The Clinical Significance of a Minimal Extra-thyroidal Extension of Papillary Thyroid Cancer for the Recurrence of Regional Cervical Lymph Nodes

PURPOSE: Extra-thyroidal extension has been recognized as a poor prognostic factor for increased regional recurrence risk in papillary thyroid carcinoma, and is known to require treatment that is more aggressive. In the recent UICC TNM 6th Classification, an extra-thyroidal extension was divided into a minimal extra-thyroidal extension (T3) and a massive extra-thyroidal extension (T4). The aim of this study was to investigate the clinical effect of a minimal extra-thyroidal extension of a papillary carcinoma for the recurrence of regional cervical lymph nodes. METHODS: We retrospectively studied 154 patients with papillary thyroid carcinoma where a thyroidectomy was performed from Feb. 2003 to May. 2006 at the Department of Surgery, with the exclusion of 6 patients with a massive extra-thyroidal extension. We divided the cases into a no extra-thyroidal extension group and a minimal extra-thyroidal extension group according to the grading of the extra-thyroidal extension. The grading of the extra-thyroidal extension was based on both pathological findings and intraoperative surgical findings. Clinicopathological factors associated with each group were analyzed by univariate and multivariate analysis. We divided the cases into two groups according to age ( or =45 yrs) and lymph node status (positive, negative), and compared each group with regards to disease free survival according to the grading of the extra-thyroidal extension. RESULTS: By univariate analysis, a minimal extra-thyroidal extension was related to lymph node metastasis, tumor size, mutifocality (P0.05). CONCLUSION: We need to downstage to less than T3 for a minimal extra-thyroidal extension because there is no significant difference in disease free survival according to the grading of an extra-thyroidal extension in patients with papillary thyroid carcinoma.

The Clinicopathologic Significance of a p63 Expression in Invasive Breast Cancer

PURPOSE: p63 is a recently described as p53 homologue. Despite their structural homologies, they have different activities. p63 is a specific myoepithelial cell marker in normal breast tissue and it is expressed in a minority of breast cancers. The aim of this study was to evaluate the prognostic significance of the p63 expression in breast cancer. METHODS: The expression of p63 in breast cancer was determined by performing immunohistochemistry on 350 patients who underwent mastectomy at the Department of Surgery at Korea University Medical Center between January 1992 and September 2004. A retrospective analysis was conducted using the medical records. A tissue microarray was constructed, and immunohistochemical analysis for p63 was performed according to the usual methods. RESULTS: Among 350 patients, 40 (11.4%) showed a p63 expression. There was a significant correlation between p63 and the histologic grade. There were significant correlations of p63 with p53 and HER2/neu, respectively. In the basal type of breast cancer, the p63 expression was significantly higher than in the luminal type of breast cancer. The 5 year disease free survival rates were 69% in the patients with a p63 expression and 76% in the patients without a p63 expression, but there was no statistical difference. CONCLUSION: The present results indicate that a p63 expression is associated with a high grade tumor, a p53 expression and a HER2/neu expression in breast cancer, which are the known poor prognostic factors of breast cancer. Immunohistochemical subtyping shows that the p63 expression is a useful predictor for the basal type of breast cancer. In addition, this study suggests that the p63 expression in the basal type of breast cancer is associated with a poor prognosis.

The Survival Analysis of Immunohistochmically Defined Basal and Luminal Subtype of Breast Cancer

PURPOSE: DNA microarray studies of breast cancer have identified distinct subtypes showing different survivals. The results of DNA microarray revealed the HER2 negative and estrogen receptor (ER) negative subtypes, which were designated as basal or basal-like subtype. The basal subtype can not be manipulated by trastuzumab or the selective estrogen receptor modulator (SERM), but DNA microarrays are not perform in clinical practice. We classified invasive ductal carcinoma (IDC) into the luminal, HER2, basal and negative groups using an immunohistochemical method and evaluated the usefulness of the method in clinical practice. METHODS: A retrospective analysis was conducted using the medical records of 295 patients, diagnosed with IDC of the breast, who subsequently underwent a mastectomy between January 1992 and September 2004. A tissue microarray was constructed and immunohistochemical studies performed for HER2, ER, HER1, c-kit and CK5/6. The breast cancers were divided into four subtypes, which included the HER2 positive, luminal, basal and negative subtypes. The basal subtype was characterized by HER2 negative, ER negative and positive for one of HER1, c-kit or CK5/6. Only the ER positive subtype was designated as a luminal subtype. The survival rates were calculated using the Kaplan Meier methods. RESULTS: The 5 year survival rates of the HER2 positive, luminal and basal subtypes were 80.4, 86.8 and 73.8%, respectively (P=0.1274). The basal subtype was predominant among the patients with poorly differentiated carcinomas (P=0.000). The 5 year overall survival of the basal subtype was lower than that of luminal (P=0.049); the prognosis was also poor in those with an age less than 35 years old, premenopausal and lymph node metastasis. CONCLUSION: The basal subtype was associated with a high histologic grade, and also showed significantly worse prognosis then the luminal subtype, especially in those patients with an age less than 35, premenopausal and lymph node metastasis. The immunohistochemical assay for the basal subtype was helpful in detecting patients with a poor prognostic.

