The Sundt Encircling Clip as a Vascular Rescue: A Case Report and a Review of Repair Methods for Arterial Tearing

The Sundt encircling clip was developed to repair defects of the vessel wall. With the advent of microvascular techniques, most parts of the damaged vessel wall during aneurysm surgery can be repaired by primary closure or by the bypass technique. However, these methods are not always successful. Here, we illustrate two cases of surgical clipping with the Sundt encircling clip in the ruptured internal carotid artery trunk aneurysm. The Sundt clip provides prompt control of unexpected tearing of the vessel wall or aneurysm and plays an important role in vascular rescue during aneurysm surgery.

Postoperative Flat Back: Contribution of Posterior Accessed Lumbar Interbody Fusion and Spinopelvic Parameters

OBJECTIVE: Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. METHODS: A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. RESULTS: A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance (R2=0.286, p=0.0005). CONCLUSION: Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.

Effect of the Genetic Polymorphism of N-acetyltransferase 2 and Diet on the Carcinogenesis of Gastric Cancer in Koreans

PURPOSE: According to the recent studies on the carcinogenic factors of gastric cancer in Koreans, dietary factors, such as stew, roasted fish, and fish boiled in soy with spices, salted foods, as well as smoking, might be risk factors of gastric cancer. N-acetyltransferase 2 (NAT2) is an enzyme that plays a role in the reduction of the toxicity of various carcinogens. There is a possibility that the genetic polymorphism of NAT2 might change a subject's susceptibility to gastric cancer. The aim of this study was to examine the effects of diet, the genetic polymorphism of NAT2 and their interaction on the risk of gastric cancer in Koreans. METHODS: The subjects of this case-control study were 214 gastric cancer patients, and 214 controls, who were admitted at the Chungbuk National or Eulji University Hospitals. Each subject was directly interview, by an experienced interviewer, with a structured questionnaire. A NAT2 genetic polymorphism analysis was performed, with a PCR-RFLP technique, and the data analyzed using the PC-SAS software package. RESULTS: Increased intakes of makkoli, soybean paste stew, kimchi and ggakdugi, soy milk, chicken boiled with rice and boiled chicken were all associated with an increased risk of gastric cancer, whereas those of fermented soybean stew, Welsh onion or leek, onions, peaches, chestnuts or gingko nuts, fatsia shoots, raw fish, salted seafood and laver were all associated with a decreased risk of gastric cancer. The odds ratio (95% confidence interval) for gastric cancer for the rapid acetylators was 1.64 (1.12, 2.41), which was statistically significant. With respect to the rapid acetylators, makkoli, kimchi and soy milk were significant risk factors, and Welsh onion/leek and onions were protective factors for gastric cancer. Whereas, soybean paste stew was a risk factor of gastric cancer with the slow or intermediate acetylators. CONCLUSION: These results suggest the genotype of a rapid acetylation is a risk factor of gastric cancer, and the effects of diet on the risk of gastric cancer vary according to the genotype of the NAT2 enzyme.

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.

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.

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.

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.

Internal Herniation Through a Defect in the Broad Ligament: A case report

Intestinal obstruction as a result of internal herniation of the bowel through a defect of the broad ligament is a rare condition. Internal herniation may occur between the layers or in an opening through both layers. Most defects in the broad ligament occur unilaterally. Symptoms and signs are those of intestinal obstruction. Preoperative diagnosis is very unusual. The herniated bowel is the ileum in almost all cases, and strangulation of the herniated bowel is usual. We experienced a case of internal herniation of the ileum through a defect of the broad ligament, which was 1.5 cm 1.5 cm round defect through the entire layers of the right broad ligament beside the uterus. The herniated ileum was strangulated at operation, so we did a resection and anastomosis of that segment and a simple closure of the defect. The patient was discharged and took follow-up checks uneventfully.

A Clinical Study on the Change of TMJ Symptoms Following IVRO in The Mandibular Prognathism

Langerhans Cell Histiocytosis Misdiagnosed as Multifocall Osteomyelitis in an Old Patients: A Case Report

A Case of Pityriasis Lichenoide Chronica Associated with Pseudoacanthosis Nigricans / 대한피부과학회지

Pityriasis lichenoides chronica is considered to be a benign disease. Erythematous yelIowieh scaly maeulea appear insidiously, chiefly on the sides of trunk, thighs and upper arms. Acanthosis nigricans is a rare cutaneous disorder with peak incidence in puberty characterized by hyperkeratosis and, dark pigmentation. We report a case of pityriasis lichenoides chronica assaciated with pseudoacanthosis nigricans in a 14 year-old obeae male patient who has bean sized erythematoua scaly papules on the trunk and extremities, velvety black brownish colored patchea on the neck and both axillary regions.

PUVA Therapy of Pityriasis Lichenoides Chronica / 대한피부과학회지

Pityriasis lichenoides chronica is characterized by unknown etiology, chronicity and by being essentially asymptomatic and refractory to therapy. Nine patients with pityriasis lichenoides chronica were treated with orally administrated 8-Methoxypsoralen and UVA irradiation(PUVA Therapy). After S-45 PUVA treatments, lesions were completely cleared.