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PURPOSE: The use of immediate breast reconstruction (IBR) has been debated because it may be a causative factor in adjuvant treatment delay and may subsequently increase the probability of recurrence. We investigated whether IBR was related to adjuvant treatment delay and survival outcomes. METHODS: We retrospectively analyzed the duration from operation to adjuvant treatment administration and survival outcomes according to IBR status among patients with breast cancer who underwent mastectomy followed by adjuvant chemotherapy from January 2005 to December 2014. Propensity score matching was performed to balance the clinicopathologic baseline characteristics between patients who did and did not undergo IBR. RESULTS: Of 646 patients, 107 (16.6%) underwent IBR, and the median follow-up was 72 months. The median duration from surgery to adjuvant chemotherapy was significantly longer in patients who underwent IBR than in those who did not (14 vs. 12 days, respectively, p = 0.008). Based on propensity score matching, patients who underwent IBR received adjuvant therapy 3 days later than those who did not (14 vs. 11 days, respectively, p = 0.044). The duration from surgery to post-mastectomy radiation therapy (PMRT) did not significantly differ between the 2 groups. Local recurrence-free survival, regional recurrence-free survival, systemic recurrence-free survival, and overall survival were also not significantly different between the 2 groups (p = 0.427, p = 0.445, p = 0.269, and p = 0.250, respectively). In the case-matched cohort, survival outcomes did not change. CONCLUSION: IBR was associated with a modest increase in the duration from surgery to chemotherapy that was statistically but not clinically significant. Moreover, IBR had no influence on PMRT delay or survival outcomes, suggesting that it is an acceptable option for patients with non-metastatic breast cancer undergoing mastectomy.
Assuntos
Feminino , Humanos , Implantes de Mama , Neoplasias da Mama , Mama , Quimioterapia Adjuvante , Estudos de Coortes , Tratamento Farmacológico , Seguimentos , Mamoplastia , Mastectomia , Pontuação de Propensão , Radioterapia Adjuvante , Recidiva , Estudos RetrospectivosRESUMO
Neonatal Marfan syndrome (nMFS) is considered to be on the most severe end of the spectrum of type I fibrillinopathies. The common features of nMFS include ascending aortic dilatation, severe mitral and/or tricuspid valve insufficiency, ectopia lentis, arachnodactyly, joint contractures, crumpled ear, loose skin, and pulmonary emphysema.We describe a newborn male diagnosed with nMFS. He presented several atypical features, such as diaphragmatic eventration, severe hydronephrosis with hydroureter, and dilated cisterna magna. Molecular analysis revealed a missense mutation at nucleotide 3217 (c.3217G>A) in exon 26 of the fibrillin-1 (FBN1) gene, resulting in the substitution of a glutamate for a lysine at codon 1073 (E1073K) in the 12th calcium binding epidermal growth factor-like domain of the FBN1 protein. Here we report a rare case of Nmfs with several combined atypical features, such as diaphragmatic eventration, severe hydronephrosis with hydroureter, and dilated cisterna magna. Our report is the first atypical nMFS case with p.Glu1073Lys mutation of FBN1 in Korea and may help clinicians with the diagnosis and follow-up of atypical nMFS.
Assuntos
Humanos , Recém-Nascido , Masculino , Aracnodactilia , Cálcio , Cisterna Magna , Códon , Contratura , Diagnóstico , Eventração Diafragmática , Dilatação , Orelha , Ectopia do Cristalino , Éxons , Seguimentos , Ácido Glutâmico , Hidronefrose , Articulações , Coreia (Geográfico) , Lisina , Síndrome de Marfan , Mutação de Sentido Incorreto , Pele , Insuficiência da Valva TricúspideRESUMO
No abstract available.
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Queimaduras , Gluconato de Cálcio , Cálcio , Ácido Fluorídrico , Injeções SubcutâneasRESUMO
No abstract available.
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Queimaduras , Gluconato de Cálcio , Cálcio , Ácido Fluorídrico , Injeções SubcutâneasRESUMO
Scabies is caused by a mite, Sarcoptes scabiei var hominis, an obligate human parasite that burrows downwards into the epidermis. Scabies may be transmitted from objects, but it is most often transmitted by direct skin-to-skin contact, with a higher risk from prolonged contact. Treatment must involve the entire household or community to prevent reinfection. In Korea, the incidence of scabies has decreased dramatically since the late 1980s, but recent outbreaks in nursing homes and hospitals have been raising public health concerns. Herein, we describe 5 cases of scabies that occurred in 3 generations of a family and were confirmed by dermoscopy-oriented skin scraping with microscopic examination.
Assuntos
Humanos , Dermoscopia , Diagnóstico , Surtos de Doenças , Epiderme , Características da Família , Incidência , Coreia (Geográfico) , Hexaclorocicloexano , Ácaros , Casas de Saúde , Parasitos , Saúde Pública , Sarcoptes scabiei , Escabiose , PeleRESUMO
Secondary lymphedema occurs when normal lymphatics suffer a significant insult such as cancer, radiation therapy, surgery, trauma, or infection. Recurrent infections such as cellulitis, lymphangitis, and cutaneous lymphorrhea are significant complications in lymphedematous sites. A 58-year-old man with endstage colon cancer was referred to our department with a skin lesion and persistent discharge on both legs. On histopathological examination, numerous dilated lymphatic channels which were D2-40 positive were seen in the dermis. Herein, we report an interesting case of lower extremity lymphedema in an endstage cancer patient complicated with persistent cutaneous lymphorrhea.
