Capsular Contracture Rates in Augmentation Mammaplasty: Comparison of Round vs Anatomical Breast Implants

Purpose@#Capsular contracture is a major cause of poor postoperative satisfaction in augmentation mammaplasty. It is unclear whether round or anatomical textured breast implants lead to differences in the rates of capsular contracture. Accordingly, the objective of this study was to compare capsular contracture rates between round and anatomical textured breast implants. @*Methods@#A total of 1,282 cases (2,564 breasts) of augmentation mammaplasty using textured type implants, performed at MD clinic between January 2012 and December 2015, were retrospectively reviewed. A total of 703 cases used round textured implants while 579 used anatomical textured implants. The median follow-up period for the round textured implant group was 9 months, and 7 months for the anatomical textured group. @*Results@#The overall capsular contracture rates in the first year was 2.0% in the round textured group and 1.5% in the anatomical textured group (p=0.609). Capsular contracture rates in the first year in those who underwent primary surgery were 1.6% in the round textured group and 1.3% in the anatomical textured group (p=0.187). The rates in those who underwent revision surgery were 5.2% in the round textured group and 2.6% in the anatomical textured group (p=0.178). Conclusion: Although the risk for capsular contracture in the anatomical textured groups appeared to be slightly lower than in the round textured groups, the difference was not significant. Further studies with longer follow-up periods are needed to assess potential differences.

Capsular Contracture Rates in Augmentation Mammaplasty: Comparison of Round vs Anatomical Breast Implants

Purpose@#Capsular contracture is a major cause of poor postoperative satisfaction in augmentation mammaplasty. It is unclear whether round or anatomical textured breast implants lead to differences in the rates of capsular contracture. Accordingly, the objective of this study was to compare capsular contracture rates between round and anatomical textured breast implants. @*Methods@#A total of 1,282 cases (2,564 breasts) of augmentation mammaplasty using textured type implants, performed at MD clinic between January 2012 and December 2015, were retrospectively reviewed. A total of 703 cases used round textured implants while 579 used anatomical textured implants. The median follow-up period for the round textured implant group was 9 months, and 7 months for the anatomical textured group. @*Results@#The overall capsular contracture rates in the first year was 2.0% in the round textured group and 1.5% in the anatomical textured group (p=0.609). Capsular contracture rates in the first year in those who underwent primary surgery were 1.6% in the round textured group and 1.3% in the anatomical textured group (p=0.187). The rates in those who underwent revision surgery were 5.2% in the round textured group and 2.6% in the anatomical textured group (p=0.178). Conclusion: Although the risk for capsular contracture in the anatomical textured groups appeared to be slightly lower than in the round textured groups, the difference was not significant. Further studies with longer follow-up periods are needed to assess potential differences.

Erratum: Validation of a Web-Based Tool to Predict the Ipsilateral Breast Tumor Recurrence (IBTR! 2.0) after Breast-Conserving Therapy for Korean Patients / 한국유방암학회지

This article was published with a misspelled the date of acceptance. The date of acceptance should be corrected as “March 7, 2013”.

Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder

OBJECTIVE: Intolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder. METHODS: We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI). RESULTS: There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001). CONCLUSION: IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.

Sentinel Lymph Node Biopsy Alone after Neoadjuvant Chemotherapy in Patients with Initial Cytology-Proven Axillary Node Metastasis / 한국유방암학회지

