Causal Attributions and Quality of Life of Korean Breast Cancer Survivors

Purpose@#The purpose of this study was threefold: to explore the causal attributions of breast cancer, examine underlying factors of the attributes, and determine their relationship to quality of life among Korean breast cancer survivors. @*Methods@#The study used a descriptive correlational design, which included quantitative survey questionnaires and an open-ended question to complement the study. Three hundred and three breast cancer survivors were recruited from two university hospitals in South Korea, between January and April 2018. The causal attributions were explored using the Illness Perception Questionnaire Revised and an open-ended question. The survivors' quality of life was assessed using the Functional Assessment of Cancer Therapy for Breast Cancer. The quantitative analysis was performed using the SPSS 25.0 software package; the ATLAS.ti 8 software was used for thematic analysis. @*Results@#Quantitative and qualitative data of 321 and 238 breast cancer survivors, respectively, were analyzed. “Stress and worry” and “diet or eating habits” were believed to be the two most likely causes of breast cancer. Eleven new causal attributes emerged from the analysis. Being diagnosed with breast cancer at an older age (p < .05), having received chemotherapy (p < .05), and holding nonbehavioral causal attributes (p < .001), were significantly related to lower quality of life. @*Conclusion@#There were differences between the survivors' beliefs on their causes of disease, and causal factors available from the literature. As the survivors' causal attributes were significantly related to their quality of life, healthcare providers should individually assess and incorporate these attributes into their care.

Causal Attributions and Quality of Life of Korean Breast Cancer Survivors

Purpose@#The purpose of this study was threefold: to explore the causal attributions of breast cancer, examine underlying factors of the attributes, and determine their relationship to quality of life among Korean breast cancer survivors. @*Methods@#The study used a descriptive correlational design, which included quantitative survey questionnaires and an open-ended question to complement the study. Three hundred and three breast cancer survivors were recruited from two university hospitals in South Korea, between January and April 2018. The causal attributions were explored using the Illness Perception Questionnaire Revised and an open-ended question. The survivors' quality of life was assessed using the Functional Assessment of Cancer Therapy for Breast Cancer. The quantitative analysis was performed using the SPSS 25.0 software package; the ATLAS.ti 8 software was used for thematic analysis. @*Results@#Quantitative and qualitative data of 321 and 238 breast cancer survivors, respectively, were analyzed. “Stress and worry” and “diet or eating habits” were believed to be the two most likely causes of breast cancer. Eleven new causal attributes emerged from the analysis. Being diagnosed with breast cancer at an older age (p < .05), having received chemotherapy (p < .05), and holding nonbehavioral causal attributes (p < .001), were significantly related to lower quality of life. @*Conclusion@#There were differences between the survivors' beliefs on their causes of disease, and causal factors available from the literature. As the survivors' causal attributes were significantly related to their quality of life, healthcare providers should individually assess and incorporate these attributes into their care.

Impact of the COVID-19 Pandemic on the Diagnosis and Surgery of Breast Cancer: A Multi-Institutional Study / 한국유방암학회지

Purpose@#The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the rates of screening, case identification, and referral for cancer diagnosis. We investigated the diagnosis and surgery status of breast cancer before and after the COVID-19 pandemic at a multi-institutional level. @*Methods@#We collected breast cancer data from the clinical data warehouse which contained the medical records of patients from six academic institutions in South Korea. Patients were divided into two groups: February to April (period A) and May to July (period B). The data from the two groups were then compared against the same periods in 2019 and 2020. The primary objective was to investigate the differences in breast cancer stages before and after the COVID-19 pandemic. @*Results@#Among 3,038 patients, there was a 9.9% reduction in the number of diagnoses in 2020. This decrease was more significant during period A than period B. The breast cancer stage was not statistically different in period A (p = 0.115), but it was in period B (p = 0.001). In the subset analysis according to age, there was a statistical difference between 2019 and 2020 in period B for patients under the age of 65 years (p = 0.002), but no difference was observed in the other groups. @*Conclusion@#The number of breast cancer cases declined during the pandemic, and the staging distribution has changed after the pandemic peak.

