A Study of Predictive Factors Affecting Health: Promoting Behaviors of North Korean Adolescent Refugees / 예방의학회지

OBJECTIVES: The present study aimed to analyze the factors that could affect the health-promoting behaviors of North Korean adolescent refugees residing in South Korea. METHODS: Questions about their sociodemographic variables, subjective health status, healthy living habits, and health-promoting behaviors were asked. RESULTS: Statistically significant differences were found in religion (t=2.30, p<0.05), having family members in South Korea (t=2.02, p<0.05), and subjective health status (t=4.96, p<0.01). Scores on health-responsible behaviors were higher with higher age (t=2.90, p<0.01) and for subjects without family or friends (t=2.43, p<0.05). Higher physical-activity behaviors were observed in males (t=3.32, p<0.01), in those with better subjective health status (t=3.46, p<0.05) and lower body mas index (t=3.48, p<0.05), and in smokers (t=3.17, p<0.01). Nutritional behaviors were higher in those who followed a religion (t=2.17, p<0.05). Spiritual growth behaviors were higher in those who followed a religion (t=4.21, p<0.001), had no family in South Korea (t=2.04, p<0.05), and had higher subjective health status (t=5.74, p<0.01). Scores on interpersonal relationships and stress-management behaviors were higher for those with higher subjective health status. A multiple regression analysis showed greater effects on health-promoting behaviors when subjective health status was better. Older people and non-smokers exhibited more health-responsible behaviors, while more physical-activity behaviors and spiritual growth activities were observed when subjective health status was better. Interpersonal relationship behaviors had positive effects on those with good subjective heath status and on non-smokers. CONCLUSIONS: Based on the results of the current study, an alternative was suggested for promoting health in North Korean adolescent refugees.

The experience of transumbilical endoscopic appendectomies

Minimally invasive surgery is being widely accepted in various fields of surgery. Although several appendectomy techniques have been reported but, there is no standardization. We report here the experiences of transumbilical endoscopic appendectomy in humans. Between July 2008 and September 2010, ten patients with appendicitis successfully underwent transumbilical endoscopic appendectomies. There were 7 cases of suppurative, 2 cases of gangrenous and 1 case of perforated in operative findings. The ages of the patients were 13-56 years (mean age, 32.7 +/- 15.4 years). Under general anesthesia, a 15-mm port was inserted through the umbilicus and then a two-channel endoscope was inserted in the peritoneal cavity. After appendix identification, counter-traction of the appendix with a direct abdominal wall puncture using a straight round needle prolene was performed to achieve good visualization of the operative field. Tissue dissection was performed using an endoscopic needle knife. Tissue grasping and resected appendix retrieval were done with endoscopic forceps. The average operation time was 79.5 +/- 23.6 minutes (range, 45 to 110 minutes). No procedures were converted to laparoscopic or open appendectomy. Hospital stay was 4-6 days. All patients completely recovered without complications. As it is highly maneuverable, we believe transumbilical endoscopic appendectomy can be a feasible method. And, as surgeons want to proceed from laparoscopic surgery to natural orifice transluminal endoscopic surgery, this procedure could be a triable method.

Synchronous Bilateral Male Breast Cancer: A Case Report / 한국유방암학회지

Synchronous bilateral breast cancer is extremely rare in men and has not, up to date, been reported in Korea. A 54-year-old man presented with a palpable mass in the right breast. The right nipple was retracted and bilateral axillary accessory breasts and nipples were present. On physical examination, a 2 cm-sized mass was palpated directly under the right nipple, and, with squeezing, bloody discharge developed in a single duct of the left nipple. There was no palpable mass in the left breast, and axillary lymph nodes were not palpable. Physical examination of external genitalia revealed a unilateral undescended testis on the left side. Synchronous bilateral breast cancer was diagnosed using mammography, ultrasonography, and core-needle biopsy. Histopathological examination revealed invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast. Bilateral total mastectomy, sentinel lymph node biopsy, and excision of accessory breasts in the axilla were performed.

