Trends of axillary surgery in breast cancer patients with axillary lymph node metastasis: a comprehensive single-center retrospective study

Purpose@#Based on the results of previous trials, de-escalation of axillary surgery after neoadjuvant chemotherapy (NAC) has increased in patients with axillary lymph node (ALN) metastasis at presentation. This study aimed to review the trends of axillary surgery by time period and molecular subtype in patients with ALN metastasis. @*Methods@#We analyzed the rates of sentinel lymph node biopsy (SLNB) and ALN dissection (ALND) based on time period and subtype. The time period was divided into 3 subperiods to determine the rate of axillary surgery type over time (period 1, from 2009 to 2012; period 2, from 2013 to 2016; and period 3, from 2017 to July 2019). @*Results@#From 2009 to July 2019, 2,525 breast cancer patients underwent surgery. Based on subtype, the ALND rate of hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2–) disease decreased by 13.0% from period 1 to period 3 (period 1, 99.4%; period 2, 97.5%; and period 3, 86.4%; P < 0.001). Conversely, the ALND rate in HR+/HER2+, HR–/HER2+, and triple-negative breast cancer (TNBC) significantly decreased by 43.7%, 48.8%, and 35.2% in period 1, period 2, and period 3, respectively (P < 0.001). In the patient group receiving NAC, HR+/HER2– had a significantly higher ALND rate (84.1%) than HR+/HER2+, HR–/HER2+, and TNBC (60.8%, 62.3%, and 70.7%, respectively; P < 0.001). @*Conclusion@#The SLNB rate in patients with ALN metastasis has increased over time. However, the ALND rate in HR+/ HER2– was significantly higher than in other subtypes.

A Maternity Waiting Home Is an Alternative Approach for the Accessibility of Pregnant Women in an Obstetrically Underserved Area of Korea

Background@#We analyzed whether a maternity waiting home (MWH) for pregnant women in an obstetrically underserved area of Gangwon-do in Korea, which has been in operation since August 2018, has improved the accessibility of a maternity hospital and pregnancy outcomes. @*Methods@#We compared and analyzed the accessibility of maternity hospitals for 170 pregnant women who applied for the MWH from August 2018 to May 2022. Among the 170 participants, 64 were MWH users and 106 non-users. The effect on pregnancy outcomes between MWH users and non-users was analyzed in the 160 people who achieved a pregnancy outcome. @*Results@#Although the average distance and travel time from the pregnant women’s residence in the obstetrically underserved area to a maternity hospital were 56.4 ± 1.6 km and 63.4 ± 1.4 minutes, respectively, the average distance between the MWH and the MWH users’ maternity hospital was 2.7 ± 0.2 km, and the travel time was 10.7 ± 0.6 minutes. The distance was 55.6 km closer on average and the travel time 54.1 minutes shorter. MWH users gave birth at a significantly later gestation age (38.9 ± 0.2 vs. 38.3 ± 0.15 weeks, P = 0.024) and to infants with heavier birth weights (3,300 ± 60 vs. 3,100 ± 50 gm, P= 0.024) compared with non-users. The rate of Cesarean section was significantly higher in the MWH users (47.5% vs. 44.6%, P = 0.047). The MWH users tended to be associated with a lower rate of neonatal intensive care unit admission (5.1% vs. 11.0%, P = 0.204), lower birth weight (< 2.5 kg) (1.7% vs. 8.0%, P = 0.155), and lower fetal death rate in the uterus (0% vs. 1.0%, P = 1.0) compared with non-users, but the differences were not significant. @*Conclusion@#The MWH helped pregnant women in obstetrically underserved areas by improving accessibility to a maternity hospital and lengthening gestation. As a result, neonatal birth weight was heavier for MWH users than non-users. MWHs in Korea can provide an alternative way to improve accessibility to maternity healthcare for pregnant women in obstetrically underserved areas, where it is difficult to establish maternity hospitals, and thereby will improve their pregnancy outcomes.

