ST-Elevation Myocardial Infarction after Intravenous Thrombolysis Treatment for Acute Ischemic Stroke

Intravenous tissue plasminogen activator (IV-tPA) is the standard treatment for acute ischemic stroke. Acute myocardial infarction (AMI) as a complication of IV-tPA therapy is rarely reported. A 56-year-old man was diagnosed with the left middle cerebral artery territory infarction. IV-tPA was administered, and AMI developed 2-hours thereafter. Coronary angiography demonstrated occlusion of the left anterior descending artery and; immediate recanalization was perfomed. The patient recovered without neurological sequelae. We report herein an unusual case of AMI that developed following IV-t-PA therapy for acute ischemic stroke.

Downregulation of the RUNX3 Gene by Promoter Hypermethylation and Hemizygous Deletion in Breast Cancer

The RUNX3 gene is regarded as a tumor suppressor gene in many human solid tumors, and its inactivation is believed to be related with solid tumor carcinogenesis. As little information is available about the role of the RUNX3 gene in breast cancer, we investigated the relationship between the RUNX3 gene and breast cancer. We performed reverse transcriptase-polymerases chain reaction (RT-PCR), methylation specific PCR, and bicolor fluorescent in situ hybridization analysis in an effort to reveal related mechanisms. Forty breast tissue samples and 13 cell lines were used in this study. Eighty-five percent of breast cancer tissues showed downregulated RUNX3 gene expression, whereas it was downregulated in only 25% of normal breast tissues by RT-PCR assay. Sixty-seven percent of breast cancer cell lines showed downregulated RUNX3 expression, but the RUNX3 gene was not expressed in two normal breast cell lines. Hypermethylation was observed in 53% of breast cancer tissues and 57% of breast cancer cell lines. Hemizygous deletion was observed in 43% of breast cancer cell lines. Hypermethylation and/or hemizygous deletion was observed in 5 of 7 breast cancer cell lines, and the four of these five examined showed no RUNX3 gene expression. We suggest that various mechanisms, including methylation and hemizygous deletion, could contribute to RUNX3 gene inactivation.

Usefulness of Ki-67 as a prognostic factor in lymph node-negative breast cancer / 한국유방암학회지

PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.

Usefulness of Ki-67 as a prognostic factor in lymph node-negative breast cancer / 한국유방암학회지

PURPOSE: To evaluate the independent prognostic value of Ki-67 in lymph node-negative breast cancer and the usefulness of Ki-67 when it combined with St. Gallen classification as a guidance of adjuvant chemotherapy for node-negative cancer. METHODS: We retrospectively reviewed the data of 534 patients with lymph node-negative breast cancer who underwent curative surgery between 1998 and 2001 at our institution. Patients were classified according to the guideline of risk groups of St. Gallen consensus and the level of Ki-67 expression. Distant metastasis-free survival (DFS) rates were compared between groups. RESULTS: With a median follow-up of 55 months, the overall 5-year DFS rate was 91.5%. The 5-year DFS rates for patients with high and low Ki-67 tumors (cut-off value: > or = 10%) were 84.6% and 93.7%, respectively (p < 0.001). In a Cox regression model involving potential prognostic factors, high Ki-67 expression could independently predict the risk of distant recurrence (odds ratio = 2.0 [95% confidence interval, 1.03-3.93]). The 5-year DFS rates for patients with average and minimal risk group of St. Gallen classification were 89.3% and 97.5%, respectively. The average risk group was further divided into two subgroups with significantly different prognosis according to the Ki-67 expression (DFS rate: 84.2% vs. 91.5%; p = 0.007). CONCLUSIONS: Ki-67 was an independent prognostic factor in lymph node-negative breast cancer and the combination of Ki-67 expression and the St. Gallen classification could provide a more useful therapeutic guideline for lymph node-negative breast cancer patients.

