ABSTRACT
PURPOSE: Tumor size is the strongest predictor of axillary node metastases. Some authors have reported that axillary dissection in T1a breast cancer is not required because the rate of incidence is less than 5%. However I have doubts concerning the omission of axillary dissection in small breast cancers. Therefore, I investigated the incidence of axillary node metastases in T1 breast cancer according to size for the purpose of using this data as a reference for determining whether or not to dissect axillary lymph nodes. METHODS: Data of patients registered at the Strang Cancer Prevention Center affiliated with the New York Hospital- Cornell Medical Center, from January 1988 to December 1998 were reviewed. After review of charts and pathologic reports for tumor size, age at operation and lymph node status, 592 patients were proven to have primary breast tumor 2 cm in size or smaller. The size of the tumor was determined as the largest diameter of the invasive lesion when possible. RESULTS: Lymph node metastases were seen in 7 of 68 cases in the 0.1~0.5 cm T1a (10.3%), 29 of 182 in 0.6~1.0 cm T1b (15.9%), 50 of 206 in 1.1~1.5 cm (24.3%) and 55 of 136 in 1.6~2.0 cm tumor size range (40.4%). CONCLUSION: Although positive node occurrence was lower in small size tumors, significant number of patients with T1a invasive tumors have a positive node. Therefore, a small size of tumor alone is not an indicator for the omission of axillary dissection.
Subject(s)
Humans , Breast Neoplasms , Breast , Incidence , Lymph Nodes , Neoplasm MetastasisABSTRACT
BACKGROUND: The formation of urinary tract stones following renal transplantation is a rare complication. The clinical features of stones after transplantation differ from those of non-transplant patients. Renal colic or pain is usually absent and rarely resembles acute rejection. METHODS: We retrospectively studied 849 consecutive kidney transplant patients in The Rogosin Institute/The Weill-Cornell Medical Center, New York who were transplanted between 1980 and 1997 and had functioning grafts for more than 3 months, to determine the incidence of stone formation, composition, risk factors and patient outcome. RESULTS: At our center, urinary stones were diagnosed in 15 patients (1.8%) of 849 functioning renal grafts for 3 or more months. Of the 15 patients, 10 were males and 5 were females in their third and fourth decade. Eight patients received their transplant from living donors and 7 from cadaveric donors. The stones were first diagnosed between 3 and 109 months after transplantation (mean 17.8 months) and 5 patients had recurrent episodes. The stones were located in the bladder in 11 cases (73.3%), transplanted kidney in 3 cases and in multiple sites in one case. The size of stones varied from 3.4 mm to 40 mm (mean 12 mm). The composition of stones was a mixed form of calcium oxalate and calcium phosphate in 5 cases and 4 patients had infected stones consisting of struvite or mixed form of struvite and calcium phosphate. Factors predisposing to stone formation included tertiary hyperparathyroidism (n=8), hypercalciuria (n=5), recurrent urinary tract infection (n=5), hypocitraturia (n=4), and obstructive uropathy (n=2). Many cases had more than one risk factor. Clinically, painless hematuria was observed in 6 patients and dysuria without bacteriuria in 5 patients. None had renal colic or severe pain at any time. There were no changes in graft function at diagnosis and after removal of stones. Five patients passed stones spontaneously and 8 patients underwent cystoscopy for stone removal. CONCLUSION: Urinary stone formation following kidney transplantation is a rare complication (1.8%). Hyperparathyroidism, hypercalciuria, recurrent urinary tract infection and hypocitraturia are the most common risk factors, but often there are multiple factors which predispose to stone formation. To detect stones and determine their location and size, ultrasonography appears to be the most useful diagnostic tool. Prompt diagnosis, the removal of stones and stone-preventive measures can prevent adverse effects on renal graft outcome.
Subject(s)
Adult , Aged , Female , Humans , Male , Age Distribution , Calculi/chemistry , Incidence , Kidney Failure, Chronic/surgery , Kidney Transplantation/adverse effects , Korea/epidemiology , Middle Aged , Prognosis , Risk Assessment , Sex Distribution , Urinary Calculi/epidemiologyABSTRACT
PURPOSE: Tumor size is the strongest predictor of axillary node metastases. Some authors have reported that axillary dissection in T1a breast cancer is not required because the rate of incidence is less than 5%. However I have doubts concerning the omission of axillary dissection in small breast cancers. Therefore, I investigated the incidence of axillary node metastases in T1 breast cancer according to size for the purpose of using this data as a reference for determining whether or not to dissect axillary lymph nodes. METHODS: Data of patients registered at the Strang Cancer Prevention Center affiliated with the New York Hospital-Cornell Medical Center, from January 1988 to December 1998 were reviewed. After review of charts and pathologic reports for tumor size, age at operation and lymph node status, 592 patients were proven to have primary breast tumor 2 cm in size or smaller. The size of the tumor was determined as the largest diameter of the invasive lesion when possible. RESULTS: Lymph node metastases were seen in 7 of 68 cases in the 0.1~0.5 cm T1a (10.3%), 29 of 182 in 0.6~1.0 cm T1b (15.9%), 50 of 206 in 1.1~1.5 cm (24.3%) and 55 of 136 in 1.6~2.0 cm tumor size range (40.4%). CONCLUSION: Although positive node occurrence was lower in small size tumors, significant number of patients with T1a invasive tumors have a positive node. Therefore, a small size of tumor alone is not an indicator for the omission of axillary dissection.
Subject(s)
Humans , Breast Neoplasms , Breast , Incidence , Lymph Nodes , Neoplasm MetastasisABSTRACT
Duplications of the stomach account for only 3.8% of gastrointestinal duplication, mainly discovered during first year of life. Etiopathogenesis is unknown. The most widely accepted theory is recannalization with fusion of longitudinal epithelial fold. The most frequent presented symptoms and signs include gastric outlet obstruction with vomiting, and palpable mass in the epigatric area. An upper gatrointestinal series usually reveals evidence of extrinsic mass effect of intramural lesion. An abdominal ultrasonographic finding is cystic mass lesion with double layer. Histologically, the wall of intramural cyst is composed of orderly layers of alimentary mucosa, submucosa, and muscle fibers. Recommended management is complete excision & simple closure of duplication without violation of the gastric lumen. In this case, 3-day old male newborn suffered from symptoms of gastric outlet obstruction, multiple gastric duplication cysts were found in pyloric canal and greater curvature. The cystic wall was composed with typical 3 layers of gastric mucosa, submucosa, and muscle fibers. The cystic wall was composed with typical 3 layers of gastric mucosa, submucosa, and muscle fibers. Surgical excision was successfully done.
Subject(s)
Humans , Infant, Newborn , Male , Gastric Mucosa , Gastric Outlet Obstruction , Mucous Membrane , Stomach , VomitingABSTRACT
No abstract available.