Peutz-Jeghers Syndrome with Multiple Genital Tract Tumors and Breast Cancer: A Case Report with a Review of Literatures

We report here on the multiple genital tract neoplasms in a 41-yr-old Korean woman with Peutz-Jeghers Syndrome (PJS). The patient presented with lower abdominal pain. Her previous medical history was PJS and breast cancer. Pelvic ultrasound showed a multilocular cyst at the right adnexal region, diagnosed as bilateral ovarian mucinous borderline tumors. An ovarian sex cord tumor with annular tubules was incidentally diagnosed together with a minimal deviation adenocarcinoma of the uterine cervix and mucinous metaplasia of both the Fallopian tubal mucosa and the endometrium. Although the cases of multiple genital tract tumors with PJS has rarely been reported, the present case appears to be the first in Korea in which the PJS syndrome was complicated by multiple genital tract tumors and infiltrating carcinoma of the breast. The clinical significance of the multiple genital tract tumors and breast cancer associated with PJS is reviewed.

The Clinical Utility of Indigo Carmine in Sentinel Lymph Node Biopsy of the Breast Cancer / 한국유방암학회지

BACKGROUND: The selection of blue dye or technetium radioisotope depends on the surgeon? experience or the availability of the center in sentinel lymph node biopsy (SLNB). The purpose of this study is to evaluate the possibility of clinical usage of indigo carmine in SLNB in breast cancer. METHODS: From the July 2001 to the March 2004, 93 consecutive cases of Tis - T2 breast cancers without palpable axillary lymph nodes were enrolled to the SLNB. After usual preparation for the breast conserving surgery or mastectomy, the patients were intradermally injected with 5 ml of indigo carmine around the subareolar area. After 4 minutes has passed, usual axillary incision of breast conserving surgery was made, and the stained lymphatics were followed to the firstly encountered lymph nodes. The dissected nodes were sent to the department of pathology for frozen and permanent sections. After SLNB, axillary lymph node dissections (ALND) were completed regardless of the result of the frozen section. RESULTS: The identification rate of SLNB using Indigo carmine was 97.8% (91/93). The axillary node metastases on complete ALND were 21 cases. 18 cases were detected with SLNB, and 3 cases were falsely reported as negative on SLNB. 11 cases had metastases in the sentinel nodes only (52.4%). Among the 3 false negative cases, one case had axillary metastasis solely in a node in level III (infraclavicular node). The sensitivity of the test was 85.7% (18/21), and the specificity was 100% (70/70). False negative rate was 9.5% (2/21), and negative predictive value was 95.9% (70/73). CONCLUSIONS: Sentinel node biopsy using indigo carmine showed similar identification rate and false negative rate with other blue dye only methods including isosulfan blue. Because indigo carmine is more available and safe than isosulfan blue, it could be an alternative to isosulfan blue.

The Clinical Utility of Indigo Carmine in Sentinel Lymph Node Biopsy of the Breast Cancer / 한국유방암학회지

