Warthin-like Tumor Variant of Papillary Thyroid Carcinoma: A Case Report

An unusual oncocytic papillary thyroid carcinoma with abundant lymphoid stroma bearing a resemblance to Warthin? tumor of salivary gland is described. We report a rare case of a Warthin-like tumor variant of papillary thyroid carcinoma in a 41-year-old-woman. Histologically, the tumor was characterized by oncocytic follicular cells showing nuclear features reminiscent of papillary carcinoma and lymphoid rich stroma. The surrounding non-neoplastic thyroid parenchyma showed focal peritumoral lymphocytic thyroiditis.

Coil Embolization in Right Superior Thyroid Artery Pseudoaneurysm by Stab Wound

A case of coil embolization in right superior thyroid artery pseudoaneurysm by stab wound is reported. A fifty-six-year old female, laceration and some bulging in right neck side. Aortic arch angiography, right common carotid angiography was done. Angiography shows 4 2 cm sized right thyroid artery pseudoaneurysm (Fig. 1) and (Fig. 2). We selected right superior thyroid artery by 3F micorofert (CooK, Bloomington, Ind.) and embolized by 2 4 mm (diameter), 2 cm (length) sized micro tornaido coil (CooK, Bloomington, Ind.). Post procedure right common carotid angiography was done. Angiography shows no visualized right thyroid artery pseudoaneurysm (Fig. 3).

Identification of Pseudomonas Aeruginosa Isolated from Burn Patients by Nested Polymerase Chain Reaction: Special reference to comparison with conventional blood culture

PURPOSE: Pseudomonas aeruginosa has emerged as one of the most problematic bacteria in modern hospital settings, and this organism is increasingly isolated as a nosocomial pathogen. Burn patients are particularly susceptible to Pseudomonas infection. Therefore, the accurate and sensitive microbiologic tests are needed for strict management of this prevalent microorganism. METHODS: A nested polymerase chain reaction test based on consecutive amplification of the lipoprotein genes, oprL and oprI, was designed and evaluated, in comparison with the conventional blood culture, for its ability to detect Pseudomonas aeruginosa in clinical materials of burn patients. RESULTS: Positive results of PCR based on oprL gene were observed only for Pseudomonas aeruginosa. All other bacteria (n=4) tested by this amplification method were negative. Also the lowest detection level was 1X101 bacteria per ml of blood samples. In addition, PCR afforded a significantly higher detection rate for Pseudomonas aeruginosa than the conventional blood culture technique in clinical materials of burn patients (25.9% vs. 8.6%). CONCLUSION: This study suggests that the nested PCR technique is highly specific and sensitive test for detectionof Pseudomonas aeruginosa, and therefore it may be a useful adjunct tool, in combination with other conventional techniques, for detection of Pseudomonas aeruginosa infection.

A Clinical Differences between Asymptomatic Varicose Vein and Symptomatic Varicose Vein

PURPOSE: This study was designed to describe clinical differences between symptomatic and asymptomatic group in varicose vein. METHOD: We reviewed 59 cases of varicose vein managed in our hospital. The retrospective review of clinical records was done from March, 1999 to October, 1999. All patients were put into two groups:those were symptomatic and asymptomatic. RESULT: Analysis showed that varicose vein was more frequent in women than in men. 27.1% were asymptomatic and 72.9% were symptomatic. The mean age was 39.1 years in asymptomatic group and 52.1 years in symptomatic group. In asymptomatic group, the mean age of the male patients was 45.2 years and that of the female patients was 35.4 years. In symptomatic group, the mean age of the male patients was 49.6 years, that of the female patients was 54.2 years. The age difference between the two groups were 5.4 years in male in comparison with 19.8 years in female. In the symptomatic group, the frequency of association with deep vein thrombosis (DVT) was 21% (male:28% vs female:8.3%). CONCLUSION: The varicose vein appears to be a gradually progressive disease. In female patients, aging factor may be more important for the development of symptom. DVT is one of major causes of development of symptom.

