Basic Knowledge of Ultrasonography and Its Clinical Use / 대한내분비외과학회지

Evaluation of thyroid and parathyroid gland scan be performed using imaging techniques such as ultrasonography, computed tomography, and magnetic resonance imaging. Each technique has advantages and disadvantages. However, ultrasonography is generally the first choice for diagnosis, preoperative evaluation, and postoperative follow up examination of thyroid and parathyroid diseases. Producing precise ultrasonography results requires knowledge of ultrasound operation and basic anatomy, as well as skills for correct interpretation of normal or abnormal ultrasound images. This article reviews the physics and technology of ultrasound imaging in its clinical application, especially in field of thyroid and parathyroid diseases.

The Effect of Individual Nutrition Counseling on Diet and Nutrition Status of Postoperative Breast Cancer Patients

This study was conducted to assess the effect of nutrition counseling for postoperative female breast cancer patients (N = 38). In baseline survey, we investigated the nutrition parameters by measuring anthropometric and biochemical blood index and assessing nutrient intake using recall method. Individual nutrition counseling was performed 3 times with 2 - 3 weeks intervals. Patients were offered nutrition information related to breast cancer and desirable life style after cancer operation. The effects of counseling program were assessed 2 month later. Of biochemical parameters, serum total cholesterol level was significantly reduced after nutrition counseling program. Nutrient intakes of postoperative breast cancer patients were generally below the RDA level at the baseline survey. After nutrition counseling, mean daily intake of total energy, protein, calcium were significantly elevated. Of dietary habit, meal regularity and control of portion size were improved and fruits and vegetables intake were significantly increased after nutrition counseling. Control of fatty food intake and alcohol drinking were significantly improved after nutrition counseling program. Score of general nutrition knowledge and knowledge about breast cancer, were significantly increased after nutrition counseling from 2.1 to 3.2 and from 2.3 to 3.8, respectively. It can be postulated that the dietary habit and nutrients intake of postoperative breast cancer patients can be improved by individual nutrition counseling program. In further study, the systematic group nutrition counseling program is needed.

A Clinical Observation on Twelve Cases of Primary Aldosteronism / 대한내분비학회지

BACKGROUND: Primary aldosteronism describes a group of disorders characterized by long-standing aldosterone excess, with suppressed renin activity, resulting in hypertension and hypokalemia. The protean clinical and biochemical characteristics of this syndrome have important implications regarding its pathophysiology and responsiveness to treatment. METHODS: The cases of 12 primary aldosteronisms, diagnosed at Hanyang University Hospital between 1996 and 1999, were reviewed. RESULTS: The 12 cases were composed of 9 aldosterone-producing adenoma, 2 adrenal hyperplasia and a case of idiopathic hyperaldosteronism. There were 9 women and 3 men. The mean age was 46 yrs (range, 23 to 64 yrs). At the initial visit, the mean blood pressure was 160+/-26/104+/-14 mmHg, and one case of idiopathic hyperplasia had normal blood pressure. The mean serum K+ level was 2.6+/-0.5 mEq/L (range, 1.5 to 3.5 mEq/L). The mean plasma renin activity and plasma aldosterone concentration were 0.4+/-0.4 ng/ml/hr (range, 0.2 to 1.6 ng/ml/hr) and 407.5+/-199.8 pg/mL (range, 225 to 800 pg/mL), respectively. Different steps of diagnostic modalities were applied for the preoperative differential diagnosis. All patients, with the exception of the one with idiopathic hyperaldosteronism, were managed by a unilateral laparoscopic adrenalectomy, as they were all diagnosed under the impression of adrenal adenomas. Ultimately, 9 cases were proven to have adrenal adenomas. One hypertensive case, with hypokalemia, had adrenal hyperplasia, and the case with normotension was found to have adrenal nodular hyperplasia from the pathology. The size of the tumors ranged from 1.4 to 2.4 cm in diameter. Among the 11 cases that underwent an adrenalectomy, the blood pressures in 6 cases normalized after the operation, while the other 5, including the one with unilateral hyperplasia, were still in need of antihypertensives for the control of elevated blood pressures, even after the operation. The other case of idiopathic hyperaldosteronism was managed by the prescription of spironolactone. CONCLUSION: From these, it can be suggested that the clinical diversity of the syndrome, especially in the pathophysiology and response to operation, awaits the development of a better preoperative lateralization procedure

