Prevalence and Risk Factors for the Peripheral Neuropathy in Patients with Peripheral Arterial Occlusive Disease

PURPOSE: Peripheral neuropathy (PN) is known as a major contributor of the worsening of ischemic symptoms and the foot ulceration in patients with peripheral arterial occlusive disease (PAOD). However, there are few studies reporting the prevalence and risk factors for PN in PAOD. This study aimed to evaluate these issues for PN and to establish the importance of screening as additional treatment target for PN in PAOD. MATERIALS AND METHODS: A total of 52 limbs with PAOD were enrolled from January 2011 to December 2012. PN was divided into radiculopathy, ischemic PN (IPN), and diabetic PN (DPN), based on electromyographic findings. We investigated the prevalence of overall PN and subtypes of PN and then analyzed the risk factors. RESULTS: The prevalence of overall PN in PAOD was 43 of 52 limbs (82.7%). In terms of subtypes of PN, the prevalence rate of radiculopathy and IPN was 30.8% and 23.1%, respectively. DPN showed in 22 limbs (73.3%) among 30 diabetic limbs. There was no significant correlation between each type of PN and ischemic symptoms. Our analysis showed that coronary artery disease (CAD) was a significant risk factor (P=0.01) for IPN, however, did not identify any significant risk factors for DPN. CONCLUSION: This present study indicated that most patients with PAOD had PN and CAD was a risk factor for IPN. In particular, PAOD with diabetes represented a higher prevalence for DPN. Our study suggests that PN should be evaluated and considered as another treatment target in patients with PAOD.

Tumescent local anesthetic technique for inguinal hernia repairs

PURPOSE: We evaluated the adequacy and feasibility of a tumescent solution containing lidocaine and bupivacaine for inguinal hernia repairs. METHODS: The medical records of 146 consecutive inguinal hernia patients with 157 hernia repairs using the tumescent local anesthesia technique performed by a single surgeon between September 2009 and December 2013 were retrospectively reviewed. RESULTS: The mean operation time (+/-standard deviation) and hospital stay were 64.5 +/- 17.6 minutes and 2.7 +/- 1.5 days. The postoperative complication rate was 17.8%. There were four cases of recurrences (2.5%) at a mean follow-up of 24 +/- 14 months. CONCLUSION: Our results suggest that local anesthesia with the tumescent technique is an effective and safe modality for inguinal hernia repairs.

Differences in the Survival of Gastric Cancer Patients after Gastrectomy according to the Medical Insurance Status

PURPOSE: In Korea, the entire population must enroll in the national health insurance system, and those who are classified as having a lower socioeconomic status are supported by the medical aid system. The aim of this study was to evaluate the association of the medical insurance status of gastric cancer patients with their survival after gastrectomy. MATERIALS AND METHODS: A total of 247 patients who underwent surgical treatment for gastric cancer between January 1999 and December 2010 at the Seoul Medical Center were evaluated. Based on their medical insurance status, the patients were classified into two groups: the national health insurance registered group (n=183), and the medical aid covered group (n=64). The survival rates were calculated using the Kaplan-Meier method. RESULTS: The median postoperative duration of hospitalization was longer in the medical aid covered group and postoperative morbidity and mortality were higher in the medical aid group than in the national health insurance registered group (P<0.05). The overall 5-year survival rate was 43.9% in the medical aid covered group and 64.3% in the national health insurance registered group (P=0.001). CONCLUSIONS: The medical insurance status reflects the socioeconomic status of a patient and can influence the overall survival of gastric cancer patients. A more sophisticated analysis of the difference in the survival time between gastric cancer patients based on their socioeconomic status is necessary.