The Effect of Long-term Tamoxifen Therapy on Endometrium Evaluated by Transvaginal Sonography in Postmenopausal Women Undergone Breast Cancer Surgery / 대한암학회지

PURPOSE: Tamoxifen is a non-steroidal antiestrogenic drug used mainly in the adjuvant therapy of breast cancer and it also has estrogenic effect to the endometrium. We investigated the effects of tamoxifen on endometrial thickening in postmenopausal women taking adjuvant tamoxifen therapy for breast cancer, and analyzed the correlation between sonographic findings, pathologic findings and duration of tamoxifen therapy. MATERIALS AND METHODS: Forty three patients previously operated and being treated by tamoxifen since July 1995 to August 1999 were involved in this study. Control group was selected from patients of postmenopausal syndrome visiting postmenopausal clinic more than 2 years after menopause since January 1994 to August 1997. Endometrial thicknesses of breast cancer patients taking tamoxifen were measured twice a year for 2 years and then once a year by transvaginal ultrasonography. They were considered abnormal when those thicknesses were greater than 6 mm. Sonographic mearsurements of control patients were done once at the first visit and which were compared with those of breast cancer patients. RESULTS: The mean endometrial thicknesses of breast cancer patients receiving tamoxifen therapy were 5.06 mm (4.86~5.21 mm) at 6th month, 5.1 mm (4.92~6.00 mm) at 12th month, 5.13 mm (4.89~5.32 mm) at 18th month, 5.15 mm (4.97~5.28 mm) at 24th month and 5.14 mm (4.96~5.21 mm) at 36th month. The mean thickness of control patients was 4.87 mm. The mean endometrial thickness of breast cancer patients and that of control patients were 5.07 mm and 4.87 mm respectively. Only one patient with stage I breast cancer showed endometrial thicknessof 6 mm during follow-up and endometrial biopsy showed atypical endometrial hyperplasia. Endometrial thickness significantly increased after 18 months of tamoxifen therapy, but the rate of increase was slow. CONCLUSION: The endometrial thickness increased with duration of tamoxifen therapy, but the rate of increase was slow and seldom exceeded 6 mm. So we concluded the risk of endometrial cancer is low.

Practicing Physicians Need Changes

No abstract available.

Correlation of Breast Cancer with Atypical Ductal Hyperplasia on Fine-needle Aspiration Cytology Speciemens / 대한암학회지

PURPOSE: Atypical ductal hyperplasia (ADH) is a lesion with significant malignant potential We evaluated the prevalence of breast carcinoma in surgical breast biopsies performed on palpable breast lesions diagnosed initially as ADH by fine needle aspiration cytology (FNAC). MATERIALS AND METHODS: Between January 1, 1996 and December 31, 1997, 942 patients who underwent FNAC at the Department of Surgery and Pathology, College of Medicine, Hallym University and Department of Surgery, Central Gil Hospital were analyzed. ADH was found in 46 (4.9%) of 942 patients, and surgica1 excision subsequently was performed in 39 of these cases. In these 39 cases, cytologic and histopathologic results from FNAC and surgical biopsies were reviewed and correlated. RESULTS: Histopathologic study of the 39 surgically excised lesions diagnosed as ADH in their FNAC specimens showed breast cancer in 15 cases (38.5%), ADH in 11 cases (28.2%) and benign disease in 13 cases (33.3%). CONCLUSION: In our patient populatian, 15 cases (38.5%) of 39 patients with ADH at FNAC had a breast cancer. Therefore, the FNAC finding of ADH may warrant a recommendation for an excisional biopsy.

