Prognostic influences of B-cell lymphoma 2–positive expression on late recurrence in breast cancer

Purpose@#B-cell lymphoma 2 (BCL2) has an antiapoptotic role, however, has resulted in it being a powerful favorable prognostic factor in breast cancer. Several studies revealed BCL2 is strongly associated with a lower rate of early recurrence after initial treatment in breast cancer patients, but study of a prolonged effect after 5 years is lacking. We investigated BCL2 as a prognostic factor in breast cancer in comparison to early and late recurrence. @*Methods@#We retrieved data from 2,198 patients with primary breast cancer who underwent surgical treatment and adjuvant treatment at the breast cancer center between 2005 and 2015. Each molecular subtype was classified, and Ki-67 and BCL2 were also assessed by immunohistochemistry. BCL2 and the association between molecular subtypes were assessed in early and late recurrences, respectively. Five-year postrecurrence survival and BCL2 were also assessed. @*Results@#The BCL2-positive group was associated with favorable clinicopathologic characteristics. The time to recurrence was significantly longer in the BCL2-positive group (P = 0.035). Late recurrence after 5 years was higher in the BCL2-positive group (P = 0.029). In multivariate survival analysis, tumor size and BCL2-positive expression were the only independent prognostic factors for late recurrence (P = 0.004). In the patients with recurrence, 5-year postrecurrence survival was significantly higher in the BCL2-positive group (P < 0.001). @*Conclusion@#Our result showed that prognosis was better in BCL2-positive patients compared to BCL2-negative patients at late recurrence. We suggested that BCL2 expression could be used as a marker to help determine additional adjuvant therapy or extended hormone therapy in hormone-dependent breast cancer.

Metastatic breast cancer from a hepatocellular carcinoma: a case report

Breast metastases from extramammary malignancies are rare. Here, we report a case of breast metastasis from hepatocellular carcinoma (HCC) after breast mass excision in a 63-year-old woman. A new breast nodule was noticed after transarterial chemoembolization, transarterial radioembolization, and stereotactic body radiation therapy for HCC. Breast ultrasound and core needle biopsy were performed to differentiate between the breast tumors. The biopsy result was invasive breast carcinoma, and wide excision of the breast was performed. The final pathological diagnosis was HCC breast metastasis based on histological findings and immunohistochemical staining results. After 9 months of follow-up, HCC and breast metastasis recurred. Despite palliative treatment, the patient died due to complications and general health deterioration. Although breast metastasis due to HCC is very rare, HCC breast metastasis should be considered when a new breast mass is discovered in a patient with a history of HCC for effective treatment and management.

Efficacy of Post-Operative Medication to Prevent Recurrence of Endometrioma: Cyclic Oral Contraceptive (OC) After Gonadotropin-Releasing Hormone (GnRH) Agonist Versus Dienogest

Background@#There are several medical treatment options for endometrioma. Progestin, especially dienogest, is an effective drug for preventing recurrence of endometrioma after surgery. Additionally, oral contraceptive (OC) use after conservative surgery has been reported to reduce significantly the risk of endometrioma recurrence. The aim of this study was to compare the long-term effects of gonadotropin-releasing hormone (GnRH) agonist followed by OC to those of dienogest alone to prevent recurrence of endometrioma after laparoscopic surgery. @*Methods@#A retrospective cohort study was performed on patients who underwent conservative laparoscopic surgery for endometrioma between January 2000 and December 2020, in the Endometriosis Clinic, Department of Gynecology, Samsung Medical Center. A total of 624 patients who received medical treatment at least six months after laparoscopic conservative surgery for endometrioma was included. Among them, 372 patients used OC after GnRH agonist therapy, and 252 patients used dienogest. Within the OC group, 148 used a 21/7 regiment and 224 used a 24/4 regimen. A cumulative endometrioma recurrence curve was presented using the Kaplan-Meier method to compare the recurrence of those groups. @*Results@#The cumulative recurrence rate of endometrioma for 60 months was 2.08% (n = 4) in the OC after GnRH agonist group and 0.40% (n = 1) in the dienogest group. There was no statistical difference in cumulative recurrence of endometrioma between the two groups. In subgroup analysis, the cumulative recurrence rate of endometrioma over 60 months was 4.21% (n = 2) in the 21/7 OC group and 1.09% (n = 2) in the 24/4 OC group and showed no significant difference. @*Conclusion@#Long-term use of OC after GnRH agonist as well as that of dienogest treatment are effective postoperative medical therapies for preventing endometrioma recurrence. Thus, the choice of regimen can be individualized or used interchangeably depending on patient condition, need for contraception, and compliance with drug therapy.

