Survival Outcomes of Different Treatment Methods for the Ipsilateral Breast of Occult Breast Cancer Patients with Axillary Lymph Node Metastasis: A Single Center Experience / 한국유방암학회지

PURPOSE: This study compared the survival outcomes of different treatment methods for the ipsilateral breast of occult breast cancer (OBC) patients with axillary lymph node metastasis. METHODS: A retrospective study was conducted in which forty OBC patients with axillary lymph node metastasis were identified out of 15,029 patients who had been diagnosed with a primary breast cancer at between 1992 and 2010. The patients were categorized into three treatment groups based on ipsilateral breast management: breast-conserving surgery (BCS) (n=17), mastectomy (n=12), and nonsurgical intervention with or without radiation therapy (No surgery with or without radiation therapy [No Op+/-RT]) (n=11). All patients underwent axillary lymph node dissection. Cases were evaluated based on treatment and potential prognostic factors with respect to overall survival (OS) and disease-free survival (DFS). RESULTS: During the follow-up period (median follow-up of 71.5 months), the overall OS and DFS were 76.9% and 74.9%, respectively. The 5-year treatment-specific OS was 72.0% for the BCS group, 74.0% for the mastectomy group, and 87.5% for the No Op+/-RT group (log-rank p=0.49). The 5-year DFS was 70.6% for the BCS group, 66.7% for the mastectomy group, and 90.9% for the No Op+/-RT group (log-rank p=0.36). Recurrence rates for the BCS and No Op+/-RT groups were 5.9% and 18.2%, respectively. Histologic grade and lymph node status were inversely correlated with DFS (log-rank p=0.04 and p<0.01, respectively). CONCLUSION: There was no difference in survival outcomes between the three treatment methods for the ipsilateral breast (mastectomy, BCS, and No Op+/-RT) of OBC patients with axillary lymph node metastasis. A large-scale multicenter study is needed to validate the results from this small retrospective study.

Sub-brow Resection via Relocation of Retro-orbicularis Oculi Fat and Preseptal Fat Unit

PURPOSE: Retro-orbicularis oculi fat (ROOF) and preseptal fat pad (PSF) are deep fat structures of frontal and supraorbital area, that encounter galeal fat pad (GFP). If galeal wall is weakened by aging process, GFP loses its anchoring structure, moved downward pushing ROOF and PSF. This especially occur in lateral brow area. As a result of drooping, eyebrow affects the eyelid covering PSF as a sac descended to a lateral hooding and ptotic eyelid simultaneously. Consequently, in the case of lateral hooding and brow ptosis, besides the skin, deep fat structures (ROOF and PSF) should be corrected as well. METHODS: ROOF-PSF repositioning technique in subbrow resection were performed. 21 cases of patients from April, 2007 to January, 2008. Before surgery, all patients were examined carefully to evaluate the degrees of dermatochalasia, drooping of the eyebrow, marginal reflex distance 1 (MRD1), eyelid crease height. Surgery was performed under local anesthesia, then excised the drooped eyelid skin by lateral subbrow resection, removed proper amount of ROOF, repositioned ROOF-PSF at the supraorbital rim, and fix it on periosteum. During follow up periods, the patients were surveyed of the satisfaction of surgery, and postoperative MRD1 was evaluated. RESULTS: One patient had a hematoma on left eyebrow, and another one patient had a numbness on left forehead for two months. Except for these two patients, all patients had good results without any significant complications. The mean follow up period was about 5 months, and the position of lateral eyebrow maintained above the supraorbital rim in all cases. Postoperatively, MRD1 increased by 0.8 mm in 5-months mean follow up period. CONCLUSION: In patient with lateral brow ptosis and lateral hooding, the ROOF-PSF repositioning technique in sub-brow resection could be a good operative option.

A Surgical Correction of Pneumosinus Dilatans of Maxillary Sinus by Segmental Zygoma Ostectomy and Maxilloplasty

Pneumosinus dilatans is defined as an abnormal enlargement of paranasal sinuses containing only air. The frontal sinus is most commonly affected, but the maxillary sinus is rare. The surgical aims of pneumosinus dilatans are to re-establish a permanent pressure equilibrium in the involved sinus and to correct possible facial deformity. Generally, pneumosinus dilatans of maxillay sinus is corrected by ostectomy of anterior wall of maxillary sinus and repositioning of removed bony fragment. Despite correction of anterior facial contour asymmetry, asymmetry of facial width remains to be a problem. Therefore, the authors present a technique for correction of pneumosinus dilatans of maxillary sinus by segmental zygoma ostectomy and maxilloplasty. A 16-year-old girl with a slowly enlarging mass in the right side of the face was referred to our department. No history of sinusitis, nasal obstruction or facial trauma were noted. CT scan presented an abnormal enlargement of right maxillary sinus. Surgery was delayed for 2 years until maturation of facial bone. Surgical correction was accomplished through circumferential osteotomy with repositioning of maxillary segment and segmental zygoma ostectomy. Postoperatively, the patient's facial contour was improved with equal malar height and width and no significant complication was noted.