Prognostic Significance of Tumor Angiogenesis in Breast Cancer / 한국유방암학회지

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for recurrence and death. Recently, much experimental evidence has accumulated showing that tumor growth and metastasis are dependent on tumor angiogenesis. To investigate the status of angiogenesis in breast cancer, we counted the microvessel density (MVD) of brest cancer tissues, which were stained with anti-CD34 antibody, as a measure of tumor angiogenesis. We classified 43 breast-cancer patients into 22 with low MVD ( or =47/200xPF). We estimated the correlations between the MVD and other established prognostic factors. We also calculated survivals based on MVD. The MVD was in the range between 10 and 93 (mean+/-SD=46.9+/-21.7). The positive rate of lymph-node metastasis in high MVD patients was 32.6%, which was higher than the 23.3% for low-MVD patients. We found a significant correlation between MVD and histologic grade (p=0.037), but could not fine any significant correlation between MVD and menopausal status, tumor size, nuclear grade, estrogen receptor, or progesterone receptor. Retrospectively, the receptor status of estrogen and of progesterone had significant impacts on survival (ER: p=0.0001, PR: p=0.0001). The 4-year disease-free survival rate of high-MVD patients was 56.6+/-12.5%, and that of low-MVD patients was 69.0+/-10.8% (p=0.449). The 4-years overall survival rate of high-MVD patients was 71.1+/-11.1%, and that of low-MVD patients was 74.1+/-12.2 (p=0.449). In conclusion, the determination of MVD in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the MVD in a large number of patients before this conclusion can be stated with certainty.

Pulmonary Infection after Kidney Transplantation / 대한이식학회지

The infectious complications after renal transplantation remain as an important causes of both mortality and graft loss. The lung is the most common target for post-transplant infection. We analyzed the causative agents, treatments and outcomes of post-transplant pulmonary infections. From 1990 to 1998, 192 renal allografts were performed at Hallym University Hospital. Seven cases (3.6%) of 5 males and 2 females developed serious pulmonary infections and required hospitalization. The mean age was 42.6 years. The onsets of pulmonary infections were from a month to 6 months in 3 cases, from 6 months to a year in one case and after a year in 3 cases. Triple therapy regimen was used in 4 cases as an immunosuppression therapy. Acute rejections developed in 6 cases. Causative organisms were Cytomegalovirus in 2 cases, Mycobacteria in 2 cases, Aspergillus in a case, Nocardia in a case and unknown in a case. Despite appropriate antibiotics, four patients did not respond to the treatment and died. The early recognition of infection and appropriate therapy is important to reduce fatal consequence.

Two Cases of Acute Mesenteric Infarction Due to Superior Mesenteric Arterial and Venous Branch Occlusion

Acute mesenteric infarction is a catastrophic illness representing a diverse spectrum of pathologic conditions which ultimately lead to necrosis of the intestine and which is uniformly fatal if left untreated. Despite better understanding of the disease process, acute mesenteric infarction continues to be a lethal disorder with high mortality rate. We experienced two cases of acute mesenteric infarction due to superior mesenteric arterial and venous branch occlusion, respectively, in recent years: One case was focal segmental ischemia with normal radiologic finding including angiography, successfully treated with segmental resection of the necrotized ileum, another case was mesenteric venous thrombosis, also treated with resection of necrotized small intestine followed by second look operation.

Bilateral Popliteal Artery Entrapment Syndrome: A case report

A case of symptomatic bilateral popliteal artery entrapment syndrome is reported. A twenty-one-year old male, a candidate of athlete, complained of coldness, weakness, pallor and cyanosis of right lower leg and intermittent claudication to both calves during walking or exercise for ten months. Studies revealed that the right popliteal artery was completely occluded, but the left popliteal artery was non-occlusive. An endarterectomy and onlay vein patch graft to the thrombosed and fibrotic right popliteal artery, and myotomies of bilateral medial heads of gastrocnemius muscle were done (May 20, 1998). Follow-up examinations for the last ten months showed a complete relief of symptoms with normal distal arterial flow. It is thought that even though the majority of patients present with unilateral calf claudication, the possiblity of bilateral problems need to be also considered.

Vascular Trauma Secondary to Orthopedic Procedure

Liability to vascular trauma in orthopedic procedures results from the close relation between bones and vessels and complicated use of sharp instruments and retractors. Prompt diagnosis and management are mandatory to avoid high mortality and morbidity. We report 6 vascular injuries secondary to orthopedic procedures performed between 1994 and 1998. Two injuries occurred as a consequence of intramedullary nailing and Ilizarov external fixation of a femur fracture, one injury from lumbar laminectomy, one injury as a result of total hip replacement, one from hip flexion contracture release and the other one secondary to knee flexion contracture release. Injury occurred to three femoral arteries, one femoral artery and vein, one popliteal artery, and one iliac artery and IVC. Four vascular injuries required bypass grafts, division was done in AV fistula following disc operation. Conservative treatment was given to one vascular injury. There was no significant complication and death in our series except one case of graft infection that was revised with extra-anatomic bypass. The goal of management of vascular trauma that occurs during the orthopedic procedure is to save the limb and even the life. Urgent management based on knowledge of vascular structure and skillful surgical technique are needed.