Prognostic Impact of Elevation of Cancer Antigen 15-3 (CA15-3) in Patients With Early Breast Cancer With Normal Serum CA15-3 Level / 한국유방암학회지

Purpose@#Cancer antigen 15-3 (CA15-3) is a serum tumor marker for breast cancer (BC) extensively used in clinical practice. CA15-3 is non-invasive, easily available, and a costeffective tumor marker for immediate diagnosis, monitoring and prediction of BC recurrence. We hypothesized that an elevation of CA15-3 may have prognostic impact in patients with early BC with normal serum CA15-3 level. @*Methods@#This was a retrospective cohort study, which included patients with BC who received curative surgery at a comprehensive single institution between 2000 and 2016.CA15-3 levels from 0 to 30 U/mL were considered normal, and patients who had CA15-3 > 30 U/mL, were excluded from the study. @*Results@#The mean age of study participants (n = 11,452) was 49.3 years. The proportion of participants with elevated CA15-3 ≥ 1 standard deviation (SD) compared with the previous examination during follow-up was 23.3% (n = 2,666). During the follow-up (median followup 5.8 years), 790 patients experienced recurrence. The fully-adjusted hazard ratio (HR) for recurrence comparing participants with stable CA15-3 level to subjects with elevated CA15-3 level was 1.76 (95% confidence interval [CI], 1.52–2.03). In addition, if the CA15-3was elevated ≥ 1 SD, the risk was much higher (HR, 6.87; 95% CI, 5.81–8.11) than in patients without elevated CA15-3 ≥ 1 SD. In sensitivity analysis, the recurrence risk was consistently higher in participants with elevated CA15-3 levels than in participants without elevated CA15-3 levels. The association between elevated CA15-3 levels and incidence of recurrence was observed in all subtypes and the association was stronger in patients with N+ than in patients with N0 stage (p-value for interaction < 0.01). @*Conclusion@#The results of the present study demonstrated that elevation of CA15-3 in patients with early BC and initial normal serum CA15-3 levels has a prognostic impact.

Current Status of the Delivery Rate within the Jurisdiction of Local Government in Korea

Purpose@#This study aimed to analyze the rate of delivery within the jurisdiction of local governments in Korea. @*Methods@#Information regarding the population, number of women of childbearing age, and number of births was extracted from the Korean Statistics Information Service, National Health Insurance Service, and health map of the National Medical Center. We defined the rate of delivery within the jurisdiction of the local government as the ratio of the number of deliveries delivered by maternity facilities in the region to the total number of deliveries of pregnant women living in the region. @*Results@#The average nationwide delivery rate in the jurisdiction of local governments was 48.0%. The Si area was the highest at 54.9%, and the Gun area was the lowest at 22.1%. Compared to 2014, the national average delivery rate in the jurisdiction decreased by 4.3%; however, the gun area increased by 4.9%. The geographic maternity service area was 122 in 2014; however, this number decreased to 104 in 2020. @*Conclusion@#The national average rate of delivery in the jurisdiction of local governments was 48.0%, and the rate decreased between 2014 and 2020.

The Relationship of Lifestyle Factors with the Prevalence of Major Depressive Disorder by Ecological Factors

Objective@#The association between ecological/lifestyle factors and major depressive disorder (MDD) have been provided but was inconsistent as characteristics of population including race, gender, etc. @*Methods@#Data were extracted from the Korean National Health and Nutrition Examination Survey and consisted of 35,839 adults including 1,537 with MDD. Ecological factors included age, sex, married status, education, family income, residence, occupation, BMI, self-recognition stress, and history of non-communicable disease. Smoking, drinking, regular exercise, total energy intake, and sleep was consisted for lifestyle factors. The relationship between MDD and ecological/lifestyle factors, was evaluated using the multiple logistic regression model after adjustment for covariates. @*Results@#The increased prevalence of MDD in men was related aged, unmarried, low educated, unoccupied, high BMI, and high self-recognition stress. To women, MDD prevalence was increased as aged, low educated and family income, resided in urban, unoccupied, high self-recognition stress and history of non-communicable disease. Current smoking/drinking and lack of sleep was positively related with prevalence of MDD in women. The relationship between lifestyle factors and MDD prevalence was influenced by ecological status, predominantly in women. @*Conclusion@#The relationship of lifestyle factors with MDD prevalence were observed and could be attenuated by various ecological factors, in women.

