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Descending necrotizing mediastinitis (DNM) is a life-threatening complication secondary to oropharyngeal abscesses, cervical esophageal perforation, or neck infections spreading along the fascial planes into the mediastinum. Post-thyroidectomy surgical site infection is a highly unusual complication that is typically localized around the incision, but may be propagated into the mediastinum, causing DNM. We encountered a case of this rare complication after thyroidectomy. The patient was a 33-year-old woman who was admitted to our center for left hemithyroidectomy. The surgery was performed without any intraoperative events. However, she later developed fever, hypotension, and tachycardia. Imaging revealed deep neck emphysema and focal pneumomediastinum with infiltration in the anterior neck and mediastinum with abscess formation. Additional imaging at 7 days postoperatively revealed reduced fluid collection deep in the neck with minimal changes in fluid collection in the mediastinum. Esophageal perforation was excluded via an esophagogram, which lead to the conclusion that the infection may have been caused by open thyroidectomy. The patient was treated with prompt medical and surgical intervention. After treatment, she was discharged from the hospital with no further complications. We present our case report as well as a literature review of the diagnosis and treatment of this disease.
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Purpose@#Sentinel lymph node biopsy (SLNB) is a well-established staging procedure for patients with early breast cancer who have clinically negative axillary lymph node. However, no consensus exists about the number of sentinel lymph nodes (SLN) that should be removed based on radioactivity counts in breast cancer. We reviewed and analyzed cases in which more than one SLN was detected and there was at least one pathologically positive node. @*Methods@#We retrospectively studied breast cancer patients who underwent lymphoscintigraphy with injection of a radioactive colloid and SLNB along with intraoperative determination of radioactive counts of lymph nodes using a gamma probe between 2006 and 2018. In total 326 patients with more than one radioactive SLN were enrolled in this study. @*Results@#Fifty-four patients had nodal metastases, of whom 46 (85.2%) had metastases in the hottest lymph node. All metastatic SLNs were identified as one of the first three lymph nodes dissected. The lowest radioactive count of a positive SLN corresponded to 10% of that of the hottest node. @*Conclusion@#We suggest that removal of the first three lymph nodes or nodes covered by the “10% rule” is sufficient in SLNB for patients with breast cancer.
ABSTRACT
Descending necrotizing mediastinitis (DNM) is a life-threatening complication secondary to oropharyngeal abscesses, cervical esophageal perforation, or neck infections spreading along the fascial planes into the mediastinum. Post-thyroidectomy surgical site infection is a highly unusual complication that is typically localized around the incision, but may be propagated into the mediastinum, causing DNM. We encountered a case of this rare complication after thyroidectomy. The patient was a 33-year-old woman who was admitted to our center for left hemithyroidectomy. The surgery was performed without any intraoperative events. However, she later developed fever, hypotension, and tachycardia. Imaging revealed deep neck emphysema and focal pneumomediastinum with infiltration in the anterior neck and mediastinum with abscess formation. Additional imaging at 7 days postoperatively revealed reduced fluid collection deep in the neck with minimal changes in fluid collection in the mediastinum. Esophageal perforation was excluded via an esophagogram, which lead to the conclusion that the infection may have been caused by open thyroidectomy. The patient was treated with prompt medical and surgical intervention. After treatment, she was discharged from the hospital with no further complications. We present our case report as well as a literature review of the diagnosis and treatment of this disease.