Correlation of Breast Cancer with Atypical Ductal Hyperplasia on Fine-needle Aspiration Cytology Speciemens / 한국유방암학회지

PURPOSE: Atypical ductal hyperplasia (ADH) is a lesion with significant malignant potential. We evaluated the prevalence of breast carcinoma in surgical breast biopsies performed on palpable breast lesions diagnosed initially as ADH by fine needle aspiration cytology (FNAC). MATERIALS AND METHODS: Between January 1, 1996 and December 31, 1997, 942 patients performed FNAC at the Department of Surgery and Pathology, College of Medicine, Hallym University and Department of Surgery, Central Gil Hospital were analyzed. ADH was found in 46(4.9%) of 942 patients and surgical excision subsequently was performed in 39 of these cases. In these 39 cases, cytologic and histopathologic results from FNAC and surgical biopsies were reviewed and correlated. RESULTS: Histopathologic study of the 39 surgically excised lesions diagnosed as ADH in their fine needle aspiration cytology specimens showed breast cancer in 15 cases(38.5%), ADH in 11 cases (28.2%) and benign disease in 13 cases (33.3%). CONCLUSION: In our patient population, 15 cases(38.5%) of 39 patients with ADH at FNAC had a breast cancer. Therefore the fine needle aspiration cytology finding of ADH warrants a recommendation for an excisional biopsy.

Prognostic Significance of Tumor Angiogenesis in Breast Cancer

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for recurrence and death. Recently, much experimental evidence has accumulated showing that tumor growth and metastasis are dependent on tumor angiogenesis. To investigate the status of angiogenesis in breast cancer, we counted the microvessel density(MVD) of breast cancer tissues, which were stained with anti-CD34 antibody, as a measure of tumor angiogenesis. We classified 43 breast-cancer patients into 22 with low MVD ( or =47/200 PF). We estimated the correlations between the MVD and other established prognostic factors. We also calculated survivals based on MVD. The MVD was in the range between 10 and 93(mean SD=46.9 21.7). The positive rate of lymph-node metastasis in high-MVD patients was 32.6%, which was higher than the 23.3% for low- MVD patients. We found a significant correlation between MVD and histologic grade (p=0.037), but could not find any significant correlation between MVD and menopausal status, tumor size, nuclear grade, estrogen receptor, or progesterone receptor. Retrospectively, the receptor status of estrogen and of progesterone had significant impacts on survival (ER : p=0.0001, PR : p=0.0001). The 4-year disease-free survival rate of high-MVD patients was 56.6 12.5%, and that of low-MVD patients was 69.0 10.8% (p=0.449). The 4-year overall survival rate of high-MVD patients was 71.1 11.1%, and that of low-MVD patients was 74.1 12.2 (p=0.449). In conclusion, the determination of MVD in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the MVD in a large number of patients before this conclusion can be stated with certainty.

Prognostic Singnificance of Peritumoral Lymphatic Vessel Invasion in Breast Cancer / 한국유방암학회지