The Effects of Pueraria lobata on Osteoclast Differentiation and Bone Resorption / 체질인류학회지

Previous researches have proved that Pueraria lobata up-regulates bone mineral contents and bone mineral density in bone-loss model, ovariectomized mice and orchidectomized rats. However, the precise effects and mechanisms of Pueraria lobata on osteoclast differentiation and bone resorbing activity of mature osteoclasts still remains unknown. Therefore, we investigated the effect and mechanism of Pueraria lobata on receptor activator of nuclear factor-kappaB ligand (RANKL) and macrophage colony stimulation factor (M-CSF)-induced osteoclast differentiation in bone marrow macro-phages (BMMs). First of all, we treated BMMs derived from mice with various concentrations of Pueraria lobata in order to perform screening by tartrate-resistant acid phosphatase (TRAP) staining. Also, we conducted western blotting and RT-PCR for the purpose of verifying the treatment mechanism of Pueraria lobata and lastly, we used hydroxyapatite-coated plate to evaluate the effects of Pueraria lobata on bone resorbing activity of mature osteoclasts. As a result, Pueraria lobata has inhibitory effect on phosphorylation of p38, Akt, c-Jun N-terminal kinase (JNK), and IkappaB which are essential early signaling pathway of osteoclastogenesis. Also, the inactivation of nuclear factor of activated T cells (NFAT)c1, and c-Fos which is caused by Pueraria lobata is followed by the suppression effects of Pueraria lobata on osteoclast-related various genes, osteoclast-associated receptor (OSCAR), TRAP, Integrin beta3, osteoclast stimulatory transmembrane protein (OC-STAMP), and dendritic cell-specific transmembrane protein (DC-STAMP). Particularly, Pueraria lobata blocks the formation of pit area on hydroxyapatite-coated plate in a dose-dependent manner as well as the mRNA expression of Cathepsin K, which is associated with bone resorbing activity. These results demonstrate the molecular mechanism relating to anti-osteoclastogenesis effect of Pueraria lobata as well as the inhibitory effect of Pueraria lobata on mature osteoclast formation and bone resorbing activity.

The Effects of Baicalein on Osteoclast Differentiation from Bone Marrow Derived Macrophage / 체질인류학회지

As prediction of rapidly aging society, bone health is considered increasingly important and received more attention than ever. Bone health is regulated by balancing between bone resorptive osteoclasts and bone formative osteoblasts. Disruption of balance between bone-resorbing osteoclasts and bone-forming osteoblasts results in bone disease. Natural products have recently received much attention as an alternative tool for the development of novel therapeutic strategy. Baicalein is reported it has anti-cancer, anti-inflammatory and antioxidant effects. Baicalein also has been known that it has both promotive effect on MC3T3-E1 cell line and inhibitory effect on RAW 264.7 cell line. However, the inhibitory mechanism of baicalein using bone marrow derived macrophages (BMMs) on osteoclast differentiation remains not clear. In this study, the suppressive mechanism by baicalein on osteoblast differentiation was evaluated. Bicalein inhibited receptor activator of nuclear factor-kappaB ligand (RANKL)-induced osteoclast differentiation in BMMs in a dose dependent manner without any toxicity. Baicalein suppressed phosphorylation of protein kinaseB (Akt), c-Jun N-terminal kinases (JNK) and phosphoinositide-specific phospholipaseCgamma2 (PLCgamma2). Furthermore, Baicalein suppressed the induction of RANKL-induced c-Fos and Nuclear factor of activated T cell c1 (NFATc1), essential genes on osteoclastogenesis. In BMMs, Bicalein inhibited the mRNA expression of tartrate-resistant acid phosphatase (TRAP), osteoclast-associated receptor (OSCAR), cathepsinK, dendritic cell-specific transmembrane protein (DC-STAMP). Moreover, baicalein promoted differentiation of osteoblast on bone marrow stromal cells (BMSCs). Taken together, these results suggest that baicalein has a potential for treating bone lytic diseases, such as osteoporosis, periodontitis, and rheumatoid arthritis.

The Effects of Phlomis umbrosa Turcz on Osteoclast Differentiation / 체질인류학회지

Many bone-related diseases such as osteoporosis, rheumatoid arthritis are occurred by excessive bone resorbing activity of osteoclasts. Recently, many studies have been proceeded to find out the new therapeutic materials from natural products of plants. Phlomis umbrosa Turcz, one of the natural products of plants has been known to improve bone health. However, the precise effects and treatment mechanisms of Phlomis umbrosa Turcz about bone diseases has been unknown. So, we examined the effects of Phlomis umbrosa Turcz on expression of receptor activator of nuclear factor-kappaB ligand (RANKL)-induced osteoclast differentiation in bone marrow-derived macrophages (BMMs) and bone resorption. Also, we investigated the treatment mechanisms of Phlomis umbrosa Turcz relating to osteoclast differentiation. Here, we showed that Phlomis umbrosa Turcz significantly suppressed RANKL-induced osteoclast differentiation and bone resportion. Furthermore, Phlomis umbrosa Turcz suppressed the activation of NF-kappaB in bone marrow macrophage treated RANKL and M-CSF. The mRNA expression of c-Fos, nuclear factor of activated T-cells (NFAT)c1, osteoclast-associated receptor (OSCAR), tartrate-resistant acid phosphatase (TRAP) in BMMs was inhibited by Phlomis umbrosa Turcz. Integrin alphanu, beta3 relating to cell adhesion and dendritic cell-specific transmembrane protein (DC-STAMP) relating to the structure of filamentous actin (F-actin) ring and cathepsin K relating to bone resorbing activity are disrupted too. These results suggest that Phlomis umbrosa Turcz will be a good materials to treat bone diseases like osteoporosis.