Eosinophilic Mastitis: A Case Report

Eosinophilic mastitis is a rare disease in which eosinophils infiltrate the ducts and lobules of the breast, causing mammary inflammation. Although eosinophilic mastitis is a benign condition, it presents similarly to and is often mistaken for breast cancer. Here we report the first case of eosinophilic mastitis in Korea. A 43-year-old woman presented with redness and swelling in her right breast. A breast ultrasound revealed ill-defined isoechoic and hyperechoic areas in the upper half and lower inner quadrant of the right breast combined with axillary level I lymphadenopathy. A histopathological examination by core needle biopsy demonstrated lymphoplasma cell infiltration with eosinophils. A peripheral blood examination revealed an eosinophil count of 5,000/mm³. The patient was treated with oral steroids, antibiotics, and leukotriene receptor antagonists. Four months later, the eosinophil count had returned to normal, and breast ultrasound exhibited marked improvement.

A population-based observational study of patients with pulmonary disorders in intensive care unit

Background/Aims@#Only a few epidemiologic studies on the patients with pulmonary disorders admitted to intensive care unit exist. We investigated the characteristics and clinical outcomes of the patients with severe pulmonary disorders. @*Methods@#The sample cohort database of National Health Insurance Sharing Service from 2006 to 2015 was used. Operational definition of critically ill patients was adults who were either admitted to intensive care unit for at least 3 days or expired within first 2 days in the unit. The pulmonary disorder group comprised of critically ill patients with respiratory disease as the main diagnosis. @*Results@#Among the 997,173 patients, 12,983 (1.3%) in 383 intensive care units were categorized as critically ill. Patients in the pulmonary disorder group tended to have more comorbidities or disabilities. The length of hospital stay and duration of mechanical ventilation were longer in the pulmonary disorder group. Overall mortality and re-admission were higher in the pulmonary disorder group, with adjusted incidence rate ratios of 1.22 (95% confidence interval, 1.18 to 1.27) and 1.26 (95% confidence interval, 1.17 to 1.36), respectively. After adjustment by Cox regression, the pulmonary disorder group was an independent risk factor for in-hospital mortality. @*Conclusions@#In critically ill patients with pulmonary disorder, the use of healthcare resources was higher, and their clinical outcomes were significantly worse than the non-pulmonary disorder group.

The Effects of Korean DASH Diet Education Program on Oxidative Stress, Antioxidant Capacity, and Serum Homocysteine Level among Elderly Korean Women

PURPOSE: The purpose of this study was to investigate the effects of the Korean Dietary Approaches to Stop Hypertension (DASH) education program on oxidative stress, antioxidant capacity, and serum homocysteine (Hcy) level in elderly Korean women. METHODS: This was a quasi-experimental study employing non-equivalent control group pretest-posttest design. The DASH group (n=27) underwent the DASH education program for 12 weeks, whereas the control group (n=21) was provided one education session. The survey was conducted before and after the intervention period. RESULTS: In DASH group, monounsaturated fatty acid (MUFA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) intakes significantly increased after the intervention as compared to prior to the intervention. No significant differences were found in the control group. After the intervention, thiobarbituric acid reactive substance (TBARS) and Hcy levels significantly decreased in the DASH group but not in the control group. CONCLUSION: The DASH education program was effective in reducing oxidative stress and Hcy levels in elderly Korean women.