Relation of Breast Cancer Risk with Alcohol Consumption and Physical Activity : A Case-Control Study

This study was conducted to investigate the relationship between alcohol consumption, physical activity and breast cancer risk in Korean women. Newly histologically identified cases (N = 108) were selected at Hanyang and Soonchunhyang University Hospitals in Seoul, from January 1998 to August 1999. Hospital-based controls (n = 121) were the patients who visited at the same hospital in the department of plastic surgery, general surgery and opthalmology. Subjects were asked informations on demographic, reproductive, and history of breast feeding as well as physical activity, exercise habit, alcohol consumption by individual interview. Odds ratio (OR) and 95% Confidence Intervals (CI) were calculated by using unconditional logistic regression after adjusted for confounding factors. Among postmenopausal women, the risk of breast cancer increased with increasing alcohol drinking: relative risk for the highest group (> or = 150 g per week) compared with the lowest group (never drinking) was 2.05 (CI=1.74-3.79). Association of exercise and high physical activity for breast cancer appeared to be limited to women with high physical index among postmenopausal women. We observed decreasing risk of breast cancer with increasing physical activity index among postmenopausal women (OR=0.49,95% CI=0.56-0.92). Results of this study support a protective effects of physical activity during adulthood for breast cancer.

Intake of Dietary Fat and Vitamin in Relation to Breast Cancer Risk in Korean Women: A Case-Control Study

To investigate association between breast cancer risk and nutrients intake in Korean women, a case-control study was carried out, at Seoul, Korea. Incident cases (n=224) were identified through the cancer biopsy between February 1999 and December 2000 at two University hospitals in Seoul. Hospital-based controls (n=250) were selected from patients in the same hospitals, during the same periods. Food intake was investigated semiquantitative frequency questionnaire (98 items) by trained dietitian. Subjects were asked to indicate the average food intake and vitamin supplement for a 12 months period of 3-yr prior to the base-line phase. In investigation of vitamin supplement use, subjects were asked the average frequency of use, duration, dose and the brand name of vitamin supplement (multivitamins, vitamin A, vitamin C and vitamin E). And nutrients were calorie adjusted by the residuals method. In this study, higher breast cancer risk incidence was not observed with higher intake of total fat and saturated fatty acids, however statistically significant trends with breast cancer incidence for total saturated fatty acids were found (p trend =0.0458). In analyses of vitamins, beta-carotene and vitamin C were significantly associated with decreasing risk of breast cancer. In analyses, results from dietary plus supplement of vitamin was not associated with breast cancer risk in this study. In conclusion, our findings suggest that antioxidant vitamins such as beta-carotene and vitamin C intake could lower the breast cancer risk in Korean women.

A Case of Malignant Fibrous Histiocytoma-like Sarcomatoid Metaplastic Carcinoma of the Breast

A metaplastic carcinoma of the breast (MpC) is a very rare malignant tumor accounting for fewer than 1% of all mammary tumors. MpCs are difficult to diagnose accurately and classify because of their rarity and varied histological patterns. A MpC is a histologically diverse type of malignancy in which an adenocarcinoma is found to co-exist with an admixture of spindle cells, squamous, chondroid, or bone-forming neoplastic cells. Cystic changes can be encountered in MpC, particularly in carcinoma with squamous metaplasia, but are rare in a sarcomatoid metaplastic carcinoma. We recently experienced an unusual case of a sarcomatoid metaplastic carcinoma mimicking a malignant fibrous histiocytoma of the soft tissue in a 34-year-old female, who had a breast tumor with an extensive cystic change, which was growing rapidly. Here, we report this unusual case of MpC with a review of the relevant literature.