Poorly Differentiated Neuroendocrine Carcinoma in a Perigastric Lymph Node from an Unknown Primary Site / Journal of the Korean Cancer Association, 대한암학회지

Neuroendocrine carcinomas from an unknown primary site are uncommon. The authors report on a case of neuroendocrine carcinoma in a perigastric lymph node (LN) with no primary site. A 52-year-old male patient with early gastric adenocarcinoma underwent treatment by endoscopic submucosal dissection, and, six months later, findings on a computed tomographic scan of the abdomen revealed a LN enlargement measuring 2.0 cm in the perigastric region. The patient underwent subtotal gastrectomy and regional LN dissection under a suggestive preoperative diagnosis of gastric adenocarcinoma with LN metastasis. However, microscopically, no residual tumor was found in the stomach, and the perigastric LN showed poorly differentiated neuroendocrine carcinoma (PDNEC). After an extensive workup, no primary site was identified. The patient also received four cycles of etoposide and cisplatin. Despite its extremely rare incidence, this case suggests that PDNEC of an unknown primary site is limited to a single site, and that resection should be considered in combination with chemotherapy.

High K(+)-Induced Relaxation by Nitric Oxide in Human Gastric Fundus

This study was designed to elucidate high K(+)-induced relaxation in the human gastric fundus. Circular smooth muscle from the human gastric fundus greater curvature showed stretch-dependent high K+ (50 mM)-induced contractions. However, longitudinal smooth muscle produced stretch-dependent high K(+)-induced relaxation. We investigated several relaxation mechanisms to understand the reason for the discrepancy. Protein kinase inhibitors such as KT 5823 (1 microM) and KT 5720 (1 microM) which block protein kinases (PKG and PKA) had no effect on high K(+)-induced relaxation. K+ channel blockers except 4-aminopyridine (4-AP), a voltage-dependent K+ channel (KV) blocker, did not affect high K(+)-induced relaxation. However, N(G)-nitro-L-arginine and 1H-(1,2,4)oxadiazolo (4,3-A)quinoxalin-1-one, an inhibitors of soluble guanylate cyclase (sGC) and 4-AP inhibited relaxation and reversed relaxation to contraction. High K(+)-induced relaxation of the human gastric fundus was observed only in the longitudinal muscles from the greater curvature. These data suggest that the longitudinal muscle of the human gastric fundus greater curvature produced high K(+)-induced relaxation that was activated by the nitric oxide/sGC pathway through a KV channel-dependent mechanism.

Microglandular Adenosis / 한국유방암학회지

Microglandular adenosis (MGA) of the breast is a very rare and benign proliferative lesion. Most patients complain of a palpable breast mass that may arouse a clinical suspicion of breast cancer. Histopathologically, it is hard to distinguish MGA from breast cancer because of the lack of a myoepithelial layer and infiltrative proliferation. Several studies have reported a strong relationship between MGA and carcinoma arising in MGA, so the mass should be excised completely in cases of MGA determined from a core needle biopsy rather than observation. A 72-years-old woman presented with a palpable breast mass. On physical examination, a mass was palpable in the right upper outer quadrant area and somewhat fixed to the surrounding tissues and pectoralis major muscle. We could not detect any mass or dense lesion on mammography because of a grade 4 dense breast. Ultrasonographic findings revealed a low echoic lesion with indistinct margins. The result of a core needle biopsy was MGA, which was confirmed by excision. We report one case of MGA, which was believed to breast cancer clinically.

Nitric Oxide-mediated Relaxation by High K+ in Human Gastric Longitudinal Smooth Muscle