BACKGROUND: The selection of blue dye or technetium radioisotope depends on the surgeon? experience or the availability of the center in sentinel lymph node biopsy (SLNB). The purpose of this study is to evaluate the possibility of clinical usage of indigo carmine in SLNB in breast cancer. METHODS: From the July 2001 to the March 2004, 93 consecutive cases of Tis - T2 breast cancers without palpable axillary lymph nodes were enrolled to the SLNB. After usual preparation for the breast conserving surgery or mastectomy, the patients were intradermally injected with 5 ml of indigo carmine around the subareolar area. After 4 minutes has passed, usual axillary incision of breast conserving surgery was made, and the stained lymphatics were followed to the firstly encountered lymph nodes. The dissected nodes were sent to the department of pathology for frozen and permanent sections. After SLNB, axillary lymph node dissections (ALND) were completed regardless of the result of the frozen section. RESULTS: The identification rate of SLNB using Indigo carmine was 97.8% (91/93). The axillary node metastases on complete ALND were 21 cases. 18 cases were detected with SLNB, and 3 cases were falsely reported as negative on SLNB. 11 cases had metastases in the sentinel nodes only (52.4%). Among the 3 false negative cases, one case had axillary metastasis solely in a node in level III (infraclavicular node). The sensitivity of the test was 85.7% (18/21), and the specificity was 100% (70/70). False negative rate was 9.5% (2/21), and negative predictive value was 95.9% (70/73). CONCLUSIONS: Sentinel node biopsy using indigo carmine showed similar identification rate and false negative rate with other blue dye only methods including isosulfan blue. Because indigo carmine is more available and safe than isosulfan blue, it could be an alternative to isosulfan blue.

Biologic behavior of E-cadherin in Invasive Ductal Carcinoma of the Breast / 한국유방암학회지

PURPOSE : E-cadherin is a tumor suppressor adhesion molecule that has an anti-invasive role and it is often considered as a useful marker for differentiating the lobular types from the ductal types of breast cancer. Yet the biological functions of E-cadherin in the invasive ductal types of breast cancers are unclear. METHODS : The E-cadherin expression was assessed immunohistochemically in 84 case of surgically resected invasive ductal carcinoma. Only the membranous expression of E-cadherin was considered and its expression was categorized as positive (>95% stained) or negative (<95% stained). The relationship between the E-cadherin expression and tumor size, the lymph node status, the histologic grade, the ER and PR status, The HER2/neu and p53 expressions was studied by performing prospective aspect. RESULTS : We analyzed 84 invasive ductal carcinomas for the E-cadherin expressions. Variable degrees of E-cadherin expression were noted in 79 cases and the complete absence of its expression was noted in 5 cases(5.9%) which showed all HER2/neu positive and p53 negative. Positive expression of E-cadherin was noted in 66cases(78.5%). Significant associations were found between the E-cadherin expression and the tumor size and the estrogen receptor status. The expression of E-cadherin was not found to be related to the lymph node status, histologic grade, the progesteron receptor status, the HER2/neu and p53 expressions. CONCLUSION: We confirmed that there was a strong correlation between the negative membrane expressions of E-cadherin and the T-stages and a negative estrogen receptor status. E-cadherin immunostaining appears to have a minimal prognostic value and it can be efficiently used for determining tumor progression of invasive ductal carcinomas of the breast.

Intracystic Papillary Carcinoma with Extensive Hemorrhage of the Breast: Sonographic and Advanced MR Findings: A Case Report

Intracystic papillary carcinoma (IPC) of the breast is very rare, and it has a much better prognosis than the other types of breast carcinoma. We experienced a case of intracystic papillary carcinoma that we diagnosed in an 83-year-old-woman. MR imaging of the IPC shows a multicystic appearance with a subacute or chronic stage of intracystic hemorrhage. The contrast-enhanced MR imaging demonstrates enhancement of the cyst wall and mural nodules, and this modality proved to be successful for making an accurate preoperative diagnosis.

The Value of Intraoperative Quick Parathyroid Hormone Assay in Patients with Renal Hyperparathyroidism / 대한내분비외과학회지

PURPOSE: Intraoperative quick parathyroid hormone assay (PTH) was introduced in the parathyroid surgery since 1988 and the value in patients with primary hyperparathyroidism was well recognized in the literature. The purpose of this study was to evaluate the usefulness of intraoperative rapid PTH assay in patients with renal hyperparathyroidism by comparing intraoperative PTH results and the biochemical results at postoperative 6(th) month, including PTH values. METHODS: Fifteen consecutive patients of renal hyperparathyroidism underwent total parathyroidectomy and immediate autotransplantation from November 2003 to February 2005. PTH levels were measured by PTH assay at the induction of anesthesia (baseline level) and in 20-minute intervals after excision of the last parathyroid gland. More than 50% drop of initial PTH level was considered as completeness of parathyroidectomy. RESULTS: Twenty minutes after resection, PTH levels decreased by 83.7% in 14 patients and by 50.2% in one patient. Ten patients (67%) were cured but 5 patients (34%) showed high PTH levels after 6 months. The drop rate of intraoperative quick PTH level in cured patients was 92% at 26 minutes after parathyroidectomy and was significantly different from 73.3% of persistent or recurrent five patients (P=0.047). Preoperative PTH level, calcium level, alkaline phosphatase level and preoperative localization were not different in the cured and recurrent or persistent patients of renal hyperparathyroidism. CONCLUSION: The value of intraoperative quick PTH assay in patients of renal hyperparathyroidism was questionable. More than 92% drop of intraoperative PTH level at 26 minutes after parathyroidectomy could predict success in our study.

