An Anxiety, Depressed Mood, and Insomnia in Newly Diagnosed Women Breast Cancer Patients and Thyroid Cancer Patients

OBJECTIVES: In this study, we identified the symptoms of insomnia, anxiety, and depressed mood in newly diagnosed women breast and thyroid cancer patients. METHODS: The subjects of this study were 1794 women patients who visited the Ewha Womans University Cancer Center for Women. They included 1119 newly diagnosed primary breast cancer patients and 675 newly diagnosed primary thyroid cancer patients. The patients completed the National Cancer Center Psychological Symptom Inventory (NCC-PSI) during their first follow-up visit after surgery, before starting chemotherapy or radiotherapy. The NCC-PSI is composed of the modified distress thermometer (MDT) and the modified impact thermometer (MIT) for insomnia, anxiety, and depressed mood. RESULTS: Anxiety severity was found to be greater in breast cancer patients than in thyroid cancer patients. Significant levels of anxiety, depressed mood and insomnia were present in 28, 24.5, and 20.7% in all the subjects, respectively. Moreover, anxiety symptoms, depressed mood and insomnia interfered with the daily lives of 20, 18.4, and 14.2% of all the subjects, respectively. Dealing with anxiety (18.8%) was found to need the most help, followed by dealing with insomnia (8.9%) and depressed mood (8.7%). CONCLUSIONS: A significant level of distress was found in about 40% of the total subjects. Nearly 30% of newly diagnosed breast cancer patients reported significant anxiety symptoms and interferences with daily living caused by anxiety, which most commonly needed special care. Early assessment and management of psychological distress, especially anxiety, in breast and thyroid cancer treatment are very important to establish integrated cancer care.

Influences of Stress, Anxiety, Depression, and Personality Trait on Nausea, Vomiting, and Retching of Breast Cancer Patients Receiving Chemotherapy / 신경정신의학

OBJECTIVES: The aim of this study was to identify influences of stress, anxiety, depression, and personality trait on nausea, vomiting, and retching of breast cancer patients perceiving chemotherapy. METHODS: Breast cancer patients who were admitted to Ewha Womans University Cancer Center for women to receive chemotherapy participated in the study. In addition to sociodemographic and clinical factors, self-reported questionnaires, including Type D personality Scale 14, Hospital Anxiety and Depression Scale, and Global Assessment of Recent Stress scale were used to evaluate psychological factors of the subjects. For examination of anticipatory and post chemotherapy nausea, vomiting, and retching, the subjects filled out the Rhodes Index of Nausea, Vomiting, and Retching and Visual Analogue Scale. RESULTS: No significant influence of type D personality, anxiety, or depression on nausea, vomiting, and retching was observed. If the patient experienced more severe stress, higher scores for anticipatory and post chemotherapy nausea, vomiting, and retching were recorded. The tendency was retained after adjusting for the cycle number of chemotherapy, the emetic risk of the chemotherapy regimen, type D personality, anxiety, and depression. Specifically, financial problems, unusual happenings, ordinary daily stress, and general stress were significantly related to nausea, vomiting, and retching. CONCLUSION: Assessment of life stress, especially for financial problems, unusual happenings, and ordinary daily stress of patients receiving cancer chemotherapy can be used as an effective way to reduce the risk of nausea, vomiting, and retching related during chemotherapy.

Comparison Study of Endoscopic Thyroidectomy Versus Robot-assisted Thyroidectomy by a Cervico-transaxillary Approach / 대한내분비외과학회지

PURPOSE: Endoscopic and robot-assisted thyroidectomy has shown rapid development worldwide. In addition, there is no treatment of choice for thyroidectomy as usual. We propose an endoscopic thyroidectomy using a cervico-transaxillary approach, comparing its results with those of robot-assisted thyroidectomy. We present this study in order to provide advantages and disadvantages. METHODS: Between January 2010 and March 2012, 132 patients were recruited with clinicopathological data for this study. We divided patients into two groups, the endoscopic and the robot groups, with respect to their clinical characteristics, surgical outcomes. The outcomes were evaluated in terms of operation time, estimated blood loss, hemovac amount, hospital stay, and number of lymph nodes harvested. RESULTS: A total of 132 patients (male 6 and female 126) were recruited with clinicopathological data for this study. Of these, 78 patients underwent endoscopic thyroidectomy (the endo group) and 54 underwent robot-assisted thyroidectomy (the robot group) using a cervico-transaxillary approach. The two groups did not differ significantly in terms of age, estimated blood loss, and complications. None of the patients experienced severe complications. CONCLUSION: Results of the preliminary comparison in this study show that both approaches are safe and feasible, with similar results. However, a smaller hemovac amount was observed with endoscopic thyroidectomy, compared to robot-assisted thyroidectomy. In order to cut costs, part of robot-assisted thyroidectomy could be replaced by endoscopic thyroidectomy.

