Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency / 임상간호연구

Purpose@#The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. @*Methods@#The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. @*Results@#Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. @*Conclusion@#Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.

Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency / 임상간호연구

Purpose@#The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. @*Methods@#The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. @*Results@#Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. @*Conclusion@#Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.

A Case of Neuroblastoma in Old Age / 대한내과학회지

Neuroblastoma originates in the sympathetic division of the autonomic nervous system, and is the most common extracranial solid malignancy in children; rarely developing in adults. Generally this primitive neuronal malignancy develops during fetal development or in early childhood. However, we have cared for one elderly patient with neuroblastoma. The 84-year-old woman suffered from several symptoms, such as general weakness, weight loss, and hematuria. Her abdominopelvic computed tomography showed an 8.5 x 8 cm mass, which originated from the right kidney. Pathological examination by explorative laparotomy indicated neuroblastoma. She was treated by radical nephrectomy. One year later, there has been no recurrence or solid organ metastasis, and the patient has been in good clinical condition.

Effects of laser-irradiated dentin on shear bond strength of composite resin / 대한치과보철학회지

PURPOSE: This study was conducted to evaluate the shear bond strength of composite resin to dentin when etched with laser instead of phosphoric acid. MATERIAL AND METHODS: Recently extracted forty molars, completely free of dental caries, were embedded into acrylic resin. After exposing dentin with diamond saw, teeth surface were polished with a series of SiC paper. The teeth were divided into four groups composed of 10 specimens each; 1) no surface treated group as a control 2) acid-etched with 35 percent-phosphoric acid 3) Er:YAG laser treated 4) Er,Cr:YSGG laser treated. A dentin bonding agent (Adapter Single Bond2, 3M/ESPE) was applied to the specimens and then transparent plastic tubes (3 mm of height and diameter) were placed on each dentin. The composite resin was inserted into the tubes and cured. All the specimens were stored in distilled water at 37degree C for 24 hours and the shear bond strength was measured using a universal testing machine (Z020, Zwick, Germany). The data of tensile bond strength were statistically analyzed by one-way ANOVA and Duncan's test at alpha = 0.05. RESULTS: The bond strengths of Er:YAG laser-treated group was 3.98 +/- 0.88 MPa and Er,Cr:YSGG laser-treated group showed 3.70 +/- 1.55 MPa. There were no significant differences between two laser groups. The control group showed the lowest bond strength, 1.52 +/- 0.42 MPa and the highest shear bond strength was presented in acid-etched group, 7.10 +/- 1.86 MPa (P < .05). CONCLUSION: Laser- etched group exhibited significantly higer bond strength than that of control group, while still weaker than that of the phosphoric acid-etched group.

Plasma cell granuloma in cyclosporin-induced gingival overgrowth: four cases report with interleukin-6 and phospholipase C-gammar1 immunohistochemistry

No abstract available.

A Case of Small Bowel Obstruction Caused by Cytomegalovirus Infection

The human cytomegalovirus (CMV), a member of the herpes virus family, can cause a lifelong infection with episodes of endogenous reactivation. Almost the entire adult Korean population has been infected with CMV; they have serum CMV antibodies of IgG class. Reactivation is clinically silent in immunocompetent individuals. Symptomatic illness, such as pneumonitis, retinitis, hepatitis or gastroenteritis, is usually confined to immunocompromized patients. The colon, stomach and esophagus are the organs frequently infected with CMV in these patients. A CMV infection may also complicate an inflammatory bowel disease. CMV enteritis involving the small bowel, which makes up less than 10% of the CMV gastroenteritis cases, usually presents with diarrhea, bleeding and perforation, but rarely evokes obstruction. The authors experienced a case of CMV enteritis of the terminal ileum, presenting as an intestinal obstruction, which developed in an immunocompetent individual with no underlying disease. This appears to be a world first.

Plasma Cell Granuloma in Cyclosporine-Induced Gingival Overgrowth: A Report of Two Cases with Immunohistochemical Positivity of Interleukin-6 and Phospholipase C-gamma1

We report two cases of gingival plasma cell granuloma in a 34-yr-old and 40-yr-old two male renal transplant recipients with cyclosporine A (CsA)-induced gingival overgrowth (GO). Histologically, these lesions were composed of mature plasma cells, showing polyclonality for both lambda and kappa light chains and fibrovascular connective tissue stroma. In addition to the fact that CsA-induced plasma cell granuloma is rare, the salient features of our cases were the secretion of interleukin-6 and overexpression of phospholipase C-gamma1 of the tumor cells, which may explain the mechanisms of CsA- induced GO.

Expressions of Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-2 with Changes of Interleukin-6 and Interleukin-18 in Atherosclerotic Lesions of Hypercholesterolemic Rabbits / 대한흉부외과학회지

BACKGROUND: Atherosclerosis is a chronic inflammatory disease of the arterial wall characterized by progressive accumulation of lipids,cells,and extracellular matrix.Matrix metalloproteinases(MMPs)and tissue inhibitor of metalloproteinases(TIMPs)contribute to vascular matrix remodeling in atherosclerosis,and some cytokines may play role in the synthesis or activation of MMPs or TIMPs. MATERIALS AND METHOD: We produced experimental atherosclerotic plaques in 9 rabbits by atherogenic hypercholesterol diet for 12 weeks,and 10 other rabbits were used as control group with standard laboratory chow.At that time,19 rabbits were sacrificed and aorta,coronary arteries and blood specimens were prepared.The expressions of MMP-9,TIMP-2 and interleukin(IL)-18,and the bioactivity of IL-6 were investigated with H&E stain,immunohistochemical stain,immunoblotting(Western blot analysis),and bioassay. RESULT: Serum cholesterol in the experimental group increased up to 1258 +/-262 mg/dL(control group:41 +/-7 mg/dL).All experimental group showed well developed atherosclerotic plaques in aorta and coronary artery.The expression of MMP-9 in aorta and coronary artery of the experimental group showed significant increase than that of the control group by immunohistochemistry.Among the experimental group, complicated lesions with intimal rupture or complete luminal occlusion,demonstrated stronger expression of MMP-9.Interestingly,there was no difference in expression of TIMP-2 between the experimental and the control group.These findings were confirmed by Western blot analysis.The bioassay revealed significant up-regulation of serum bioactivity of IL-6 in the experimental group(4819.60 +/-2021.25 IU/ml)compared to that of IL-6 in the control group(27.20 +/-12.19 IU/ml).IL-18 was expressed in all atherosclerotic plaques, whereas little or no expression was detected in the control group. CONCLUSION: The increased MMP-9 expression along with the unchanged TIMP-2 expression seem to be contributory factors in extracellular matrix degradation in atherosclerosis.Focal overexpression of MMP-9 may promote plaque destabilization and cause complications of atherosclerotic plaques such as thrombosis with/without acute coronary syndrome.Elevation of IL-6 and IL-18 may be more than just markers of atherosclerosis but actual participants in lesion development.Identification of critical regulatory pathway is important to improve the understanding of the cellular and molecular basis of atherosclerosis and may open the way for novel therapeutic strategies.

Expression of Vascular Endothelial Growth Factor and Interleukin-6 in Multiple Myeloma / 대한혈액학회지

BACKGROUND: Vascular endothelial growth factor (VEGF) is a multifunctional cytokine involved in angiogenesis as selective mitogen for endothelial cells as well as potent permeability factor. And interleukin-6 (IL-6) is also known to be a growth factor of myeloma cells. To determine the role of angiogenesis, VEGF and IL-6 in the patients with multiple myeloma, the relationship between the level of VEGF expression, microvessel count (MVC), IL-6 expression in the bone marrow specimen of multiple myeloma patients and stage, response, survival duration were evaluated in 18 patients with multiple myeloma who underwent bone marrow biopsy. METHODS: VEGF expression, MVC and IL-6 expression were assessed by immunohistochemical stain with polyclonal antibody to VEGF, factor VIII related antigen and IL-6 respectively. RESULTS: VEGF expression was higher in multiple myeloma than that of control (61.4+/-34.4% vs 19.0+/-25.9%, P<0.001), and MVC was also higher in multiple myeloma than that of control (11.7+/-6.1 vs 6.2+/-3.8, P=0.005). IL-6 was expressed in 66.7% of multiple myeloma but not in control (P<0.001). Between high VEGF expression group and low VEGF expression group, there were no significant differences in the stage, response or survival. There were no significant differences between hypervascular group and hypovascular group. Also IL-6 expression was not a prognostic indicator. After treatment, VEGF expression, MVC and IL- 6 expression were decreased in the responder, but these differences were not statistically significant (P=0.23, P=0.07, P=0.06), probably due to limited number of cases. CONCLUSION: VEGF, angiogenesis and IL-6 can play a role in the pathogenesis of multiple myeloma. But we cannot confirm the prognostic role of those parameters. Further study with more cases in longer duration as well as prospective study would be necessary for the establishment of relationship between VEGF expression, neovascularization, IL-6 expression and disease severity and prognosis of multiple myeloma.

Altered Expression of Tissue Inhibitor of Matrix Metalloproteinase-2 in Complicated Mice Heart Secondary to Experimentally Induced Viral Myocarditis

BACKGROUND: The pathogenesis of transition from viral myocarditis to dilated cardiomyopathy is elusive, although the incidence of dilated cardiomyopathy in human is increasing. METHODS: To clarify the role of the tissue inhibitor of matrix metaloproteinase-2 (TIMP-2) in this event, we performed immunohistochemistry, immunoblotting and immunoassay of matrix metalloproteinase-9 (MMP-9) and TIMP-2 in the serum and heart tissue of mice, which were inoculated with 4000 plaque-forming units of coxsackie B virus. RESULTS: The MMP-9 was expressed in damaged cardiomyocytes, and the TIMP-2 was expressed in mainly interstitial connective tissue between cardiac muscle bundles by immunohistochemistry. The level of serum MMP-9 was higher in the complicated than non-complicated group (p<0.001), but the level of TIMP-2 was much lower in complicated than non-complicated group (p<0.05). These findings were similar to the results of immunohistochemistry and immunoblotting in tissues. CONCLUSIONS: These results suggest that an imbalance in the level of MMP-9 and its inhibitor might activate cardiac complication in viral myocarditis.

Immunohistochemical localization of eight phospholipase C isozymes in pancreatic islets of the mouse

The possible involvement of phospholipase C (PLC) in the regulation of insulin secretion is not clearly understood and neither its isozymes expressed nor cellular localization in the pancreatic islets is known. By using specific monoclonal antibodies, we have investigated the expression and localization of eight different PLC isozymes, beta1, beta2, beta3, beta4, gamma1, gamma2, delta1, and delta2, in the pancreatic islets of adult mice. Immunohistochemical analysis carried out on paraffin embedded sections showed a distinct pattern of expression for each of the PLC isozymes. In the central part of the islets containing beta cells, a high level of beta4 and moderate levels of beta3 and gamma1 were expressed, whereas PLC-beta1 and -gamma1 were abundantly expressed in the exocrine pancreas. These results demonstrated the heterogeneity in expression of the phospholipase C isozymes in pancreatic islets. It is conceivable that these isozymes are coupled to different receptors and perform selective tasks in the regulation of insulin secretion for glucose homeostasis.

Expression of Phospholipase C-gamma1 and gamma2 in Non-Hodgkin's and Hodgkin's Lymphoma

Phospholipase C (PLC) plays a role in ligand-mediated signal transduction for cellular activity such as proliferation and differentiation. A recent observation that PLC- gamma1 is highly expressed in some kinds of human cancer tissue supports the view that PLC-gamma1 may be involved in proliferation and carcinogenesis. PLC-gamma2 is known to be involved in B cell differentiation and maturation. However, there have been few studies about the expressions of PLC-gamma1 and gamma2 in human lymphoid malignancy. In the present study, we examined the contents of PLC-gamma1 and gamma2 in 10 cases of B cell, 10 cases of T cell non-Hodgkin's lymphoma and 5 cases of Hodgkin's lymphoma to find out whether these enzymes play any role in the carcinogenesis by immunohistochemistry and immunoprecipitation. Immunoprecipitation analysis revealed that in contrast to increased expression of PLC-gamma2 only in B cell lymphoma, a considerably higher level of PLC-gamma1 was detected in both B and T cell lymphoma. Immunohistochemical finding confirmed this observation. PLC-gamma1 and PLC-gamma2 were expressed in the cytoplasm of most tumor cells. PLC-gamma2 was also expressed in mature B cells, while PLC-gamma1 was not expressed in reactive non-tumor cells. These results suggest that PLC-gamma1 mediated signal transduction implicates a significant role in the carcinogenesis of all types of lymphoid tissue, and PLC-gamma2 may play a role in the carcinogenesis of B cell lymphoma as well as B cell differentiation.

A Case of Intraparotid Facial Nerve Neurofibroma / 대한이비인후과학회지

Neurogenic neoplasms of the facial nerve are uncommon. These neoplasms are usually classified into two types: schwannoma and neurofibroma. Although intraparotid facial nerve schwannomas have been documented sporadically throughout the medical literature, neurofibromas from intraparotid facial nerve are extremely rare. Neurogenic neoplasms of the intraparotid facial nerve are usually diagnosed intraoperatively by tissue biopsy. The management of neurogenic tumors associated with normal facial function is a particularly difficult problem. These benign tumors of neurogenic origin should be considered in the differential diagnosis of parotid masses. This is a case report of a solitary neurofibroma involving the main trunk of the facial nerve in the parotid gland.

Interleukin-6 Level as a Marker of Disease Activity in Rheumatoid Arthritis / 대한정형외과학회잡지

Rheumatoid arthritis (RA) is a systemic disease characterized by chronic inflammation of synovial joints accompanied by a marked acute phase response, and interleukin-6 (IL-6) is a major mediator of the inflammatory response which is involved in the induction of acute phase protein, To evaluate the significance of IL-6 levels in patients with RA, IL-6 activity was measured by radioimmunoassay in 13 patients with RA and 5 patients with traumatic arthritis (TA) or osteoarthritis (OA) was used as a control group. Serum IL-6 activity was significantly elevated in 2 RA patients without treatment compared with that of 11 RA patients with treatment and all the TA and OA patients. Synovial fluid IL-6 activity was elevated in all RA patients (markedly elevated in 2 RA patients without treatment) compared with that of TA and OA patients. Immunohistochemical analysis of synovial tissue from 3 RA patients revealed strong expression of IL-6 in most inflammatory synovial cells. The results indicate that IL-6 level, especially that of synovial fluid, is related to disease activity in patients with RA.

Phospholipase D, MMP-2 and TIMP-2 Expression in the Human Colorectal Cancer

BACKGROUND: Tumor invason and metastasis are the major causes of morbidity and death for cancer patients. Metastatic spread depends critically upon the invasiveness of the tumor cells, i.e., their ability to breach basement membrane by profusely secreting specific proteolytic enzymes such as MMP-2. TIMP-2 has a high affinity for progelatinase A and will form a 1:1 complex with either the latent or activated forms of the enzyme and has inhibitory activity against MMP-2. Laminin induced activation of Phospholipase D (PLD) and consequent generation of phosphatidic acid are involved in a signal propagation pathway leading to induction of MMP-2 in metastatic HT 1080 fibrosarcoma cells. We also studied a expression of PLD, MMP-2 and TIMP-2 in colorectal adenocarcinoma. METHODS: Colorectal adenocarcinomas from 13 patients in our hospital were studied for immunohistochemical expression of PLD, MMP-2, and TIMP-2 to assess their diagnostic and prognostic importance as well as relation between PLD and MMP-2. RESULTS: 1) Expression of PLD-2 was detected in 77% of the cases in colorectal adenocarcinomas. 2) MMP-2 expression was significantly associated with the presence of lymph-node metastasis, with moderated to strong expression present in 100% of the cases compared with 28.6% of the non-metastatic cases (P-value=0.017). 3) For colorectal adenocarcinomas, a strong correlation between PLD and MMP-2 expression was detected (P-value=0.008). CONCLUSION: PLD-2 can be used as a potential marker for malignant disease in colorectal adenocarcinomas. MMP-2 expression was significantly associated with the presence of lymph-nodemetastasis. A strong correlation between PLD and MMP-2 expression was also detected in colorectal carcinoma.

The Expression of a Novel 90 kDa Stress Protein in Human Malignant Neoplasms / 대한암학회지

PURPOSE: When cells are subjected to stressful stimuli such as, heat shock, toxic metal, nutrient deprivation, and metabolic disruption, they increase production of specific stress proteins that buffer them from harm. We reported that the expression of a navel 90 kDa cellular protein was increased by the infection of a fish rhabdovirus and heat shock in a fish cell. This new 90 kDa protein is not expressed in normal animal tissues but is highly induced in progressively transforming tissues or cells. That gives us some ideas tl at it is possible for this stress protein to be expressed in specific human cancer tissues. MATERIALS AND METHODS: Commercialized checkerboard multi-tumor block (DAKO Co. Carpinteria, CA) was used for immunohistochemical analysis. The samples of human gastric cancer, colon cancer and breast cancer tissues were evaluated by Western blot and Northern blot for overexpression of the novel 90 kDa stress protein. Sera of those patients were analyzed by ELISA for the presence of antibody against the novel 90 kDa stress protein. RESULTS: Immunohistochemical staining of human tumor tissue blocks showed significant immunostaining of novel 90 kDa stress protein in carcinomas such as colon cancer, breast cancer and stomach cancer but no apparent immunostaining in sarcomas. Coinciding with the immunohistochemical result, Western blotting and Northern blotting analyses indicate that the expression of the novel 90 kDa stress protein was increased in carcinomas. In addition, the antibody titer against the novel 90 kDa stress protein was found to be elevated in the sera of cancer patients. CONCLUSIONS: The novel 90 kDa stress protein gene expression was elevated in carcinomas such as gastric cancer, breast cancer and colon cancer. These findings suggest that this new stress protein can be used as a tumor marker and may function as a chaperone in tumor growth.

Correlation of Radiologic and Pathologic Lymph Non Involvement with TIMP-2 ( tissue inhibitors of metalloproteinase-2 ) in Gastric and Colon Carcinomas / 대한암학회지

PURPOSE: To evaluate the correlation between the expression of TIMP-2 (tissue inhibitors of metalloproteinase-2) and negative lymph node involvement of colon and gastric carcinoma. MATERIALS AND METHODS: We studied 26 cases (13 each) of gastric and colon carcinoma specimens along with dissected lymph nodes by immunohistochemical staining to investigate the correlation of the expression of TIMP-2. Lymph nodes involvement by CT scan was defined by size criteria and the presence of central low density. RESULTS: Eight cases with positive lymph node involvement by CT scan showed weak expression of TIMP-2. Ten cases with positive lymph node involvement had weak expression of TIMP-2. Among eight cases with strong expression of TIMP-2 7 patients were negative by radiologic exam. Good correlation between strong TIMP-2 expression and negative lymph node involvement by CT scan was found (<0.05). CONCLUSION: As the expression of TIMP-2 had a good correlation with radiologic involvement of lymph nodes, the study of expression of TIMP-2 in patients with stomach and colon carcinoma might be helpful in planning surgery and predicting the prognosis.

Fine Needle Aspiration Cytology of Papillary Renal Cell Carcinoma: A Case Report / 대한세포병리학회지

Papillary renal cell carcinoma(RCC) is an uncommon subtype of RCC that has distinctive gross, histologic, and cytogenetic features. The cytologic features of FNA are abundant papillary clusters and relatively few single cells. The cells are usually small and contain uniform nuclei; numerous macrophages with foamy cytoplasm are often found in the background. We describe a case of papillary renal cell carcinoma evaluated by fine needle aspiration cytology(FNAC) in a 42 year-old man. The smear showed a few papillary clusters and numerous macrophages with foamy cytoplasm in the background. With adequate cellularity, papillary RCC can be distinguished reliably from non-papillary RCC by FNAC.

Histiocytic Necrotizing Lymphadenitis(Kikuchi's Disease) A clinicopathologic study of 1 cases

The Kikuchi's disease is a distinctive type of histiocytic necrotizing lymphadenitis that affects primarily the cervical lymphadenites of young adults and has a self-limited clinical course. Authors report the case of a 77-year old patient who presented with axillary and cervical, tender lymphadenopathy and who was diagnosed as having Kikuchi's disease upon excisional biopsy.

Immunodetection of Metalloproteinases(MMP-2 and MMP-9) and Tissue Inhibitors of Metalloproteinases(TIMP-2) in Breast Cancer Tissues

The enhanced process of proteolysis of both the basement membrane and the stromal extracelluar matrix (ECM) contributes to the escape of breast cancer cells into the neighboring tissues, eventually leading to the formation of distant metastases. A group of enzymes thought to play a role in tumor cell invasion are the matrix metalloproteinases (MMPs). Much attention has been focused on MMP-2 and MMP-9, which are 2 members of the MMP family active against collagen of the basement membrane. The enzymatic activities of MMP-2 and MMP-9 are inhibited by the tissue inhibitors of metalloproteinases (TIMPs). TIMP-2, one member of TIMPs, inhibits MMP-2 and MMP-9. The imbalance between TIMPs and MMPs permits to tumor invasion and metastasis. Theretore, TIMPs constitute promising targets in the developmemt of anticancer terapies. Immunohistological stainings of MMP-2, MMP-9 and TIMP-2 were performed on paraffin-embedded tissue sections of 31 invasive breast carcinomas. MMP-2 and MMP-9 were associated with neoplastic cell cytoplasms in 65% of the cases and exhibited inter-tumoral variability of the staining intensity. The MMP-2 and MMP-9 stainings did not correlate with presence of metastases at time of diagnosis. TIMP-2 was detected in the peri-tumoral stroma and was present in 81% of the cases. Residual benign breast tissue was negative for TIMP-2 staining. Neoplasms with diffuse TIMP-2 staining (32%) have metastasis significantly more frequently (50% metastasis) than ceses with focal (20% metastasis) or absent (0% metastasis) TIMP-2. We conclude that the clinical outcome such as metastasis is more closely related to the presence of TIMP-2 than the corresponding MMPs. Enhanced TIMP-2 expression, therefore, may denote a stromal response to tumor invasion, indicative of aggressive behavior in the subset breast carcinoma.