PURPOSE: Neoadjuvant chemotherapy (NAC) has been recently used to downstage breast cancer. However, in patients with initial axillary lymph node (ALN) metastasis, ALN dissection regardless of the NAC response remains the standard treatment. The purpose of this study was to identify the feasibility and accuracy of sentinel lymph node biopsy (SLNB) after NAC in patients with ALN metastasis at diagnosis. METHODS: From January 2007 to August 2013, data of patients who were diagnosed with invasive breast cancer and ALN metastasis and treated with NAC followed by definitive surgery in two centers were collected retrospectively. A total of 386 patients were enrolled and classified into five groups according to surgical procedure for the ALNs and pathologic results. RESULTS: At SLNB after NAC, sentinel lymph nodes (SLNs) that stained blue or were hot, including suspicious nodes, were identified; the SLN identification and false-negative rates was 96% and 10%, respectively. There was no difference in the overall survival among the groups. For patients who revealed a pathologic complete node response, there was a significant difference in the disease-free survival rate between the SLNB only and complete ALN dissection groups (p=0.031). However, the rate of axillary recurrence demonstrated no significant differences among the groups (p>0.050). CONCLUSION: SLNB after NAC in breast cancer patients with initial ALN metastasis may help identify downstaging to negative nodal status and thereby reduce the surgical morbidity by avoiding standard ALN dissection.

Aromatase inhibitor-associated musculoskeletal symptoms: incidence and associated factors / 대한외과학회지

PURPOSE: Arthralgia is the most common side effect in breast cancer patients receiving aromatase inhibitor (AI) therapy. Few studies have evaluated the risk factors, onset, and incidence of musculoskeletal pain in these patients. This study identifies the risk factors of AI-related severe arthralgia and their prevalence. METHODS: All the clinical and pathological records of postmenopausal patients diagnosed with invasive breast cancer using AI at Samsung Medical Center from January 2005 to November 2007 were reviewed. Multivariate logistic regression analyses were performed to evaluate the risk factors of AI-associated musculoskeletal symptoms (AIMSS) and factors associated with AI discontinuance. RESULTS: Among 299 patients, 69 patients (23%) experienced musculoskeletal symptoms attributed to AI use. In multivariate logistic regression analysis, no statistically significant outcome was found to confirm the risk factors for the development of AIMSS. Among the 69 patients who experienced AI-associated musculoskeletal symptoms, 29 (39.7%) discontinued AI use. Multivariate logistic regression analyses revealed an association of prior tamoxifen use with discontinuance of AI (P < 0.01; odds ratio, 4.27; 95% confidence interval, 1.74 to 10.50). CONCLUSION: Prior use of tamoxifen is related to discontinuation of AI due to AI-associated severe arthralgia. Special monitoring and proper pain control for these patients should be considered during the treatment period.

Validation of a Web-Based Tool to Predict the Ipsilateral Breast Tumor Recurrence (IBTR! 2.0) after Breast-Conserving Therapy for Korean Patients / 한국유방암학회지

PURPOSE: IBTR! 2.0 is a web-based nomogram that predicts the 10-year ipsilateral breast tumor recurrence (IBTR) rate after breast-conserving therapy. We validated this nomogram in Korean patients. METHODS: The nomogram was tested for 520 Korean patients, who underwent breast-conserving surgery followed by radiation therapy. Predicted and observed 10-year outcomes were compared for the entire cohort and for each group, predefined by nomogram-predicted risks: group 1, 10%. RESULTS: In overall patients, the overall 10 year predicted and observed estimates of IBTR were 5.22% and 5.70% (p=0.68). In group 1, (n=124), the predicted and observed estimates were 2.25% and 1.80% (p=0.73), in group 2 (n=177), 3.95% and 3.90% (p=0.97), in group 3 (n=181), 7.14% and 8.80% (p=0.42), and in group 4 (n=38), 11.66% and 14.90% (p=0.73), respectively. CONCLUSION: In a previous validation of this nomogram based on American patients, nomogram-predicted IBTR rates were overestimated in the high-risk subgroup. However, our results based on Korean patients showed that the observed IBTR was higher than the predicted estimates in groups 3 and 4. This difference may arise from ethnic differences, as well as from the methods used to detect IBTR and the healthcare environment. IBTR! 2.0 may be considered as an acceptable nomogram in Korean patients with low- to moderate-risk of in-breast recurrence. Before widespread use of this nomogram, the IBTR! 2.0 needs a larger validation study and continuous modification.

