Factors Influencing Musculoskeletal Symptoms in Military Personnel during Basic Combat Training

PURPOSE: This study was done to examine physical, psycho-social, and individual factors influencing musculoskeletal symptoms among Korean military trainees. METHODS: Using a correlation study design, military trainees who had completed almost of all the basic combat training (BCT) days were recruited from two military training units selected by convenience sampling. Data from 415 participants were analyzed. RESULTS: Prevalence of musculoskeletal symptoms was 29.6% defined as a participant having pain or discomfort in one or more body parts during training hours for more than seven consecutive days. Back/pelvic (10.8%), knees (10.1%), shoulders (7.7%), feet/toes (5.6%), ankles (4.8%) were prone to musculoskeletal symptoms. Musculoskeletal symptoms appeared to be related to physical exertion during BCT, stress during BCT, social support from fellow trainees, or previous musculoskeletal injuries. In the logistic regression model, physical exertion during BCT (OR=2.27, 95% CI: 1.42~3.65), stress during BCT (OR=1.79, 95% CI: 1.15~2.78), and previous musculoskeletal injuries (OR=1.58, 95% CI: 1.01~2.47) were the significant factors affecting prevalence of musculoskeletal symptoms. CONCLUSION: Findings indicate that physical exertion and psycho-social stress should be managed to prevent musculoskeletal symptoms in military trainees with more attention being given to trainees having a history of musculoskeletal injuries.

Erratum: Analysis of Infections Occurring in Breast Cancer Patients after Breast Conserving Surgery Using Mesh / 한국유방암학회지

No abstract available.

Recurrence Pattern of Intrathyroidal Papillary Carcinoma / 대한내분비외과학회지

PURPOSE: We investigated the pattern of regional recurrence pattern of intrathyroidal node negative - T1N0 or T2N0 - papillary carcinoma, focusing on skip versus continuous central and lateral lymph node metastasis. Most lymph node metastasis of papillary thyroid carcinoma appear in a step-wise sequential pattern, but discontinuous lymph node metastasis may occur in 11.1~37.5% in node positive papillary cancer. While skip metastasis has been studied on the synchronous central and lateral lymphatic clearance, it has not been studied in reoperative settings on lateral recurrence. METHODS: From January 2000 to December 2005, Two hundred and seventy-five T1/T2 N0 patients underwent reoperative lymphatic clearance after total thyroidectomy and clinical - not prophylactic - central neck dissection in Gwangju and Hwasoon Chonnam National University Hospitals. We enrolled 210 patients who showed central and lateral neck metastasis as the continuous recurrence group and 65 patients who showed lateral metastasis without central lymph node metastasis as the skip recurrence group. RESULTS: Skip metastasis occurred in 17.6% (9/27 patients), and skip recurrence was in 23.6% (65/275 patients). In univariate analysis, in case of a single lesion, the skip recurrence was more prone to occur than multiple (P=0.026) and bilateral (P=0.048) papillary carcinoma. Multivariate analysis showed that tumor less than 1 cm (OR=2.24, P=0.009), single lesion (OR=3.23, P=0.019) for multiple lesion, and (OR=2.22, P=0.025) for bilateral lesion. CONCLUSION: Skip metastases were found in 17.6% (9 out of 27) of patients, and skip recurrence in reoperative surgery was found in 23.6% (65 out of 275) of patients. Careful follow-up and low dose radioiodine therapy may be considered in T1N0 or T2N0 papillary carcinoma in selected patients.

Expression of c-erbB2 and p53 in Curatively Resected Gastric Cancer: Correlation with Clinicopathologic Features and Prognosis

PURPOSE: We investigated the correlation between expression of c-erbB-2 and p53 proteins and clinicopathologic features of gastric cancer to reveal prognostic factors. METHODS: 125 patient records under going curative resection for gastric carcinoma at our institution from January 2000 to June 2003 were collected. Surgical specimens embedded in paraffin block were evaluated for p53 and c-erbB-2 protein as detected by immunohistochemistry. RESULTS: Samples from 30 cases (24.0%) of 125 patients with gastric adenocarcinomas demonstrated positive staining for c-erbB-2 and 72 patients (57.6%) showed positive nuclear staining for p53 protein. c-erbB-2 stained tumors were significantly associated with the depth of tumor invasion (P=0.022), lymph node metastasis (P=0.004) and lymphatic invasion (P=0.019). In a subgroup of patients with gastric carcinoma not exposed to serosa (n=91), expression of both c-erbB-2 and p53 significantly related with poor disease-free survival (OR=5.107) and survival (OR=4.449) in multivariate analysis. CONCLUSION: When patients with gastric adenocarcinoma showed expression of c-erbB-2 with p53, they were associated with aggressive pathologic features. In the subgroup of patients with gastric adenocarcinoma that did not involve serosa, expression of c-erbB-2 combined with p53 could become a predictive factor for recurrence and survival in multivariate analysis.