Granular Cell Tumor of the Thyroid Gland: A Case Report and Review of the Literature / 대한내분비외과학회지

Granular cell tumor (GCT) is a rare tumor of Schwann cell origin. While this tumor can occur anywhere in the body, GCT of the thyroid gland is very rare. This tumor is benign, despite showing grossly and histologically malignant features, and should be differentiated from oncocytic/Hurthle cell neoplasm and medullary carcinoma of thyroid. Immunohistochemistry can confirm the final diagnosis and differentiate from other tumors and cell types. We report on a GCT of thyroid in a 46-year-old woman with medical history of right breast cancer and review of literatures.

Poor nutrition and alcohol consumption are related to high serum homocysteine level at post-stroke

BACKGROUND/OBJECTIVES: Increased serum homocysteine (Hcy) levels have been reported to be related to the occurrence of cardio- and cerebrovascular diseases. High serum Hcy levels are also related to the development of secondary stroke and all-cause mortality. The purpose of this study was to investigate the prevalence of high serum homocysteine level and relating factors, and the change over the 10 month period post-stroke. SUBJECTS/METHODS: Consecutive stroke patients who were admitted to the Asan Medical Center were enrolled. Ten months after the onset of stroke, an interview with a structured questionnaire was performed and blood samples were obtained for the biochemical parameters. Nutritional status was determined using the mini nutritional assessment (MNA) score and dietary nutrient intakes were also obtained using a 24 hour recall method. RESULTS: Out of 203 patients, 84% were malnourished or at risk of malnutrition, and 26% had high homocysteine levels at 10 months post-stroke. Using logistic regression, the factors related with high homocysteine levels at 10 months post-stroke included heavy alcohol consumption (P = 0.020), low MNA scores (P = 0.026), low serum vitamin B12 (P = 0.021) and low serum folate levels (P = 0.003). Of the 156 patients who had normal homocysteine levels at admission, 36 patients developed hyperhomocysteinemia 10 months post-stroke, which was related to heavy alcohol consumption (P = 0.013). Persistent hyperhomocysteinemia, observed in 22 patients (11%), was related to male sex (P = 0.031), old age (P = 0.042), low vitamin B6 intake (P = 0.029), and heavy alcohol consumption (P = 0.013). CONCLUSION: Hyperhomocysteinemia is common in post-stroke, and is related to malnutrition, heavy alcohol drinking and low serum level of folate and vitamin B12. Strategies to prevent or manage high homocysteine levels should consider these factors.

Factors Affecting Nursing Students' Practice of Patient Safety Management in Clinical Practicum / 간호행정학회지

PURPOSE: This study was done to assess nursing students' practice of patient safety management (PSM), identify factors affecting PSM and provide basic data to develop education programs to strengthen students' competencies for patient safety. METHODS: In this descriptive research the practice of PSM by nursing students was examined and predictive factors were identified. Participants were junior and senior nursing students from 7 universities in 7 cities. Self-report questionnaires were used for data collection. RESULTS: Significant positive correlations were found between knowledge of PSM, perception of the importance of PSM and practice of PSM. In multivariate analysis, women students, participation in patient safety education in school, knowledge of PSM, and practice of PSM predicted high perception of the importance of PSM. In multivariate analysis, senior year and participation in patient safety education in school predicted higher knowledge of PSM. In multivariate analysis, perception of the importance of PSM predicted high practice of PSM. CONCLUSION: In this study, knowledge was not found to directly affect PSM practice, but was found to affect the perception of the importance of PSM, a significant predictive variable. Thus, the importance of PSM should be strongly emphasized during education.

The effects of the DASH diet education program with omega-3 fatty acid supplementation on metabolic syndrome parameters in elderly women with abdominal obesity

BACKGROUND/OBJECTIVES: The purpose of this study was to investigate the overall effects of a tailored Dietary Approaches to Stop Hypertension (DASH) nutritional intervention program which included omega-3 fatty acids supplementation, on dietary self-efficacy, dietary knowledge, and dietary behaviors in Korean elderly women with abdominal obesity. Furthermore, we investigated the effects of the program on metabolic syndrome parameters including the antioxidant capacities in these subjects. SUBJECTS/METHODS: A randomized, controlled trial was conducted for 8 weeks. The experimental group (n = 21) received a weekly tailored nutritional program for 8 weeks and the control group (n = 18) received only one educational session. The clinical survey was conducted before and after the intervention period. RESULTS: After the intervention, dietary self-efficacy (P = 0.023), frequency of fruit intake (P = 0.019), and dietary fiber intake (P = 0.044) were higher in the experimental group than in the control group. The oxidative stress (P < 0.001) was lower in the experimental group than in the control group. Moreover, low density lipoprotein (LDL) cholesterol (P = 0.023) had significantly decreased in the experimental group but not in the control group after the intervention. CONCLUSIONS: The intervention program including omega-3 fatty acid supplementation had a positive effect on dietary self-efficacy, dietary behaviors, and oxidative stress among aged women with abdominal obesity.

The effects of the DASH diet education program with omega-3 fatty acid supplementation on metabolic syndrome parameters in elderly women with abdominal obesity

BACKGROUND/OBJECTIVES: The purpose of this study was to investigate the overall effects of a tailored Dietary Approaches to Stop Hypertension (DASH) nutritional intervention program which included omega-3 fatty acids supplementation, on dietary self-efficacy, dietary knowledge, and dietary behaviors in Korean elderly women with abdominal obesity. Furthermore, we investigated the effects of the program on metabolic syndrome parameters including the antioxidant capacities in these subjects. SUBJECTS/METHODS: A randomized, controlled trial was conducted for 8 weeks. The experimental group (n = 21) received a weekly tailored nutritional program for 8 weeks and the control group (n = 18) received only one educational session. The clinical survey was conducted before and after the intervention period. RESULTS: After the intervention, dietary self-efficacy (P = 0.023), frequency of fruit intake (P = 0.019), and dietary fiber intake (P = 0.044) were higher in the experimental group than in the control group. The oxidative stress (P < 0.001) was lower in the experimental group than in the control group. Moreover, low density lipoprotein (LDL) cholesterol (P = 0.023) had significantly decreased in the experimental group but not in the control group after the intervention. CONCLUSIONS: The intervention program including omega-3 fatty acid supplementation had a positive effect on dietary self-efficacy, dietary behaviors, and oxidative stress among aged women with abdominal obesity.

Laparoscopic Primary Closure: A Better Method of Treatment in Perforated Peptic Ulcer Disease than Open Repair

PURPOSE: Perforation is a dreadful complication of peptic ulcer disease requiring immediate management. This study examined the feasibility of laparoscopic primary closure in perforated peptic ulcer disease to allow an earlier return to normal life. METHODS: This study reviewed our experience retrospectively with 72 consecutive patients treated with the simple closure of a perforated peptic ulcer disease in our hospital from December 2002 to January 2011. Thirty five patients were treated laparoscopically and the rest underwent open surgery. The operative time, nasogastric tube utilization, abdominal drain usage, time to oral feeding, hospital stay, postoperative complications and recurrence in both groups were compared. A student's t-test was used to make the comparisons. A p value<0.05 was considered significant. RESULTS: The operative time, use of nasogastric tubes, and abdominal drainage were similar in both groups. After laparoscopic surgery, the patients showed an earlier return to normal oral feeding and discharge than the open surgery group (4.17+/-0.62 vs. 5.03+/-2.34 days, p=0.040, 8.63+/-1.96 vs. 10.24+/-3.59 days, p=0.021, respectively). The decreased handling of tissue in laparoscopic surgery led to less wound infection (0 in laparoscopic surgery vs. 3 in open) and postoperative ileus (0 vs. 2). CONCLUSION: Laparoscopic repair of a perforated peptic ulcer is a safe and feasible treatment that offers early oral feeding and a shorter postoperative hospital stay.