Use of video-assisted thoracoscopic surgery to retrieve a broken guidewire / 대한외과학회지

Subclavian venous catheterization was once widely used for volume resuscitation, emergency venous access, chemotherapy, parenteral nutrition, and hemodialysis. However, its use has drastically reduced recently because of life-threatening complications such as hemothorax, pneumothorax. In this case, a patient admitted for a scheduled operation underwent right subclavian venous catheterization for preoperative, intraoperative, and postoperative volume resuscitation and parenteral nutrition. The procedure was performed by an experienced senior resident. Despite detecting slight resistance during the guidewire insertion, the resident continued the procedure to the point of being unable to advance or remove it, then attempted to forcefully remove the guidewire, but it broke and became entrapped within the thorax. We tried to remove the guidewire through infraclavicular skin incision but failed. So video-assisted thoracoscopic surgery was used to remove the broken guidewire. This incident demonstrates the risks of subclavian venous catheterization and the importance of using a proper and gentle technique.

Pinch-off syndrome / 대한외과학회지

Subclavian venous catheterization was previously frequently performed, but because of life-threatening complications such as hemothorax, pneumothorax, mediastinal hematoma, and myocardial injury, its use has become less common. However, this practice has some advantages in patient mobility, secured dressing, and rapidity and adequacy of vascular access. In some situations where patient comfort is an especially important consideration, such as with totally implantable venous port insertion for chemotherapy, the subclavian route can be a good choice if an experienced and well-trained faculty is available. The authors have had recent experience with pinch-off syndrome-in other words, spontaneous catheter fracture-in 3 patients who had undergone venous port implantation through the right subclavian route. Through these cases, we intend to review the dangers of subclavian venous catheterization, the causes of pinch-off syndrome, and its clinical presentation, progress, treatments, and prevention.

Chylous Leakage: A Rare Complication after Axillary Lymph Node Dissection in Breast Cancer and Surgical Management / 한국유방암학회지

Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemotherapy. The postoperative serosanguinous drainage fluid became "milky" on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alternative in cases where leakage persists or where the output is high.

Clinical Analysis of Endoscopic Thyroidectomy by the Axillary Approach for Papillary Thyroid Microcarcinoma / 대한내시경복강경외과학회지

PURPOSE: The aim of this study is to evaluate the feasibility and surgical outcomes of endoscopic thyroidectomy by the axillary approach for treating papillary thyroid microcarcinoma (PTMC). METHODS: We analyzed 56 patients who underwent endoscopic thyroidectomy by the axillary approach for treating PTMC between May 2002 and October 2008 at Bucheon ST hospital. We evaluated the operation type, the tumor size, the operative time, the hospital days, the number of retrieved lymph nodes and the complications. RESULTS: All the patients except one were women. The mean age was 40.5+/-8.7 years. All the procedure was performed by one surgeon and endoscopic thyroidectomy was done by the axillary approach. There was no conversion to open surgery. The type of operation was classified according to the extent of the surgery. The mean operative time for lobectomy and isthmectomy with CLND (24 cases) and total thyroidectomy with CLND (5 cases) was 142.5+/-40 minutes and 270+/-84.3 minutes, respectively. The mean tumor size was 0.66+/-0.46 cm. The mean number of retrieved lymph nodes was 3.7+/-2.4. The mean number of hospital days was 3.7+/-1.4 days. There were no serious complications. There were no tumor recurrence and the mean follow-up was 50.7 months. All the patients were satisfied with the cosmetic results. CONCLUSION: Endoscopic thyroidectomy by the axillary approach for PTMC is feasible and safe. Although a larger series and longer follow up are necessary, endoscopic thyroidectomy can be a alternative treatment method for selected patients with PTMC.

Two cases of small bowel herniation through 5 mm trocar site following removal of drains after gynecologic laparoscopy / 대한산부인과학회지

After laparoscopic surgery, most cases of incisional hernia occur when a trocar greater than 10 mm is used and this rarely occurs when a 5 mm trocar is used. We recently experienced two cases of incisional herniation at a 5 mm port site in connection with withdrawal of the drain after laparoscopic procedure.