The Relationship of Lifestyle Factors with the Prevalence of Major Depressive Disorder by Ecological Factors

Objective@#The association between ecological/lifestyle factors and major depressive disorder (MDD) have been provided but was inconsistent as characteristics of population including race, gender, etc. @*Methods@#Data were extracted from the Korean National Health and Nutrition Examination Survey and consisted of 35,839 adults including 1,537 with MDD. Ecological factors included age, sex, married status, education, family income, residence, occupation, BMI, self-recognition stress, and history of non-communicable disease. Smoking, drinking, regular exercise, total energy intake, and sleep was consisted for lifestyle factors. The relationship between MDD and ecological/lifestyle factors, was evaluated using the multiple logistic regression model after adjustment for covariates. @*Results@#The increased prevalence of MDD in men was related aged, unmarried, low educated, unoccupied, high BMI, and high self-recognition stress. To women, MDD prevalence was increased as aged, low educated and family income, resided in urban, unoccupied, high self-recognition stress and history of non-communicable disease. Current smoking/drinking and lack of sleep was positively related with prevalence of MDD in women. The relationship between lifestyle factors and MDD prevalence was influenced by ecological status, predominantly in women. @*Conclusion@#The relationship of lifestyle factors with MDD prevalence were observed and could be attenuated by various ecological factors, in women.

Diagnostic Value of Elevated D-Dimer Level in Venous Thromboembolism in Patients With Acute or Subacute Brain Lesions

OBJECTIVE: To define the risk factors that influence the occurrence of venous thromboembolism (VTE) in patients with acute or subacute brain lesions and to determine the usefulness of D-dimer levels for VTE screening of these patients. METHODS: Medical data from January 2012 to December 2013 were retrospectively reviewed. Mean D-dimer levels in those with VTE versus those without VTE were compared. Factors associated with VTE were analyzed and the odds ratios (ORs) were calculated. The D-dimer cutoff value for patients with hemiplegia was defined using a receiver operating characteristic (ROC) curve. RESULTS: Of 117 patients with acute or subacute brain lesions, 65 patients with elevated D-dimer levels (mean, 5.1+/-5.8 mg/L; positive result >0.55 mg/L) were identified. Logistic regression analysis showed that the risk of VTE was 3.9 times higher in those with urinary tract infections (UTIs) (p=0.0255). The risk of VTE was 4.5 times higher in those who had recently undergone surgery (p=0.0151). Analysis of the ROC showed 3.95 mg/L to be the appropriate D-dimer cutoff value for screening for VTE (area under the curve [AUC], 0.63; 95% confidence interval [CI], 0.5-0.8) in patients with acute or subacute brain lesions. This differs greatly from the conventional D-dimer cutoff value of 0.55 mg/L. D-dimer levels less than 3.95 mg/L in the absence of surgery showed a negative predictive value of 95.8% (95% CI, 78.8-99.8). CONCLUSION: Elevated D-dimer levels alone have some value in VTE diagnosis. However, the concomitant presence of UTI or a history of recent surgery significantly increased the risk of VTE in patients with acute or subacute brain lesions. Therefore, a different D-dimer cutoff value should be applied in these cases.