Postoperative Survival and Prognostic Factors in Breast Cancer : a Single Center Analysis of 4,063 Cases / 한국유방암학회지

PURPOSE: The incidence of breast cancer in Korea has been continuously growing and is now the most common cancer in females. The proportion of early stage cancer was found to have increased. A survival analysis and the establishment of prognostic factors are essential for proper management of breast cancer in Korean. METHODS: 4063 breast cancer cases operated on Seoul National University Hospital between Jan. 1981 and Dec. 2002, were retrospectively analyzed. RESULTS: The median age of the patients was 46, with those in their 5th decade being most prevalent. The ratio of breast conservation to mastectomy was also found to be growing. The overall and disease-free survival rates after breast conservation were equivalent to those after a mastectomy. The overall 5- and 10-year survival rates were 85.9 and 71.2%, and those of the disease-free survival rates were 79.5 and 68%, respectively. From a univariate analysis, The tumor size, lymph node status, nuclear grade, histologic grade, hormonal receptor status, C-erbB2, Bcl-2 and an age 5 cm (HR 2.4 [95%CI 1.15-5.26]) and NG (HR 0.5 [95%CI 0.35-0.93]) were found to be significant prognostic factors. CONCLUSIONS: Since 1991, patients with early breast cancer have progressively increased. To date, there are more patients with early than advanced breast cancer. In addition, BCS has been rapidly increased since 1993. The tumor size, lymph node status, nuclear grade, PR and C-erbB2 were significant prognostic factors of survival in this our study.

Postoperative Survival and Prognostic Factors in Breast Cancer : a Single Center Analysis of 4,063 Cases / 한국유방암학회지

PURPOSE: The incidence of breast cancer in Korea has been continuously growing and is now the most common cancer in females. The proportion of early stage cancer was found to have increased. A survival analysis and the establishment of prognostic factors are essential for proper management of breast cancer in Korean. METHODS: 4063 breast cancer cases operated on Seoul National University Hospital between Jan. 1981 and Dec. 2002, were retrospectively analyzed. RESULTS: The median age of the patients was 46, with those in their 5th decade being most prevalent. The ratio of breast conservation to mastectomy was also found to be growing. The overall and disease-free survival rates after breast conservation were equivalent to those after a mastectomy. The overall 5- and 10-year survival rates were 85.9 and 71.2%, and those of the disease-free survival rates were 79.5 and 68%, respectively. From a univariate analysis, The tumor size, lymph node status, nuclear grade, histologic grade, hormonal receptor status, C-erbB2, Bcl-2 and an age 5 cm (HR 2.4 [95%CI 1.15-5.26]) and NG (HR 0.5 [95%CI 0.35-0.93]) were found to be significant prognostic factors. CONCLUSIONS: Since 1991, patients with early breast cancer have progressively increased. To date, there are more patients with early than advanced breast cancer. In addition, BCS has been rapidly increased since 1993. The tumor size, lymph node status, nuclear grade, PR and C-erbB2 were significant prognostic factors of survival in this our study.

A case of Breast Gigantism in a Patient with Wilson's Disease treated by Penicillamine / 한국유방암학회지

We report a case of breast gigantism in a patient with Wilson's disease treated with penicillamine. A 19-year-old female with alleged Wilson's disease visited our hospital due to diffuse enlargement of both breasts. She had been treated with penicillamine 1,000 mg/day since her age of 15 after diagnosis of Wilson's disease. At the initial presentation, there were diffuse skin thickenings in both lower inner breasts and huge lesion which replaced almost all the breast parenchyma. After gun biopsy and excision for tissue diagnosis, fibroadenoma with ductal epithelial hyperplasia was diagnosed. Although daily dose of penicillamine was lowed to 500 mg/day, her symptom progressed. After 1 year of follow up, she and her parents strongly wanted to remove her breasts because of distorted body shape and weight of breasts. The patients underwent subcutaneous mastectomy with the designed incision of the reduction mammoplasty for the future mammoplasty. Although the breast gigantism is a rare side effect of penicillamine, female patients should be followed up cautiously for the possible change of breasts. Because penicillamine is no more the first choice for Wilson's disease, it would be better to avoid using penicillamine for Wilson's disease patients especially for the young females.