Mesenteric Castleman's Disease

We report here a rare case of mesenteric Castleman's disease presenting as a mesenteric mass. A 13-year-old female child was admitted to our hospital complaining of intermittent vague abdominal pain. She had hypochromic anemia, thrombocytosis and an elevated erythrocyte sedimentation rate (ESR). Ultrasonography and computed tomography indicated an intra- abdominal mass might represent a lymphoma or gastrointestinal stromal tumor or leiomyoma, but the definitive preoperative diagnosis couldn't be confirmed. The surgical resection of the mass revealed the mesenteric hyaline vascular- type Castleman's disease.

Significance of Akt Expression in Node-negative Breast Cancer

BACKGROUND: Patients with lymph node-negative breast cancer show a 10-year recurrence rate of approximately 20%. In node-negative breast cancer, the prognostic factors are age, menopause, tumor size, hormone receptors, p53, DNA ploidy, Ki-67 index (Ki-67) and c-erbB2. Of these, ErbB2 (the protein of the c-erbB2 gene) is a member of the receptor tyrosine kinase family. Overexpression of ErbB2 is known to regulate cell proliferation, differentiation, growth and apoptosis via the ErbB2/Phosphoinositol 3-Kinase (PI 3-K)/Akt signaling pathway. Therefore, it is important to identify high- risk patients that would benefit from adjuvant therapies related with ErB2. For this purpose, the prognostic relevance of the ErbB2/PI 3-K/Akt pathway was examined in node-negative breast cancer. METHODS: A retrospective analysis was performed on the hospital records of all 72 patients diagnosed with breast cancer, and who underwent surgical treatment between January 1996 and December 2003. Clinicopathological data were compared with the results of immunohistochemical staining using the phospho-specific antibody for the expression of Akt. RESULTS: The mean age of the patient's was 48.6 years. Phospho-Akt (pAkt) was expressed in 24 cases (33.3%), but there was no statistical relationship between pAkt expression and the known prognostic factors of breast cancer. There was no statistical significance in the survival rates between the pAkt positive and negative expression groups (P=0.123). In the ErbB2 positive patients, the expression of pAkt was associated with a shorter disease-free survival (P=0.045), and the disease-free survival was shorter in patients whose tumors expressed pAkt and had a high level of Ki-67 (P=0.040). CONCLUSION: The co-expression of ErbB2 and pAkt positivity implied a poor prognosis in node-negative breast cancer patients, and the co-expression of high Ki-67 and pAkt positivity also revealed a poor prognosis in these patients. These results show that the expression of pAkt could be considered a prognostic marker of node-negative breast cancer with ErbB2 positive expression and high levels of Ki-67.

Axillary Lymph Node Metastasis in Patients of Ductal Carcinoma in Situ or Ductal Carcinoma in Situ with Microinvasion / 한국유방암학회지

PURPOSE: The development of publicized screening methods for breast carcinoma detection has led to a marked increase in the discovery of ductal carcinoma in situ (DCIS) or DCIS with microinvasion (DCIS-MI). Axillary lymph node status has been believed to be not only an indicator of prognosis, but also a direction of adjuvant therapy. But the incidence of axillary metastasis in DCIS or DCIS-MI has diversely found in from 0% to 20%. This study was performed to analyze the incidence of axillary metastasis and the predictive factors associated with axillary lymph node metastasis in DCIS or DCIS-MI. METHODS: Patients with DCIS or DCIS-MI and axillary lymph node dissection from 1987 to 2004 were selected from Korea University Medical Center. We reviewed their medical records for age, palpability and size of the tumor, histolgic subtype, nuclear grade, hormone receptor status, and pathologic slides. RESULTS: Fifty two patients in DCIS and Thirty eight patients in DCIS-MI were included in the study. Axillary lymph node metastases were identified in 2 patients (3.8%) in DCIS and 4 patients (10.5%) in DCIS-MI. Tumor size and nuclear grade in DCIS had a borderline significance in association with microinvasion. We could not be able to find any predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. CONCLUSION: Axillary lymph node metastasis in DCIS or DCIS-MI appeared to be not low and there was no predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. But DCIS patients with large tumor size and poor nuclear grade have the high possibility associated with microinvasion, therefore, in that cases, there is a need to consider the possibility of axillary metastasis.