ABSTRACT
Purpose@#Sentinel lymph node biopsy (SLNB) is a well-established staging procedure for patients with early breast cancer who have clinically negative axillary lymph node. However, no consensus exists about the number of sentinel lymph nodes (SLN) that should be removed based on radioactivity counts in breast cancer. We reviewed and analyzed cases in which more than one SLN was detected and there was at least one pathologically positive node. @*Methods@#We retrospectively studied breast cancer patients who underwent lymphoscintigraphy with injection of a radioactive colloid and SLNB along with intraoperative determination of radioactive counts of lymph nodes using a gamma probe between 2006 and 2018. In total 326 patients with more than one radioactive SLN were enrolled in this study. @*Results@#Fifty-four patients had nodal metastases, of whom 46 (85.2%) had metastases in the hottest lymph node. All metastatic SLNs were identified as one of the first three lymph nodes dissected. The lowest radioactive count of a positive SLN corresponded to 10% of that of the hottest node. @*Conclusion@#We suggest that removal of the first three lymph nodes or nodes covered by the “10% rule” is sufficient in SLNB for patients with breast cancer.
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Purpose@#The purpose of this study was to determine the rate and outcomes of pregnancies subsequentto breast cancer in Korea, and the effect of such pregnancies on the prognosis ofwomen who survived breast cancer and subsequently conceived. @*Materials and Methods@#We followed a total of 31,761 Korean women 45 years of age or younger who were treatedfor primary breast cancer from 2002 to 2010. We also included follow-up surveys that wereconducted through December 2011. We identified recurrence and mortality from breastcancer using data linked to the Korea National Health Insurance database. We used propensityscore matching of the study cohort to analyze the risks of recurrence and mortality frombreast cancer depending on pregnancy. @*Results@#Within our sample, 992 women (3.1%) became pregnant after receiving treatment for breastcancer. Of those, 622 (67.5%) successfully delivered; the remaining 370 (32.5%) failed todeliver. After propensity score matching, we found that the women who became pregnantafter breast cancer did not have a different risk of recurrence (hazard ratio [HR], 0.503;95% confidence interval [CI], 0.434 to 0.584) and death (HR, 0.520; 95% CI, 0.397 to0.681), compared with those who did not conceive after breast cancer treatment. @*Conclusion@#Our study is the first to report outcomes for Korean women who survived breast cancer andsubsequently conceived. Women who survived breast cancer and subsequently becamepregnant did not show a poorer survival outcome, compared with those who did not becomepregnant.
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PURPOSE: The present study investigated the psychosocial health of disease-free breast cancer survivors who receive health examinations compared to matched non-cancer controls in a community setting. MATERIALS AND METHODS: We used baseline data from the Health Examinee cohort, which is composed of subjects participating in health. The disease-free breast cancer survivors were defined as those who were ≥ 2 years from initial diagnosis of breast cancer who had completed treatment. Females without a history of cancer were randomly selected at 1:4 ratio by 5-year age groups, education, and household income as a comparison group. We analyzed results from the Psychosocial Well-being Index-Short Form (PWI-SF) as a psychosocial health measurement. RESULTS: A total of 347 survivors of breast cancer and 1,388 matched controls were included. Total scores on the PWI-SF were lower in breast cancer survivors than matched non-cancer controls (p=0.006), suggesting a lower level of psychosocial stress in breast cancer survivors. In comparison to the control group, prevalence of drinking, smoking and obesity were lower, while exercising for ≥ 150 min/wk was higher in breast cancer survivors (p < 0.05). These findings suggest that breast cancer survivors have better health behaviors than their noncancer controls. After adjusting for other sociodemographic variables, breast cancer survivors were 36% less likely to be included in the stress group (odds ratio, 0.64; 95% confidence interval, 0.42 to 0.98). CONCLUSION: The disease-free breast cancer survivors resuming daily life demonstrated better psychosocial health status compared to matched non-cancer controls.