This study was designed to elucidate high-K+induced response of circular and longitudinal smooth muscle from human gastric corpus using isometric contraction. Contraction from circular and longitudinal muscle stripes of gastric corpus greater curvature and lesser curvature were compared. Circular smooth muscle from corpus greater curvature showed high K+ (50 mM)-induced tonic contraction. On the contrary, however, longitudinal smooth muscle strips showed high K+ (50 mM)-induced sustained relaxation. To find out the reason for the discrepancy we tested several relaxation mechanisms. Protein kinase blockers like KT5720, PKA inhibitor, and KT5823, PKG inhibitor, did not affect high K+-induced relaxation. K+ channel blockers like tetraethylammonium (TEA), apamin (APA), glibenclamide (Glib) and barium (Ba2+) also had no effect. However, N(G)-nitro-L-arginine (L-NNA) and 1H-(1,2,4) oxadiazolo (4,3-A) quinoxalin-1-one (ODQ), an inhibitor of soluble guanylate cyclase (sGC) and 4-AP (4-aminopyridine), voltage-dependent K+ channel (KV) blocker, inhibited high K+-induced relaxation, hence reversing to tonic contraction. High K+-induced relaxation was observed in gastric corpus of human stomach, but only in the longitudinal muscles from greater curvature not lesser curvature. L-NNA, ODQ and KV channel blocker sensitive high K+-induced relaxation in longitudinal muscle of higher portion of corpus was also observed. These results suggest that longitudinal smooth muscle from greater curvature of gastric corpus produced high K+-induced relaxation which was activated by NO/sGC pathway and by KV channel dependent mechanism.

Can Review of Sonographic Findings Spare Diagnostic Thyroidectomy in Patients with Thyroid Nodules Suspicious of Follicular Neoplasm Cytologically?

PURPOSE: Follicular neoplasms (FNs) such as follicular adenoma and carcinoma (FTC), nodular hyperplasia (NH) and follicular variant of papillary carcinoma (FVPC) share cytological features. In the present study, we investigate whether review of sonographic findings in patients with thyroid nodules suspicious of FN spares diagnostic thyroidectomies (DTs) by excluding benign diseases such as NH or not. METHODS: From June 1999 to May 2007, DTs were performed on 98 patients who had nodules suspicious of FN. High resolution sonographic findings are available for 53 patients. According to the final histologic diagnosis: Group I (23 patients) consisted of 20 FNs (11 FTCs), 1 Hurthle cell adenoma, 2 FVPC; Group II (30 patients) consisted of all others (23 NHs, 4 Hashimoto's thyroiditis, 3 papillary carcinomas (PTCs). Sonographic features were compared between the two groups. RESULTS: Three differential sonographic findings (DSF) i.e. irregular margin, absence of peripheral halo or marked inhomogeniety were identified more often in Group II than Group I (P<0.05). If we spared DTs for patients who have at least one DSF, 18 patients (34.0%) would have been selected for clinical follow-up whose final diagnoses were 14 NHs and 4 PTCs (including 1 FVPC). Sparing DTs by DSFs shows sensitivity, 56.7%; specificity, 95.7%; positive predictive value, 94.4%; negative predictive value, 62.9%; and accuracy, 73.6%, respectively. CONCLUSION: In patients with thyroid nodules suspicious of FN, sonographic findings such as irregular margin, absence of peripheral halo or marked inhomogeneity might spare DTs with the help of other diagnostic modalities such as cytogenetic or immunohistochemical studies.

A case of choledochogastric fistula accompanying epigastric pain / 대한내과학회지

Biliary enteric fistula is fistulous communication between the biliary tract and the gastrointestinal tract due to gallstones, peptic ulcer, malignancy and trauma. The types of fistulas are cholecystoduodenal, cholecystocolonic, choledochoduodenal, cholecystogastric and very rare choledochogastric. The preoperative diagnosis is difficult because their symptoms are usually nonspecific. Pneumobilia on plain film of the abdomen has been considered as a clue. Reflux of contrast media into the biliary tree during a barium study or an endoscopic retrograde cholangiopancreatography is most suggestive finding. We experienced a case of spontaneous choledochogastric fistula. A 62-year-old man was admitted to Chungbuk National University Hospital with epigastric pain. A 5 mm sized orifice of fistula on the prepyloric antrum of the stomach was observed on gastroscopy. Abdominal computed tomography scan showed pneumobilia in the intrahepatic duct of the liver. Upper gastrointestinal series showed the contrast media leaking from the posterior wall of antrum of the stomach into the common bile duct.