Clinicopathological Analysis of Superficial Spreading and Small-sized Types of Early Gastric Cancer

PURPOSE: The superficial spreading type of early gastric cancer has different clinicopathologic features from other types of early gastric cancers in terms of its invasiveness and lymph node metastases. Therefore, the clinicopathological features of the superficial spreading type and the small-sized early gastric cancers, were analyzed, and the influence of those features on the surgical procedures and prognosis was investigated. METHODS: During an 8-year period (1992~1999), 22 superficial spreading early gastric cancers were analyzed with respect to the macroscopic type, lymph node metas tasis, and the surgical procedure, and compared with those of 219 small-sized early gastric cancers. The superficial spreading type was defined as a lesion more than 5 5 cm and small-sized type, as a lesion less than 2 2 cm. The survival rate was analyzed using the Kaplan-Meier method and those patients who died of diseases unrelated to gastric cancer were excluded. Other statistical analyses were performed using the chi-square test. RESULTS: Twenty two out of 369 (6%) early gastric cancers were the superficial spreading type. The incidence of a LN metastasis was 12.3% in early gastric cancer, 8.7% in the small-sized type, and 27.3% in the superficial spreading type. The incidence of a LN metastasis was greater in the superficial spreading type than in the small-sized type (P=0.006). The location of the lesions, the histological type, and the depth of the invasion in the superficial spreading and small-sized early gastric cancers were similar There was difference in the method of surgery and the extent of the lymph node dissection between two groups. CONCLUSION: Because the incidence of a lymph node meta stasis is higher in the superficial spreading type than in the small-sized early gastric cancer, a wide resection with an extensive lymph node dissection appears to be appropriate treatment for the superficial spreading type of early gastric cancer.

Advantage of Transilluminated Powered Phlebectomy in Patients with Varicose Veins of Lower Extremities as a Surgical Treatment

PURPOSE: Transilluminated powered phlebectomy (TIPP) offers a minimally invasive operation alternative to stab avulsion for varicose veins. The purpose of this study is to compare the safety and efficacy of TIPP with conventional phlebectomy (CP) for removal of varicose veins. METHOD: A retrospective review was performed on the clinical records from March 2001 to March 2002. We divided the patients into 2 groups. The first group consisted of 87 patients (107 limbs) who had undergone TIPP. The second group of 27 patients (29 limbs) had undergone CP by the stab avulsion. We compared operation time, number of skin incisions, duration of hospital stay, patient's satisfaction scores, and complications. RESULT: Mean operation time was significantly shorter in the TIPP group than in the CP group (47.3 min vs. 64.0 min). The number of skin incision was also significantly less in the TIPP group (3.4 vs. 4.9). Length of hospital stay was significantly shorter in the TIPP group (2.5 days vs. 4.0 days). However, postoperative patient's satisfaction score was similar in both groups. 81 patients (93%) in the TIPP group developed ecchymosis postoperatively, resolved spontaneously within approximately 8 weeks. CONCLUSION: TIPP can make the better cosmetic result, shorter duration of hospitalization and operation time. These results suggest that TIPP is a feasible surgical treatment modality for varicose veins of the lower extremity. However, we should minimize postoperative ecchymosis and improve the surgical technique.