Malignant Peripheral Nerve Sheath Tumor of the Breast in a Patient without Neurofibromatosis: A Case Report / 한국유방암학회지

Malignant peripheral nerve sheath tumors (MPNSTs) are malignant variants of peripheral nerve sheath tumors that develop at major or minor peripheral nerve branches or at the sheaths of peripheral nerve fibers. These tumors are derived from Schwann cells or pluripotent cells of a neural crest origin. Malignant tumors of the peripheral nerve sheath are most commonly seen in deeper soft tissues, and usually in the proximity of a nerve trunk. MPNSTs of the breast are very uncommon and they have rarely been reported on. We report here on a case of MPNST of the breast in a 59-year-old female who presented with a painless breast lump for two months. The excisional biopsy revealed a malignant peripheral nerve sheath tumor based on the microscopic findings and immunohistochemical staining. We performed wide excision of breast tissue around the biopsy site and thereafter the patient underwent radiation therapy. The patient remains well without signs of recurrence 1 year following surgery.

An Endobronchial Metastasis from Breast Cancer Seven Years after Modified Radical Mastectomy: A Case Report / 한국유방암학회지

A 39-year-old woman was admitted to our hospital because of her chronic cough. She had undergone modified radical mastectomy for breast cancer 7 year before admission. A chest radiograph showed collapse of the left upper lobe (LUL) and computed tomography of the chest revealed a mass in the proximal portion of the LUL bronchus and distal atelectasis. Bronchoscopy showed obstruction of the LUL bronchus. The microscopic examination showed findings consistent with breast cancer with the same immunohistochemical features for the hormone receptors, as compared to those features of the previously resected tumor. Positron emission tomography showed increased fluorodeoxyglucose uptake only in the LUL. Left upper lobectomy was performed and she is now undergoing systemic chemotherapy. We report here on this rare case to emphasize that when a patient with a history of breast cancer complains of respiratory symptoms, and even though the patient was treated curatively a long time ago, we should suspect the possibility of endobronchial metastasis.

DNA Methylation and Expression Patterns of Key Tissue-specific Genes in Adult Stem Cells and Stomach Tissues

CpG-island margins and non-island-CpG sites round the transcription start sites of CpG-island-positive and -negative genes are methylated to various degrees in a tissue-specific manner. These methylation-variable CpG sites were analyzed to delineate a relationship between the methylation and transcription of the tissue-specific genes. The level of tissue-specific transcription was estimated by counting the number of the total transcripts in the SAGE (serial analysis of gene expression) database. The methylation status of 12 CpG-island margins and 21 non-island CpG sites near the key tissue-specific genes was examined in pluripotent stromal cells obtained from fat and bone marrow samples as well as in lineage-committed cells from marrow bulk, stomach, colon, breast, and thyroid samples. Of the 33 CpG sites examined, 10 non-island-CpG sites, but none of the CpG-island margins were undermethylated concurrent with tissue-specific expression of their nearby genes. The net methylation of the 33 CpG sites and the net amount of non-island-CpG gene transcripts were high in stomach tissues and low in stromal cells. The present findings suggest that the methylation of the non-island-CpG sites is inversely associated with the expression of the nearby genes, and the concert effect of transitional-CpG methylation is linearly associated with the stomach-specific genes lacking CpG-islands.

Malignant Fibrous Histiocytoma in the Breast: A Case Report / 한국유방암학회지

Malignant fibrous histiocytoma is the most common form of soft tissue sarcoma during middle and late adulthood in the deep connective tissues of the extremities, abdominal cavity, and retroperitoneum. Primary breast sarcoma is a rare disease entity, comprising less than 1% of all breast malignancies. Malignant fibrous histiocytoma of the breast is very rare. We presented one case of a malignant fibrous histiocytoma of the right breast in a 49-year-old woman and report the case with a review of the literature.

Choledochocele Associated with Recurrent Pancreatitis in an Adult

Choledochocele is a rare cystic dilatation of the distal common bile duct in the wall of the duodenum. It is a type III choledochal cyst among the five types according to Todani's modification of the Alonso-Lej classification, and this type lll cyst comprises less than 4% of all choledochal cysts. We experienced one case of choledochocele in a 41-year-old woman who presented with recurrent pancreatitis, and we report on this case, along with a review of the literature.

