Induction Chemotherapy for Breast Cancer: A case control study

PURPOSE: Preoperative chemotherapy has been extensively used in inoperable or locally advanced breast cancer to achieve tumor reduction and, thus, to facilitate extensive surgery. METHODS: A hospital-based case-control study was carried out to identify the effect of induction chemotherapy on breast cancer. 49 patients with breast cancer were treated with initial chemotherapy between October 1986 and June 1998. 43 patients were treated with three courses of the CMF regimen (cyclophosphamide and metho trexate and 5-fluorouracil), four patients with three courses of the FEC regimen (5-fluorouracil, epirubicine and cyclophosphamide), two patients with three courses of the FAC regimen (5-fluorouracil, adriamycin and cyclophosphamide). RESULTS: The response, rate to induction chemotherapy was 83.7% including 4% complete response, and there were no significant differences in response rates according to the chemo therapy regimen. At a mean follow-up of 51.9 months, recurrence and distant metastasis were observed in 32.7% and 18.4% of the patients, respectively. The five-year disease- free survival rate of the patients in the induction group was lower than that of the patients in the control group (35.5+/-8.7% versus 59.9+/-9.0%), but the five-year overall survival rate in the induction group was higher than control group (88.7 5.3% versus 76.9+/-6.6%). CONCLUSIONS: Preoperative induction chemotherapy is a useful treatment option for patients with locally advanced breast cancer. Also, there is an improvement in the five-year overall survival rate for patients in the induction chemotherapy group compared with that for patients in the age- and stage-controlled postoperative adjuvant chemotherapy group.

Clinical and Immunohistochemical Characteristics of Pancreatic Neuroendocrine Tumor: Immunohistochemical Analysis of 7 Tumors

BACKGROUND: Neuroendocrine tumors of the pancreas are classified according to the endocrine function as insulinomas gastrinomas somatostatinomas, or nonfunctioning tumors. However, the morphologic features are not different from each other. Therefore, we tried to compare correlations among the morphologic features, endocrine function, and the immunohistochemical reaction with specific monoclonal antibodies to the tumors. METHOD: We reviewed the medical records of seven patients with pancreatic neuroendocrine tumors retrospectively, and analysed the clinical manifestations, the methods of diagnosis, the pathological characteristics and the results of surgery. Additionally, we compared the correlation between the clinical manifestations and the expression of immunohistochemical staining by using six different kinds of monoclonal antibodies to each tumor. RESULTS: The seven pancreatic neuroendocrine tumor patients were treated by surgical excision. Four patients had benign insulinomas, two had nonfunctioning malignant tumor and one patient had a benign nonfunctioning tumor associated with stomach cancer. The pattern of immunohistochemical stain of each tumor was not correlate with the clinical manifestations. CONCLUSION: The morphologic study with H & E stain, even with immunohistochemical staining of pancreatic neuroendocrine tumor, cannot support differentiation of the functional diagnoses, such as insulinoma, gastrinoma, somatostatinoma, nonfunctional tumors and so forth.

A Retrospective Study Comparing Clinical Characteristics between

PURPOSE: This study was undertaken to obtain better clinical insights and therapeutic approaches to the diverticular diseases of the colon by identifying the clinical characteristics of the right and left colonic diverticular diseases. METHODS: A retrospective analysis was made of 68 colonic diverticular patients treated between August of 1986 and July of 1997. Right colonic diverticular disease was present in 55 patients, left side disease in eight patients, and bilateral disease in five patients. According to the location of the colonic diverticular disease, various clinical parameters such as the nature of the diverticula, age and sex, diagnostic accuracy, and methods of treatment were assessed. RESULTS: The average age of 68 patients in this study was 50.94 years. Fifty two patients were male and sixteen were female. The disease was far more common in the right colon (80.9%) than the left colon (11.7%) and the right colonic diverticular disease was the most common source of confusion in diagnosis from acute appendicitis. Conservative management was tried in 30 of 35 patients above age 50 and obtained a good result without any complication. CONCLUSIONS: There has been a tendency toward increased incidence of annual colonic diverticular diseases in this study. The right colonic diverticular disease was far more common than the left side disease and the disease was more common in the male. In patients above age 50, initial conservative management is a reasonable approach, although early surgical exploration might be better in younger patients. Acute appendicitis should be ruled out before any treatment decision was made.

