cervical lesions.
Administration, Topical ; Animals ; Antineoplastic Agents ; Body Temperature ; Cell Line ; Eosine Yellowish-(YS) ; Gels ; Hematoxylin ; Humans ; Lifting ; Mice ; Mice, Nude ; Models, Animal ; Paclitaxel ; Polymers ; Transition Temperature ; Ursidae ; Uterine Cervical Neoplasms

PURPOSE: Sentinel lymph node (SLN) biopsy is considered a highly accurate and very economic method of assessing the axillary nodal status in breast cancer patients. Recently immunohistochemical (IHC) staining and reverse transcriptase polymerase chain reaction (RT-PCR) are commonly used to evaluate micrometastasis in the sentinel lymph node. However, most of the RT-PCR studies have been performed using fresh tissue. This study was conducted to assess micrometastasis in clinically node-negative breast cancer by using RT-PCR technique on the paraffin embedded sentinel lymph nodes. METHODS: Sixty patients who undergone SLN biopsy followed by axillary lymph node dissection due to breast carcinoma were evaluated from February 2000 to January 2001 at the Breast Cancer Center, Department of Surgery, Yongdong Severance Hospital. Serial sections were made from all sentinel lymph nodes for the H&E staining and for the IHC staining with monoclonal anti-cytokeratin antibody. RNA was extracted from the paraffin embedded sentinel lymph nodes and RT-PCR was performed using cytokeratin 19 mRNA, MUC-1 mRNA, and MAGE-A3 mRNA. RESULTS: In 32 out of 60 cases, beta-actin mRNA was detected after RT-PCR, and the 28 cases which had no product after RT-PCR for beta-actin were excluded from this study. Twenty five cases showed as being metastasis positive and 7 cases showed as being metastasis negative by serial section (SS) H&E staining. Three out of 25 negative cases tested for by SS H&E staining were found to be positive by IHC. Ten, six and, eight cases out of the 25 negative cases tested for by SS H&E were found to be positive by RT-PCR for cytokeratin 19, MUC-1, and MAGE-A3, respectively. Among the 22 cases that were found to be negative by both SS H&E staining and IHC staining, 9, 4, and 6 cases were converted to positive by RT-PCR for cytokeratin 19, MUC-1, and MAGE-A3, respectively. Using the combination of two or three markers for performing RT-PCR was more sensitive than any single marker to detect micrometastasis (p < 0.05). CONCLUSION: Even though we failed to extract RNA in 46% of the paraffin embedded tissues, it may be possible to detect micrometastasis by using RT-PCR with the paraffin embedded tissue. RT-PCR is far more sensitive than IHC for detecting microme tastasis, and when we combine multiple markers, the detection rate is higher than for any one marker.
Actins ; Biopsy ; Breast Neoplasms* ; Breast* ; Humans ; Keratin-19 ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Paraffin ; Reverse Transcriptase Polymerase Chain Reaction ; RNA ; RNA, Messenger

PURPOSE: Sentinel lymph node (SLN) biopsy is considered a highly accurate and very economic method of assessing the axillary nodal status in breast cancer patients. Recently immunohistochemical (IHC) staining and reverse transcriptase polymerase chain reaction (RT-PCR) are commonly used to evaluate micrometastasis in the sentinel lymph node. However, most of the RT-PCR studies have been performed using fresh tissue. This study was conducted to assess micrometastasis in clinically node-negative breast cancer by using RT-PCR technique on the paraffin embedded sentinel lymph nodes. METHODS: Sixty patients who undergone SLN biopsy followed by axillary lymph node dissection due to breast carcinoma were evaluated from February 2000 to January 2001 at the Breast Cancer Center, Department of Surgery, Yongdong Severance Hospital. Serial sections were made from all sentinel lymph nodes for the H&E staining and for the IHC staining with monoclonal anti-cytokeratin antibody. RNA was extracted from the paraffin embedded sentinel lymph nodes and RT-PCR was performed using cytokeratin 19 mRNA, MUC-1 mRNA, and MAGE-A3 mRNA. RESULTS: In 32 out of 60 cases, beta-actin mRNA was detected after RT-PCR, and the 28 cases which had no product after RT-PCR for beta-actin were excluded from this study. Twenty five cases showed as being metastasis positive and 7 cases showed as being metastasis negative by serial section (SS) H&E staining. Three out of 25 negative cases tested for by SS H&E staining were found to be positive by IHC. Ten, six and, eight cases out of the 25 negative cases tested for by SS H&E were found to be positive by RT-PCR for cytokeratin 19, MUC-1, and MAGE-A3, respectively. Among the 22 cases that were found to be negative by both SS H&E staining and IHC staining, 9, 4, and 6 cases were converted to positive by RT-PCR for cytokeratin 19, MUC-1, and MAGE-A3, respectively. Using the combination of two or three markers for performing RT-PCR was more sensitive than any single marker to detect micrometastasis (p < 0.05). CONCLUSION: Even though we failed to extract RNA in 46% of the paraffin embedded tissues, it may be possible to detect micrometastasis by using RT-PCR with the paraffin embedded tissue. RT-PCR is far more sensitive than IHC for detecting microme tastasis, and when we combine multiple markers, the detection rate is higher than for any one marker.
Actins ; Biopsy ; Breast Neoplasms* ; Breast* ; Humans ; Keratin-19 ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis* ; Paraffin ; Reverse Transcriptase Polymerase Chain Reaction ; RNA ; RNA, Messenger

