Optimized Criteria for Sentinel Lymph Node Biopsy in Patients with Clinically Node Negative Breast Cancer

Purpose@#Sentinel lymph node biopsy (SLNB) is a well-established staging procedure for patients with early breast cancer who have clinically negative axillary lymph node. However, no consensus exists about the number of sentinel lymph nodes (SLN) that should be removed based on radioactivity counts in breast cancer. We reviewed and analyzed cases in which more than one SLN was detected and there was at least one pathologically positive node. @*Methods@#We retrospectively studied breast cancer patients who underwent lymphoscintigraphy with injection of a radioactive colloid and SLNB along with intraoperative determination of radioactive counts of lymph nodes using a gamma probe between 2006 and 2018. In total 326 patients with more than one radioactive SLN were enrolled in this study. @*Results@#Fifty-four patients had nodal metastases, of whom 46 (85.2%) had metastases in the hottest lymph node. All metastatic SLNs were identified as one of the first three lymph nodes dissected. The lowest radioactive count of a positive SLN corresponded to 10% of that of the hottest node. @*Conclusion@#We suggest that removal of the first three lymph nodes or nodes covered by the “10% rule” is sufficient in SLNB for patients with breast cancer.

Optimized Criteria for Sentinel Lymph Node Biopsy in Patients with Clinically Node Negative Breast Cancer

Purpose@#Sentinel lymph node biopsy (SLNB) is a well-established staging procedure for patients with early breast cancer who have clinically negative axillary lymph node. However, no consensus exists about the number of sentinel lymph nodes (SLN) that should be removed based on radioactivity counts in breast cancer. We reviewed and analyzed cases in which more than one SLN was detected and there was at least one pathologically positive node. @*Methods@#We retrospectively studied breast cancer patients who underwent lymphoscintigraphy with injection of a radioactive colloid and SLNB along with intraoperative determination of radioactive counts of lymph nodes using a gamma probe between 2006 and 2018. In total 326 patients with more than one radioactive SLN were enrolled in this study. @*Results@#Fifty-four patients had nodal metastases, of whom 46 (85.2%) had metastases in the hottest lymph node. All metastatic SLNs were identified as one of the first three lymph nodes dissected. The lowest radioactive count of a positive SLN corresponded to 10% of that of the hottest node. @*Conclusion@#We suggest that removal of the first three lymph nodes or nodes covered by the “10% rule” is sufficient in SLNB for patients with breast cancer.

Analysis of Performance on Activities in Critical Pathway of Total Hip Replacement Surgery / 성인간호학회지

PURPOSES: The purpose of this study was to evaluate the extent of performance on activities in critical pathway (CP) according to eight domains and six admission days on nursing records of patients who received total hip replacement surgery. METHODS: We reviewed 90 nursing records of patients who received total hip replacement surgery from June, 2004 to July, 2005 at C University Hospital. Data were collected using Hong's CP (2002) and were analyzed using ANOVA. RESULTS: The domain of diet was valued the highest in CP performance scoring, followed by the domains of assessment, activities, and test. There were differences in the performance scores according to the period of admission in all of the domains. Among 132 activities in the CP, 18 activities were completely performed, of which most included activities belonging to the domain of assessment on the admission day. Twelve activities were never performed, of which most included activities belonging to the domain of treatment on the day of operation and the first day after operation. CONCLUSIONS: Therefore, further studies on the development of a new system to increase CP utilization and on updating the contents of CP from the best practice based on evidence is recommended.

A Clinical Usefulness of Office Hysteroscopy / 영남의대학술지

BACKGROUND: Hysteroscopy is considered to be the gold standard not only for visualizing the cervical canal and the uterine cavity, but also for treating many different types of benign pathologies localized to those regions. The advent and evolution of endoscopic imaging and surgery during the last two decades has added new dimensions to the armamentarium of a gynecologist to combat intrauterine lesions. Office hysteroscopy is increasingly being used as a first line investigation for abnormal uterine bleeding and other diseases involving the uterine cavity. The aim of our study is to assess the diagnostic and operative efficacy of office hysteroscopy. MATERIALS AND METHODS: In our department, 140 patients underwent a hysteroscopy examination and 18 of these underwent an office based hysteroscopy examination from September 1995 to March 2005. The cases who underwent an office based hysteroscopy examination were reviewed in order to assess the clinical usefulness and significance in the management of intrauterine lesions. RESULTS: Major indication was abnormal uterine bleeding (12 cases, 66.7%). The others were a missed IUD and infertility. The hysteroscopic findings were a normal uterine cavity (6 cases, 33.3%), IUD in situ, polyp, submucosal myoma, endometrial hyperplasia and a placenta remnant. CONCLUSION: Office hysteroscopy is a safe, quick and effective method for making an intrauterine evaluation. In addition, it provides immediate results, offers the capacity of direct targeted biopsies of suspicious focal lesions, and offers the direct treatment of some intrauterine conditions.