Retroperitoneal Duodenal Perforation Following a Endoscopic Sphincterotomy: A case report

The endoscopic sphincterotomy plays an important role in the treatment of common duct stones; however, with a sphincterotomy has the potential hazard of critical complications. Retroperitoneal duodenal perforation during the endoscopic sphincterotomy is a well-recognized complication causing retroperitoneal abscess, sepsis, and sometimes death. We experienced a patient who complained a severe abdominal pain with a febrile sensation after an endoscopic retrograde cholangiopancreatography with sphincterotomy. The diagnosis was delayed, but confirmed by the CT scan, and a duodenal diverticulization with T-tube drainage was performed. The patient was managed by using a duodenal diverticulization with T-tube drainage, but a conservative management is usually effective if the duodenal perforation is recognized immediately and occurs together with uninfected minimal soilage.

Peripheral Artery Aneurysm

Compare to aortic aneurysm, peripheral artery aneurysm is rare but has a tendency of developing multiple arterial aneurysms at the same time. Popliteal artery is the most frequent site of involvement and followed by femoral artery. More than 90% of peripheral artery aneurysms are occurred at these two arteries. Since we have no written nationwide report of peripheral artery aneurysm, we reviewed aneurysms that developed outside of the thoracoabdominal cavity and compared it with western reports. From January 1991 through December 1998, we experienced 19 cases of peripheral artery aneurysms and these included pseudoaneurysms that developed long after vascular trauma. Most frequent ages were 30's and about 3/4 of the patients were male. More than 75% of the patients had symptom of pulsating mass or tender mass when they visited hospital but symptoms associated with mass, such as compression of surrounding structure, were developed in only one patient. Nine cases were developed at femoral arteries and three at popliteal artery and these included 5 cases of pseudoaneurysm. One patient showed multiple arterial aneurysms and 7 patients had atherosclerosis or hypertension. Three cases had Behcet's disease and two of them developed pseudoaneurysm at arterial puncture site and vascular anastomotic site. Most of the aneurysms were excised and performed patch graft, bypass graft or simple closure according to the size of the aneurysm. Three of the patients were died due to myocardial infarction, sepsis and advanced renal failure but aneurysm related mortality was only one who developed sepsis after bypass graft. In summary, we have different incidence of peripheral artery aneurysm in site, multiplicity and presenting symptoms but these are not sufficient because of small limited number of patients. Nationwide report and analysis is necessary.

The Effect of Donor and Recipient Gender on Renal Allograft Survival / 대한이식학회지

The role of the donor and recipient gender have been a controversial point in the outcome of renal transplantation and the pathophysiologic mechanisms are not understood clearly. In order to evaluate the effect of gender on the renal graft survival, we reviewed our 400 consecutive living donor renal transplantation. The patients were divided into four groups, Group 1; male donor and male recipient(n=152), Group 2; female donor and male recipient(n=61), Group 3; male donor and female recipient(n=135), and Group 4; female donor and female recipient(n=52). To estimate the transplant outcome between the groups, we analyzed patient and graft survival, acute tubular necrosis, BUN, creatinine and rejection episode for maximum 5 years after transplantation. The level of BUN(34.7+/- 26.4, 19.8+/- 6.4, 30.5+/- 14.6, 23.1+/- 10.5 in group 1,2,3,4 respectively) and serum creatinine(2.62+/- 2.3, 1.48+/- 1.1, 2.24+/- 1.2, 1.65+/- 0.9 in group 1,2,3,4 respectively) were higher in male recipient groups regardless of donor gender. However, donor and recipient gender had no influence on post-graft blood pressure and acute tubular necrosis(p>0.05). Acute rejection episode was predominent at female donor graft than male donor graft(36.4% vs 30.1%). The 5 year graft survival in group 1,2,3,4 were 67.8, 67.2, 60.1, 72.7% and patient survival were 76.9, 75.6, 72.6, 80.5% in their orders. These results suggest that donor and recipient gender might play a role in the outcome of renal transplantation. The mechanism of these results must be analyzed by further evaluation using larger patient group.