Differential Response Style on the Personality Assessment Inventory according to Compensation-Seeking Status in Patients with Traumatic Brain Injury / 정신신체의학

OBJECTIVES: This study examined the characteristics and differences of PAI(Personality Assessment Inventory) profile between compensation-seeking(CS) and treatment-seeking(TS) patients with traumatic brain injury(TBI) and assessed the clinical meaning of the characteristics and differences of profiles between the two groups. METHODS: 36 TBI patients who visited the Wonkwang University Hospital were selected. The patients were categorized as compensation-seeking TBI patients(n=22) and treatment-seeking TBI patients(n=14). The PAI scales and subscales were used to compare differences between two groups. t-verification for each variable and comparison analysis were performed. RESULTS: In validity scales, CS group showed significantly higher NIM scores and lower PIM scores than TS groups. In full scales, CS group showed significantly higher SOM, ANX, ARD, DEP, and SCZ scores than TS group. In subscales, CS group showed significantly higher SOM-S, ANX-A, ARD-P, DEP(-C, A, P), (MAN-I), PAR-H, SCZ(-T, P), BOR(-A, N), and ANT-S scores than TS groups. In supplementary scales, CS group showed significantly higher SUI, NON and AGG-P, and lower RXR scores than TS group. CONCLUSIONS: There were significant differences in PAI scales with validity scales, some full and subscales according to compensation seeking status in TBI patients. The CS patients tended to exaggerate their symptoms on PAI, and showed higher scores representing somatic preoccupation and emotional distress. These results show the usefulness of PAI in reflecting the significant psychological differences between two groups.

Successful Early Clozapine Trial in the Treatment of First-episode Schizophrenia: A Case Report

Clozapine remains the treatment of choice in refractory schizophrenia despite its various requirement to prescribe, such as mandatory blood monitoring program and various metabolic complication. Currently, clozapine is recommended only after two failed adequate antipsychotics trials. We report a case of a successful early clozapine trial in the treatment of first-episode schizophrenia patient, considering poor treatment response and repeated self-injurious behavior. This case highlights the efficacy of an early clozapine trial as a second-line treatment for first-episode schizophrenia in contrast to switching or combination treatment strategy.

Inhibition of Human Pancreatic Tumor Growth by Cytokine-Induced Killer Cells in Nude Mouse Xenograft Model

Pancreatic cancer is the fourth commonest cause of cancer-related deaths in the world. However, no adequate therapy for pancreatic cancer has yet been found. In this study, the antitumor activity of cytokine-induced killer (CIK) cells against the human pancreatic cancer was evaluated in vitro and in vivo. Human peripheral blood mononuclear cells were cultured with IL-2-containing medium in anti-CD3 for 14 days. The resulting populations of CIK cells comprised 94% CD3+, 4% CD3-CD56+, 41% CD3+CD56+, 11% CD4+, and 73% CD8+. This heterogeneous cell population was called cytokine-induced killer (CIK) cells. At an effector-target cell ratio of 100:1, CIK cells destroyed 51% of AsPC-1 human pancreatic cancer cells, as measured by the 51Cr-release assay. In addition, CIK cells at doses of 3 and 10 million cells per mouse inhibited 42% and 70% of AsPC-1 tumor growth in nude mouse xenograft assays, respectively. This study suggests that CIK cells may be used as an adoptive immunotherapy for pancreatic cancer patients.

A Case of Early Stage Mycosis Fungoides that was Successfully Treatedwith a Combination Therapy of PUVA and Interfernon-gamma / 대한피부과학회지

Early stage mycosis fungoides (MF) is known to be responsive to various topical and systemic therapies such as corticosteroids and ultraviolet light radiation, photochemotherapy with psoralens and whole-body electron beam irradiation. However, these treatments have all revealed a high relapse rate. Thus, we suggest that more invasive therapy, including PUVA combined with interferon-gamma, is one of the possible treatments for early MF because this treatment displays a reduced relapse rate. We report here on a case of early stage MF (Stage Ib) that was successfully treated with PUVA (total dose: 105.7 J/cm2) and intravenous administration of recombinant human interferon-gamma (total 5.4x10(6) IU), and the patient has been without relapse 1 year after treatment.