Three cases of squamous cell carcinoma arising in mature cystic teratoma of the ovary / 부인종양

Benign mature cystic teratoma is a very common ovarian lesion. It commonly occurs during a woman's reproductive years and most often is benign. In approximately 1% to 3% of cases, however, it can undergo a malignant transformation with a very poor prognosis. The frequency of malignant degeneration of dermoid is related to age, with the highest in-cidence in the postmenopausal years. Squamous cell carcinoma accounts for 70-88% of all malignant tumors arising in the mature cystic teratom-as followed by the much rarer adenocarcinomas and carcinoids. Preoperative diagnosis is difficult due to the rarity of this tumor and its similarity to mature cystic teratoma. We experienced 3 cases of squamous cell carcinoma arising in mature cystic teratoma and report our cases with a brief review of the literature.

A Case of Spontaneous Uterine Rupture of the Unscarred Uterus in 14 Weeks Gestation / 영남의대학술지

Spontaneous uterine rupture of the unscarred uterus during the second trimester of pregnancy is rare, but it is a surgical emergency. Because it results in rapid deterioration of patient and high mortality despite of prompt operation and massive transfusion, early diagnosis and proper management are critical for optimizing patient care. We present a case of spontaneous uterine rupture with fetal death in 14 weeks gestation with a brief review of literatures.

Pulmonary Oncocytic Carcinoid: 1 Case report / 대한흉부외과학회지

Oncocytic carcinoid is a very rare tumor and only few cases have been reported in the literatures. We have experienced one case of pulmonary oncocytic carcinoid occuring at the left upper lobe. The patient was a 56 years old female with no spedific symptoms. Chest Computed tomography showed about 3X3.5cm sized homogenous mass at the left upper lobe. After the evaluation, surgical resection was performed. Gross finding showed a well-defined and well-encapsulated mass of 3X4cm in size, and yellowish-gray in color. Pathohistologically, the tumor was abundant granular eosinophilic cytoplasm. Immunohistochemical stain showed positive cytokeratin and was focal positive reaction in EMA and chromograin. It was confirmed as pulmonary oncocytic carcinoid. Postoperative course was uneventful and the patient has been followed up with no problem.

General Anesthesia for the Management of Status Epilepticus Refractory to Conventional Drugs: A case report / 대한마취과학회지

A 2.5-year-old female patient who has a prior history of partial seizures was admitted by generalized tonic-clonic status epilepticus secondary to tapering of phenobarbital. Tonic-clonic status epilepticus was refractory to phenytoin, phenobarbital, valproic acid, diazepam, and pentobarbital. After 4 days of unsatisfactory control of seizure activity, isoflurane was administered for 4 hours. Inspired isoflurane concentration of 1.3% were required to control seizures. Heart rate and blood pressure were supported with infusions of dopamine and fluid. After discontinuation of isoflurane, the patient developed partial seizures but seizure activity was controlled with anticonvulsants. She was discharged alive from the hospital after weaning of the ventilator.

Pyloric Stenosis in Premature Infants: Report of two cases / 대한소아소화기영양학회지

The incidence of Hypertrophic pyloric stenosis (HPS) in premature infants is rare, the presentation is not typical, and the diagnosis delayed due to uncertain diagnostic criteria in abdominal ultrasonography (US). We report two premature infants with HPS diagnosed by US and upper gastrointestinal (UGI) contrast study. Patient 1. A premature female infant (birth weight 1950 gm at 34 week's gestation) with the onset of intermittent vomiting at 9 days of age was evaluated. US was normal at 13 days of life, however, abnormal at 41 days of life (pyloric muscle length 16.5 mm). Patient 2. A premature male infant (birth weight 1470 gm at 29 week's gestation) with the onset of intermittent vomiting at 10 days of age was evaluated. US showed pylorospasm at 11 days of life, however, findings compatible with HPS at 57 days of life (pyloric muscle thickness 11 mm).UGI contrast study at 48 days of life showed similar findings in both cases. Both patients had undergone pyloromyotomy. In conclusion, the diagnosis of HPS in premature infants requires careful follow-up by US and UGI contrast study.