Two cases of small bowel herniation through 5 mm trocar site following removal of drains after gynecologic laparoscopy / 대한산부인과학회지

After laparoscopic surgery, most cases of incisional hernia occur when a trocar greater than 10 mm is used and this rarely occurs when a 5 mm trocar is used. We recently experienced two cases of incisional herniation at a 5 mm port site in connection with withdrawal of the drain after laparoscopic procedure.

Malignant Peripheral Nerve Sheath Tumor of the Breast in a Patient without Neurofibromatosis: A Case Report / 한국유방암학회지

Malignant peripheral nerve sheath tumors (MPNSTs) are malignant variants of peripheral nerve sheath tumors that develop at major or minor peripheral nerve branches or at the sheaths of peripheral nerve fibers. These tumors are derived from Schwann cells or pluripotent cells of a neural crest origin. Malignant tumors of the peripheral nerve sheath are most commonly seen in deeper soft tissues, and usually in the proximity of a nerve trunk. MPNSTs of the breast are very uncommon and they have rarely been reported on. We report here on a case of MPNST of the breast in a 59-year-old female who presented with a painless breast lump for two months. The excisional biopsy revealed a malignant peripheral nerve sheath tumor based on the microscopic findings and immunohistochemical staining. We performed wide excision of breast tissue around the biopsy site and thereafter the patient underwent radiation therapy. The patient remains well without signs of recurrence 1 year following surgery.

Intracystic Papillary Carcinoma in the Male Breast: A Case Report / 한국유방암학회지

Intracystic papillary carcinoma of the breast is a variant of ductal carcinoma in situ (DCIS) characterized by the presence of papillary carcinoma within a cystically dilated duct. DCIS of the male breast is an uncommon disease, accounting for approximately 7% of all male breast carcinomas. Most DCIS in men is of the papillary type. We experienced one case of intracystic papillary carcinoma in the right breast of a 49-yr-old male and report the case with a review of the literature.

Malignant Fibrous Histiocytoma in the Breast: A Case Report / 한국유방암학회지

Malignant fibrous histiocytoma is the most common form of soft tissue sarcoma during middle and late adulthood in the deep connective tissues of the extremities, abdominal cavity, and retroperitoneum. Primary breast sarcoma is a rare disease entity, comprising less than 1% of all breast malignancies. Malignant fibrous histiocytoma of the breast is very rare. We presented one case of a malignant fibrous histiocytoma of the right breast in a 49-year-old woman and report the case with a review of the literature.

Synchronous Carcinoma Showing Thymus-like Elements (CASTLE) of the Thyroid Combined with Rectal Carcinoma: Report of a Case and Review of the Literature / 대한내분비외과학회지

Carcinoma showing thymus-like elements (CASTLE) is a rare neoplasm arising from the thyroid gland. This tumor is thought to originate from ectopic thymic tissue or remnants related to thymic development in or adjacent to the thyroid gland and usually located in the lower two-thirds of the thyroid gland. The patient was a 66-year-old man admitted to our hospital with rectal carcinoma for surgery. He had undergone a right upper lobectomy of the lung for the pulmonary tuberculosis 35 years previously. He underwent a chest computed tomography (CT) pre-operatively, and an incidental nodule of the thyroid gland was detected. Based on aspiration cytology of the nodule, the lesion was suspected to be an anaplastic carcinoma. He underwent a low anterior resection and thyroid lobectomy for a double primary neoplasm. On the final pathologic examination, the thyroid lesion was shown to be CASTLE. Therefore, completion thyroidectomy with lymph node dissection of the central compartment and radiotherapy were performed, and there was no evidence of recurrence 15 months postoperatively.

A Comparison between Endoscopic Thyroidectomy Performed by the Axillary Approach and by a Conventional Thyroidectomy / 대한내분비외과학회지