A Review of the Classification of the Practice Characteristics and the Physicians' Work in Vascular Surgery

PURPOSE: Since the medical insurance system was started in Korea, there has been an imbalance in the medical charges among the procedural items of special departments. For correcting this problem, the Resource-based Relative Value Scale (RBRVS) was introduced to determine the relative values of physician services and practices. The RBRVS is the prevailing model used today to describe, quantify and reimburse physicians for their services. In this study we attempted to clarify the relative values of the practice characteristics in vascular surgery and evaluate the propriety compared with the relative value unit (RVU) of the American Medical Association (AMA). METHOD: The classification of practice characteristics in vascular surgery was compared with that of the AMA. The propriety of physicians' work was measured according to the Korean and American physicians' work. The rate more than 70, between 50 to 69, and less than 49 were used to decide over-, proper- or under-estimation, respectively. RESULT: The ratio of the number of practice characteristics in Korean and American vascular surgery was 1:3.31 (97:321). The over-, proper- or under-estimated physicians' work among the identical American practice characteristics was 8/46 (17.4%), 19/46 (41.3%) and 19/46 (41.3%) respectively. CONCLUSION: Our results demonstrated that the practice characteristics of Korean vascular surgery are not sorted by detail and a large percentage of physicians' work (41.3%) is under-estimated. Therefore, reasonable payment for physician services or practices can not be determined for Korean vascular surgery.

Surgical Treatments for Takayasu's Arteritis

PURPOSE: Takayasu's arteritis (TA) is a chronic inflammatory, stenotic or aneurysmal disease of an unknown etiology. TA occurs worldwide, but it disproportionately affects young females of Asian descent. TA is known to affect a variety of vessels, but the subclavian artery, axillary artery, carotid arteries and infraabdominal aorta are most frequently affected. In this article, we evaluated surgical treatment as a modality for the management for TA. METHOD: We retrospectively reviewed 20 patients with TA and who were operated on from January 1994 to December 2007. RESULT: The ages of patients were ranged from 12 to 56 years. The ratio of males to females was 1 to 19. The main affected vessels were the subclavian artery (n=10), the common carotid artery (n=10), the abdominal aorta (n=4) and the renal artery (n=4). 20 patients with TA were operated on. 17 of them underwent arterioarterial bypass, and 5 patients received angioplasty. There were 8 cases of reoperation due to the effect on other arteries, or due the stenosis or occlusion of the previous bypass graft. Angioplasty and stenting can be used in the treatment of shorter stenoses such as those encountered in the renal arteries. CONCLUSION: Symptomatic patients who have Takayasu's arteritis can be operated on. Our surgical experiences have showed low mortality and the surgical procedures relieved the symptoms. Surgical therapy for Takayasu's arteritis was safe and it showed good results.

The Risk Factors for Pulmonary Embolism in Patients with Lower Extremity Deep Vein Thrombosis

PURPOSE: Pulmonary embolism (PE) represents the most important and fatal complication of deep vein thrombosis (DVT), of which a dislodged thrombus is most commonly derived from the deep venous system of the lower extremity. The aim of this study is to define the incidence and risk factors of PE in DVT patients. METHOD: We retrospectively reviewed 248 patients with DVT in a lower extremity at Uijeongbu St. Mary's Hospital between January 2000 and August 2008 and they had received additional examinations for making the diagnosis of PE regardless of its symptoms. RESULT: There were 117 men and 131 women, and their mean age was 59 years old (range: 13~91) at the time of diagnosis. There were 190 DVT-only patients and 58 patients with PE (the incidence rate of PE in the DVT patients: 23.8%). The gender ratio of the DVT only group was 1:1.3 (males: 83, female: 107) and the gender ratio of the DVT with PE group was 1:0.7 (males: 34, females: 24) (P<0.05). The risk factors of PE in the DVT patients were hypercoagulability (34%), cancer (23%), immobilization (17%), trauma/operation (10%), obesity (10%) and a past DVT history (7%). The idiopathic DVT patients had a relatively high cancer diagnosis rate (18.5%) and the majority of the newly detected cancer were from the chest or abdominal cavity. CONCLUSION: The incidence of DVT and PE is increasing and 23.8% of the DVT patients showed PE on their chest CT scan. The most significant risk factor for PE in the DVT patients was the male gender, yet an evaluation for cancer should be carefully done for idiopathic DVT patients because of their high rate of having cancer diagnosed.