The Experience of Surgical Management for Parathyroid Hyperplasia / 대한내분비외과학회지

Parathyroid hyperplasia is a pathologic finding that can be found in hyperparathyroidism. Unlike parathyroid adenoma, treatment of parathyroid hyperplasia is still quite controversial. In addition, the relative merits of two alternative surgical approaches-subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation have not been clearyly elucidated. The records of 10 patients who had parathyroid hyperplaisa and who underwent parathyroid surgery at the Department of Surgery, Hanyang University Hospital, between April 1992 and April 2003 were retrospectively reviewed. The 10 patients were comprised of 3 males and 7 females. The age distribution was between 29 and 73 years. The presenting clinical manifestations were associated with bone pain in 8 patients, muscle weakness in 4, headache in 4, gastrointestinal symptoms in 3, renal symptoms in 3 and psychologic symptoms in 2. The serum parathyroid hormone level was elevated in all patients. The serum alkaline phosphatase level was elevated in seven among the ten patients. Histopathologic findings revealed chief cell hyperplasia in all patients. Postoperative transient hypocalcemia occurred in 5 patients and they were supplied with oral calcium and calcitriol for several months. There were no major complications. The results indicate that a subtotal parathyroidectomy can be performed without mortality or morbidity and provides good control of primary parathyroid hyperplasia, A total prathyroidectomy with autotransplantation can be performed without mortality or morbidity and provides good contril of secondary and tertiary parathyroid hyperplaisa.

A Case of Surgical Experience of Secondary Hyperparathyroidism / 대한내분비외과학회지

The enlarged parathyroid glands associated with chronic renal failure were recognized during the 1930's. The number of patients on long-term hemodialysis due to chronic renal failure is steadily increasing and the hyperparathyroid state certainly became a clinical problem in the dialysis population. The physiologic mechanisms leading to secondary hyperparathyroidism are multifactorial with renal phosphate retention, skeletal resistance to parathyroid hormone (PTH) action and impairment vitamin D metabolism being some of the known factors. Despite intensive medical management however inadequate control of parathyroid hyperplasia may necessitate surgical intervention. The goal of surgical therapy is to resect sufficient tissue to reverse the hyperparathyroidism without rendering the patient permanently hypoparathyroidism. We experienced a case of secondary hyperparathyroidism and reported its result of total parathyroidectomy, autogenous transplantation and cryopreservation of parathyroid gland.

A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

A Clinical Review of Initial 20 Cases of Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholaminesecreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

A Case of Persistent Primary Hyperparathyroidism Caused by Parathyroid Carcinoma Recurred Along Esophagus / 대한내분비외과학회지

Primary hyperparathyroidism is most commonly caused by an adenoma but rarely by carcinoma of the parathyroid gland. The common clinical manifestations were bone pain, recurrent urinary stone and asymptomatic. Parathyroid carcinoma is different from the parathyroid adenoma in that the invasion to the surrounding tissue or metastasis to the regional lymph nodes and persistent hyperparathyroidism are common in parathyroid carcinoma. It is important that radical en-bloc resection of parathyroidal mass including the lobe of the thyroid that is on the same side and post op follow up is important as well. There is the need of radical surgery even in recurrence of metastatic parathyroid carcinoma for improving hypercalcemia. We experienced a 50-year-old man with primary hyperparathyroidism caused by a parathyroid carcinoma in the left lower parathyroid which was confirmed by histopathologic findings. He was cured by using en-bloc resection of the parathyroid including the left lobe of the thyroid and a left side modifed radical neck dissection. But after 2 months hypercalcemia occurred again and therefore examination with computed tomography, endoscopic ultrasonography and esophagogram revealed a metastasis to the upper and mid esophagus. We opened the chest cavity and resected the surrounding mass of the esophagus. the mass was confirmed to be metastatic tissue from parathyroid carcinoma by histopathologic finding. therefore we report this case.

Genetic Polymorphism of Xenobiotics Metabolizing Enzymes and Individual Susceptible Genes to Colorectal Cancer Patients in Korea

