Clinicopathologic Characteristics and Local Recurrence after Skin-sparing Mastectomy with Immediate Reconstruction

PURPOSE: For those women with breast cancer who require mastectomy for surgical treatment, consideration should be given to optimize the cosmetic outcome. Skin-sparing mastectomy (SSM) is being used more frequently to treat many of these patients. Skin-sparing mastectomy can maximize breast skin preservation and facilitate immediate reconstruction, and so result in an excellent cosmetic appearance. The aim of this study was to access the local recurrence rate of breast cancer after SSM. METHODS: A retrospective review was conducted of 53 patients who underwent skin-sparing mastectomy with immediate reconstruction between January 1996 and February 2006. Immediate reconstruction was achieved via the TRAM flap or latissimus dorsi flap or artificial bag. The mean follow-up time was 34.6 months (range: 7~142 months). RESULTS: Local recurrence occurred in 1 (2.1%) of 53 patients. The time to local recurrence was 44 months. The patient with local recurrence was well controlled by wide excision and postoperative chemotherapy and radiotherapy. The patient with local recurrence is still free of disease. Distant metastasis occurred in 7 (14.9%) of 53 patients. Of the 7 patients with distant metastasis, 1 patient was died from brain involvement. CONCLUSION: The risk of local recurrence after skin-sparing mastrectomy was not different from that of conventional mastectomy. Local recurrence was effectively managed with surgical excision of the involved tissues and then administering chemotherapy or radiotherapy.

A Case of Left Ventricular Thrombi in a Patient with Active Ulcerative Colitis and Normal Left Ventricular Systolic Function

Patients with ulcerative colitis(UC) can experience various extraintestinal complications in their course of disease, such as skin lesions, arthritis, cholangitis, ocular manifestation. Thrombosis may occur in 1.2~7.5% of patients, and it is known that the mortality is up to 25%. The sites of thrombosis are usually in deep veins, such as veins of lower extremities, pelvic venous plexus. But, on rare occasion, thrombosis can occur in cerebral veins, and result in cerebral infarct and hemorrhage. It is known that left ventricular(LV) thrombi can be developed when LV dysfunction exists, but it is extremely rare that LV thrombi occur in patients with normal LV function. So far, in patients with UC, there were a lot of cases complicated with venous thrombosis but arterial thrombosis was uncommon. Moreover, there was the only one case of LV thrombi with normal LV function in patient with UC. Accordingly, we report one case of LV thrombi with hemorrhagic cerebral infarct despite normal LV function in a patient with UC.

Bone Mineral Density in Postsurgical Thyroxine Replacement / 대한내분비외과학회지

PURPOSE: Bone turnover is increased in patients suffering with hyperthyroidism, and this results in osteoporosis. Especially after total thyroidectomy for the treatment of thyroid papillary cancer, it is necessary to pay attention to osteoporosis because we must treat these patients with suppressive thyroxine therapy. METHODS: Among the patients who underwent endocrine surgery of Chonnam National University, 110 cases had taken thyroxine for more than one year. We analyzed them on the basis of their medical record. The study consisted of women between 45 and 74 years of age who were treated with thyroxine for more than one year, who had total thyroidectomy performed for thyroid papillary carcinoma and who taken thyroxine for 12~142 months (mean: 53 months). We measured the bone mineral density at the lumbar spine and the femoral neck with using dual energy X-ray absorptiometry. RESULTS: The bone mineral density of the lumbar spine and femur neck was significantly reduced with the increasing the duration of thyroxine medication. Yet this was not significant after adjusting by age. There was correlation between the TSH levels and bone mineral densities. CONCLUSION: After total thyroidectomy, it may be necessary to evaluate the bone mineral density of the patients who were treated with suppressive thyroxine and also to warn them about osteoporosis.

A case of membranous glomerulonephritis induced by lithium / 대한내과학회지

The lithium is widely employed as a psychotropic agent, specially in manic illness. Lithium nephrotoxicity can be divided into three main categories: nephrogenic diabetes insipidus, acute intoxication, chronic nephropathy including interstitial nephropathy and glomerulopathy manifested as nephrotic syndrome. But, nephrotic syndrome induced by lithium is very rare. We reported a nephrotic syndrome induced by lithium in a 27-year-old woman who was taking lithium carbonate for 11 years due to bipolar disorder. Renal biopsy showed membranous nephropathy. After withdrawal of lithium, clinical symptoms and proteinuria significantly improved.