A Case of Jejunal Extranodal MALT Lymphoma Diagnosed by Single-balloon Enteroscopy / 대한소화기내시경학회지

Small bowel lesions located in long and multiple complex loop configurations were difficult to diagnose early because of vague clinical manifestations and because of the poor diagnostic yield of conventional examination methods. In this setting, double-balloon enteroscopy (DBE) was an epoch-making diagnostic and therapeutic tool for the management of patients with small bowel disease. Single-balloon enteroscopy (SBE), lacking a balloon at the endoscopic tip, is also a useful method for investigating and managing suspected small bowel lesions. Mucosa associated lymphoid tissue (MALT) lymphoma of the small bowel is relatively uncommon and remains a localized disease for long periods in most patients. Recently, we experienced a case of advanced-stage MALT lymphoma in the jejunum. A 60-year old female, with a history of anemia of unknown etiology and who was suspected of having a small bowel lesion, presented with complaints of vague abdominal pain and dizziness. She had undergone SBE via the oral route. She was diagnosed with MALT lymphoma of the jejunum and treated with medical management.

Inter-Physician Variation in Treatment for Patients with Crohn's Disease

BACKGROUND/AIMS: The incidence and prevalence of Crohn's disease are increasing in Korea. However, the guidelines for the management of Crohn's disease have not been established in Korea. In the current study we determined the difference in the treatment methods between physicians in Korea for Crohn's disease. METHODS: We retrospectively analyzed the use of medical and surgical treatment modalities in 92 patients with newly diagnosed Crohn's disease. We compared the treatment strategies among 4 physicians at 3 different institutions. RESULTS: Prednisone, 5-aminosalicylates, antibiotics, immunomodulators, infliximab, and surgery were prescribed or preformed in 64%, 92%, 24%, 35%, 9%, and 22% of the patients, respectively. The surgical procedures included 12 bowel resections and 8 fistulectomies. The prescription rates for 5-aminosalicylates, prednisone, antibiotics, and infliximab did not differ, but of the use of immunomodulators was significantly different between physicians (p=0.012). The mean interval between diagnosis and the start of immunomodulators was 14 months, and was not different between physicians. The median dosage of immunomodulators was 50 mg per day, and was not different between physicians. CONCLUSIONS: A difference in medical treatment strategies for Crohn's disease between physicians exists in Korea. Specifically, there was a significant difference in the use of immunodulators between physicians. The development of treatment guidelines for Crohn's disease, together with efforts to decrease the inter-physician difference for treating Crohn's disease are needed.

A Benign Ulcer of the Gastric Fundus Reminiscent of a Malignant Submucosal Tumor / 대한소화기내시경학회지

The gastric fundus is a rare site for benign ulcer occurrence as it consists of parietal cells, which secret gastric acid. It is resistant to gastric acid and pepsin, and has an abundant blood supply. Varices or other vascular lesions, such as polyps and submucosal tumors, are more frequently found in the gastric fundus. When an ulcer is found in the gastric fundus, it is important to consider underlying conditions such as a malignancy. In this case, a benign gastric ulcer in the gastric fundus dome formed a protruding mass-like lesion with central necrosis, which was reminiscent of a malignant submucosal tumor. Proper follow-up gastroscopy with endoscopic ultrasonography helped to differentiate these similar lesions. We report here a case of a benign gastric ulcer in the fundus dome that was reminiscent of a malignant submucosal tumor, with a review of the literature.