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Humanos , Pessoa de Meia-Idade , Celulite (Flegmão) , Neoplasias do Colo , Derme , Perna (Membro) , Extremidade Inferior , Linfangite , Linfedema , PeleRESUMO
BACKGROUND/AIMS: We investigated the clinical outcomes according to the method of treatment in synchronous esophageal and gastric cancer. METHODS: Synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma were diagnosed in 79 patients between 1996 and 2010. We divided the patients into four groups according to treatment; Group 1 received surgical resection for both cancers or surgery for gastric cancer with chemoradiotherapy for esophageal cancer (n=27); Group 2 was treated by endoscopic resection with or without additional treatment (n=14); Group 3 received chemoradiotherapy only (n=18); and Group 4 received supportive care only (n=20). RESULTS: The median survival times in groups 1 and 2 were 86 and 60 months, respectively. The recurrence rate and mortality were 23% and 48%, respectively, in group 1 and 21% and 4%, respectively, in group 2. The median survival time was 12 months in group 3 and 9 months in group 4. Multivariate analysis showed that age (p<0.001) and treatment group (p=0.019) were significantly associated with death. Compared with group 1, treatment in the intensive care unit (p=0.003), loss of body weight (p=0.042), and decrease in hemoglobin (p=0.033) were worse in group 1. CONCLUSIONS: Endoscopic resection for synchronous esophageal and gastric cancer could be considered as a possible alternative to surgery for early-stage cancer.
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/mortalidade , Carcinoma de Células Escamosas/mortalidade , Terapia Combinada , Endoscopia Gastrointestinal/métodos , Neoplasias Esofágicas/mortalidade , Neoplasias Primárias Múltiplas/mortalidade , Estado Nutricional , Fatores de Risco , Neoplasias Gástricas/mortalidade , Análise de SobrevidaRESUMO
BACKGROUND/AIMS: With technical and instrumental advances, the endoscopic removal of bezoars is now more common than conventional surgical removal. We investigated the clinical outcomes in a patient cohort with gastrointestinal bezoars removed using different treatment modalities. METHODS: Between June 1989 and March 2012, 93 patients with gastrointestinal bezoars underwent endoscopic or surgical procedures at the Asan Medical Center. These patients were divided into endoscopic (n=39) and surgical (n=54) treatment groups in accordance with the initial treatment modality. The clinical feature and outcomes of these two groups were analyzed retrospectively. RESULTS: The median follow-up period was 13 months (interquartile range [IQR], 0 to 77 months) in 93 patients with a median age of 60 years (IQR, 50 to 73 years). Among the initial symptoms, abdominal pain was the most common chief complaint (72.1%). The bezoars were commonly located in the stomach (82.1%) in the endoscopic treatment group and in the small bowel (66.7%) in the surgical treatment group. The success rates of endoscopic and surgical treatment were 89.7% and 98.1%, and the complication rates were 12.8% and 33.3%, respectively. CONCLUSIONS: Endoscopic removal of a gastrointestinal bezoar is an effective treatment modality; however, surgical removal is needed in some cases.
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Abdominal/etiologia , Bezoares/diagnóstico , Endoscopia Gastrointestinal/métodos , Gastroenteropatias/diagnóstico , Litotripsia/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Subepidermal calcified nodule is a rare form of calcinosis cutis, which is not associated with any dermatologic or systemic diseases, and usually presents as a solitary hard nodule on the face or neck of children. A 25-month-old boy had a small pea-sized, tender nodule on his left sole that had been present for several months. There was no history of previous trauma or systemic illness. The clinical diagnosis as a viral wart was initially made and treated with cryotherapy. Because the lesion was not clear and a yellow-white firm papule was seen after cryotherapy, punch excision was done. Histologic examination showed cystic structure with calcium deposition in the upper dermis. Herein, we present the findings of a patient with a rare, solitary subepidermal calcified nodule on the sole.
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Criança , Pré-Escolar , Humanos , Masculino , Calcinose , Cálcio , Crioterapia , Derme , Diagnóstico , Pescoço , VerrugasRESUMO
Piercing of various parts of the body is common practice in Korea nowadays. In particular, ear piercing appears to be increasingly prevalent among adolescents and young-adults. Because of the complication of the procedure, auricular perichondritis after piercings can arise in this patient population. Staphylococcus aureus and Pseudomonas aeruginosa are the most common causative organisms associated with infections due to ear piercing. In most cases, however, the patients were not prescribed anti-pseudomonal antimicrobial agent at presentation. This may result in persistent complicated infection and permanent cosmetic deformities. Herein, we describe two cases of post-piercing auricular perichondritis caused by P. aeruginosa successfully treated with intravenous antimicrobial agents. Also, a literature review of auricular perichondritis after ear piercing was done.