Subject(s)
Female , Humans , Breast Neoplasms , Breast , Cohort Studies , Diagnosis , Drinking , Education , Family Characteristics , Health Behavior , Obesity , Prevalence , Smoke , Smoking , SurvivorsABSTRACT
PURPOSE: The aim of this study was to examine molecular subtype conversions in patients who underwent neoadjuvant chemotherapy (NAC) and analyze their clinical implications. MATERIALS AND METHODS: We included consecutive breast cancer patients who received NAC at the National Cancer Center, Korea, between August 2002 and June 2011, and had available data on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) receptor status prior to NAC. Molecular subtypes, hormone receptor (HR) status, and ER and PR Allred scores before and after NAC were compared, and the long-term outcomes were analyzed. RESULTS: Of 322 patients, 32 (9.9%) achieved a pathologic complete response after NAC. HR+/HER2- tumors tended to convert into triple negative (TN) tumors (10.3%), whereas 34.6% of TN tumors gained HR positivity to become HR+/HER2- tumors. Clinical outcomes of molecular subtype conversion groups were compared against patients who remained as HR+/HER2- throughout. The HR+/HER2- to TN group had significantly poorer recurrence-free survival (RFS) (hazard ratio, 3.54; 95% confidence interval [CI], 1.60 to 7.85) and overall survival (OS) (hazard ratio, 3.73; 95% CI, 1.34 to 10.38). Patients who remained TN throughout had the worst outcomes (for RFS: hazard ratio, 3.70; 95% CI, 1.86 to 7.36; for OS: hazard ratio, 5.85; 95% CI, 2.53 to 13.51), while those who converted from TN to HR+/HER2-showed improved comparable survival outcomes. CONCLUSION: Molecular subtypes of breast cancers changed frequently after NAC, resulting in different tumor prognostication. Tumor subtyping should be repeated after NAC in patients with breast cancer.
Subject(s)
Humans , Breast Neoplasms , Breast , Drug Therapy , Epidermal Growth Factor , Estrogens , Korea , Receptors, ProgesteroneABSTRACT
PURPOSE: The 21-gene (Oncotype DX) recurrence score (RS) assay is useful in predicting the benefits of adjuvant chemotherapy for early breast cancer patients and is widely used in Western countries. However, to date, it has not gained much popularity in East Asia. We analyzed the results from five institutions' experience from using the 21-gene assay and examined the impact of assay results on decision making of chemotherapy in Korean breast cancer patients and the associations between RS and clinicopathologic characteristics. MATERIALS AND METHODS: The 21-gene assay was performed on 212 patients with estrogen receptor-positive early breast cancer in five institutions. Each center made systemic treatment decisions both before and after the knowledge of assay results. RESULTS: Among the 212 patients, 132 (62.3%) had a low RS of or = 31. Histologic grade, presence of micrometastases, Ki-67, and presence of lymphatic invasion were statistically associated with the RS results. Treatment decisions were changed in 115 of 212 patients (54.2%) in 109 of 212 (51.4%) from chemotherapy plus hormone therapy to hormone therapy, and in six of 212 (2.8%) from hormone therapy to chemotherapy plus hormone therapy. CONCLUSION: The 21-gene breast cancer assay proved to have a significant impact on treatment decision- making. The test reduces chemotherapy use in more than 50% of Korean estrogen receptor-positive, early breast cancer patients.
Subject(s)
Humans , Breast Neoplasms , Chemotherapy, Adjuvant , Decision Making , Drug Therapy , Estrogens , Asia, Eastern , Korea , Neoplasm Micrometastasis , RecurrenceABSTRACT
Amiodarone is an antiarrhythmic drug known to have adverse effects on multiple organs. Most studies have reported the side effects of the drug, which may result from rapid administrations or from long-term, high dosage administrations. However, toxicity issues have also been reported from patients administered with low doses of the drug for a long period of time. Here we report a case of an 82-year-old female who had shown symptoms and signs of pulmonary, hepatic, and neurotoxicity after taking amiodarone for 14 months in order to treat her atrial fibrillation without regular outpatient follow-up. We highlight the importance of the recommended evaluations, including lung, liver, and thyroid functions, as well as the neurological examinations in patients treated with amiodarone for a long period of time during regular follow-up.