The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for the disease recurrence and death. Recently, there are reports that peritumoral lymphatic vessel invasion is a good prognostic factors to solid tumors in animal studies and clinical trials. This study was performed to estimate the significance of peritumoral lymphatic vessel invasion (PLVI) as a prognostic factor in breast cancer. Also, PLVI was compared withb establishwd established clinicopathological prognostic factors and hormone receptors. MATERIALS AND METHODS: A group of patient was selected from the Department of Surgery, College of Medicine, Hallym University, which consists of 43 out of 96 patients who received curative operation from 1985 to 1993. Peritumoral lymphatic vessel invasion by tumor cells on H&E stain was considered PLVI positive. We classified 43 breast-cancer patients into 32 with negative PLVI and 11 with positive PLVI. We estimated the correlation between the PLVI and other established prognostic factors. We also calculated survivals based on PLVI. RESULT: The 4-year disease-free survival rate was 61.8+/-.7%, and the 4-year overall survival rate was 73.0+/-.0%. The receptor status of estrogen and of progesterone had significant impacts on survival (ER: p=0.0001, PR: p=0.0001). Also, metastasis status of lymph node had significant impacts on overall survival (p=0.0148). We found a significant correlation between PLVI and tumor size (p=0.004), estrogen receptor (p=0.002), progesterone receptor(p=0.006), but could not find any significant correlation between PLVI and menopausal status, histologic grade, unclear grade, lymph node metastasis. PLVI status was correlated with disease free survival rate (p=0.01) and overall survival rate(p=0.01). CONCLUSIONS: The determination of PLVI in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the PLVI in a large number of patients before this conclusion can be stated with certainty.

Clinical Experience of Kidney Transplantation in the Hallym University Hospital / 대한이식학회지

Renal transplantation has been adopted as the treatment of choices for most patients with a end stage renal disease. This is the presentation of our experience of renal transplantation at Hallym University Hospital. From March 1984 to July 1998, 207 cases of renal transplantations were performed, 15 cases out of which were lost during follow-up period and excluded from the study. The mean age of recipients was 37.1 years. The male to female ratio was 1.5:1. Eighty nine renal allografts (46.4%) were from living unrelated donors, 59 (30.7%) from living donors and 44 (22.9%) from cadaveric donors. As an immunosuppression theray, a triple regimen was used in 104 cases (54.2), a double regimen in 86 (44.8%) and a single regimen in one (0.5%). The overall rejection developed in 87 cases (45.3%). The rejection rate was 59.3% in renal allografts from living related donors, 37.1% from living unrelated donors and 43.2% from cadavaric donors. The OKT3 and the antilymphocyte globulin (ALG) were used for steroid resistent rejection in 8 and 2 cases, respectively. Post-transplant diabetes mellitus were noticed in 22 cases (11.5). The most common complication was infection (28.1%), and 11 recipeints (5.7%) died during follw-up period. Infection was the leading cause of mortality. The overall graft survival was 92.2% at 1 year span and 83.1% at 3 year span. The overall patient survival was 95.6% at 1 year span and 92.5% at 3 year span.

Relationship of Renal Implantation Biopsies and Acute Rejection during Immediate Posttransplantation Period / 대한이식학회지

Many factors can be recognized for the acute rejection such as: degree of HLA mismatching, cytokine gene expression, ischemic time, etc. Some authors have suggested the importance of early routine biopsy of renal allograft to predict acute rejection. This prospective study on renal implantation biopsies was performed to evaluate the relationship between the implantation biopsies and the acute rejection during the immediate post-transplantation period. From December 1996 to February 1998 implantation biopsies were performed on 46 renal allografts within 40~60 minutes after vascular anastomosis using tru-cut needle (18G). Two samples were obtained from transplanted kidney in each patient. Serial sections were stained for the light microscopic examination. The slides were evaluated for histologic features such as interstitial cellular infiltration, nephrosclerosis, tubular damage, glomerular neutrophil count (GL-PMN), and peritubular neutrophil count (PTC-PMN). Forty six biopsies were grouped into acute rejection group (R group, n=10) and non-rejection group (N group, n=36) during immediate posttransplantation period (1 month). Acute rejections were confirmed by ultrasonography guided biopsy. Histologic findings were classified according to Banff schema. The statistical analysis was performed by using Chi-Square Test and Spearman Rank Sum Test. During the immediate post-transplantation period, acute rejection developed in 10 cases (21.7%) of which 9 cases were the biopsy-proven rejection. The male to female ratio was 21:25. Recipients were ranged from 22 to 54 years old with a mean age of 38.2+/- 9.1. Original disease of recipient were chronic glomerulonephritis in 15 cases (32.6%), hypertension in 8 cases, diabetes mellitus in 3 cases, RPGN in 2 cases. Fifteen cases (32.6%) were of unknown etiology. The mean number of HLA mismatches was 4.6+/- 0.9 in R group, 4.7+/- 1.2 in N group, and the mean number of HLA-B & DR mismatches was 2.2+/- 0.4 in R group, 2.3+/- 0.7 in N group. The ratio of the living vs. cadaveric donors was 34:12. No statistical difference was observed between two groups in interstitial cellular infiltration, nephrosclerosis and tubular damage. The GL-PMN was 0.6 0.9 in R group, while 0.1 +/- 0.4 in N group. The PTC-PMN was 5.3+/- 3.3 in R group and 0.3+/- 1.1 in N group (p<0.05). The presence of more than five PTC-PMN count was related with the occurrence of acute rejection (p<0.01). In conclusion, the PTC-PMN of renal implantation biopsies is a possible predicting factor for acute rejection in this preliminary report.