Individual susceptibility to cancers may result from several factors including differences in xenobiotics metabolism, DNA repair, altered oncogenes and suppressor genes, and environmental carcinogen exposures. To determine the frequencies of the genotypes of phase I (CYP1A1 and CYP2E1) and phase II (GSTM1 and NAT2) metabolizing enzymes and to identify the high-risk genotypes of these metabolic enzymes to colon cancer in Korean, we have analyzed 113 colorectal cancer patients and corresponding age and sex matched healthy controls using polymerase chain reaction-restriction fragment length polymorphi(PCR-RFLP). In analysis of phase I enzymes, m1/m2, m2/m2 and Val/Val genotypes in CYP1A1 enzyme polymorphisms and C1/C2 genotype in CYP2E1 polymorphism were associated with high relative risks to colorectal cancers (Odds ratio; 1.51, 1.59, 1.76 and 1.38, respectively). Among the phase II enzymes polymorphisms, GSTM (-) genotype of GSTM1 enzyme and slow acetylator (S/S) of NAT2 enzyme had 1.48 and 1.34 times of relative risks to colorectal cancers, respectively. In combined genotyping of phase I enzymes and GSTM1 polymorphisms, the patients with m1/m2 and GSTM (-), Val/Val and GSTM (-), and C1/C2 and GSTM (-) combined genotypes had higher relative risk than the patients with each baseline of combined genotypes (Odds ratio; 2.15, 5.81 and 2.20, respectively). In combined genotyping of phase I enzyme and NAT2 polymorphisms, the combined genotypes of m1/m2 with slow acetylator and C1/C2 with slow acetylator were more susceptible to colorectal cancer (Odds ratio; 3.5 and 4.5, respectively). These results suggest that the combined genotypes of Val/Val and GSTM (-), m1/m2 and slow acetylator, and C1/C2 and slow acetylator were more susceptible to colorectal cancer in Korean. And genotyping of xenobiotics metabolizing enzymes could be useful for predicting an individual susceptibility to colorectal cancer.

Nonfunctioning Huge Malignant Pheochromocytoma with Liver Metastasis

A 27-year-old woman with a 4-month history of right upper quadrant dull pain and normal blood pressure was admitted in May 2001. Abdominal ultrasonography and abdominal computed tomography revealed a huge retroperitoneal mass with hepatic nodules. Histologic diagnosis was paraganglioma based on gun biopsy. Hormonal study for pheochromocytoma was negative. I-metaiodobenzylguanidine (MIBG) scintigraphy and angiography were performed for operation. The tumor was removed en bloc with part of the pancreas, spleen and hepatic mass. Pathologic examination with immunohistochemical staining revealed a malignant pheochromocytoma growing exophytically from the left adrenal and metastasizing to the liver. The postoperative course has been uneventful and no recurrence has been noted over a 2-months follow-up period.

A Clinical Review of Initial 20 Cases of a Laparoscopic Adrenalectomy / 대한내분비외과학회지

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors since it has many advantages; a more rapid and comfortable recovery, shorted hospitalization, and fewer complications. The purpose of this study was to report the initial 4 years experiences of LA and describe the unusual findings encountered during the operations. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Several techniques of LA have been described already. We prefer the transabdominal approach in the lateral decubitus position using 3 or 4 trocars. RESULTS: 20 patients had all unilateral tumor. The pathological findings were 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. 18 cases of 20 patients were successfully operated by laparoscopic procedure and 2 cases were converted to open adrenalectomy. The reasons of conversion were sudden cardiac arrest due to unknown origin and intraoperative bleeding due to periadrenal massive fat. During the laparoscopic operation, 2 patients showed abnormal EKG findings. The pathologies of those patients were non-catecholamine-secreting cortical adenomas. After operation, they have been completely normal in EKG. The average operating time for the complete laparoscopic adrenalectomies was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There was no postoperative complication and no operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: The LA is relatively fast and safe method and is accepted as the preferred procedure for the adrenal tumors but it should be well prepared perioperatively. Surgeons and anesthesiologists should be aware of those possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

Immediate Free TRAM Flap Reconstruction after Mastectomy in Breast Cancer Patients / 한국유방암학회지

PURPOSE: Despite the advocation of a breast conserving approach to the treatment of breast cancer, many women continue to surgically require or choose mastectomy for the treatment of breast cancer. In many cases, breast reconstruction after mastectomy is being performed using tissue expander, implants or a myocutaneous flap. In recent years, immediate free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction has become an cosmetically and economically attractive alternative, compared to other types of reconstruction, although the technique is not easy. The author's experience with 25 successful immediate free TRAM flap reconstructions is reviewed. METHODS: We analyzed 25 cases of immediate free TRAM reconstruction that were performed at the Department of Surgery, Hanyang University Hospital, from August 1995 to June 2000, for age, histologic type, stage and estimated degree of patient satisfaction. RESULTS: The patient age distribution ranged from 26 to 58 years old, the mean age was 38.3, and the majority of tumors were invasive ductal carcinoma (13 cases) and intraductal carcinoma (8 cases). All tumor sizes were less than 3 cm (Tis: 8 cases, T1: 8 cases, T2: 7 cases) with the exception of the phyllodes tumors (8 cm and 6 cm). The stage was from 0 to IIB (0: 7 cases, I: 7 cases, IIA: 8 cases, IIB: 1 case, phyllodes tumor: 2 cases). Immediate posto-perative complications included 3 cases of bleeding and 1 case of wound infection at the donor site. According to the patients' expressed opinions, almost all patients were pleased with the result. There was no local recurrence during the follow-up period except for one case of bone metastasis that developed. CONCLUSION:This technique undoubtedly can play a major role in the so called "onco-plastic" surgical management of breast cancer.