Subject(s)
Aged, 80 and over , Female , Humans , Amiodarone , Atrial Fibrillation , Cardiomyopathy, Hypertrophic , Follow-Up Studies , Liver , Lung , Neurologic Examination , Outpatients , Thyroid GlandABSTRACT
PURPOSE: Despite the increasing use of breast-conserving therapy, modified radical mastectomy retains an important primary treatment of breast cancer. The aim of this study was to evaluate the survival of patients with isolated locoregional recurrence (LR) and the prognostic factors for LR after mastectomy. METHODS: We retrospectively analyzed 76 patients who were treated for LR after mastectomy at our hospital between 1987 and 2002. These patients had only isolated LR. The following parameters were analyzed: primary tumor size, primary nodal status, stage, estrogen receptor status, treatment modalities for LR, disease free interval from primary operation and re-recurrence interval. RESULTS: The median time to develop LR was 18.4 months and the median follow-up period from LR was 19.3 months (range 1.3~113 months). The 2-year overall survival rate from LR showed 46% and 5-year overall survival rate was 15%. Out of 76 patients, 47 patients (61.8%) developed re-recurrence and the median duration to re-recurrence was 9.6 months. The pattern of re-recurrence showed 45 patients with systemic recurrence and 2 patients with LR. The initial node status (P=0.041), the estrogen receptor status (P=0.009) and re-recurrence interval from LR (P=0.017) were statistically significant factors for survival. The primary tumor size, the stage, the disease free interval, and the treatment modalities for LR were not statistically significant. CONCLUSION: The re-recurrence rate after isolated LR in patients with breast cancer showed 61.8% and these patients almost always had systemic recurrence. This study could not show the difference of survival according to the treatment modality for LR but the systemic treatment should be considered for the patients with unfavorable prognostic factors.
Subject(s)
Humans , Breast Neoplasms , Estrogens , Follow-Up Studies , Mastectomy , Mastectomy, Modified Radical , Prognosis , Recurrence , Retrospective Studies , Survival RateABSTRACT
Psoas abscess is a rarely encountered disease, and frequently presents non-specific and insidious clinical manifestation, because of which diagnosis and treatment may delay. Staphylococcus aureus has been reported to be the predominant pathogen, whereas Salmonella species have rarely been mentioned as a pathogen. Usually, Salmonella psoas abscess occurs as a complication of a ruptured mycotic aneurysm of the intra-abdominal aorta, or as a consequence of direct extension of an adjacent lumbar spine infection. We report herein an unusual case of primary Salmonella psoas abscess, complicated with deep vein thrombosis and aneurysmal change of the iliac vessels, in a patient with diabetes mellitus who was treated only with antimicrobial therapy. Computed tomography is the most useful and sensitive diagnostic method. A high index of suspicion, early diagnosis, adequate drainage and effective antimicrobial treatment are essential elements in managing the disease.
Subject(s)
Humans , Aneurysm , Aneurysm, Infected , Aorta , Diabetes Mellitus , Diagnosis , Drainage , Early Diagnosis , Iliac Aneurysm , Iliac Artery , Psoas Abscess , Salmonella , Spine , Staphylococcus aureus , Venous ThrombosisABSTRACT
Psoas abscess is a rarely encountered disease, and frequently presents non-specific and insidious clinical manifestation, because of which diagnosis and treatment may delay. Staphylococcus aureus has been reported to be the predominant pathogen, whereas Salmonella species have rarely been mentioned as a pathogen. Usually, Salmonella psoas abscess occurs as a complication of a ruptured mycotic aneurysm of the intra-abdominal aorta, or as a consequence of direct extension of an adjacent lumbar spine infection. We report herein an unusual case of primary Salmonella psoas abscess, complicated with deep vein thrombosis and aneurysmal change of the iliac vessels, in a patient with diabetes mellitus who was treated only with antimicrobial therapy. Computed tomography is the most useful and sensitive diagnostic method. A high index of suspicion, early diagnosis, adequate drainage and effective antimicrobial treatment are essential elements in managing the disease.