Comparative Study of 20% Aluminum Chloride Solution and Botulinum Toxin A Injection in the Treatment of Patients with Primary Palmar Hyperhidrosis / 대한피부과학회지

BACKGROUND: Primary hyperhidrosis carries a substantial psychological and social burden. Early detection and management can significantly improve a patient's quality of life. A large number of therapeutic options are used, such as the application of topical agents, iontophoresis, sympathectomy, and botulinum toxin injection. OBJECTIVE: We aim to comprehensively evaluate the effects of botulinum toxin type A and 20% aluminum chloride on primary palmar hyperhidrosis. METHODS: A total of 55 patients with clinical diagnosis of primary hyperhidrosis were treated by botulinum toxin type A and 20% aluminum chloride solution. To prospectively assess the effects on primary palmar hyperhidrosis, we checked corneometer at baseline, 2 and 4 months later. By regular meetings with patients, including telephone interviews, we analyzed patients' subjective satisfaction scores and complaints during the follow=up periods. RESULTS: During the 2-month period, as compared with that of the control group, the level of corneometer of both groups declined. In the 4-month period, the group treated with 20% aluminum chloride sustained a lower level of corneometer. In the questionnaire, in the 2-month period, the group treated with botulinum toxin resulted in a lower level of overall treatment scores than that of the group treated with 20% aluminum chloride. However, in the 4-month period, the group treated with aluminum chloride showed lower scores. CONCLUSION: Both botulinum toxin type A and aluminum chloride solution were safe and well tolerated, producing high levels of patient satisfaction. However, considering the long-term efficacy of treatment, aluminum chloride may be a more suitable mode of treatment for primary palmar hyperhidrosis.

The Use of Dynamic Ultrasonography for the Confirmation of Lower Leg Muscle Herniation

The term muscle herniation represents focal muscular protrusions through an acquired or congenital fascial defect. The anterior tibialis muscle is the most common site of herniation. Dynamic ultrasonography has become an important tool in dermatology for diagnosing suspected muscle herniation because it is a non-invasive, highly accurate, readily available and cost-effective imaging technique. We present here the case of a 21-year-old male Korean soldier who underwent dynamic ultrasonography to confirm the diagnosis of anterior tibialis muscle herniation.

The Efficacy of Electric Nail Grinding with Nail Lacquer in the Treatment of Onychomycosis / 대한피부과학회지

BACKGROUND: There is a need for additional effective treatments for onychomycosis. Aggressive debridement has been explored as a therapeutic option for onychomycosis, but rigorously designed studies in this area have been limited. OBJECTIVE: We sought to examine the efficacy of the nail grinder and nail lacquer in the treatment of onychomycosis. We planned the study to determine whether adding aggressive nail grinding to nail lacquer for treating toenail onychomycosis improves the efficacy. METHODS: To provide better delivery of drug to bed and nail plate, we trimmed with electric nail grinder (KHP 3000 Frees(R), Germany), and then applied nail lacquer (Amorolfine HCl, Loceryl(R), Galderma korea). Clinical photo was taken for infected area evaluation. The phototrichogram system (Folliscope, LeadM Corporation, Seoul, Korea) was used for the computer-aided evaluation of the nail plate thickness. RESULTS: Aggressive debridement of infected nail with electric nail grinder made an improvement over the duration of the treatment with nail lacquer. CONCLUSION: Aggressive debridement with an electric nail grinder is likely to be more effective than with a nail file. Electric nail grinder could be adopted as the treatment of onychomycosis. The potential for synergism of electric nail grinder with topical antifungal agent is expected.