Clinicopathologic Characteristics of Stage IV Early Gastric Cancer

PURPOSE: Stage IV early gastric carcinoma (EGC) is a rare disease. We report here on 10 cases of EGC that showed metastasis in more than 15 lymph nodes. MATERIALS AND METHODS: A total of 8354 cases of gastric carcinoma in patients who underwent surgical procedures between January 2001 and January 2007 at Samsung Medical Center were studied, and 10 cases were classified as stage IV EGC. We investigated their clinicopathologic characteristics. RESULTS: There were 5 males and 5 females. Their ages at operation ranged from 46 to 76 years with a mean age of 61. All of the 10 patients had undergone curative resection for gastric cancer. The pathological diagnosis confirmed that all of the patients had tumor confined to the submucosa. The median size of the tumors was 5.3cm and the mean number of dissected nodes was 45.5 with a mean number of 22.2 involved nodes. Six cases were classified as the diffuse type and 4 were classified as the intestinal type by Lauren's classification. Histologically, 3 cases were signet ring cell carcinoma, 3 were poorly differentiated, 2 were moderately differentiated and 2 were well differentiated adenocarcinoma. Endolymphatic invasion was found in 9 cases. The median follow-up was 31 months. Adjuvant chemotherapy was done in 9 patients, and the patient who did not receive chemotherapy died by cerebrovascular accident. 2 patient had recurrence of gastric cancer and 7 survived without recurrence. CONCLUSION: More cases should be collected and further studies on the molecular and cellular tumor characteristics are required to characterize these tumors that show aggressive lymphatic spread.

The Re-infection of Helicobacter pylori and the Presence of Metachronous Lesions after Endoscopic Mucosal Resection of Gastric Neoplasias / 대한소화기내시경학회지

BACKGROUND/AIMS: The aims of this study were to determine the H. pylori re-infection rate in patients that underwent endoscopic mucosal resection (EMR) due to a gastric adenoma and gastric adenocarcinoma, and to define the correlation between H. pylori re-infection and the presence of metachronous lesions. METHODS: An endoscopic examination with a biopsy was performed at six months, 12 months, and every year thereafter to determine if H. pylori re-infection occurred and if metachronous lesions were present in patients that had undergone EMR (EMR group). At least a three-year follow-up examination was performed, and patients with an on-site recurrent lesion were excluded. The re-infection rate was compared to the rate in patients with peptic ulcers (control group). RESULTS: Six patients (24%) among the 25 patients included in this study had H. pylori re-infection, an indication of a high re-infection rate as compared to the rate in patients with peptic ulcers (p=0.03). Two patients (33.3%) who were re-infected with H. pylori had metachronous lesions (p=0.009). CONCLUSIONS: Determination of the H. pylori status during a follow-up study after EMR is essential and re-eradication therapy is recommended in patients with H. pylori re-infection to prevent metachronous lesions.

Four Synchronous Colorectal Cancers and One Small Bowel Cancer in a Patient with HNPCC

The frequency of multiple synchronous carcinomas of the colon and rectum have varied in different reports from 3~4% to more than 10% of all tumors of the large bowel. Especially, the frequency is higher in hereditary non-polyposis colorectal cancer (HNPCC) patients. There are a few reported cases of five simultaneous cancers in a patient at the same time. We report here on a case of five synchronous cancers arising from the terminal ileum and colon in a patient with a strong familial tendency for colon cancer. The patient was a 43-year-old-female who presented with intermittent abdominal pain and diarrhea for one month. Colonoscopic examination revealed four adenocarcinomas at the proximal ascending, the proximal transverse, the distal descending and the sigmoid colon; the cancer in the sigmoid colon was at 30 cm above the anal verge. During the operation, another 3 cm sized ulcerative lesion was noted at the terminal ileum. Total colectomy, including the lesion of the terminal ileum, and ileorectal anastomosis were performed. Histologic evaluation revealed that all those lesions were adenocarcinomas invading the pericolic fat and three out of 126 lymph nodes were invaded by the cancer cells. It was a MSI-high cancer; 5 markers of MSI (BAT25, BAT26, D5S346, D17S250 and D2S123) were all unstable. We revealed a point mutation of the 67th base (GaT) of the 1st exon of hMLH1.