Prognostic Significance of Peritumoral Lymphatic Vassel Invasion in Breast Cancer / 대한암학회지

PURPOSE: The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The developinent of other accurate prognostic factors would help in assessing high risk for the disease recurrence and death. Recently, there are reports that peritumoral lymphatic vessel invasion is a good prognostic factor to solid tumors in animal studies and clinical trials. This study was performed to estimate the significance of peritumoral lymphatic vessel invasion (PLVI) as a prognostic factor in breast cancer. Also, PLVI was compared with established clinicopathological prognostic factors and hormone receptors. MATERIALS AND METHODS: A group of patient was selected from the Department of Surgery, College of Medicine, Hallym University, which consists of 43 out of 96 patients who received curative operation from 1985 to 1993. Peritumoral lymphatic vessel invasion by tumor cells on H&E stain was considered PLVI positive. We classified 43 breast-cancer patients into 32 with negative PLVI and ll with positive PLVL. We estimated the correlation between the PLVI and other established prognostic factors. We also calculated survivals based on PLVI. RESULTS: The 4-year disease-free survival rate was 61.8+/-8.7%, and the 4-year overall survival rate was 73.0+/-8.0%. The receptor status of estrogen and of progesterone had significant impacts on survival (ER: p=0.0001, PR: p=0.0001). Also, metastasis status of lymph node had significant impacts on overall survival (p=0.0148). We found a significant correlation between PLVI and tumor size (p=0.004), estrogen receptor (p=0.002), progesterone receptor (p=0.006), but could not find any significant corelation between PLVI and menopausal status, histologic grade, nuclear grade, lymph node metastasis. PLVI status was corelated with disease free survival rate (p=0.01) and overall survival rate (p=0.01). CONCLUSION: The determination of PLVI in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the PLVI in a large number of patients before this conclusion can be stated with certainty.

Foreignbody Removal Using Goose Neck Snare

PURPOSE: To valuate the value of goose neck snare in removal of foreignbody in endovascular system. METHODS & MATERIAL: Foreignbody removal in endovascular system using goose neck snare were done in 4 cases. In one case, a broken guide-wire was located in left subclaviar vein and in three cases, guide-wires were located in vena cava. RESULTS: Technical success was achieved in all four cases. CONCLUSION: Goose neck snare technique is safe and effective in removal of Foreignbody in endovascular system.

Orthotopic Liver Transplantation in the Oldest Patient in Korea / 한국간담췌외과학회지

We present a case of orthotopic liver transplantation in 63 year-old female patient with liver cirrhosis, who is the record of the oldest recipient in Korea. The donor was 20 year-old male patient with subarachnoidal hemorrhage. The operation time was 12 hours. The duration of cold ischemic time and anhepatic phase were 8 hours and 85 minutes respectively. After operation the patient resumed clear consciousness. The ventilator was weaned and removed. On the third postoperative day, reoperation was required due to hemoperitoneum. Splenectomy was performed for a tearing in the hilum. After reoperation, acute renal failure and sepsis developed. Continous arteriovenous hemofiltration was continued for 3 weeks. The patient was discharged on postoperative 59th day. The patient is doing well with normal liver function. No episode of acute rejection occurred until now. More aggressive approach has been feasible in organ transplantation for older patients by advanced knowledge of perioperative management. We conclude that age over 60 years should not be a barrier to liver transplantation.