Analysis of Infections Occurring in Breast Cancer Patients after Breast Conserving Surgery Using Mesh / 한국유방암학회지

PURPOSE: Breast conserving surgery using mesh can effectively fill the defective space, but there is the risk of infection. METHODS: From June 2007 to August 2010, 243 patients who underwent breast conserving surgery with polyglactin 910 mesh insert for breast cancer at our institution were retrospectively studied. RESULTS: Infection occurred in 25 (10.3%) of 243 patients. When comparing the infection and non-infection groups in multivariate analysis, there was no significant difference in age, underlying disease, preoperative biopsy methods, mass location, axillary lymph node dissection, operative methods, neoadjuvant or adjuvant chemotherapy use, mass size and removed breast volume. The infection appeared more common only in patients with body mass index (BMI) greater than 25. Infection symptoms occurred, on average, 119.5 days after surgery, and the average duration of the required treatment was 34.4 days. Out of 25 patients with postoperative infection complications, 16 (64%) patients underwent incision and drainage with mesh removal, whereas the remaining 9 (36%) only required conservative treatment. CONCLUSION: During breast conserving surgery, the risk of infection is increased in patients with high BMI, and should be taken into account when considering insertion of a polyglactin 910 mesh. Patient's age, underlying disease and perioperative treatment methods were not significant risk factors for developing mesh infection. Given that most infections seem to develop symptoms one month after surgery, a long enough observation period should be initiated. Early detection and appropriate conservative treatments may effectively address infections, thus reducing the need for more invasive therapies.

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.

Is a Fast-track Critical Pathway Possible in Gastric Cancer Surgery?

PURPOSE: The postoperative hospital stay after gastric cancer surgery is usually 8 to 14 days. The main reason for a prolonged hospital stay may be the 3 to 4 day period of postoperative starvation. The aim of this study is to investigate the feasibility of a critical pathway for early recovery after gastric cancer surgery, and this pathway included early postoperative feeding. MATERIALS AND METHODS: One hundred three consecutive patients who underwent gastric resection and reconstruction for gastric cancer from October 2007 to June 2008 at St. Mary's Hospital were prospectively enrolled in a fast-track critical pathway. The pathway included minimal preoperative procedures, optimal pain relief, proper fluid administration, early mobilization and early enteral nutrition at postoperative 1 day. The exclusion criteria were determined preoperatively, intraoperatively and postoperatively. RESULTS: Of the 103 patients, 19 patients were excluded for preoperative (5), intraoperative (7) and postoperative (7) reasons. Eighty-four patients (81.6%) were included in the fast-track critical pathway. Sixty-eight (88.6%) of 84 patients were discharged at the planned 8 day after surgery during the initial period of the study, and the postoperative hospital stay was shortened up to 6 days during the more recent period. Postoperative complications occurred in 22 patients (26.2%), and these were gastrointestinal track-related complications in 6 cases (3 cases of ileus, 1 case of stasis and 2 cases of leakage) and infection-related complications in 8 cases. There was no statistical difference in the incidence of morbidity according to the clinic-operative features that included age, gender, stomach resection and lymphadenectomy. CONCLUSION: The fast-track critical pathway with using the available exclusion criteria was a valid option for patients who underwent gastric cancer surgery.

The Significance of Peritoneal Effusion in Colorectal Cancer

PURPOSE: It has been reported that in colorectal cancer, the positive rate of the cytological examination of ascites is low and that the cytologically positive result of the cancer cell influences its prognosis; nonetheless, not many studies on the correlation of the formation of peritoneal effusion and cancer have been done yet. Thus, this study on the correlation of clinico-pathological findings with peritoneal effusion was initiated. METHODS: The study population, includes a total of 191 patients who underwent an operation for colon cancer and rectal cancer from May 1, 2004, to December 31, 2005. Peritoneal effusion considered to be present in cases with more than 10 cc of body fluid retained in the Douglas pouch, and a cytological test was performed on patients whose retained fluid was more than 50 cc. In all patients, the correlation of the clinico-pathological findings with peritoneal effusion was analyzed, and the volume of effusion and the positive result of peritoneal cytology were compared. RESULTS: Among the 191 patients, patients without peritoneal effusion numbered 133 (69.6%) and patients with peritoneal effusion numbered 58 (30.4%). Between the two groups, the presence of intestinal obstruction due to cancer (P0.05). CONCLUSIONS: For colorectal cancer patients with peritoneal effusion, but without co-morbid medical diseases inducing such peritoneal effusion, by regarding peritoneal effusion itself as meaningful, the range of lymphadenectomies, adjuvant chemotherapy, and other additional therapy should be considered.