A case of Breast Gigantism in a Patient with Wilson's Disease treated by Penicillamine / 한국유방암학회지

We report a case of breast gigantism in a patient with Wilson's disease treated with penicillamine. A 19-year-old female with alleged Wilson's disease visited our hospital due to diffuse enlargement of both breasts. She had been treated with penicillamine 1,000 mg/day since her age of 15 after diagnosis of Wilson's disease. At the initial presentation, there were diffuse skin thickenings in both lower inner breasts and huge lesion which replaced almost all the breast parenchyma. After gun biopsy and excision for tissue diagnosis, fibroadenoma with ductal epithelial hyperplasia was diagnosed. Although daily dose of penicillamine was lowed to 500 mg/day, her symptom progressed. After 1 year of follow up, she and her parents strongly wanted to remove her breasts because of distorted body shape and weight of breasts. The patients underwent subcutaneous mastectomy with the designed incision of the reduction mammoplasty for the future mammoplasty. Although the breast gigantism is a rare side effect of penicillamine, female patients should be followed up cautiously for the possible change of breasts. Because penicillamine is no more the first choice for Wilson's disease, it would be better to avoid using penicillamine for Wilson's disease patients especially for the young females.

Preoperative Evaluation of Lymph Node Metastasis with Using Ultrasonography for Examining the Axilla in Early Stage Breast Cancer / 한국유방암학회지

PURPOSE: The axillary lymph node status is the most significant prognostic factor in breast cancer. The development of tools to accurately evaluate the axillary lymph node status with less morbidity has been the important treatment issue. Although sentinel lymph node biopsy is the promising alternative to axillary lymph node dissection, the high false negative rate of this procedure is a considerable problem. This study aimed to evaluate the efficacy of performing preoperative axillary ultrasonography (US) for predicting axillary lymph node metastasis. METHODS: Between January 2003 and December 2004, preoperative axillary US was performed in 646 patients who were suffering with T1 or T2 infiltrating ductal carcinoma and they had no palpable axillary lymph nodes. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of preoperative axillary US findings were 82.8%, 93.2%, 86.3%, 91.2%, and 89.6%, respectively. The positive and negative predictive values for performing axillary US findings for tumors with a size 2cm, the positive and negative predictive values were 90.6 and 89.4, respectively. CONCLUSION: We found that performing preoperative axillary US is a relatively accurate and useful non-invasive method for assessing axillary lymph node metastasis. It showed the potential to replace sentinel lymph node biopsy in tumors > or = 2cm in size with low false negative rate. If we can improve the positive predictive value of US finding by using strict decision criteria, and especially for the tumors >2cm in size, then axillary lymph node dissection might be recommended for the cases with positive US finding.

Changes of Symptoms and Manometric Results after Hemorrhoidectomy for Hemorrhoids with Difficulty in Evacuation

PURPOSE: We aimed to identify the need for an adjunctive internal sphincterotomy based on an evaluation of the changes in the symptoms and manometric results after a hemorrhoidectomy for hemorrhoids with difficulty in evacuation. METHODS: Twenty-five (25) patients who had hemorrhoids with difficulty in evacuation and 13 patients who had hemorrhoids without difficulty in evacuation were prospectively evaluated. Patients were interviewed about symptoms and underwent anorectal manometry before and 2 months after surgery. Difficulty in evacuation is defined as the difficulty that a patient has when trying to evacuate the rectum. RESULTS: There were significant differences in the sex ratio, the frequency of bowel movements, and the duration of bowel movements between the two groups (P<0.05). In cases with difficulty in evacuation, the frequency of bowel movements was significantly higher postoperatively and the duration of bowel movements was significantly shorter (P<0.05). The symptom of difficulty in evacuation disappeared in 21 of the as patients experiencing such a symptom, and was improved in the remaining of patients (P<0.05). Following the hemorrhoidectomy for the patients with difficulty in evacuation in the mean and the maximum resting pressure, and the maximum squeeze pressure decreased significantly (P<0.05). CONCLUSIONS: An adjunctive internal sphincterotomy was not necessary for patients who had hemorrhoids with difficulty in evacuation because following the hemorrhoidectomy, the resting pressure was significantly decreased, and the difficulty in evacuation had nearly subsided.