Paraganglioma Arising from Retroperitoneum, Mediastinum

A paraganglioma that arises from the Retroperitoneum, mediastinum is an extra-adrenal form of pheochromcytoma. Extra-adrenal pheochromocytomas can occur at any site in the abdomen where chromaffin tissue is located and have been found in the paravertebral ganglia, the organ of Zuckerkandl, and the urinary bladder. An extra-adrenal pheochromocytomas can arise from a collection of para-aortic, paraganglion cells located at the origin of the inferior mesenteric artery, This collection of paraganglia was first described in fetuses by Zuckerkandl in 1901 and has subsequently been referred to as the organ of Zuckerkandl. Extra-adrenal pheochromocytoma generally secrete norepinephrine, not epinephrine, because there is an absence of the enzyme phenyl- ethanolamine-N-methyl transferase. Therefore symptoms are related to the production of norepinephrine. Extra-adrenal pheochromocytomas pursue a more aggressive course than their adrenal counterparts. It was found to metastasize in approximately 20% to 40% of cases, compared with only a 2% to 10% rate of metastasis in all adrenal tumors. We report on a three case of paragangliomas that had a functional and non-functional paraganglioma of the organ of Zuckerkandl and a case of a non-functional paraganglioma of the posterior mediastinum.

Diagnostic Value of Fine-Needle Aspiration Cytology in the Operative Management of Thyroid Nodules / 대한내분비외과학회지

PURPOSE: Fine-needle aspiration cytology (FNA) and Frozen section biopsy (FS) have been used to distinguish benign lesions from malignancies and for deciding the extent of operative procedures to be used in the management of thyroid nodules. We performed this study in order to determine the diagnostic value of FNA, the need for FS in intraoperative procedures, and their value in deciding the extent of surgery. METHODS: The medical records of 365 consecutive patients who had undergone surgery for thyroid nodules at the Department of Surgery, Hanyang University Hospital, between Jan. 1996 and Dec. 1998 were reviewed retrospectively. Both FNA and FS were performed on all patients who underwent thyroid surgery during this period. Among these, 35 patients who were diagnosed as insufficient for diagnosis by FNA were excluded. RESULTS: Definitive histopathological diagnosis revealed benign lesions in 232 patients and malignancies in 98. A borderline group consisted of patients whose specimens were interpreted as follicular neoplasms by FNA and FS. The overall results for FNA and FS were as follows: sensitivity, 98 versus 100; specificity 97 versus 99; and diagnostic accuracy, 97 versus 99%. Five patients who were diagnosed with benign lesions by FNA were rediagnosed by FS as having malignant lesions. The final diagnosis was papillary carcinoma. Of the 45 patients who were interpreted borderline by FNA, 7 patients had benign lesions and 38 were borderline by FS. Finally, 34 patients were diagnosed as having benign lesions and 11 as having malignancies. CONCLUSION: FNA has a high diagnostic accuracy for the differential diagnosis of thyroid nodules. FS may be unnecessary for patients whose FNA results indicate malignancy, particularly in cases of papillary carcinoma, therefore the routine use of FS for patients who have been diagnosed as having a papillary carcinoma by FNA may be omitted. If FNA results are borderline, FS may be helpful in confirming a follicular neoplasm. If FNA indicates a benign status, FS seems to be necessary to decide the extent of surgery.