Status and prospect of workforce requirement for surgery in republic of Korea / 대한외과학회지

PURPOSE: In order to prepare long-term alternatives to surgical residency training and workforce policies in Korea, objective data are needed; in addition, determination of the status of surgical procedures being performed is also needed. METHODS: Cases of surgeries performed by board-certified Korean surgeons for 1 year, from July 2009 to June 2010 were reviewed and analyzed. Variation of the last five years was also investigated against the number of surgery cases of the same item and for data on status of population, medical institutions, and surgeons. RESULTS: Difficulty in distribution of a given surgery varied according to the classification of medical institution types, and performance of highly difficult surgeries occurred more in tertiary hospitals. The number of surgeries has increased over the last 5 years (28.1%). The number of surgeries among elderly patients (41.5%), high difficulty (41.8%), and tertiary hospitals (34.9%) has especially increased. There has been no increase in the number of diagnosis related group claim cases for the last 5 years (-0.8%). 43.3% of surgeons working at private clinics in Korea did not present surgery as an indicating item of their clinics. CONCLUSION: While the demand for surgeons in high risk and highly difficult surgeries is continuously increasing, stagnation is expected in the traditional area. Considering the proportion and current status of surgeons working at private clinics, the need for a realistic reduction in the quota of surgical residents and reconsideration of personnel policies is raised.

Expression of Survivin and Its Correlation with Prognosis in Colorectal Cancer

PURPOSE: Survivin is involved in both the control of cell division and the inhibition of apoptosis. Specifically, its anti-apoptotic function is related to the ability to inhibit caspases directly or indirectly. This study examined the expression patterns of survivin in normal colorectal tissues and in colorectal cancer tissues to determine whether the expression of survivin is associated with either the colorectal cancer characteristics or the prognosis. METHODS: 4micrometer sections of the formalin-fixed paraffin-embedded samples of colorectal cancer tissues were the immunostained using antibodies for survivin. The immunostain was recorded as 0~3 depending on the stain intensity distribution in the cytoplasm and the nucleus. RESULTS: Survivin was localized in the nucleus and/or cytoplasm of tumor cells. We could differentiate between cytoplasmic and nuclear localization of survivin protein expression. Among the cancer expressions, 35.8% demonstrated nuclear staining, and 51.9% demonstrated cytoplasm staining. Statistical analysis revealed that cytoplasmic survivin expression was correlated with lymph-node metastasis, tumor stage, and patient survival. CONCLUSIONS: Survivin expression was correlated with clinicopathologic prognostic parameters and with the outcome. Thus, it can be both a useful diagnostic marker for colorectal carcinomas and an important source of prognostic information for patients with a colorectal carcinoma. Survivin will become a potential new target in anti-cancer therapy in near future.

Establishment for Reference Range of Serum HER-2/neu in Korean Healthy Women / 한국유방암학회지