Management of Breast Masses Detected only by Ultrasonography / 한국유방암학회지

PURPOSE: Whether they are mammographically visible or not, breast ultrasonography is widely used for differential diagnosis of palpable breast masses. The aim of this study is to evaluate the usefulness of cytological examinations and ultrasonographical follow-ups in the management of non-palpable, mammographically non-visible breast masses incidentally detected only by ultrasonography screening. METHODS: One hundred forty-six lesions of non-palpable and mammographically non-visible, but ultrasonographically detected solid masses (sonic masses) from 120 female patients were examined at the Breast Clinic, Chungbuk National University Hospital from January, 2000, to February, 2003. We performed ultrasonogram-guided percutaneous fine-needle aspiration biopsy in all sonic masses and proceeded all sonic masses by sequential ultrasonography at 3-, 6- and 12-month intervals if there was no suspicion of malignancy. RESULTS: One hundred thirty-eight lesions (94.5%) were ultrasonographically diagnosed as benign and eight lesions (5.5%) as malignant. Eight ultrasonographically malignant lesions were all proved to be benign by cytological examinations or ultrasonogram-guided needle localization biopsies and not palpable during the follow-up period. Cytological interpretations revealed 127 lesions (87.0%) as benign, 5 lesions (3.4%) as atypical epithelial cells and 14 lesions (9.6%) as nondiagnostic. Five atypical epithelial lesions were found benign through ultrasonogram-guided needle localization biopsies or core needle biopsies in the final diagnosis. The ultrasonography was used for follow-up in all lesions. There was no evidence of malignancy in any lesion during the follow-up. CONCLUSION: In our study, there was no evidence of malignancy in breast sonic masses during the follow-up period. Our data showed that sequential ultrasonographical follow-up is sufficient for ultrasonographically benign sonic masses.

Clinicopathologic Significance of p53 and c-erbB-2 Protein Expression in Breast Carcinoma

PURPOSE: Reliable prognostic factors, including clinicopathological parameters (Ed-alternatively, "Reliable clinicopathologic prognostic factors") such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid receptor status, are necessary in the management of breast cancer for predicting clinical course and as guide lines for adjuvant therapy. Recently, many reports have shown that expression of p53 and c-erbB-2 products is associated with poor prognosis. To elucidate the clinical value of p53 and c-erbB-2 protein expression as prognostic factors, their immunoreactivities were compared with known clinicopathologic prognostic factors. METHODS: The expressions of p53 and c-erbB-2 proteins were analyzed by immunohistochemical method with formalin-fixed and paraffin-embedded tissue samples of 71 invasive breast carcinomas accumulated between 1996 and 1999 at Chungbuk National University Hospital. The expressions of p53 and c-erbB-2 proteins were compared with established prognostic factors such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid hormone receptor status. Statistical significance was analyzed by chi-square test. RESULTS: The immunoreactivities of p53 and c-erbB-2 proteins were detected in 29.6% and 46.5%, respectively, of the samples. p53 positivity was significantly higher in breast carcinoma that showed higher histologic grade or was metastasized to more than 3 axillary lymph nodes (P<0.05). There were no significant correlations between c-erbB-2 positivity and known clinicopathologic prognostic factors. CONCLUSION: This study suggests that expression of p53 protein could be used as a prognostic indicator in the management of breast cancer. But the impact of p53 and c- erbB-2 protein expression on overall survival and disease free survival rates should be evaluated further before being used as independent prognostic factors.

Diagnosis of Palpable Breast Masses by the Modified Triple Test Score: A prospective study / 한국유방암학회지