A Case of Reactivation of Herpes Simplex Virus in Foot Dorsum Followed by Friction by Sandals' Trap / 대한피부과학회지

Herpes simplex virus (Herpesvirus hominis), a member of the herpeptoviridae family, is among the most common infectious viral pathogens in humans. Types of HSV can be subdivided into HSV-1 and HSV-2 on the basis of physiological, serologic and epidemiologic differences, although both are closely related immunologically and DNA sequence homology. HSV-1 is frequently associated with oropharyngeal, eye and skin infections, while HSV-2 is most commonly associated with genital tract infections. Characteristically after the primary infection, HSV can be linked to latency in neural tissue. Reactivation of HSV can be triggered by sunburn, fever, stress, menstruation and local trauma. Here we report a case of reactivation of herpes simplex virus type 2 in foot dorsum followed by repetitive friction due to Sandals' trap.

Two Cases of Onychomycosis Treated with Electric Nail Grinder and Nail Lacquer / 대한의진균학회지

rue fungal infection of the nail plate is known as onychomycosis. Systemic therapy of onychomycosis is more likely to be effetive than topical treatment. However, the potential for adverse reactions and for interaction with the metabolism of other medication can preclude their use. Furthermore, some people do not want to take oral medicine for treatment of onychomycosis. Because of this, the prospect of effective topical therapy is a welcome alternative. To provide better delivery of drug to bed and nail plate, we trimmed with electric nail grinder (KHP 3000 Frees(R), Germany), and then applied nail lacquer (Amorolfine HCl, Loceryl(R), Galderma korea). The potential for synergism of electric nail grinder with topical antifungal agent is expected.

A Case of Graphite Foreign Body Misdiagnosed as Blue Nevus

The lead of a pencil is composed of graphite and clay. Although considered as biologically inert for a long time, the lead of a pencil can result in undesirable local pain, pigmentation, abscess formation and graphite foreign body reaction. Therefore, all penetrating injuries caused by a pencil should be carefully assessed and treated in order to remove all pieces of lead from the wound by specialized paramedics or medical doctors. We should be aware that graphite granules embedded in the skin may give rise to clinically alarming delayed reactions. Here we present a 19-year-old woman with a foreign body, the lead of a pencil, misdiagnosed as a blue nevus.

A Case of Tufted Hair Folliculititis

Tufts folliculitis is an uncommon folliculitis of the scalp that resolves with patches of scarring alopecia within which multiple hair tufts emerge from dilated follicular orifices. Each tuft consists of 5 to 20 normal-appearing hairs arising from a single follicular orfice. It has a prolonged relapsing clinical course, and results in a scarring alopecia. Systemic antibiotics and steroids are commonly used for anti-inflammatory effects, but have only a brief response. Here, we report a case of tufted hair folliculitis in a 36-year-old woman, with the clinical, histological findings and computerized hand-held phototrichogramical evaluations.

A Case of Giant Tuberculosis Verrucosa Cutis Associated with Bladder Cancer / 대한피부과학회지

Tuberculosis verrucosa cutis (TVC) is one of the most common forms of cutaneous tuberculosis in Asia. It occurs as a result of inoculation of mycobacteria into the skin of an individual who has previously been infected and who has a moderate-to-high degree of immunity. Although the chronic nature of tuberculosis verrucosa cutis is well known, we report an unusual case of rapid spreading of giant tuberculosis verrucosa cutis which had been present for 1 year in a 41-year-old man with bladder cancer-transitional cell carcinoma.

A Case of Anal Erosion Treated with Chamomile and Myrrh Extracts / 대한피부과학회지

Anal disorders are common and more than one half of the population will experience one at some time during their lives. Anal erosion and fissures can cause discomfort, severe pain, bleeding and inflammation. In the acute phase of anal erosion, with bowel habit management and topical emollient, lesions can be improved. Chamomile and Myrrh are known for centuries to have several effects and have anti-inflammatory, sedative, antibacterial and antifugal properities. Here, We report a case of anal erosion treated with Chamomile and Myrrh extracts (Ad-Muc(R)). Our case indicates that Chamomile and Myrrh extracts might play a role in the management of anal erosion and fissure.