PURPOSE: HER-2/neu oncogene is known to play a part in the process of carcinogenesis, while the biological characteristics of HER-2/neu oncoprotein include regulating cell growth and increasing the reproductionability of a tumor. The extracelluar domain (ECD), whose molecular weight is between 95 and 105 kD among the HER-2/neu oncoprotein structures, is proteolyzed and separated from the cell surface by metalloproteases and goes into the blood stream where it starts circulation. Since monoclonal antibody was developed for the serum HER-2/neu ECD, it's now possible to measure HER-2/neu ECD in the serum with the immunoassay method. The measurement of serum HER-2/neu ECD is used for prognosis of metastatic breast cancer and for testing the treating effect of trastuzumab (Herceptin(R)), a target agent for the patients positive to the HER-2/neu receptor. In Korea there is no report on the accurate reference range of serum HER-2/neu for healthy women. The purposes of this study were to measure the serum HER-2/neu ECD in healthy Korean women, analyze the reference range. METHODS: The subjects of the study include 200 healthy Korean women with 50 from each in their twenties, thirties, forties, and fifties. As for methodology, the HER-2/neu in the serum separated from their blood was measured. The serum HER-2/neu level was measured quantitatively with the recently developed ADVIA Centaur(R) automated immunoassay analyzer and ADVIA Centaur(R) HER-2/neu assay reagent. With the measurement, you can use the sandwich immunoassay and direct chemiluminescence technique for two monoclonal antibodies for the epitopes located in the serum HER-2/neu ECD. The reference ranges were calculated based on the mean +/- 2 SD. RESULTS: One of the 200 healthy subjects was excluded from analysis for having the highest value of serum HER-2/neu (23.1 ng/ml), and the data of total 199 were used for analysis. The analysis results indicated that the minimum value was 3.5 ng/mL, the maximum value 14.5 ng/mL, the mean 8.6 ng/mL, average 8.77 ng/mL, and SD 1.61 ng/mL. The reference range of the 199 subjects's serum HER-2/neu measurements was calculated by the mean +/- 2 SD. Since the mean +/- SD of their HER-2/neu measurements was 8.8 +/- 1.6 ng/mL, the reference range was 5.6~12.0 ng/mL. The reference ranges for the age groups were 6.1~10.9 ng/mL, 5.3~11.4 ng/mL, 5.0~12.6 ng/mL and 6.3~12.6 ng/mL for the twenties, thirties, forties and fifties, respectively. The reference ranges for the age groups were analyzed statistically and there was statistical difference (p= 0.002) between fifties and twenties or thirties. The upper limit level of the reference range of serum HER-2/neu in healthy Korean women was 12.0 ng/mL. CONCLUSION: The results suggest that the reference range of serum HER-2/neu in healthy Korean women is 6.1~10.9 ng/mL, 5.3~11.4 ng/mL, 5.0~12.6 ng/mL and 6.3~12.6 ng/mL for the twenties, thirties, forties, and fifties, respectively. There is no significant difference between the twenties, thirties, forties, each other. According to analyzed statistically, there is difference between fifties and twenties or thirties (p= 0.002), but there is no statistically significant difference between forties and fifties.

COX-2 and iNOS Expression and Microvessel Density by Microsatellite Instability in Colorectal Cancer

PURPOSE: We tried to identify the overall incidence of microsatellite instability (MSI) and the utility of mismatch repair (MMR) protein expression in sporadic colorectal cancers in Korean. We also investigate the role of angiogenesis in colorectal cancers by MSI status. METHODS: A total 85 resected colorectal cancers were submitted for MSI study using PCR methods with 5 markers and immunohistochemistry (IHS) for hMLH1 and hMSH2. Expression of COX-2 and iNOS and microvessel density by IHS were correlated with various clinicopathologic prognostic factors. RESULTS: Among 85 cases of sporadic colorectal cancers, MSI was observed in 11 cases (12.9%) including 10 MSI-H and 1 MSI-L cases. Patients with MSI (+) showed female prevalence (1.75 : 1), low Dukes stage, mucinous histologic type, and Crohn-like lymphoid reaction than those with MSS. Overall sensitivity of hMLH1 and/or hMSH2 expression was 98.6% and specificity was 72.7%. iNOS expression was significantly correlated with COX-2 expression in tumor cells (P=0.006), however, they were not correlated with MSI status. High microvessel density was correlated with hMLH1 expression (P=0.025), COX-2 expression (P= 0.05), and Crohn-like lymphoid reaction (P=0.041). CONCLUSIONS: IHS for MMR proteins is a valuable substitute of MSI status and COX-2 related neoangiogenesis is thought to be related to inhibition of microsatellite unstable colorectal cancer progression via decreased microvessel density.

