Clinical Features of Breast Cancer without Axillary Lymph Node Metastasis

PURPOSE: Axillary dissection has, for many years, maintained its role as the primacy surgical therapy for invasive breast carcinomas for many years. However, with the advent of screening mammography, more breast cancers are detected at an earlier stage and are apparently confined to the breast without nodal involvement. Therefore, axillary node dissection may no longer be considered to be the standard treatment for all patients with invasive breast cancer. METHODS: We reviewed the case histories of 404 patients with breast cancer who had been treated at the Department of Surgery, Samsung Medical Center between Jan 1997 and Dec 1998. Two-hundred two of those patients had negative nodal involvement. Clinical and pathological results were compared between node negative and node positive cases and the results were analyzed by using the chi-square test. RESULTS: The peak age of the patients was in the forties but premenopausal patients were more frequent in node negative patients than in nodal involvement patients. More node negative patients than node-positive patients had tumor mass less than 2 cm in size in node-negative patients invasive carcinomas were less frequent than in node-positive patients, but and special type with good prognostic histology and intraductal carcinomas were found more frequently. Lymphatic or vascular invasions were less frequent (4.5%) in the node negative group than in the node positive group (33.5%). Tumors located in the upper outer quadrant were less frequent in node negative cases than in node positive cases. Breast conservation surgery was performed more frequently in node negative cases than in node positive cases. Symptoms and signs, mammographic findings, hormonal receptor status and C-erbB2 & p53 were not associated with nodal status. In node negative patients, the estrogen receptor status and the histologic or nuclear grade were linearly correlated in this study. CONCLUSION: Compared to node positive breast cancer, age, tumor size, histologic type, and lymphovascular invasion were different in node negative malignancies. The characteristics of the primary tumor can be helpful to assess the risk for axillary node metastasis.

Clinical Analysis of Total Colectomy for Chronic Idiopathic Constipation

The aim of this study was to analyse clinical feature and outcome of patients following total abdominal colectomy and ileorectal anastomosis. METHODS: All of 8 patients subjected to surgery during 5 year period from May 1995 to December 1999 were reviewed using retrospective method. RESULTS: All patients had slow colonic transit and 7 patients (male to female, 1:1.6) with a mean age of 54 (range, 27~70) years underwent total abdominal colectomy and ileorectal anastomosis and one patient had right hemicolectomy. Major symptoms were abdominal pain and bloating and mean bowel action was 18.5 days, mean suffered time before operation was 26.3 years. Colonic transit study, defecography and rectal manometry were done in all cases. Pelvic floor dysfunction was combined in 5 patients. Median follow up was 2.7 years. There was one mortality case due to postoperative pneumonia and ARDS in a 70 year old patient. Except one mortality case, there was significant success rate, overall 71%. CONCLUSIONS: Colectomy with ileorectal anastomosis produces a satisfactory outcome in the majority of patients undergoing surgery for chronic idiopathic constipation.

Clinical Experience with Combination of Selective Embolization and Surgery for Treatment of Congenital Vascular Malformation(CVM)

As for treatment of congenital vascular malfomation (CVM), intra-arterial embolization provide transient symptomatic relief but recurrence of the lesion occurs in most cases and surgical excision alone has great potential risk such as massive bleeding, functional deformity and explosive recurrence. Combination of selective embolization of vascular pedicle and immediate surgical excison offers the best chance for definite results. We report here two cases of sucessful treatment of CVM with combination of N-butyl-2-cyanoacrylate (NBCA) glue in embolization and surgery.