Risk Factors of Local Recurrence after Breast Conserving Therapy in Invasive Breast Cancer / 한국유방암학회지

PURPOSE: Twenty-year follow-up results of two pioneering randomized controlled trials have demonstrated equal patient survival after mastectomy and breast conservation therapy. The use of breast conservation therapy has undoubtedly provided substantial progress towards a better quality of life for women with breast cancer. Outcomes of breast conservation therapy performed at Asan medical center were retrospectively reviewed and analyses were performed to determine significant risk factors of local recurrence. METHODS: A total of 578 women with stage I, stage II or stage III breast cancer were treated with conservative surgery and radiation therapy between January 1997 and December 2002. Outcomes of local recurrence and survival were recorded. RESULTS: During a median follow-up of 54.1 months, 21 patients (3.6%) developed local recurrence as first event and 10 patients (1.7%) developed regional recurrence and 19 patients (3.3%) developed systemic recurrence. Univariate analysis of the prognostic factors determined that age (p=0.005), nuclear grade (p=0.013), estrogen receptor negativity (p=0.008), lymphovascular invasion (p=0.009), progesterone receptor negativity (p=0.016) and lack of hormone therapy (p=0.005) were statistically significant factors associated only with locoregional recurrence. Results of multivariate analysis determined that lymphovascular invasion (p=0.045) strongly independent predictors for local recurrence. CONCLUSION: Age, nuclear grade, estrogen receptor negativity, lymphovascular invasion, progesterone receptor negativity and lack of hormone therapy were associated with local recurrence after Breast conserving surgery. The lymphovascular invasion was the strongest independent risk factors for local recurrence.

Correlation between the Her-2/neu Status as Determined by Immunohistochemical Analysis and the Serum Her-2/neu Concentration as Determined by the Use of ADVIA Cencaur(R) Automated Immunoassay in Breast Cancer Patients / 한국유방암학회지

PURPOSE: Serum Her-2/neu is extracted from the extracelluar domain of the Her-2/neu tyrosine kinase to serum. We evaluated the correlation between the Her-2/neu status as determined by immunohistochemical analysis (IHC) and the serum Her-2/neu concentration in a population of Korean women with breast cancer. METHODS: Serum Her-2/neu levels were examined from 254 female patients with primary breast cancer and 38 patients with metastatic breast cancer. Serum Her-2/neu levels were measured by the use of a chemiluminescence immunoassay (ADVIA centaur(R) system) during the preoperative period. The level of Her-2/neu in all of the breast cancer tissue samples was determined by IHC, and samples with an IHC grade +2 were subject to fluorescence in situ (FISH). When tissue samples exhibited IHC grade +3 or showed amplification of Her-2/neu as determined by FISH analysis, Her-2/neu was considered overexpressed. The cut-off value for serum Her-2/neu level was 10.2 ng/mL. RESULTS: The mean serum Her-2/neu level was 10.1 ng/mL in primary breast cancer samples. The serum Her-2/neu concentration significantly correlated with expression of Her-2/neu as determined by tissue IHC analysis (grade 1/3, 9.33+/-1.7 ng/mL; grade 2/3, 8.89+/-1.6 ng/mL; grade 3/3, 12.37+/-4.0 ng/mL, p<0.001). Increased serum HER-2/neu levels were associated with the lymph node status (p=0.003) and hormone unresponsiveness (p<0.001), tumor size (p<0.01) and age group (p<0.001). In metastatic breast cancer samples, the mean serum Her-2/neu level was 13.6 ng/mL. Elevated serum Her-2/neu levels were seen in 71.7% of metastatic breast cancer samples. The serum Her-2/neu level correlated with expression of Her-2/neu in metastatic tissue as determined by IHC analysis (p<0.001) rather than with the Her-2/neu status of the primary breast cancer (p=0.16) CONCLUSION: Serum Her-2/neu appears to be correlate with tissue Her-2/neu expression in primary and metastatic breast cancer where Her-2/neu is overexpressed. Further studies to determine levels of serum Her-2/neu are required to determine cuttoff values and the clinical application of the finding for breast cancer patients in Korea.