Clinical Significance of Lymph Node Micrometastasis in Patients with Dukes' B Colorectal Cancer

PURPOSE: This study aimed to provide immunohistochemical evidence of micrometastasis in patients with node-negative Dukes' B colorectal cancer and to evaluate the clinical implications, including prognostic significance, of lymphatic metastasis. METHODS: A retrospective study of 90 patients who underwent a curative operation due to colorectal neoplasms from 1996 to 2001 was performed. Two consecutive sections of lymph nodes were prepared: one for ordinary hematoxylin-eosin staining, and the other for immunohistochemistry with pancytokeratine antibody. All clinical factors, including survival rate, were compared between patients with and without lymph-node metastasis. The mean follow- up period was 36.1 months. RESULTS: Micrometastasis was confirmed in 115 nodes (7.9%) from 32 patients (35.6%). No correlations were observed between micrometastases and prognostic factors, including survival rate, except for lymphatic invasion and postoperative TNM staging. Twenty-six of the 32 (81.3%) patients with micrometastases belonged to stage T3N0M0 (P<0.003). CONCLUSIONS: The immunohistochemical assay may be a useful way to identify micrometastasis in patients with Dukes' B colorectal neoplasms, but we were not able to demonstrate the prognostic significance of micrometastasis.

Intraductal Mucosal Spreading Mucin Secreting Intrahepatic Cholangiocarcinoma / 한국간담췌외과학회지

Peripheral cholangiocarcinoma refers to an adenocarcinoma arising from the bile ducts peripheral to the secondary confluence. The growth pattern of the peripheral cholangiocarcinoma may be classified into the mass-forming type, the infiltrating type, the intraductal polypoid type and the combined type. Intraductal mucosal spreading, mucin secreting intrahepatic cholangiocarcinoma is a rare subtype of peripheral cholangiocarcinoma. Its existence has been neglected due to its paucity. A 59-year old male who presented with jaundice was admitted to our hospital because of recurrent cholangitis. A MRI of the abdomen showed the dilated intrahepatic duct without mass lesions. Left hepatectomy was done with negative surgical margins. The pathologic diagnosis was intraductal mucinous type cholangiocarcinoma without stromal invasion. Intrahepatic duct stone was found. The postoperative duodenal ulcerous bleeding was treated by suture ligation of the bleeding vessels of the duodenum. The patient discharged 65 days after the operation.

Breast Metastases from Malignant Melanoma / 한국유방암학회지

Breast metastases from extramammary primary tumors are uncommon, accounting for approximately 1.3~6.6% of all malignant mammary tumors. Apart from hematopoietic neoplasms, malignant melanoma is one of the most common neoplasms with which secondary involvement of the mammary parenchyme is known. Although they are so rare, breast metastases from such neoplasms can mimic primary breast carcinoma clinically and on imaging studies. Approximately 20% of the patients affected by malignant melanoma will develop metastases, the commonest sites being liver, lung, and brain; metastases to the breast from malignant melanoma are rare, and in about 40% of the patients affected the breast lesion is the first manifestation of disease. Correct management of metastatic disease to the breast can prevent unnecessary mutilation; in fact, in the majority of patients so far widespread metastases have appeared rapidly despite various systemic treatments, showing that major surgery gives very poor results in terms of controlling the disease. In this paper, we present the case of a 49-year-old woman with a history of a malignant cutaneous melanoma of nasal cavity that had been surgically excised in 2004. She was admitted to our Breast Division 6 months later because a screening mammogram and anultrasound evaluation had revealed the presence of a nodular opacity in the both breast, without any clinical manifestations. For this reason, in September 2004 the patient underwent a simple mastectomy of both breasts.