Expression of Vascular Endothelial Growth Factor (VEGF) in Papillary Thyroid Carcinoma

PURPOSE: Papillary thyroid carcinomas are hypervascular tumors. The tumor growth and their metastases are dependent on factors that stimulate vessel formation (angiogenesis). Vascular endothelial growth factor (VEGF) has been reported to play an important role in the angiogenesis in papillary thyroid carcinomas in terms of the clinicopathological prognostic factors. METHODS: The expression of VEGF in specimens surgically removed from 23 papillary thyroid cancer patients were examined by immunohistochemical methods. RESULTS: The rate of VEGF expression was 56.5% in the tumor cells. The degree of VEGF expression was significantly correlated with local lymph node metastases (P=0.029) and the tumor extent (P=0.036). However, the degree of VEGF expression did not correlate with any clinicopathological characteristics. CONCLUSION: VEGF expression can be a useful prognostic factor of papillary thyroid carcinomas.

Bone Mineral Density of Upper Limbs in Patients with Adhesive Capsulitis of the Shoulder

OBJECTIVE: To examine the relation of shoulder adhesive capsulitis and local bone loss to affected limb. METHOD: Twenty-nine patients with the adhesive capsulitis of the shoulder were studied. For reference, 29 patients, without history of injury or disease in the upper limbs, were randomly selected. Areal bone mineral density (BMD) was measured from the proximal humerus, distal humerus and forearm of upper limbs using a Prodigy (Lunar, USA). The BMD of the affected side versus the unaffected were compared. RESULTS: The reference group: no significant difference between the mean BMDs in the right and left upper limb. The adhesive capsulitis group: 1) The mean BMD in the proximal humerus of the affected upper limb was significantly lower than the unaffected limb (0.85 g/cm2 vs 0.88 g/cm2; p<0.05). 2) No significant difference between the mean BMDs in the distal humerus of the affected and unaffected limb (1.10 g/cm2 vs 1.10 g/cm2). 3) No significant difference between the mean BMDs in the forearm of the affected and unaffected limb (0.82 g/cm2 vs 0.82 g/cm2). CONCLUSION: In patients with adhesive capsulitis of the shoulder, the mean BMD of the affected limb, compared with the unaffected side, was significantly lower in the proximal humerus. But distal humerus and forearm showed no significant side-to-side differences.

The Emotional Problem and Its Relation to Lesion Location in Stroke Patient

OBJECTIVE: This study is aimed at the pathoanatomic correlates of emotional problem in the patients with stroke. METHOD: Thirty patients with single, unilateral hemispheric lesion and no predisposing factors for psychiatric disorder were selected. Several neuropsychological assessments such as Mini- mental status examination-Korean (MMSE-K), Minnesota multiphasic personality inventory (MMPI), Symptom checklist-90-Revision (SCL-90-R) and Functional independence measure (FIM) were performed on all patients by a clinical psychologist and an occupational therapist. RESULTS: There were statistically significant differences between right and left hemisphere lesion group in emotional problems. Right hemispheric lesion group showed significantly higher scores of psychasthenia (MMPI), Obsessive-compulsive (SCL-90-R) and self care (FIM) than left hemispheric lesion group did. But there were no statistically significant differences between cortical and subcortical lesion group. Groups of left cortical lesion, right cortical lesion, left subcortical lesion and right subcortical lesion were not significantly different in their neuropsychological assessments and FIM except self care. CONCLUSION: Obsessive-compulsive and anxious emotional problems are more closely related with right hemispheric lesion. Therefore patients with right hemispheric lesion need more careful psychological and psychiatric evaluation. However, because of the small numbers of subjects involved in the study, the role of lesion location remains unclear so that consecutive follow-up studies are needed.