Clinical application of the cartilage formed by tissue engineering is of no practical use due to the failure of long-term structural integrity maintenance. One of the important factors for integrity maintenance is the biomaterial for a scaffold. The purpose of this study is to evaluate the difference between polylactic-co-glycolic acids (PLGA) and chitosan as scaffolds. Human auricular chondrocytes were isolated, cultured, and seeded on the scaffolds, which were implanted in the back of nude mice. Eight animals were sacrificed at 4, 8, 12, 16, and 24 weeks after implantation respectively. In gross examination and histological findings, the volume of chondrocyte-PLGA complexes was decreased rapidly. The volume of chondrocyte-chitosan complexes was well maintained with a slow decrease rate. The expression of type II collagen protein detected by immunohistochemistry and western blots became weaker with time in the chondrocyte-PLGA complexes. However, the expression in the chondrocyte-chitosan complexes was strong for the whole period. Collagen type II gene expressions using RT-PCR showed a similar pattern. In conclusion, these results suggest that chitosan is a superior scaffold in cartilage tissue engineering in terms of structural integrity maintenance. It is expected that chitosan scaffold may become one of the most useful scaffolds for cartilage tissue engineering.
Animals ; Blotting, Western ; Cartilage* ; Chitosan* ; Chondrocytes ; Collagen Type II ; Gene Expression ; Humans ; Immunohistochemistry ; Mice ; Mice, Nude ; Tissue Engineering*

PURPOSE: The need for completion axillary lymph node dissection, even in early breast cancer patients with a positive sentinel lymph node, has been questioned. The purpose of this study was to determine the factors that predict the presence of metastasis in non-sentinel lymph nodes (NSLNs) when the sentinel lymph node (SLN) was positive. METHODS: Between December 1998 and June 2004, the records of 104 early breast cancer patients with a positive SLN and who underwent completion axillary lymph node dissection were reviewed. The clinicopathological features in SLN-positive patients were evaluated as possible predictors of metastatic NSLN. RESULTS: Forty four (42.3%) of the 104 patients with positive SLN had metastatic NSLNs. In a univariate analysis, unicentric multifocality (P=0.016), lymphovascular invasion (P=0.006) and SLN metastasis larger than 2 mm (P= 0.003) were associated with positive NSLN findings. The number of SLNs removed was significantly associated as a negative predictor (P=0.043). A multivariate analysis revealed that SLN metastasis >2 mm (P=0.021) and lymphovascular invasion (P=0.040) were independent predictors of metastatic NSLN. CONCLUSION: The likelihood of metastatic NSLNs correlates with the size of the largest SLN metastasis and the presence of lymphovascular invasion of the primary tumor. Even though in early breast cancer with positive SLNs, incorporating these factors may help determining which patients would benefit from additional axillary lymph node dissection.
Breast Neoplasms* ; Breast* ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis

PURPOSE: Sentinel lymph node (SLN) biopsy has become a new standard procedure in the treatment of patients with early breast cancer. Furthermore, many institutions have begun offering the sentinel lymph node biopsy without simultaneous axillary dissection as a possible standard procedure when the SLN was free from tumors. For appropriate intraoperative decision making on the presence of cancer cells in axillary lymph nodes, a fast and accurate method to assess the SLN is required. The authors performed a prospective investigation of the relative merits of rapid cytokeratin immunohistochemical (IHC) staining of the SLN removed during the operations of breast cancer patients. METHODS: Between December 2002 and August 2003, 38 patients with T1and T2 breast cancer were enrolled after undergoing successful sentinel lymph node biopsy. A total of 60 sentinel lymph nodes (mean number, 1.58) were biopsied and first examined by hematoxylin-eosin (H&E) staining. All the tumor free sentinel lymph nodes by H&E stained section were immunostained for cytokeratin using a rapid immunohistochemical assay (Cytokeratin (PAN), 1:50, Newcastle, UK) during the operation. Finally, the sentinel lymph nodes were submitted for paraffin embedding and serial section after surgery. Both H&E stained and cytokeratin immunostained sections were also performed. RESULTS: This technique has a turnaround time of less than 20 minutes during the operation. Rapid IHC staining revealed 4 positive sentinel lymph nodes that were negative for metastasis by H&E staining. Among these false negative 4 cases, two cases had problems with the frozen section of H&E staining and the other 2 cases had problems due to micrometastasis. This study showed a sensitivity of 88.89%, a specificity of 100%, an accuracy of 98.33%, and a negative predictive value of 98.08%. The false-negative case (1 of 52), which was negative on H&E staining and rapid IHC staining during the operation, was disclosed as positive only after a serial permanent section examination with IHC stain. CONCLUSION: The introperative examination of sentinel lymph nodes is a highly accurate and effective way of predicting the axillary lymph node status of patients with breast cancers. This may be a promising technique in deciding whether to spare axillary lymph node dissection for the patient in the operating room.
Biopsy ; Breast Neoplasms* ; Breast* ; Decision Making ; Frozen Sections ; Humans ; Keratins* ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Operating Rooms ; Paraffin Embedding ; Prospective Studies ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy