The Use of Absorbable Surgical Mesh after Partial Mastectomy for Improving the Cosmetic Outcome / 한국유방암학회지

PURPOSE: Partial mastectomy without immediate volume replacement can be associated with cosmetic failure. The aim of the present study was to assess cosmesis achieved in patients who underwent partial mastectomy and reconstruction using absorbable surgical mesh. METHODS: We used absorbable surgical mesh (Polyglactin 910, Vicryl(R)) to repair defects after performing partial mastectomy in 25 patients. Endoscopy-assisted partial mastectomy was performed with conservation of the whole skin of the breast and areola. A tailored fan-shape mesh was inserted into the postoperative defect. The cosmetic appearance was evaluated using a simplified five-grade for five-items scoring system at 3 and 6 months after the operation. RESULTS: An excellent or good cosmetic result was obtained in 82.6% of the patients (19/23) after 3 and 6 months, and no major complications were noted. CONCLUSION: This procedure can be easily performed by general surgeons. Insertion of an absorbable surgical mesh into the postoperative defect could be an effective modality for reconstructing a defect after breast surgery.

Metastasis of Non-Small Cell Lung Cancer to Ipsilateral Breast: A Case Report / 한국유방암학회지

Breast tissue is an unusual site for metastatic disease, particularly for non-small cell lung cancer (NSCLC). Aside from contralateral breast cancer, the most common tumors metastasizing to the breast are malignant melanoma and hematopoietic malignances. We recently experienced a case of a 49-year-old female patient with solitary metastasis of NSCLC to ipsilateral breast tissue. She was diagnosed as NSCLC of left lung and underwent left upper lobectomy in 2001. She was then treated with etoposide/cisplatin chemotherapy and radiation therapy. After 35 months, she was referred to our breast clinic because of a nodular opacity in the left breast revealed by screening breast ultrasound, which proved to be of pulmonary origin. She was treated by wide excision and with docetaxel/cisplatin chemotherapy. However, 37 months after breast surgery, a metastatic lesion developed in the same breast and she received modified radical mastectomy. We report this case with a review of the literature.

Is CO2 Gas Insufflation in Endoscopic Thyroidectomy Safe or Not?: A Prospective Study through the Continuous Measurement of the End-tidal CO2 Pressure

PURPOSE: Endoscopic thyroidectomy has recently been widely used in clinical practice. The operative method can be classified into CO2gas insufflation and the gasless technique. This study assessed the safety of low pressure CO2gas insufflation (up to 6 mmHg) by performing continuous measurement of the end-tidal CO2 (ETCO2) pressure. METHODS: From March 2003 to October 2006, 95 patients (90 hemithyroidectomies and 5 total thyroidectomies) underwent endoscopic thyroidectomy. The low pressure CO2gas insufflation technique was applied in all cases. The ETCO2 pressure of the patients was measured by capnometry at the time of a pre-gas insufflation status (0 minutes) and at the time of post-CO2gas insufflation (30 minutes) and then it was measured every 30 minutes with also performing capnograms. We analyzed the ETCO2 pressure at the time of the pre-CO2gas insufflation status (0 min) and we compared this with that of each status by using paired T-test. RESULTS: For all 95 cases, the mean patient age was 36.2+/-9.1 (range: 21~57 years), the mean tumor size was 1.7+/-1.1 (range: 0.1~4.5 cm) and the mean operative time was 135.0+/-46.1 (range: 50~340 min). The mean ETCO2 pressure (mmHg) was 33.0+/-3.9 at the time of pre-CO2gas insufflation status (0 min); the mean ETCO2 pressure was 31.1+/-3.7 at 30 min (n=95), 33.5+/-3.7 at 60 min (n=95), 35.2+/-3.6 at 90 min (n=95), 34.9+/-3.7 at 120 min (n=90), 34.6+/-3.8 at 150 min (n=70), 34.1+/-3.4 at 180 min (n=40), 34.3+/-5.2 at 210 min (n=15) and 34.0+/-4.2 at 240 min (n=9). There was a significant difference the early post-CO2gas insufflation status (P0.05; at 60 min, 150 min, 180 min, 210 min, 240 min). At each time point, the ETCO2 pressures were all within the normal range. CONCLUSION: We successfully performed endoscopic thyroidectomy with using the low pressure CO2gas insufflation technique and there were no significant complications. We think that performing endoscopic thyroidectomy with using the low pressure CO2gas insufflation technique is a safe procedure.

US-guided Vacuum-assisted Breast Biopsy with Air Localization for Patients with Microcalcifications

PURPOSE: Stereotactic vacuum-assisted breast biopsy (SV AB) has recently been introduced as an alternative to the traditional surgical excisional biopsy with needle localization (NLBB). Although SVAB has excellent sensitivity and specificity with very low false negative results, patients might complain about the uncomfortable table and the painful breast compression that is done during SVAB. Furthermore, the cost of SVAB is too expensive to be widely adopted in Korea. So we developed a new technique of vacuum-assisted breast biopsy with air localization (VAB-AL) for the patients suffering with microcalcifications. METHODS: From April 2005 to Oct 2005, 10 microcalcification patients, whose lesions were difficult to be seen on breast ultrasonography, underwent vacuum-assisted breast biopsies with air localization (VAB-AL). First, classical NL was done to localize the mammographic abnormalities. Instead of insertion of the wire, 1 cc amounts of air were injected through a needle. The injected air could be easily visualized as a hyperechogenic density on breast sonography. Vacuum-assisted breast biopsy for the air-induced hyperechogenic densities was then done under sonographic guidance. The specimen radiography was performed to confirm that the lesion was removed. RESULTS: The mean age of the patients was 46 (range: 37~55). The upper-outer quadrant of the breast was the most common site of the lesions (6/10, 60%); the upper-inner quadrant (2/10, 20%), and then the lower-inner quadrant (1/10, 10%) followed. The specimen radiology for all 10 patients showed that the mammographic abnormalities were successfully removed. The most common pathologic type was fibrocystic disease (6/10, 70%); intraductal carcinoma (3/10, 30%), and then atypical ductal hyperplasia (1/10, 10%) followed. There were no major complications. CONCLUSION: Vacuum-assisted breast biopsy with air localization is a new technique that can minimize the complaints of patients with microcalcifications about the uncomfortable table, the painful breast compression and the economic burden of SVAB. This new procedure was successfully performed in our 10 patients, and we believe this procedure shows a lot of promise as one of alternatives to classical NLBB and SVAB.

Chronic Granulomatous Mastitis

PURPOSE: Granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology. Clinically and radiologically, it can mimic a breast carcinoma. Therefore, surgeons, pathologists, radiologists need to be aware of this condition in order to avoid unnecessary mastectomies. This study examined the modalities that are important for diagnosing and treating of the granulomatous mastitis. METHODS: The data regarding 14 patients with histologically confirmed granulomatous mastitis and treated at our hospital were analyzed. Age, associated disease, parity, past history of breast feeding and oral contraceptives, radiology findings were retrospectively evaluated. RESULTS: Among the 14 patients, the mean age was 41 years with 5 being in their thirties. Breast pain was the most common presentation. Of the 14 patients, 11 patients had breast-fed and none had previously used oral contraceptives. No patient suffered from pulmonary tuberculosis. Preoperative mammography and ultrasonography was not helpful in identifying granulomatous mastitis. After ultrasonography, 7 patients were found to have mastitis with an abscess and a benign or malignant tumor was found in 3 patients. Two of the 14 patients were diagnosed using pre-operative fine-needle aspiration, which that showed an epithelial histiocyte or multinucleated giant cell. Three cases completely recovered after an excision. In 11 cases, incision and drainage were performed but there was a recurrence in 4 of these, which needed to be treated more than twice by an incision and drainage and steroid. The average treatment period was 5 months and a recurrence was encountered in 4 patients within a 30-month follow-up period. CONCLUSION: Granulomatous mastitis is rare, but it is important to make a histological diagnosis at the early stages. It is believed that a complete excision of the lesion will help prevent a recurrence, and patients with a frequent recurrence can be treated with steroid after stopping unnecessary antibiotic treatment.

Sparganosis : two cases report / 한국유방암학회지

Sparganosis is not a common disease. Uncooked snake or frog, infected water and fresh water fish are the usual important source of sparganosis. Most cases of sparganosis are found in subcutaneous or adipose tissue of the abdominal and thoracic wall, and also in the inguinal inguinal regions, but the lesions are rarely found in the breast. We experienced 2 cases of sparganosis in the breast of a 69-year-old female & in the breast of a 37-year-old female. Among them, the 37-year-old female had a history of drinking impure water. The diagnosis was confirmed by surgical excision of the mass, and the plain mammography showed the characteristic finding of an irregular shaped, heterogenous mass lesion. We report here on this case and we briefly review the related literature.

No title available in English / 대한내분비외과학회지

No abstract available.

A Clinical Analysis of One Hundred Cases of Endoscopic Thyroidectomy: Breast Approach

PURPOSE: Neck surgery is one of the newest fields of endoscopic surgical application. We have developed a technique for performing endoscopic thyroidectomy using a breast approach and low-pressure CO2. We report this surgical procedure and its results. METHODS: One hundred patients underwent endoscopic thyroidectomy using a breast approach. Preoperative fine needle aspiration cytology revealed 74 benign nodules, 21 follicular neoplasms, 4 in which there was difficulty in distinguishing between benign and malignant tumor and 1 not checked. We used 3 incisions on both upper circumareolar areas and one at about 3 cm below the clavicle on the tumor side. Three trocars, 5 mm, 10 mm, 15 mm were used. Subplatysmal and subcutaneous operative space was created with CO2 insufflation at 6 mmHg of pressure. The thyroidal vessels and the parenchyme of the gland were dissected and divided with an ultrasonically activated scalpel and commonly used laparoscopic instruments. RESULTS: The subjects were 93 women and 7 men with ages ranging from 7 to 63 years (mean 38.9 yerars). The operation time 136+/-9.85 minutes before year 2000 and 66.8+/-8.26 at year 2000. There were 6 cases of conversion to conventional thyroidectomy, 1 case of uncontrolled intraoperative bleeding, 1 case of invasive follicular carcinoma and 4 papillary carcinoma. Postoperative complications occurred in 5 cases; 1 case of permanent recurrent laryngeal nerve palsy, 3 cases of transient voice change and 1 case of severe chest discomfort for 3 months. There was no occurrence of subcutaneous emphysema. The average of postoperative hospitalization time was 4.5+/-0.35 days. Operative scars were completley concealed by clothes and the patients were satisfied with the cosmetic result. CONCLUSION: This approach completely avoided operative scars in the neck and resulted in satisfactory cosmetic result with minimal scars in the breast. We believe that endoscopic thyroidectomy using breast approach is feasible and safe for resection of thyroid tumors.

A Clinical Review of the Advantages of Laparoscopic Inguinal Herniorrhaphy

PURPOSE: Laparoscopic surgery has became or is being tried as a standard procedure in most of abdominal surgeries due to the advantages of little postoperative pain, shortened of hospital stay, early return to daily life, the cosmetic effect etc. In this article, we examine the availability of laparoscopic herniorrhaphy through a clinical review of patients who had undergone by laparoscopic or conventional herniorrhaphy. METHODS: The records and data of 137 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=57) or conventional herniorrhaphy (n=80), with similar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to transabdominal preperitoneal repair and conventional herniorrhaphy to Bassini's or Ferguson's repair. As statistical method, the Chi-square and T-test was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site and type of hernia, complication rate, or recurrence rate in both group. The laparoscopic group had a longer mean operative time (87.3 vs 68.6 min) and less frequent postoperative analgesic use (49.1 vs 72.6%) as compared to the conventional group. However there was no statistical significance. The laparoscopic group had a significantly shorter mean postoperative hospital day (3.6 vs 7.8 days) and the mean period of return to work (6.2 vs 15.2 days) as compared to the conventional group. CONCLUSION: Laparoscopic herniorrhaphy is thought to be becoming the preferred operative procedure for young patients with a flourishing social activity particularly due to its shortening of the postoperative hospital stay and facilitating the early return to work. There is a need for the complication and recurrence rate to be reestimated following a sufficient and strict follow up. After studying more cases, a reevaluation must be done concerning the advantage of laparoscopic herniorrhaphy.