PURPOSE: The modified triple test (MTT; physical examination, ultrasonography, and fine-needle aspiration cytology) for palpable breast masses yielded 100% diagnostic accuracy when all 3 components were concordant (all benign or all malignant) in our previous study. However, about 30% of cases were discordant and required open or core needle biopsy. This study is designed to evaluate the modified triple test by scoring system, based on our experience, and to develop a method to further limit the need for surgical biopsy of discordant cases. METHODS: The MTT was performed in 175 palpable breast masses of 166 female patients between August 1998 and June 2001 at the Outpatient Clinic, Department of Surgery, Chungbuk National University Hospital. Each component of the MTT was assigned 1, 2, or 3 points for a benign, suspicious, or malignant result, respectively, yielding a total modified triple test score (MTTS) from 3 to 9 points, and 25 cases with 3 points of MTTS were clinically followed up without histological confirmation. RESULTS: Among 175 cases, concordant cases were 120 (68.6%); benign cases was 66 (37.7%), and malignant cases were 54 (30.8%). Concordant cases had 100% of diagnostic accuracy, sensitivity, and specificity. Among the 25 cases of benign concordant (MTTS 3 points), no case was proved to be malignant through clinical follow-up observation. Total discordant cases were 55 (31.4%); 15 cases of 4 points (8.6%), 11 cases of 5 points (6.3%), 4 cases of 6 points (2.3%), 18 cases of 7 points (10.3%), 7 cases of 8 points (4.0%). In each discordant group, 0 cases of 4 points (0%), 2 cases of 5 points (18.2%), 3 cases of 6 points (75%), 15 cases of 7 points (83.8%), and 7 cases of 8 points (100%) were proved to be malignant by histologic confirmation. Aspiration cytology has the highest specificity and positive predictive value of the 3 MTT components. CONCLUSION: Palpable breast masses that score 3 or 4 points by MTTS are benign and could be clinically followed up, and masses that score 8 or 9 points are malignant and should undergo defiitive therapy. Confirmatory biopsy might be applied on only 20% of the masses the reserve MMTTS of 5, 6, and 7 points.

Clinicopathologic Significance of p53 and c-erbB-2 Protein Expression in Breast Carcinoma / 한국유방암학회지

PURPOSE: Reliable prognostic factors, including clinicopathological parameters (Ed-alternatively, "Reliable clinicopathologic prognostic factors") such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid receptor status, are necessary in the management of breast cancer for predicting clinical course and as guide lines for adjuvant therapy. Recently, many reports have shown that expression of p53 and c-erbB-2 products is associated with poor prognosis. To elucidate the clinical value of p53 and c-erbB-2 protein expression as prognostic factors, their immunoreactivities were compared with known clinicopathologic prognostic factors. METHODS: The expressions of p53 and c-erbB-2 proteins were analyzed by immunohistochemical method with formalin-fixed and paraffin-embedded tissue samples of 71 invasive breast carcinomas accumulated between 1996 and 1999 at Chungbuk National University Hospital. The expressions of p53 and c-erbB-2 proteins were compared with established prognostic factors such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid hormone receptor status. Statistical significance was analyzed by chi-square test. RESULTS: The immunoreactivities of p53 and c-erbB-2 proteins were detected in 29.6% and 46.5%, respectively, of the samples. p53 positivity was significantly higher in breast car-cinoma that showed higher histologic grade or was metastasized to more than 3 axillary lymph nodes (P<0.05). There were no significant correlations between c-erbB-2 positivity and known clinicopathologic prognostic factors. CONCLUSION: This study suggests that expression of p53 protein could be used as a prognostic indicator in the management of breast cancer. But the impact of p53 and c- erbB-2 protein expression on overall survival and disease free survival rates should be evaluated further before being used as independent prognostic factors.

Diagnosis of Palpable Breast Masses by the Modified Triple Test Score-A prospective study-

PURPOSE: The modified triple test (MTT; physical examination, ultrasonography, and fine-needle aspiration cytology) for palpable breast masses yielded 100% diagnostic accuracy when all 3 components were concordant (all benign or all malignant) in our previous study. However, about 30% of cases were discordant and required open or core needle biopsy. This study is designed to evaluate the modified triple test by scoring system, based on our experience, and to develop a method to further limit the need for surgical biopsy of discordant cases. METHODS: The MTT was performed in 175 palpable breast masses of 166 female patients between August 1998 and June 2001 at the Outpatient Clinic, Department of Surgery, Chungbuk National University Hospital. Each component of the MTT was assigned 1, 2, or 3 points for a benign, suspicious, or malignant result, respectively, yielding a total modified triple test score (MTTS) from 3 to 9 points, and 25 cases with 3 points of MTTS were clinically followed up without histological confirmation. RESULTS: Among 175 cases, concordant cases were 120 (68.6%); benign cases was 66 (37.7%), and malignant cases were 54 (30.8%). Concordant cases had 100% of diagnostic accuracy, sensitivity, and specificity. Among the 25 cases of benign concordant (MTTS 3 points), no case was proved to be malignant through clinical follow-up observation. Total discordant cases were 55 (31.4%); 15 cases of 4 points(8.6%), 11 cases of 5 points (6.3%), 4 cases of 6 points (2.3%), 18 cases of 7 points (10.3%), 7 cases of 8 points (4.0%). In each discordant group, 0 cases of 4 points (0%), 2 cases of 5 points (18.2%), 3 cases of 6 points (75%), 15 cases of 7 points (83.8%), and 7 cases of 8 points (100%) were proved to be malignant by histologic confirmation. Aspiration cytology has the highest specificity and positive predictive value of the 3 MTT components. CONCLUSION: Palpable breast masses that score 3 or 4 points by MTTS are benign and could be clinically followed up, and masses that score 8 or 9 points are malignant and should undergo defiitive therapy. Confirmatory biopsy might be applied on only 20% of the masses the reserve MMTTS of 5, 6, and 7 points.