Factors Influencing the Therapeutic Compliance of Patients with Lung Cancer / 결핵

BACKGROUND: In recent years, lung cancer has been one of most common cause of death in Korea. Despite many physician's high degree of pessimism about the gains made in treatments progressive improvement in the survival of lung cancer by treatment has occurred, particulary in the early stages of the disease. However, a lot of patients refuse treatment or give up in the fight against the disease. This study was done to evaluate factors ifluencing the compliance to therapy and to lead in the establishment of special programs to enhance compliance in patients with lung cancer. METHODS: The medical records of 903 patients, whose ECOG(Eastern Cooperative Oncology Group) performance status was 3 or less and whose medical record was relatively satisfactory, among 1141 patients diagnosed with lung cancer between January 1989 and December 1996 were reviewed retrospectively. Compliance was classified into three groups based on the degree of compliance with physicians practice guideline : (a) complaints ; (b) patients who initially complied but gave up of themselves midway during the course of treatment ; (c) noncompliants who refused the treatment. RESULTS: The overall compliance rats was 63.9%, which was progressively increased from 57.3-61.3% in 1989 and 1990 to 64.2-67.5% in 1995 and 1996. Age, education level and occupation of patients bore statistically significant relationship with the compliance but sell marital status and smoking history did not. The compliance was significantly higher in patients without symptoms than with, and was also significantly higher in patients with good performance status. The compliance was significantly high in patients with NSCLC(non-small cell lung cancer) compared to SCLC(small cell lung cancer), but after exclusion of stage l and ll, among NSCLC, which had higher compliance to surgery there was no significant difference of compliance by histology. The compliance was significantly lower in advanced stage. CONCLUSION: To enhance the compliance, special care including education programs about therapy including complicantion and prognosis are necessary, especially for educationally and economically disadvantaged patients.

Clinical study on the width of attached gingiva the subjects with healthy gingiva, or early stage of gingivitis / 대한치주과학회지

The purpose of this study was to investigate the width of attached gingiva of 414 subjects with healthy gingiva, or early stage of gingivitis. We compared the differences according to the tooth location, age (Yonger group : 14~30, Older group : 31~67) and gender. In addition, we compared the width of attached gingiva in the subjects with less than 2 sites of gingival recession(Re or =3) to study the relationship between the gingival recession and the width of attached gingiva. The results were as follows : 1. The width of keratinized gingiva was widest in maxillary incisors(5.3+/-1.4mm) and narrowest in mandibular right 1st bicuspid and mandibular right and left 2nd molars(3.5+/-1.1mm). 2. The width of attached gingiva was widest in maxillary right central incisor(3.8+/-1.5mm) and narrowest in mandibular right 2nd molar(1.2+/-1.0mm). 3. In the comparison between the age groups, the width of keratinized in older group was significantly(p<0.05) wider than that in younger group in maxillary right and left 1st bicuspids, mandibular right and left 1st and 2nd molars, maxillary right and left cuspids and mandibular right 1st bicuspid. There was no significant difference in the width of attached gingiva between the two groups except for maxillary right and left 1st molars and maxillary left 2nd molar. 4. In the comparison between male group and female group, in maxillary right and and left lateral incisors and cuspids, mandibular right and left cuspids and 1st bicuspids, the width of attached gingiva in female was significantly(p<0.05) wider than that in male group. 5. In the comparison between the Re 3 group and Re 2 group, there was no significant difference except for maxillary right and left 2nd molars and maxillary left 1st molar. 6. The frequency of gingival recession was in the order of mandibular right 1st bicuspid(16.6%), maxillary right 1st bicuspid(13.7%), maxillary and mandibular left 1st bicuspids(13.4%), mandibular left cuspid(10.5%), maxillary left and mandibular right cuspids(10.1%) and maxillary right cuspid(7.9%).

The accuracy of chest P-A interpretation by practicing familyphysician

No abstract available.