The Predictor of Axillary Lymph Node Metastases in Breast Cancer

BACKGROUND: The presence of axillary lymph node metastases (ALNM) and tumor size are two most important prognostic factors in breast cancer. An axillary lymph node dissection (ALND) is usually performed in infiltrating breast cancer for the information of therapeutic decision and prediction of prognosis. However this procedure results in lymphedema of the affected upper extremity, increased axillary drainage, sensory abnormality, and pain. If the axillary lymph node status could be predicted accurately prior to an ALND, selected patients with a low probability of ALNM could be spared the procedure. The purpose of this study was to determine the association between the incidence of ALNM and 14 clinico-pathologic factors by using univariate and multivariate analysis and to investigate the possibility of using those factors as predictors for ALNM. METHODS: We reviewed data from 253 patients with breast cancer who had undergone at least a level I/II axillary dissection between 1991 and 1998. The association between the incidence of ALNM and 14 clinico-pathologic factors (age, menstruation, tumor size, palpability of tumor, tumor site, pathologic type, nuclear grade, estrogen receptor status, progesteron receptor status, p53, c-erbB-2, Ki67, Cd34, and Cathepsin D) were analyzed by using univariate and, when significant, multivariate analysis. RESULTS: Approximately 38.7% of the 253 patients with breast cancer had ALNM. Univariate analysis showed that ALNM were associated with tumor size (P<0.01), pathologic type (P<0.001), palpability (P<0.01), and nuclear grade (P<0.01). However, independent predictors of ALNM in the multivariate analysis were tumor size and pathologic type. Among the patients with smaller than 1.0 cm in the tumor size and DCIS in the pathologic type, the ALNM was not founded. CONCLUSIONS: We conclude that the characteristics of primary breast cancer can help assess the risk for ALNM. Selected patients, who are assessed to be minimal risk, might be spared a routine ALND, if the treatment decision would not be influenced by the lymph node status.

A Retrospective cohort study on the effect of health counselling through the level of gamma-GTP after screening test / 예방의학회지

1,281 male subjects who had been examined more than 3 times for regular check-up in one human dock center of the university hospital were studied between 1990-1995, to evaluate the effect of health counseling with life style and gamma-GTP value between 1054 normal group without intervention and 227 abnormal group with intervention, ages from 30 to 69 years old. Total mean value of gamma-GTP was 45.7+/-40.7 unit with highest gamma-GTP value in age group 50-59 on initial examination. Total abnormal rate was 17.7% with the highest abnormal rate of 18.6% in age group 50-59. Initially, the value of gamma-GTP was significantly different according to the degree of alcohol intake, relative weight and smoking in normal group(p<0.01) not in abnormal group. In conclusion, the value of gamma-GTP were significantly increasing in normal group without intervention and significantly decreasing in abnormal group with intervention(p<0.05), which suggests the effect of health counseling, such as the recommendation to change the health behaviour.

An analysis of liver function test of preemployment screening for office workers / 예방의학회지

This is to analyze and compare the distribution of the liver function test and its abnormal rates of the preemployment screening for office workers in asymptomatic young age groups between female and male. Liver function test(SGPT and SGOT) of 8,184 young adults(2,633 in female and 5,551 in male) were examined during the period from Jan.1,1994 to Dec. 31, 1994. The results were as follows; 1. Mean level of SGPT was 9.l+/-7.6(IU/L) in female, 21.0+/-27.9(IU/L) in male, and that of SGOT was 15.1+/-6.0(IU/L) in female, 20.5+/-26.5(IU/L) in male. There were significant differences(p<0.01) between female and male in both SPT and SGOT. And also there was significant increasing trend(p<0.05) by age groups in male for SGPT, decreasing trend(p<0.01) in female for SGOT. 2. In the abnormal rates of liver function test by the level of cut-off value, there were significant differences up to twice between the lowest and the highest cut-off value in both female(0.4% vs 0.7%) and male(6.5% vs 12.4%) 3. Abnormal rate of SGPT was 0.4% in female and 6.3% in male, and that of SGOT was 0.2% in female and 1.2% in male with significant differences between female and male in both tests.

The Percieved Health Status of Female Workers and It's Determinants in the Small and Medium Scaled Industries / 한국역학회지

458 female workers working in the small and medium scaled industries in Inchon area were surveyed to study their general characteristics, health behavior, working and environmental conditions, current health status etc. Self-administered questionnaire was developed by authors and distributed to the female workers with the explanation by trained interviewer on the purpose of survey and the method how to answer. The results were as follows: t. General characteristics showed that most(75.3%) of workers were living in their own home, and their age distribution was relatively even from teenagers to the forties. The level of education was high school graduate(including drop-out) in 69.4%, suggesting that the education level of female workers was increasing gradually. The marrital status was 69% in unmarried, and 31% in married state. 2. Survey on their health status showed that more than 20% of female workers complained that they have some kind of disease and most of them complained that they have chronic symptoms more than three kinds. Also, they complained at least two or three symptoms in physical, mental or sensoryneural symptoms respectively. But their medical care utility rate was only 22%. 3. There were no significantly correlated variables between health status and general characteristics(by x2-test). Among the variables on the health behavior, only alcohol drinking was significant to health status. Perceived health status related to the working environment was significantly different to the degree of work satisfaction and awareness for the exposure to harzadous materials. 4. Multivariable analysis showed that work satisfaction, awareness for the exposure to harzadous materials, alcohol drinking, type of employment were significantly related to the physical or mental health index, and also marrital status was to the physical health index. Work satisfaction, awareness for the exposure to harzadous materials, marrital status were related to the sensoryneural health index. Alcohol drinking, work satisfaction, awareness for the exposure to harzadous materials, marrital status were significantly related to the number of complained chronic symptoms. In summary, this study showed that inspite of wide and various range of the general characteristics of female industrial workers in Korea comparing to the past, there was high prevalence of disease due to the poor working conditions and low work satisfaction etc. Therefore, more detailed disease preventive policies or improvement of the work environment, and systematic management to raise the work satisfaction of female workers are urgently needed. And also, occupational health policies increasing the access to health care to provide the adequate health service for the workers who have perceived need are necessary.