The Clinical Significance of Fas and Fas Ligand Expression in Thyroid Neoplasms

PURPOSE: Recent studies indicate that Fas and Fas Ligand (Fas-L) are implicated in autoimmune endocrine diseases and tumors of the thyroid. In this study we tried to elucidate the expression stati of Fas and Fas-L in some kinds of thyroid neoplasms, and their relationships with 4 prognostic factors in papillary thyroid cancer (i.e., size, lymph node metastasis, capsule invasion, age). METHODS: 66 cases of thyroid neoplasm including 45 cases of papillary cancer (PTC), 3 of a follicular cancer (FTC), 1 of a poorly differentiated cancer (PDC), 1 of a undifferentiated cancer (UC), 7 of follicular adenoma (FA), and 9 of nodular hyperplasia (NH) were examined, and estimated as negative, weak positive and strong positive about the Fas and Fas-L expression by the immunohistochemical staining intensities. We then collected and compared the differrences between benign and malignant tumors. The expressions of Fas and Fas-L in papillary thyroid cancers were evaluated relating to the differences in the prognostic factors (i.e., the size, lymph node status, capsule invasion, and age of the patients). RESULTS: Malignant thyroid tumors revealed stronger staining intensity than benign neoplasms. In papillary thyroid cancers, Fas-L staining intensities were significantly stronger in the cases with perithyroidal lymph node metastasis, or in those of 45 years old or over than in those with no lymph node metastasis, or younger than 45 years. CONCLUSION: Both Fas and Fas-L are implicated in thyroid tumorigenesis and revealed stronger staining intensities in malignant than benign tumors, and the Fas-L staining intensities may have some prognostic implications at least in papillary thyroid cancers.

Clinical Analysis of 28 Multiple Primary Cancers (MPC) Including Breast Cancer

PURPOSE: Due to improving breast cancer screening programs and treatment methods, we can expect improved long-term survival of breast cancer patients. Given the longer survival times, other primary cancers may develop in other organs of breast cancer patients during their long term follow up period. Our purpose was to elucidate the clinical characteristics of multiple primary cancers developed in breast cancer patients. METHODS: We retrospectively investigated 28 patients with multiple primary cancers including breast cancer. However, we excluded contra-lateral breast cancer. We investigated the patients' clinical characteristics including mean age, stage, hormone receptor status, cause of death, time interval between the breast cancer and other cancers, and common cancers which were combined with breast cancer. RESULT: The mean age of the study group was 53+/-2, higher than the 47.7+/-0.4 of our hospital breast cancer patients group. However, other tumor characteristics were not significantly different from other general breast cancer patients. Among the patients 5 were synchronous and 23 were metachronous MPC. The most common cancer combined with breast cancer was gastric cancer (8, 27.6%), followed by cervical cancer (3, 10.7%) and colon cancer (3, 10.7%). The ranks of the other cancer co-occurred with breast cancer were not significantly different than the Korean 1999 Korean women's cancer incidence ranks excluding breast cancer. CONCLUSION: Due to the increasing length of the follow up period for breast cancer patients, primary cancers may develop in other organs. Therefore, physicians should be concerned and increase efforts to detect these other cancers early in these patients. Additionally, it appears that the prevalence ranking of common cancers developing in breast cancer patients is not significantly different than the ranking of other cancer incidence in the general population.

Effect of Intracavitary Injection of Urokinase in the Experimentally Induced Early Pyogenic Liver Abscess of the Rabbit

This study was carried out to assess the effects of intracavitary injection of urokinase in the early liver abscess (ELA) of the rabbits. ELAs were induced on 25 in 47 New Zealand rabbits, which were divided into two groups, with 15 in group A, and 10 in group B. Urokinase was injected into the ELA of group A, and normal physiologic saline into those of group B. One and a half hours after the injections, the rabbits were sacrificed and evaluated by pathologists for the degree of fibrosis of the ELA wall, and fibrinolysis in the ELA itself. Statistical analyses were performed between the two groups. The following ELA sizes for each group were obtained: Group A, 4.3 X 2.9-10.1 X 7.2 mm (mean 7.1 X 4.1 mm); Group B, 4.6 X 2.7-15.0 X 9.7 mm (mean 8.5 X 4.57 mm). Eleven (73%) in group A showed grade II fibrosis of ELA wall, and 8 (80%) in group B showed grade III fibrosis of ELA wall (p=0.002). On pathological analysis, 5 (46%) in group A showed grade II fibrin, and 8 (80%) in group B showed grade III fibrin, of the ELA (p=0.09). In conclusion, injection of urokinase, into the ELAs, can reduce the degree of fibrosis of abscess walls.