Transcutaneous Electrical Stimulation of the P6 Acupoint Reduces Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: It is believed that stimulation of the P6 acupoint minimizes nausea and vomiting, and has been used to prevent and treat nausea and vomiting in various situations. The present study was undertaken to investigate whether the transcutaneous electrical stimulation of the P6 acupoint prevents postoperative nausea and vomiting (PONV) in female patients undergoing laparoscopic cholecystectomy. METHODS: In this prospective, randomized, double-blind, placebo-controlled study, we investigated 59 ASA I or II female patients who underwent laparoscopic cholecystectomy under general anesthesia using isoflurane or enflurane. We used a ReliefBand(R) unit (NSTTM 600, Woodside Biomedical Inc, USA) for the transcutaneous electrical stimulation of the P6 acupoint. Patients were randomly divided into two groups; in the P6 group (n = 29) the activated ReliefBand(R) was placed at the P6 acupoint; and in the placebo group (n = 30) the inactivated ReliefBand(R) was placed at the P6 acupoint. The ReliefBand(R) was applied 10 min before the end of surgery and remained in place for 24 h. We evaluated the incidence and severity of PONV, and need for rescue antiemetics during the first 6 h and 24 h after surgery. RESULTS: No differences in age, weight, previous PONV history, or duration of anesthesia were present between groups. The incidence of PONV was significantly lower (34%) in the P6 group than in the placebo group (63%) during the first 24 h after surgery. The severity of nausea and vomiting was also significantly lower in the P6 group than in the placebo group. However, the need for rescue antiemetics was similar in the two groups. CONCLUSIONS: Transcutaneous electrical stimulation of the P6 acupoint significantly reduces the incidence and severity of PONV in female patients undergoing laparoscopic cholecystectomy during the first 24 h after surgery.

Immunohistochemical Assay for Lymph-Node Micrometastasis in Gastric Cancer and Correlation with Survival Rate

PURPOSE: The purpose of this study is to identify immunohistochemical evidence of lymph-node micrometastasis in histologic node-negative gastric cancer patients and to evaluate the prognostic significance of lymph-node micrometastasis. MATERIALS AND METHODS: A retrospective study of 50 gastric cancer patients who underwent curative resections from October 1990 to November 1994 was performed. Two consecutive sections were prepared: one for ordinary hematoxylin and eosin staining, and the other for immunohistochemical staining with Pan cytokeratin antibody (Novocastra, UK). In the univariate analysis, the survival rate was calculated using the Life Table Method, and the multivariate analysis was determined using a Cox Proportional Hazards Model. The statistical analyses of the relationships between the clinicopathologic factors and micrometastases were performed by using a Chi-square test. RESULTS: Of 2522 harvested lymph nodes, 81 (4.1%) nodes and 19 (38%) of 50 patients were identified as having lymph- node micrometastases by using immunohistochemical staining for cytokeratin. The incidence of lymph-node micrometastases was significantly higher in diffuse type carcinomas (54%, P=0.024) and in patients with serosal invasion (52.2%, P=0.05). For patients with lymph-node micrometastases (n=19), the 5-year survival rate was significantly decreased (73.7%, P=0.015). The Lauren's classification (P= 0.021) and the depth of invasion (P=0.035) were shown by multivariate analysis to have a significant relationship with the presence of micrometastases. Multivariate analysis revealed that lymph-node micrometastasis was independently correlated with survival in histologic node-negative gastric cancer patients. CONCLUSION: The presence of cytokeratin detected lymph-node micrometastases correlates with the worse prognosis for patients with histologic node-negative gastric cancer.