Elementary School Children's Lifestyle / 아동간호학회지

The purpose of this study was to provide basic data on elementary school children's lifestyle and to contribute to developing on the health education program in elementary schools. The subjects were 1,412 children in 4 elementary schools in Gangwon-Do and Chonrabuk-Do area. Data collection was done from September to November 2001 by questionnaire and school health documents. The questionnaire corrected for the purpose of this study which had been developed by Bronson School of Nursing(1991), 'Lifestyle Questionnaire for School-age Children'. The questionnaire consists of 3 categories; 'Activities that promote health', 'Injury prevention', 'Feeling'. Cronbach coefficient alpha for the 29 items was .68. The data analyzed to obtain frequency, mean, percentage, t-test, ANOVA and Pearson correlation coefficient by SPSS Win program. The results of this study were as follows. 1. Females(50.2%) of gender, 6th grade(24.2%) of grade, nuclear family(82.0%) of family type, beyond college graduate(54.5%) of father's school career, under high school graduate(58.1%) of mother's school career, first of birth order(47.1%) were majority. Mean of father's age was 41.2 and mother's age was 38.1. 2. The mean of lifestyle was 66.4, feeling was 73.3, activities that promote health was 60.3 and injury prevention was 64.0. The highest degree of activities that promote health was "I eat fruits" and injury prevention was "I look both ways when crossing streets"and feeling was "I enjoy my family". The lowest degree of activities that promote health was "I visit the dentist every tear" and injury prevention was "I wear a helmet when I go on bike trips" and feeling was "I think it is okay to cry". 3. There were significant differences in lifestyle of gender(t=4.309, p=.000), grade(F=6.299, p=.000), father's age(t=2.534, p=.011), father's education(t=-4.933, p=.000), mother's education(t=-3.360, p=.001), birth order (t=5.363, p=.000). There were significant differences in activities that promote health of gender(t=-2.462, P=.014), grade(F=4.893, p=.000), father's education(t=-4.480, p=.000), birth order(t=4.343, p=.000), in injury prevention of gender(t=-4.452, p=.000), grade(F=8.636, p=.000), father's age(t=3.386, p=.001), mother's age(t=2.059, p=.040), father's education(t=-6.051, p=.000), mother's education(t=-5.173, p=.000), birth order(t= 4.417, p=.000) and in feeling of gender (t=-3.285, p=.001), grade(F=7.526, p=.000), mother's age(t=-3.268, p=.001). 4. Activities that promote health was positively correlated with injury prevention(r=.432, p=.000), feeling(r=.210, p=.000), lifestyle (r=.785, p=.000). Injury prevention was positively correlated with feeling(r=.256, p=.000), lifestyle(r=.854, p=.000) also feeling was positively correlated with lifestyle(r=.504, p=.000). These findings suggest the need to develop nursing strategy to promote elementary school children's health. Because helmet use score in injury prevention marked the lowest score, it is necessary to encourage helmet use when planning injury prevention and health promotion.