A Case Report of Osteochondroma Occuring on the Right Zygoma Body

PURPOSE: An osteochondroma, also known as osteocartilaginous exostosis, is a common bone tumor, but rarely occurs in the facial bone, especially in the zygoma body. Because most of the craniofacial bones develop from intramembranous ossification, osteochondromas are relatively infrequent in mesenchymal bones of the head and neck. The osteochondroma of the facial bone is a slow growing, painless mass, and causes facial asymmetry. In spine and other extremities, it rarely changes malignant, but until now, there is no evidence of malignant change in facial bone. We herein describe a rare case of osteochondroma occurring on zygoma body with review of the literature. METHODS: A 50-year-old male has painless, slowly growing mass on a right cheek for several years. For a diagnosis, CT and whole body bone scan were done and a diagnosis, osteochondroma was made. The tumor was removed with osteotome under general anesthesia. RESULTS: Radiography showed a well-defined calcified mass attached to the anterior aspect of the right zygoma body. And pathologic exam showed degenerative chondocyte and cancellous bone. As a result, this appearance is that of an osteochondroma. CONCLUSION: An osteochondroma is a common bone tumor, but rarely occurs in the facial bone. To the authors knowldege, this is the first case of osteochondroma occuring on zygoma in korea, body. For this case, we reviewed literature related to this topic.

Acute Myocardial Infarction in Patient with Spontaneous Coronary

Spontaneous coronary artery dissection is a rere incident occurring usually in young patients, predominautly in females. It is usually fatal and found postmortem. It is also a rare cause of acute myocardial infarction. We present the case of a twenty nine-year-old-man with spontaneous right coronary artery dissection found angiographically which caused an inferior wall myocardial infarction. He was treated with medical therapy only amd after uneventful hospital course, he was discharged with medication. Three months later, coronary angiography was done to follow up the lesion and found that the site was completely healed.

Spontaneous Retroperitoneal Hematoma due to Liver Cirrhosis: A Case Report / 대한간학회지

Spontaneous retroperitoneal hemorrhage due to liver cirhosis associated with impaired coagulopathy is very rare disease. Spontaneous retroperitoneal hemorrhage has been recorded as having originated from many retroperitoneal organs and blood vessels, and it may be due to local disease and/or systemic factors. In the majority of patients the bleeding arose from the kidney or adrenal gland. Among the systemic causes of spontaneous retroperitoneal hemorrhage are anticoagulation therapy and chronic hemodialysis during the course of which hemorrhagic complications may occur at many site, including the retroperitoneal space. Blood dyscrasias have been a rare cause of spontaneous retroperitoneal hemorrhage. Conditions reported have been included hemophilia, leukemia, polycythemia and sickle cell trait. Virtually every hemostatic function may be impaired in patients with severe hepatic disease as the result of failure of both the biosynthetic and clearence function of the liver, thrombocytopenia, platelet dysfunction, intravascular coagulation and fibrinogenolysis, and the effects of products of fibrinogen catabolism on the coagulation mechanism. We are reporting a case of spontaneous retroperitoneal hematoma in a patient with alcoholic liver cirrhosis with brief review of literature.

A Case of Primary Parathyroid Carcinoma with full-brown Symptom / 대한내분비학회지

Primary hyperparathyroicism is a state of hypersecretion of PTH by the parathyroid. The etiology has not been established. The three possible etiologies of piimary hyperparathyroidism and incidences are adencena(83%), hyperplasia(15%), and carcinoma(1~2%). Parathyroid carcinoma usually presents in the fourth decades. The hallmark preoperative signs are hypercalcemia(serum calcium 15mg/dl). Palpable neck mass and bane and renal disease. Patients may present with multiple signs and syrnptoms, including recurrent nephrolithiasis, peptic ulcers, mental change, less frequently, extensive bone resorption. However, with greater awareness of the disease and wider use of screening tests, including blood calcium determinations, the diagnosis is frequently made in patients who have no symptoms and minimal, if any, signs of the disease ather than hypercalcemia and elevated levels of parathyroid Hormone. An 38-years-old woman was admitted to the hospital due to pain on the left knee joint. We experienced full-brown symptom pertaining to hyperpara- thyroidism. Thus we report a case herein and also discuss clinical anifestation, histologic features and treatment.