Varicose Veins that Well Treated by Sclerosing Agents in Lower Extremity

In the early period (B'C) the definition of the primary varicose vein in lower extremity was dilate, tortuous and elongated vein. It has been known that the varicose vein in lower extremity is more involved in western people than orintal. However nowadays this disease is also well involved in oriental because of incresed economic level and well equipped culture. BACKGROUNDS: We has been tried the clinical reserch because of good result & possibility of therapy by only sclerotheray in well defined selected indication of primary varicose vein. MATERIAL AND METHOD: We reviewed primary varicose vein involved in lower extremity of 23cases that was well treated by sclerosing agents to Dept of Surg, Kangbuk Samsung Hosp, SungKyunKwan University College of Medicine, From January 1996 To December 1997. RESULTS: 1. The distribution of the age were the first in 5th decade (39.1%), followed by 6th decade, 4th decade. The ratio of sex were more prevalent in female than male (6.7:1). The median age was 47.3 years-old. 2. Sx & sign were showed cosmetic problem (82.6%) in most patients, followed by heaviness (47.8%), numbness (39.1%), pain (21.7%). 3. The duration of illness were over 10years in 17cases (73.9%). 4. The size of varicose vein were type II in 16case (69.6%), follwed by type I (21.7%), type III (8.7%) according to the classification by Dr. Weiss. 5. The frequency of injection were 1st injection in 12cases (52.2%), 2nd-4th injection (26.1%), over 5th injection (21.7%). 6. Post injection complication were pigmentation in 1case and thrombosis in 1case. 7. The predisposing factors were corelated with pregnancy in most patients, others were long standing position, familiar tendency, trauma. CONCLUSION: Double therapy (operation and sclerotherapy) has been tried in primary varicose vein, however if we are well select indication of therpy, sclerotherapy is also choice of treatment in the primary varicose vein.

The Klippel-Trenaunay Syndrome, 2 Cases

The Klippel-Trenaunay syndrome is a rare congenital pathology that includes hemangioma and varicose vein to involving lower extremity, hypertrophies of soft tissue and bone. When this syndrome has been associated with additional arteriovenous fistula,it has been termed Klippel-Trenaunay-Parkes-Weber syndrome. To avoid errors in managament, it is important to recognize the syndrome. Surgical correction should be performed only to relieve deep venous obstruction(if present) or to correct inequality in the lengths of legs. We report these cases with the review of literatures of Klippel-Trenaunay Syndrome.

Patency Rate of Internal A-V Fistula for Hemodialysis in ESRD Patients

Hemodialysis that to maintain life quality and may be preliminary stage of kidney transplantation is essential in end-stage renal disease(Esrd) patients. Since 1996, Brescia-cimino are used to internal radio- cephalic fistula and this fistula method was the most popular in world-wide. And then variable methods (e.g, Autogenous, PTFE, Dacron etc.) were usually tried instead of above standard fistula. We experienced 75 fistulas in 62 cases from Jan. 1993 to Dec. 1996 and among 75 fistula operations standard radio-cephalic fistula was 56, brachio-cephalic fistula 10, graft fistula 9. Early patency failure rate of A-V fistula was 9 cases, 14.5%. Significant factors to effect in patency of A-V fistula were propably diabetic mellitus, venous diameter, graft material and were not related to age/sex, blood pressure, BUN/creatinine etc. In conclusion the reduction of early patency failure rate in A-V fistula is to maintain long patency rate of A-V fistula