The Effect of Donor and Recipient Gender on Renal Allograft Survival / 대한이식학회지

The role of the donor and recipient gender have been a controversial point in the outcome of renal transplantation and the pathophysiologic mechanisms are not understood clearly. In order to evaluate the effect of gender on the renal graft survival, we reviewed our 400 consecutive living donor renal transplantation. The patients were divided into four groups, Group 1; male donor and male recipient(n=152), Group 2; female donor and male recipient(n=61), Group 3; male donor and female recipient(n=135), and Group 4; female donor and female recipient(n=52). To estimate the transplant outcome between the groups, we analyzed patient and graft survival, acute tubular necrosis, BUN, creatinine and rejection episode for maximum 5 years after transplantation. The level of BUN(34.7+/- 26.4, 19.8+/- 6.4, 30.5+/- 14.6, 23.1+/- 10.5 in group 1,2,3,4 respectively) and serum creatinine(2.62+/- 2.3, 1.48+/- 1.1, 2.24+/- 1.2, 1.65+/- 0.9 in group 1,2,3,4 respectively) were higher in male recipient groups regardless of donor gender. However, donor and recipient gender had no influence on post-graft blood pressure and acute tubular necrosis(p>0.05). Acute rejection episode was predominent at female donor graft than male donor graft(36.4% vs 30.1%). The 5 year graft survival in group 1,2,3,4 were 67.8, 67.2, 60.1, 72.7% and patient survival were 76.9, 75.6, 72.6, 80.5% in their orders. These results suggest that donor and recipient gender might play a role in the outcome of renal transplantation. The mechanism of these results must be analyzed by further evaluation using larger patient group.

Effect of External Beam Irradiation on Intimal Hyperplasia in Autografted Femoral Artery of Dog

BACKGROUNDS: It is well known that intimal hyperplasia is one of the most important cause of vascular graft failure in angioplasty, autogenous venous graft and prosthetic bypass graft. Clinical trials of drugs including antiplatelet agents, anticoagulant, corticosteroid, cyclosporine and prostaglandin were not satisfactory in suppressing intimal hyperplasia. Seeding of endothelial cell also have been done for this purpose with some success. There are several reports that endovascular low dose irradiation and external beam irradiation might reduce the amount of proliferative neointima after arterial injury. METHODS: In order to evaluate the effect of external beam irradiation on intimal hyperplasia in grafted vessel, femoral artery autografts using external jugular vein were performed in dogs, and studied the morphological finding under microscope and compared intimal hyperplasia between control and radiated groups. Group I (control) was not irradiated after graft. But experimental groups were irradiated with 6 Mev electron: Group II, 800 cGy on day 1; Group III, 400 cGy on day 1 and day 4 each; and Group IV, 800 cGy on day 4. Radiation efficacy on intimal hyperplasia was histologically assessed by measuring neointimal thickness at the proximal and distal site of grafted vessel at 6 weeks after graft. RESULTS: Mean neointimal thickness in all irradiated groups were significantly lesser than control group (p0.05). CONCLUSION: These data suggest that low dose external beam irradiation might suppress intimal hyperplasia in grafted vessel, but further study will be necessary to determine optimal dose and timing of radiation delivery, and its efficacy in long segment bypass graft.

Glomus Tumor in Radial Artery: A case report

Glomus tumor, a rare benign vascular tumor arising from the neuromyoarterial apparatus, is usually located at the tip of digits, especially at subungual region. Most of this tumor present typical symptoms such as hypersensitivity to cold, severe pain and point tenderness but frequently misdiagnosed as neuroma, gout or causalgia. Concerning about the origin of the glomus tumor, there were few written reports about extra-digit vascular origin glomus tumor especially that occurred at forearm artery. Recently we experienced a glomus tumor which arised at forearm radial artery and reported with review of literatures. A 31-year-old female admitted to our department with pulsating, slow growing, tender mass at her left forearm for about 1 year. After diagnostic evaluation of ultrasonography and magnetic resonance angiography, surgical resection was performed under the diagnosis of radial artery aneurysm but the histologic final diagnosis made by special immunohistochemical stains was glomus tumor originated from radial artery. The postoperative course was uneventful up to 2 years of follow up.

Reclassification of the Medullary Carcinoma and It's Clinical Characteristics / 대한암학회지