PURPOSE: Endoscopic thyroidectomy has not become a widespread procedure because of limited advantages to its use. We have performed endoscopic thyroidectomies by use of the axillary approach. The purpose of this study was to determine the efficacy of this surgical procedure. METHODS: Between June of 2002 and December of 2002, 17 patients underwent an endoscopic thyroidectomy by use of the axillary approach while 11 patients underwent a conventional thyroidectomy. Each procedure was performed by one surgeon under general anesthesia. Patients with thyroid carcinoma at the preoperative diagnosis or who received a bilateral thyroidectomy were excluded. We compared the age, size of the tumor, postoperative pain (48 hours after surgery), surgical time, cosmetic result, length of hospital stay, and paresthesia. Statistical analysis was determined by use of the Mann-Whitney test and the chi-square test using SPSS software. RESULTS: The mean age of the patients was 46.6 years who received a conventional thyroiodectomy and 32.9 years who underwent the axillary approach. The size of the tumor was 3.1 cm for patients who received conventional thyroiodectomy and 3.3 cm for patients who underwent the axillary approach. The operation time was 80.91±16.1 (65~100) minutes for the conventional thyroiodectomy and 135.3± 34.6 (80~210) minutes for the axillary approach. The difference between the two approaches in regards to parameters such as postoperative pain, parethesia, and total hospital days was negligible. The degree of satisfaction was 2.7±0.8 for the conventional thyroiodectomy and 1.1±0.3 for the axillary approach. CONCLUSION: While conventional thyroidectomy still offers an advantage in terms of surgical time, performance of endoscopic thyroidectomy by the axillary approach has an advantage in producing better cosmetic results. Although a multitude of patients will be necessary to follow in further studies, the use of endoscopic thyroidectomy by the axillary approach could become the procedure of choice by offering better cosmetic results to young patients who present with thyroid nodules.

Wernicke's Encephalopathy following Gastrectomy in Patients with Gastric Cancer

Wernicke's encephalopathy is a neurological disorder that is caused by a thiamine deficiency, and characterized by acute confusion, ataxia, a change in the patient's state of mind and abnormal eye movement (op-thalmophlegia and nystag-mus). This encephalopathy can be found in patients with chronic alcoholism, anorexia nervosa, hemodialysis, AIDS and gastroplasty for morbid obesity. The diagnosis of this disease is difficult because not all cases display the typical symptoms. However, this disease can be confirmed not only by the clinical symptoms but also by the brain MRI findings, low thiamine level and clinical response to thiamine replacement therapy. We experienced two cases of Wer-nicke's encephalopathy in patients who underwent a gas-trec-tomy for gastric cancer. However, this condition was not diagnosed until the patients showed neurological symptoms and the typical MRI findings. These patients improved after vitamin B(1) (thiamine) replacement.

A Carcinosarcoma of the Esophagus

A carcinosarcoma of the esophagus is an uncommon malignancy accounting for approximately 1~2% of all esophageal neoplasms. Histologically, both carcinomatous and sarcomatous components are observed. The terms used to describe this lesion include carcinosarcoma, pseudosarcoma, polypoid carcinoma, pseudosarcomatous carcinoma pseudosarcomatous squamous cell carcinoma and a spindle cell variant of a squamous cell carcinoma. It presents as a bulky intraluminal polypoid lesion mainly in the mid to lower esophagus. It often presents relatively early because of its rapid intraluminal growth. Ultimately, the treatment is similar to that of an esophageal carcinoma requiring an esophagectomy for resectable lesions. We report a case of a 64-year-old man with a carcinosarcoma of the esophagus. Endoscopy revealed a 1.5 cm sized polypoid mass located 25 cm from the incisor with friable nature. Radiological studies revealed a bulky polypoid intraluminal mass with a lobulated border, measuring approximately 7 cm in length, in the mid esophagus that expands the lumen in conjunction with the enlargement of the regional lymph nodes. An esophagectomy was performed.

Male Breast Cancer / 한국유방암학회지

PURPOSE: Carcinomas of the male breast constitutes only 1% of all breast cancer and less than 1.5% of all malignant tumors in men. The low incidence of this disease prevents therapeutic questions from being addressed in prospective randomized trials. Our aim was to cover the characteristics of the etiology, presentation and treatment of male breast cancer; and therefore provide an overview of knowledge in this area. METHODS: We retrospectively analyzed 16 male breast cancer patients, who had been treated between 1983 and 1992 at the Department of Surgery, College of Medicine, The Catholic university of Korea. RESULTS: The peak age of incidence was in the 7th and 8th decades. The most common symptom was a palpable mass in the breast (75.1%), and the duration of symptom varied between 3 days and 10 years. According to the TNM staging system, there were 18.8%, 31.3%, 18.8%, 12.5%, 6.3%, at stages 0, I, II, III and IV, respectively, and 12.5% with an unknown stage. A modified radical mastectomy was performed in 11 patients (68.8%) and postoperative adjuvant therapy in 12 patients (75.1%). The mean duration of following up was 41.2 months, during which time 2 patients were lost. CONCLUSION: Sixteen male breast cancer patients were encountered and men with breast cancer were observed to be older, have a longer duration of symptom, and more likely to have a familial tendency. However, our review revealed that male breast cancer was not as far advanced and had more chance of cure than initially thought. Therefore, the early detection and aggressive treatment of breast cancer are important for improving the survival.