A cross-sectional study on prevalence rate and contributing factors of fatty liver diagnosed by ultrasonography / 예방의학회지

Fatty liver is caused by derangement of fat metabolism and can be reversed by removal of contributing factors. The contributing factors of fatty liver is known to be overweight, chronic alcoholism, diabetes mellitus, malnutrition, and drug abuse such as tetracycline. This study was carried out on 1335 persons who visited 'Soon Chun Hyang Human Dock Center' from March to June 1990. In analysis of the data, prevalence of fatty liver diagnosed by ultrasonogram by age and sex, laboratory finding between fatty liver group and normal group, and odds ratio of known contributing factors, were compared. The results obtained are as following; 1) The prevalence rate of fatty liver diagnosed by ultrasonogram is 29.6% in male and 11.5% in female. 2) Age groups with high prevalences are 40~50's in male (32.0%) and 50's in female (24.5%). 3) The fatty liver shows significant association with style (p0.05). 4) All laboratory values except alkaline phosphatase and bilirubin are elevated significantly in accordance with the degree of fatty liver (p<0.01). 5) Fatty liver diagnosed by ultrasonogram showed so strong associations with body index, triglycerides and gamma-glutamyl transferase for males, and body index and fasting blood sugar for females that these factors may be used as supplementary data in establishing diagnosis of fatty liver. 6) Odds ratio of contributing factors are as follows; If the odds ratio of below 29 year of age is 1.0 then that of 30~39 is 1.74 (p=0.33), 40~49 is 2.47 (p=0.10), 50~59 is 2.86 (p=0.0570), over 60 is 1.81 (p=0.34). If the odds ratio of female is 1.0 then that of male is 5.67 (p<0.01). If the odds ratio of body index below zero is 1.0 then that of 0~9 is 5.08 (p<0.01), 10~19 is 12.37 (p<0.01), 20~29 is 29.19 (p<0.01), 30 above is 154.02 (p<0.01). If the odds ratio of below 99 mg/dl FBS is 1.0 then that of 100~120 is 106 (p=0.76), over 120 is 1.91 (p=0.02). If the odds ratio of below 29 micron/1 gamma-GT is 1.0 then that of 30~s59 is 2.11 (p<0.01), 60~90 is 1.87 (p<0.05), 90 above is 1.69 (p=0.15). If the odds ratio of below 149 mg/dl TG is 1.0 then 150~199 is 1.49 (p=0.05), 200~250 is 1.09 (p=0.77), 250 above is 2.53 (p<0.01). In summary, early diagnosis of fatty liver could be made by ultrasonogram supplemented with body index and serum triglyceride. The fatty liver could be preventive by avoiding contributing factors such as obesity, alcohol intake, high blood sugar appropriately.

Relationship of between blood lead level and lead related symptoms in low level lead exposure / 예방의학회지

This study intended to obtain an useful information on the prevalence of subjective symptoms, and to clarify the interrelationships between blood lead and lead related symptoms in low level lead exposure. The 93 male workers exposed to lead and 56 male nonexposed workers were examined for their blood lead (PBB), Zinc-protoporphy (ZPP), hemoglobin (HB) and personal history, and completed 15 questionnaires related to symptoms of lead absorption; also measured lead concentration in air (PBA) in the workplace. The results obtained were as follow; 1. The means of blood lead (PBB), blood ZPP and hemoglobin (HB) among workers exposed to lead were 26.1+/-8.8 microgram/dl, 28.3+/-26.0 microgram/dl and 16.2+/-1.2g/dl; whereas those of nonexposed workers were 18.7+/-5.1 microgram/dl, 20.6+/-8.7 microgram/dl and 17.3+/-1.1g/dl. The means of above three indicies between two groups showed significant difference statistically (p0.05). 3. The most frequently by complained symptom was "Generalized weakness and fatigue", and fewest symptom was "Intermittent pains in abdomen". 4. Only two symptoms out of fifteen symptoms checked by themselves revealed significant difference between exposed and nonexposed groups. These were "Intermittent pains of abdomen" and "Joint pain or arthralgia" (p<0.05). No positive correlation was found between the levels of blood lead and symptom groups categorized as gastrointestinal, neuromuscular and constitutional symptoms. 5. Blood lead (r=0.3995) and ZPP (r=0.2837) showed statistically significant correlation with mean lead concentration in air, whereas correlations were not demonstrated between blood lead and lead related symptoms or blood ZPP and lead related symptoms. 6. Blood lead (PBB) and ZPP showed association (r=0.2466) and the equation PBB=23.75+0.0842 ZPP was derived. 7. On stepwise multiple regression, using blood lead level as a dependent variable and ZPP, hemoglobin (HB), age, work duration (WD) and symptom prevalence as a independent variables, only ZPP significantly contributed a lot to blood lead level. 8. While the ZPP measurement was found to be a good indicator in evaluating health effect of lead absorption in low level lead exposure, lead related symptoms were not sensitive enough to evaluate of lead absorption in low level exposure.