A Study on Modified Triple Test for Palpable Breast Mass / 한국유방암학회지

PURPOSE: The "triple test" (TT) which consists of a physical examination (PE), mammography (MMG), and fine needle aspiration (FNA) has been used for diagnosing a palpable breast mass. However, the TT is not always accurate when it is applied to young women. This is because a dense breast hampers the sensitivity of a mammograph. Here, we introduce breast ultrasonography (USG) in place of a MMG (Modified TT; MTT) to determine whether this method can facilitate a correct diagnosis of a breast mass. METHODS: A MTT was performed in 142 palpable solid breast masses from 126 female patients between August 1998 and July 2000 at the out-patient breast clinic, Chungbuk National University Hospital. The breast masses were listed as benign or suspicious/malignant. All patients underwent a subsequent needle biopsy or surgical biopsy for a definitive diagnosis. RESULTS: 78 out of 142 palpable breast masses (54.5%) were benign, while 64 (45.5%) were diagnosed as having breast cancer. In all 105 cases (73.9%) where the MTT was concordant (elements had either all malignant or benign results), a needle or surgical biopsy was confirmatory (predictive values, sensitivity, and specificity 100%). In 37 cases of the non-concordant results, 16 (44.7%) were proven as malignant. The positive predictive value for PE, USG, and FNA was 80.6%, 87.1%, and 100% respectively. The negative predictive value for PE, USG, and FNA was 91.4%, 95.8%, and 91.8% respectively. The sensitivity for PE, USG, and FNA was 90.6%, 95.3%, and 89.1% respectively. The specificity for PE, USG, and FNA was 82.1%, 88.5%, and 100% respectively. CONCLUSION:The modified triple test was 100% accurate for diagnosing a palpable breast mass when all three elements were concordant. A palpable breast mass with a concordant benign modified triple test could be safely followed up without a surgical biopsy, and a final treatment could be applied to patients who have had a concordant malignant modified triple test.

A Study on Modified Triple Test for Palpable Breast Mass: A prospective study

PURPOSE: The "triple test" (TT) which consists of a physical examination (PE), mammography (MMG), and fine needle aspiration (FNA) has been used for diagnosing a palpable breast mass. However, the TT is not always accurate when it is applied to young women. This is because a dense breast hampers the sensitivity of a mammograph. Here, we introduce breast ultrasonography (USG) in place of a MMG (Modified TT; MTT) to determine whether this method can facilitate a correct diagnosis of a breast mass. METHODS: A MTT was performed in 142 palpable solid breast masses from 126 female patients between August 1998 and July 2000 at the out-patient breast clinic, Chungbuk National University Hospital. The breast masses were listed as benign or suspicious/malignant. All patients underwent a subsequent needle biopsy or surgical biopsy for a definitive diagnosis. RESULTS: 78 out of 142 palpable breast masses (54.5%) were benign, while 64 (45.5%) were diagnosed as having breast cancer. In all 105 cases (73.9%) where the MTT was concordant (elements had either all malignant or benign results), a needle or surgical biopsy was confirmatory (predictive values, sensitivity, and specificity 100%). In 37 cases of the non-concordant results, 16 (44.7%) were proven as malignant. The positive predictive value for PE, USG, and FNA was 80.6%, 87.1%, and 100% respectively. The negative predictive value for PE, USG, and FNA was 91.4%, 95.8%, and 91.8% respectively. The sensitivity for PE, USGand FNA was 90.6%, 95.3%, and 89.1% respectively. The specificity for PE, USG, and FNA was 82.1%, 88.5%, and 100% respectively. CONCLUSION: The modified triple test was 100% accurate for diagnosing a palpable breast mass when all three elements were concordant. A palpable breast mass with a concordant benign modified triple test could be safely followed up without a surgical biopsy, and a final treatment could be applied to patients who have had a concordant malignant modified triple test.

Stomach Cancer Presenting with Meigs' Syndrome

Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with "fibroma-like" benign ovarian tumors. Tumor extirpation resulted in a resorption of the ascites and a pleural effusion. A Krukenberg tumor resulting from stomach cancer would be highly suggested when stomach cancer, ovarian tumor, and ascites are found concomitantly. However, when a patient presents with ovarian tumor, stomach cancer, and repeated cytologic examination of the ascitic fluid renders negative results, stomach cancer associated with Meigs' syndrome should be considered in the differential diagnosis. We report a case of stomach cancer presenting with Meigs' syndrome in a 70-year-old woman who had been referred for control of intractable ascites. The patient was cured by radical subtotal gastrectomy and bilateral oophorectomy.