A Clinical Review of 20 Initial Cases of Laparoscopic Adrenalectomy

PURPOSE: The laparoscopic adrenalectomy (LA) has become the preferred procedure for adrenal tumors due to many advantages; a more rapid and comfortable recovery, shortened hospitalization period, and fewer complications. This study reports on an initial 4 year period of experience with LA and describes various unusual findings encountered during the treatment. METHODS: From February 1997 to November 2000, a total of 20 LA were performed. Of the several LA techniques previously described we prefer the transabdominal approach in the lateral decubitus position utilizing 3 or 4 trocars, and this method was employed in all the cases presented here. RESULTS: All 20 patients had a unilateral tumor. The pathological findings consisted of 11 aldosteronomas, 6 Cushing adenomas, 2 pheochromocytomas and 1 cortical carcinoma. Of the 20 patients, 18 were successfully operated with the laparoscopic procedure and the remaining 2 cases were converted to open adrenalectomy. The reasons for conversion were sudden cardiac arrest of unknown origin in one and intraoperative bleeding due to periadrenal massive fat in the other. During LA, 2 patients with non-catecholamine-secreting cortical adenomas pathologies displayed abnormal EKG findings, which reverted to normal after the operation. The average complete LA operation times was 186 minutes in the first 9 cases and 132 minutes in the next 9 cases. The first oral intake was started within 24 hours in all cases. There were no postoperative complications, operative morbidity or mortality. The average hospital stay was 6.2 days in the first 9 cases and 4.2 days in the next 9 cases. CONCLUSION: LA is a relatively fast and safe method and has become is accepted as the preferred procedure for adrenal tumors but it requires good perioperative preparation. Surgeons and anesthesiologists need to be aware of the possible cardiovascular complications and of the problems inherent in the manipulation of the adrenal gland during LA.

Immediate Free TRAM Flap Reconstruction after Mastectomy in Breast Cancer Patients

PURPOSE: Despite the advocation of a breast conserving approach to the treatment of breast cancer, many women continue to surgically require or choose mastectomy for the treatment of breast cancer. In many cases, breast reconstruction after mastectomy is being performed using tissue expander, implants or a myocutaneous flap. In recent years, immediate free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction has become an cosmetically and economically attractive alternative, compared to other types of reconstruction, although the technique is not easy. The author's experience with 25 successful immediate free TRAM flap reconstructions is reviewed. METHODS: We analyzed 25 cases of immediate free TRAM reconstruction that were performed at the Department of Surgery, Hanyang University Hospital, from August 1995 to June 2000, for age, histologic type, stage and estimated degree of patient satisfaction. RESULTS: The patient age distribution ranged from 26 to 58 years old, the mean age was 38.3, and the majority of tumors were invasive ductal carcinoma (13 cases) and intraductal carcinoma (8 cases). All tumor sizes were less than 3 cm (Tis: 8 cases, T1: 8 cases, T2: 7 cases) with the exception of the phyllodes tumors (8 cm and 6 cm). The stage was from 0 to IIB (0: 7 cases, I: 7 cases, IIA: 8 cases, IIB: 1 case, phyllodes tumor: 2 cases). Immediate postoperative complications included 3 cases of bleeding and 1 case of wound infection at the donor site. According to the patients' expressed opinions, almost all patients werepleased with the result. There was no local recurrence during the follow-up period except for one case of bone metastasis that developed. CONCLUSION: This technique undoubtedly can play a major role in the so called "onco-plastic" surgical management of breast cancer.

Expression of Cyclooxygenase-2 in Human Breast Carcinoma: Relevance to Tumor Angiogenesis and Expression of Estrogen Receptor / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study investigates the COX-2 expression in human primary breast carcinomas and its relationship with both angiogenesis and the expression of estrogen receptor. MATERIALS AND METHODS: COX-2 expression, angiogenesis, and estrogen receptor expression were examined by immunohistochemical methods in 167 human breast carcinomas by using monoclonal antibodies against COX-2, CD34, and estrogen receptor protein. RESULTS: Although COX-2 was expressed in 77.8% of the breast carcinomas (130/167) regardless of histological types, it was not detected at all in benign epithelial cells. Interestingly, COX-2 expression was found to be significantly correlated with tumor angiogenesis (p=0.004), but not with estrogen receptor and other histopathologic parameters. CONCLUSION: The results suggest that COX-2 expression occurs frequently in breast tissue during transformation of benign epithelial cells to malignant cells regardless of the estrogen receptor status. COX-2 expression may play a role in tumor angiogenesis that is responsible for tumor growth and metastasis.