Utility of digital pulse oximetry in the screening of lower extremity arterial disease / 대한외과학회지

PURPOSE: The aim of this study was to evaluate screening methods in the lower extremities by measurement of the digital pulse oximetry (oxygen percent saturation [SpO2]) of toes for peripheral arterial disease (PAD). METHODS: A prospective study was performed among 49 patients (98 limbs) with lower extremity arterial occlusive disease. We attempted to measure the ankle-brachial index (ABI), digital pulse oximetry (SpO2), and computerized tomographic angiography (CTA). Patients were divided into three groups by the traditional Fontaine classification system by symptom and CTA criteria: 1) Critical limb ischemia (Fontaine III and IV), 2) Claudication; (Fontaine II), and 3) asymptomatic limbs (Fontaine I). RESULTS: The sensitivity, specificity, positive and negative predictive values between active treatment groups (group I and II; endovascular and open surgery) and conservative group (group III) are all statistically significant. ABI; 55.09%, 94%, 96.7%, 39.02% (R = 12.54, P < 0.000) SpO2; 87.06%, 87.8%, 84.3%, 90% (R = 40.11, P < 0.000). Pre-SpO2 and pre-ABI all show statistically significant correlation in group I vs. group II, symptomatic PAD (group I and II) vs. asymptomatic PAD (group III), and the total PAD comparison. The Pearson's correlation coefficient between SpO2 and ABI all show significant correlation in group II. Pre-SpO2 vs. Pre-ABI show strong positive correlation except asymptomatic group (group III). CONCLUSION: Digital pulse oximetry can be a useful, simple, noninvasive screening device as well as ABI in PAD.

A case of retroperitoneal leiomyosarcoma presenting as a pelvic mass / 부인종양

The authors report a rare case of retroperitoneal leiomyosarcoma in a 49 year-old woman, with a palpable mass in the left lower abdomen. There is a large neoplasm which was soft and movable, looking a pelvic mass. Abdominal and pelvic CT scan showed a 11.0x9.2x7.5 cm-sized lobulated heterogenous enhancing mass with multifocal necrotic portion near the left ovary. Laparotomy and resection of the mass was performed. Microscopic examination revealed 15 mitoses per 10 high power fields. She was diagnosed as primary leiomyosarcoma originated from the left common iliac vein, stage I (IB). The best treatment of these neoplasms is complete surgical excision, and no therapeutic benefit has been derived from chemotherapy or radiotherapy. Though metastases are occasional, local recurrences can be taken into consideration and, after a careful tumoral re-staging, they can be resected once more. Therefore, careful follow-up is necessary on the basis of neoplastic grading, extension and involvement of the adjacent structures.

A Case of Hemoperitoneum Caused by Spontaneous Rupture of Metastatic Omental Hepatocellular Carcinoma

It is known that most of the extrahepatic metastasis of hepatocellular carcinoma occurs through the blood stream and the most frequent target organ is the lung. Intraperitoneal metastasis via the lymphatics is rare (2~16%) and this has been largely demonstrated by laparosopy or on the autopsy findings. Especially, omental metastasis of hepatocellular carcinoma has only been rarely reported on. A 62-year-old male patient who underwent TACE for hepatocellular carcinoma was admitted for an emergency operation for hemoperitoneum. On the operative findings, there were two 1.5 by 3 cm-sized masses in the omentum and one of them was ruptured and bleeding. The masses were diagnosed as metastatic hepatocellular carcinoma on the pathologic examination. The patient recovered and is being followed.

Clinical Features of the Male Breast Cancer-13 Cases / 한국유방암학회지

Purpose: Breast cancer is one of the most frequent malignant tumors in American and European countries, with incidences increasing every year. In Korea it was the second most frequent cancer in 2002, followed by stomach cancer. However, in 2001 the incidence of breast cancer was first, followed by colon cancer, with incidences increasing every year. Conversely, breast cancer in men is not frequent, with an incidence of less than 1%, according to studies from both Korea and abroad. Studies on the treatment methods and prognostic factors of breast cancer in men are limited, with little clinical experience. Although there was difficulty in collecting complete data, due to lack of awareness of male breast cancer, the clinical characteristics could be determined from the experience and treatment outcomes of male breast cancer patients. Methods: The medical records of 13 male patients with breast cancer, who could be followed up, were retrospectively evaluated from 4809 patients with breast cancer, evaluated between 1989 and 2003. Results: The average age of the subjects was 64.3 years, with the breast masses with no pain situated at the center of the breast in most cases. The affected period in most patients was 1 year, with most having stage II breast cancer. Conclusion: Although asymptomatic unilateral subareolar breast mass in old ages is the most frequent symptom, most missed the period for early treatment due to lack of awareness of male breast cancer, therefore, their breast cancer had been for more than a year. Despite the difficulty due to the lack of data, attention needs to paid, and continuous studies required, toward male breast cancer.

Congenital Diaphragmatic Hernia in Rats Using Nitrofen: An Animal Model

PURPOSE: Since 1971, Nitrofen (2,4-dichloro-4`-nitrodiphenyl ether) herbicide has been known to induce variable congenital abnormalities in rats. However, until now there has been no animal model of congenital diaphragmatic hernia (CDH) using this herbicide in Korea. Therefore, CDH in rats using Nitrofen was tried for searching on pathogenesis or using therapeutic modalities of CDH. METHODS: 20 Sprague-Dawley rats ingested Nitrofen as indicated on the 9.5th day of gestation, and after sacrificing on the 21th day of gestation. 243 offspring were harvested for the examination of diaphragmatic herniations. Dissections were made along sites of herniations to confirm the diaphragmatic herniation's site and size, lung/body weight ratio comparison as well as to accomplish microscopic radial saccular counting and evaluation of alveolar septal wall maturations and a comparision was made between the groups. RESULTS: CDH appeared in 149 of 243 offspring. CDH only appeared in the posterior portion of the diaphragm regardless of size or the side of appearance. Left sided CDH was the most common single diaphragmatic anomaly, represented in 112 offspring. Right sided CDH was next, found in 31 offspring, and bilateral CDH was seen in 6 offspring. Left sided CDH was almost always associated with visceral herniations and with pulmonary hypoplasia on the affected side, which was proved in the decreased Lung/Body weight ratio and in decreased radial saccular counts and in increased alveolar septal wall thickness in the affected lungs of CDH. In94 offspring without CDH following exposure to Nitrofen, moderate pulmonary hypo plasia was microscopically observed. CONCLUSION: Initial Rat modeling of congenital diaphragmatic hernia using Nitrofen showed results of herniation and pulmonary hypoplasia of the affected lungs acceptable for further experimental studies on CDH and accompaning pulmonary abnormalities.