Subject(s)
Humans , Aneurysm , Aneurysm, Infected , Aorta , Diabetes Mellitus , Diagnosis , Drainage , Early Diagnosis , Iliac Aneurysm , Iliac Artery , Psoas Abscess , Salmonella , Spine , Staphylococcus aureus , Venous ThrombosisABSTRACT
Diverticular bleeding is a common cause of lower gastrointestinal bleeding in adults. Most of colonic diverticular bleeding stop spontaneously without any treatment. But diverticular bleeding develops at arterial vessel, which results in massive bleeding in a short period of time and may shows recurrence. Acute lower intestinal bleeding has been treated with heater probe coagulation, injection therapy, bipolar coagulation and endoscopic hemoclips. We experienced a 67-year-old woman presented hematochezia. Emergency colonoscopy was performed and showed a diverticulum with a visible vessel at the cecum. Hemostasis with hemoclip was successfully done. We herein report a case of hemostasis by capping a diverticulum of the colon with hemoclips.
Subject(s)
Adult , Aged , Female , Humans , Cecum , Colon , Colonoscopy , Diverticulum , Emergencies , Gastrointestinal Hemorrhage , Hemorrhage , Hemostasis , RecurrenceABSTRACT
Bicuspid aortic valve is the most common form of congenital valvular disease, and its presence may predispose the patients to development of true aortic or dissecting aortic aneurysms. An intrinsic aortic weakness may underlie a bicuspid aortic valve, aortic aneurysm or aortic dissection. We experienced a case of an ascending aortic aneurysm associated with a functionally normal bicuspid aortic valve. A screening echocardiograph was performed due to atypical chest pain, which detected a large ascending aortic aneurysm and a bicuspid aortic valve. The patient underwent an operation for an ascending aortic aneurysm and, is living one year later, and is asymptomatic. To the best of our knowledge, this may be the first case of an ascending aortic aneurysm associated with a bicuspid aortic valve in Korea.
Subject(s)
Humans , Aortic Aneurysm , Aortic Valve , Bicuspid , Chest Pain , Korea , Mass ScreeningABSTRACT
Mucocele is a cystic dilatation of the vermiform appendix that contains mucous material. The symptoms are non- specific and the diagnosis is seldom made prior to surgery. The reported prevalence in appendectomy specimens at surgery is 0.2~0.3%. We have recently experienced three cases of appendiceal mucocele by colonoscopic examination. Two cases showed "volcano sign" which is typical colonoscopic feature of a smooth mound with normal overlying mucosa surrounding the appenciceal orifice. The first case was a 67-year-old male who presented for diagnostic work-up of stomach cancer. Abdomen CT suggested appendiceal mucocele, and colonoscopy showed volcano sign of mucocele. The second case was a 56-year-old female patient who had a RLQ pain of 2 months duration. The presumptive diagnosis of appendiceal mucocele was made, and we performed appendectomy. The pathologic finding was a hyperplastic mucocele. The third case was a 48- year-old male who had one month history of RLQ pain. Colonoscopy showed markedly protruding mass in the lumen with hyperemic surface, and appendectomy was performed. The pathologic finding was a hyperplastic mucocele.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Abdomen , Appendectomy , Appendix , Colonoscopy , Diagnosis , Dilatation , Mucocele , Mucous Membrane , Prevalence , Stomach NeoplasmsABSTRACT
Aortic dissection is the most common fatal condition that involves the aorta. Occasionally, symptoms mimic acute myocardial infarction leading to thrombolytic treatment which may have lethal consequences in aortic dissection. Thus, accurate diagnosis in patients with chest pain is therefore essential. We present a case of acute myocardial infarction which resulted from the acute aortic dissection with obstruction of the left and right coronary ostia by intimal flap. Transesophageal echocardiography was used as the diagnostic tool.