PURPOSE: Reclassfication of the medullary carcinoma using a strict histologic criteria and analysis of the clinical and pathological characteristics of the medullary carcinoma. MATERIAL & METHODS: Thirty-seven cases of the breast carcinoma originally diagnosed as medullary carcinoma were reviewed. One to ten microscopic slides of each case were reexamined and reclassified using the strictly defined histologic criteria defined by Ridolfi et al. Tumors were excluded from the category of the typical medullary carcinoma (TMC) on the basis of presence of glandular features, focal marginal infiltrations, or sparse mononuclear infiltrations. Tumor with two or more atypical features, or extensive marginal infiltrations, no mononuclear cell infiltration and/or less than 75% syncytial growth were classified as infiltrating ductal carcinoma with medullary feature (IDC). A predominantly syncytial growth pattern (75% or more) was requisite for inclusion in both TMC and atypical medullary carcinomas (AMC). RESULTS: Twenty-two tumors (60%) fulfilled the criteria for TMC, and 12 tumors (32%) were AMC and three tumors (8%) were IDC. TMC occupied 3.1% of breast cancer. The mean age of patients with TMC was 45.4+/-11.2 years and the average size of the tumor in TMC was slightly larger than that of breast cancer in general, although not statistically significant. The frequency of lymph node metastasis in TMC was similar to breast cancer in general. Five year survival of patients with TMC was 95.5% which was significantly better than breast cancer in general. CONCLUSION: The TMC occupied 3.1% of breast cancer. The mean age of patient, tumor size and lymphnode metastasis were not different from that of breast cancer but 5 years survival of patient with TMC was significantly better than breast cancer in general.

Morphological Analysis of Intimal Hyperplasia in Allografted Aorta of Rat

Intimal hyperplasia, an abnormal migration and proliferation of vascular smooth muscle cells with associated deposition of extracellular connective tissue matrix, is a chronic structual changes occuring in denuded arteries, arterialized vein and prosthetic bypass graft. This is one of the most important cause of vascular graft failure within the first year after operation. Certain growth factors, particularly basic fibroblast growth factor, transforming growth factor- , and platelet-derived growth factor, are believed to be the cause of the smooth muscle cell proliferation and migration. This smooth muscle cell proliferation and collagen deposition eventually produce intimal thickening with subsequent stenosis or occlusion of the vascular lumen. In order to evaluate the serial changes of injured vessel wall, aortic patch allograft was done in rat, and studied the morphological finding at 1 day, 1, 2, 6, and 8 weeks after graft. The results were summerized as follows; (1) During the early phase after graft, no significant wall changes were seen in the region of the anastomotic site except the presence of acute inflammatory cells with platelet aggregation and thrombus formation. (2) The intimal thickening was apparent by 1 week and was predominantly composed of smooth muscle cells. At the 2 weeks after graft, endothelial cells were partially regenerated to cover the patch graft, and intimal hyperplasia was composed of a mixture of smooth muscle cells and extracellular matrix, mostly collagen. (3) Six weeks after graft, prominent features were production and deposition of collagen rather than proliferation of smooth muscle cells. Reendothelialization over the thickened intima was seen at 8 weeks and the propagation of intimal hyperplasia to adjacent intima of normal vessel was also noted. In conclusion, intimal hyperplasia after vascular injury seemed to be a progressive response of the proliferation and migration of smooth muscle cells and this result might be used for further study about the suppression of intimal hyperplasia.

Causes of Failed Internal Arteriovenous Fistula and Their Salvage Procedures

Adequate vascular access is essential for hemodialysis and Cimino type arteriovenous fistula is the solution for this purpose. But even after we made that fistula, we faced with early fistula failure in about 5~15% of these internal fistula and about 10% drop of fistula patency during the follow up each year. In order to select adequate salvage procedures after fistula failure, we analyzed the causes of failure and compared the result of salvage procedures performed in 423 re-arteriovenous fistula cases which were done between March 1983 through February 1996 in the Department of Surgery Dongsan Hospital, Keimyung University. In early failure cases, poor arterial flow(51.4%) and missed proximal obstruction of fistulated vein before fistula creation(20.9%) were two most common causes of failure but in late failure, stricture and thrombosis were leading causes(81.4%). In the case of repeated arteriovenous fistula, usage of proximal artery showed less early failure rate(5.6%) than opposite radial or ulnar artery(14.8%). This is especially true in patient with diabetes, collagen disease or obesity. Both repeat arteriovenous fistula and salvage procedure showed more early fistula rate and less mean patency compare with primary fistula. Among the salvage procedures of late onset fistula failure, patch graft and bridge graft showed less failure rate(7.1% and 8.3% each) compared with balloon angioplasty(60.0%) or thrombectomy(25.0%). Thrombosis or occlusion at around the fistula site can be managed by performing new fistula using the arterized vein and artery 1~2 cm proximal to the previous fistula. In summary, salvage procedure in the failed arteriovenous fiatula should be chosen according to their failure causes and onset time.