The Significance of Periurethral Fibrosis and the Change of Nitric Oxide Synthase Containing Nerves in the Urethra of Diabetic Rats / 대한비뇨기과학회지

PURPOSE: We have previously demonstrated that increased urethral resistance was more prominent in diabetic rats than in controls. This may result from a compressive obstruction such as damage of the urethral nerve containing nitric oxide. Another possible cause for urethral obstruction could be a constrictive obstruction such as a periurethral fibrosis. In the present study, we investigated the changes in the expression of nitric oxide synthase(NOS) isoforms(compressive obstruction) and collagen subtypes (constrictive obstruction) in the urethral tissues of non-insulin dependent diabetic rats. MATERIALS AND METHODS: Thirty-six male Sprague-Dawley rats(18 diabetic rats and 18 control rats), bred from birth, were included in this study. Diabetes mellitus was induced by intraperitoneal administration of streptozotocin(90mg/kg) on the second day after birth. Urethral tissues were harvested at 12, 24 and 36 weeks after induction of diabetes and were stained for neuronal NOS(nNOS) and Masson trichrome. We also performed reverse transcriptase-polymerase chain reaction or Western blot analysis to evaluate mRNA or protein expression of NOS isoforms and collagen subtypes in the urethral tissues. RESULTS: Immunohistochemical staining and Western blot analysis of nNOS revealed that the immunoreactivity and nNOS expression in the urethra was lower in the diabetic rats than in the controls. The Masson trichrome staining showed that there was urethral fibrosis in the diabetic rats. The mRNA or protein expression of collagen subtypes, especially type I collagen, were higher in the diabetic rat urethra than in the controls. CONCLUSIONS: These data suggest that the increased urethral resistance in diabetic rats may be attributable to a decrease in the urethral nNOS expression and an increase in collagen content. Urethral dysfunction as well as a cystopathy may play an important role in the pathogenesis of diabetes- induced voiding dysfunction. (Korean J Urol 2007;48:1050-1057)

Acute Mesenteric Ischemia

PURPOSE: Clinical manifestations of acute mesenteric ischemia (AMI) may be nonspecific and early diagnosis is difficult. Despite advances in diagnostic and surgical techniques, AMI is still associated with high morbidity and mortality due to delayed diagnosis. METHODS: To analyze the causes, diagnosis, and treatment of AMI, as well as the factors affecting prognosis, we retrospectively reviewed 32 patients treated for AMI between 1980 and 2002. RESULTS: There were 19 men and 13 women. The mean age was 61.5+/-15.5 years. The average duration of symptoms was 50.3 hrs (2~168). AMI presented as abdominal pain in 30, and other symptoms included vomiting, hematochezia, and melena. The most commonly associated medical condition was heart disease (valvular disease, arrhythmia, etc.). For diagnosis, conventional angiography was performed in 6, CT in 14 and exploratory surgery in 14. The predictive value of angiography and CT was 100% and 85.7%, respectively. The causes of ischemia were SMA embolism in 11, SMA thrombosis in 8, SMV thrombosis in 7, non-occlusive in 2 and indeterminate in 4. Thirty patients underwent operation. At initial operation, bowel resection was performed in 26 and thromboembolectomy only in 2. Second-look operation was performed in 4. Two patients received radiological interventional treatment; one with urokinase and the other with papaverine. Of 19 arterial ischemia, 6 patients received long term anticoagulation, whereas all 7 patients with SMV thrombosis received long term anticoagulation. The mean F/U was 27.4 mons (1~131). Complications occurred in 16 (53.3%), wound infection in 6, sepsis in 5, short bowel syndrome in 4 and anastomoticsite leakage in 2. Mortality associated with operation occurred in 7 (23.3%). The patients aged over 65 years and with postoperative complication showed higher mortality. CONCLUSION: When mesenteric ischemia is suspected, early CT or angiography and an appropriate surgical approach should be performed to improve the prognosis.