A Case of Huge Gastric Angiodysplasia Treated with Argon Plasma Coagulation / 대한소화기내시경학회지

Gastric angiodysplasia is an uncommon cause of upper gastrointestinal blood loss that may occur in the stomach or duodenum, and is responsible for up to 1~6% of upper gastrointestinal bleeding. In contrast to colonic angioectasia, gastric lesions are more common in young individuals and originate from developmental causes. On an endoscopic examination, the lesions typically show a spider-shape or coral reef-like pattern of dilated and tortuous vessels and measure approximately 2 to 10 mm in diameter. We encountered a case of huge gastric angiodysplasia that presented with overt bleeding and anemia and was successfully treated with argon plasma coagulation.

A Case of Pulmonary Endometriosis Treated by Resection / 결핵및호흡기질환

Periodic hemoptysis occurring at the time of menstruation (catamenial hemoptysis) is a rare disorder and generally signifies indicates the presence of thoracic endometriosis. A diagnosis of catamenial hemoptysis is usually established based on the clinical history and the exlusion of other causes of the recurrent hemoptysis. Serial computed tomograms of the chest during and in the interval between menstruations periods is a useful confirmatory test. We report the case of a 22 year-old women who suffered from catamenial hemoptysis for 10 months and was treated successfully with a wedge resection of the lesion by video-assisted thoracoscopic surgery(VATS). There was no evidence of recurrence. In conclusion. VATS is a good choice as a for single focus for catamenial hemoptysis.

A Case of Aortic Arch Thrombus Associated with Acute Pyelonephritis in a Patient with Thrombocythemia / 대한신장학회잡지

Aortic thrombus is a rare but life threatening disorder. The usual causes of aortic thrombus are primary or secondary thrombocythemia, malignancy, atherosclerosis, trauma, and acute infectious disease. Here, we report a case of aortic arch thrombus associated with acute pyelonephritis in a patient with thrombocythemia. A 78-year-old woman was admitted with acute pyelonephritis. A complete blood cell count showed severe thrombocythemia with platelet count of 1, 340, 000/mm3. Chest CT scan demonstrated floating thrombus in the aortic arch. After antibiotic treatement, platelet count decreased to 770, 000/mm3 and aortic thrombus disappeared without thrombolytic therapy.

A Case of Bilateral Psoas Abscess Complicated by Acute Pyelonephritis due to Klebsiella Pneumoniae / 대한신장학회잡지

Psoas abscess is rarely encountered with various etiologies and nonspecific clinical presentation, frequently resulting in delayed diagnosis, with increased morbidity and mortality. Two types of psoas abscess are recognized. The primary psoas abscess is generally following hematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is Staphylococcuss aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle, especially in diabetes, malnutrition, alcoholism, and steroid abuse. A 83-year-old woman presented with high fever and progressive back pain. Abdominal CT scan showed bilateral psoas abscesses combined with lobulated kidney. Both cultures of blood and urine showed Klebsiella pneumoniae. By prolonged antibiotic treatment and abscess drainage, she showed clinical, and radiological improvement. Here, we report an unusual case of bilateral pyogenic psoas abscess complicated by acute pyelonephritis due to Klebsiella pneumonia.

A Case of Allopurinol Hypersensitivity Syndrome in a Patient with Chronic Renal Failure / 대한신장학회잡지

Allopurinol hypersensitivity syndrome is a rare but life-threatening complication. We here report a case of allopurinol hypersensitivity syndrome manifested with irreVersible change of renal function and severe toxic epidermal necrolysis in a patient with chronic renal faiure. A 29-year-old male patient with chronic renal failure due to chronic glomerulonephritis presented with high fever and skin rash. He had been taking allopurinol for 6 weeks due to asymptomatic hyperuricemia. Blood chemistry showed severe hepatic dysfunction and aggrevated renal function. Skin biopsy revealed consistent findings with allopurinol hypersenstivity syndorme. Allopurinol was discontinued and steroid was instituted. His cutaneous lesion and high fever, and hepatic dysfunction improved but renal function irreversibly progressed in end stage renal failure requiring maintenance hemodialysis treatment.