Distribution and Prognostic Effect on Adjuvant Hormone Therapy of Body Mass Index (BMI) in Korean Breast Cancer Patients

PURPOSE: Obesity has been shown to have important effects related to breast cancer. But there have been few data available on the distribution of body mass index (BMI) among Korean breast cancer patients and on the effects of this distribution on patient prognosis. Therefore we investigated the BMI distribution of Korean breast cancer patient's and its relationship with other tumor markers, in order to elucidate the relationship between BMI and patient prognosis. METHODS: We measured the BMI of 266 Korean adult women with breast carcinoma.and divided the subjects into the following subgroups according to BMI; low body weight (BMIor=25). We compared this distribution with that of the general Korean women's population. and investigated the correlation with other prognostic factors and tumor markers. The 5 year overall and disease free survival rates were evaluated for both the total breast cancer patients and the adjuvant hormone treated breast cancer patients, according to BMI subgroup, using the Kaplan-Meier method. RESULTS: Mean BMI for the breast patients was 23.4+/-3.1, and did not differ from that of the general Korean adult women's population ('1994 National Nutrition Survey Report). BMI increased with increasing age and was highest in the 60~69 yr age group. BMI was correlated with tumor size and stage. The survival rates were low in the high BMI group among both total and adjuvant hormone treated breast cancer patients, but in neither was any statistical difference found between BMI subgroups. CONCLUSION: Korean breast cancer patients are not obese as the general population and their BMI increases with increasing age and menopausal status. There was a tendency for higher BMI to be associated with poorer prognosis, although not to a statistically significant degree.

Distribution and Prognostic Effect on Adjuvant Hormone Therapy of Body Mass Index (BMI) in Korean Breast Cancer Patients / 한국유방암학회지

PURPOSE: Obesity has been shown to have important effects related to breast cancer. But there have been few data available on the distribution of body mass index (BMI) among Korean breast cancer patients and on the effects of this distribution on patient prognosis. Therefore we investigated the BMI distribution of Korean breast cancer patient's and its relationship with other tumor markers, in order to elucidate the relationship between BMI and patient prognosis. METHODS: We measured the BMI of 266 Korean adult women with breast carcinoma.and divided the subjects into the following subgroups according to BMI; low body weight (BMI or25). We compared this distribution with that of the general Korean women's population. and investigated the correlation with other prognostic factors and tumor markers. The 5 year overall and disease free survival rates were evaluated for both the total breast cancer patients and the adjuvant hormone treated breast cancer patients, according to BMI subgroup, using the Kaplan-Meier method. RESULTS: Mean BMI for the breast patients was 23.4+/-3.1, and did not differ from that of the general Korean adult women's population ('1994 National Nutrition Survey Report).BMI increased with increasing age and was highest in the 60~69 yr age group. BMI was correlated with tumor size and stage. The survival rates were low in the high BMI group among both total and adjuvant hormone treated breast cancer patients, but in neither was any statistical difference found between BMI subgroups. CONCLUSION: Korean breast cancer patients are not obese as the general population and their BMI increases with increasing age and menopausal status. There was a tendency for higher BMI to be associated with poorer prognosis, although not to a statistically significant degree.

An Analysis of Complications according to Cartridge Size Following Total Gastrectomy with Roux-en-Y Esophagojejunostomy Using the EEA Stapler

PURPOSE: Anastomotic stricture is one of the most common problems in esophagojejunostomy using an end-to-end anastomosing (EEA) instrument following total gastrectomy. Because anastomotic stricture often develops with small- cartridge EEA, a larger EEA may be used to avoid stricture. The purpose of this retrospective study is to evaluate the difference of complications between patients treated using the EEA25 and ones using EEA28. METHODS: A total of 283 patients underwent curative total gastrectomy and esophagojejunostomy with Roux-en-Y anastomosis, using EEA25 or EEA28, between January 1992 and December 1999. The differences between the EEA25 and EEA28 groups were investigated by comparing them in terms of reflux esophagitis, dysphagia, and stricture. RESULTS: Stricture developed in five patients (13.8%) in the EEA28 group and in 11 patients (4.45%) in the EEA25 group (P<0.05), dysphagia was experienced less frequently in the EEA25 than in the EEA28 group (P<0.05), and no significant differences were evident with regards to reflux esophagitis. CONCLUSION: The choice of a large EEA to avoid anastomotic stricture did not affect the development of dysphagia or stricture. However, a randomized, prospective study should be done to better define the relationship between the size of EEA and the complications of total gastrectomy.