Causes and Sexual Hormonal Changes in Patients with Gynecomastia / 한국유방암학회지

PURPOSE: Gynecomastia, a benign enlargement of the male breast due to proliferation of the glandular component, is a common clinical condition with various causes. This study investigates the changes of serum sexual hormones levels and the causes of patients with gynecomastia METHODS: The conditions associated with gynecomastia were evaluated in 68 gynecomastia patients. The levels of serum estradiol (E2), and testosterone (T), and the estradiol to testosterone (E2/T) ratio were measured in 37 of these 68 subjects along with 10 healthy male controls. Ultrasound for the adrenal gland and liver diseases, liver function test, and physical examination or ultrasound for testicular pathology were also performed. RESULTS: The most common cause of gynecomastia was idiopathic (50.0%). The conditions associated with gynecomastia were drugs (23.5%), hormone (10.3%), and various associated diseases (16.2%) including liver diseases (8.8%), chronic lung diseases (4.4%), lung cancer (1.5%) and chronic renal failure (1.5%). The levels of E2 and T, and the E2 to T ratio in the control group were 35.3+/-3.9 pg/ml, 5.0+/-0.4 ng/ml and 7.1+/-0.5 respectively. Those in the gynecomastia group were 48.7+/-7.1 pg/ml, 4.3+/-0.3 ng/ml and 12.0+/-1.8 respectively. The differences between the two groups for the E2 to T ratio as well as the levels of E and T were not significant, though the average E2 level and the E2 to T ratio in the gynecomastia group were higher than those in the control group. The causes of gynecomastia varied according to the patient age. CONCLUSION: The differences of the E2 to T ratio, and the level of E2 and T in the patients with gynecomastia were not the only cause of gynecomastia, Thus, considerations need to be given to the changes of sexual hormones as well as associated diseases or drugs to enable better understanding of the causes of gynecomastia.

Causes and Sexual Hormonal Changes in Patients with Gynecomastia / 한국유방암학회지

PURPOSE: Gynecomastia, a benign enlargement of the male breast due to proliferation of the glandular component, is a common clinical condition with various causes. This study investigates the changes of serum sexual hormones levels and the causes of patients with gynecomastia METHODS: The conditions associated with gynecomastia were evaluated in 68 gynecomastia patients. The levels of serum estradiol (E2), and testosterone (T), and the estradiol to testosterone (E2/T) ratio were measured in 37 of these 68 subjects along with 10 healthy male controls. Ultrasound for the adrenal gland and liver diseases, liver function test, and physical examination or ultrasound for testicular pathology were also performed. RESULTS: The most common cause of gynecomastia was idiopathic (50.0%). The conditions associated with gynecomastia were drugs (23.5%), hormone (10.3%), and various associated diseases (16.2%) including liver diseases (8.8%), chronic lung diseases (4.4%), lung cancer (1.5%) and chronic renal failure (1.5%). The levels of E2 and T, and the E2 to T ratio in the control group were 35.3+/-3.9 pg/ml, 5.0+/-0.4 ng/ml and 7.1+/-0.5 respectively. Those in the gynecomastia group were 48.7+/-7.1 pg/ml, 4.3+/-0.3 ng/ml and 12.0+/-1.8 respectively. The differences between the two groups for the E2 to T ratio as well as the levels of E and T were not significant, though the average E2 level and the E2 to T ratio in the gynecomastia group were higher than those in the control group. The causes of gynecomastia varied according to the patient age. CONCLUSION: The differences of the E2 to T ratio, and the level of E2 and T in the patients with gynecomastia were not the only cause of gynecomastia, Thus, considerations need to be given to the changes of sexual hormones as well as associated diseases or drugs to enable better understanding of the causes of gynecomastia.

Causes and Sexual Hormonal Changes in Patients with Gynecomastia

PURPOSE: Gynecomastia, a benign enlargement of the male breast due to proliferation of the glandular component, is a common clinical condition with various causes. This study investigates the changes of serum sexual hormones levels and the causes of patients with gynecomastia. METHODS: The conditions associated with gynecomastia were evaluated in 68 gynecomastia patients. The levels of serum estradiol (E2), and testosterone (T), and the estradiol to testosterone (E2/T) ratio were measured in 37 of these 68 subjects along with 10 healthy male controls. Ultrasound for the adrenal gland and liver diseases, liver function test, and physical examination or ultrasound for testicular pathology were also performed. RESULTS: The most common cause of gynecomastia was idiopathic (50.0%). The conditions associated with gynecomastia were drugs (23.5%), hormone (10.3%), and various associated diseases (16.2%) including liver diseases (8.8%), chronic lung diseases (4.4%), lung cancer (1.5%) and chronic renal failure (1.5%). The levels of E2 and T, and the E2 to T ratio in the control group were 35.3+/-3.9 pg/ml, 5.0+/-0.4 ng/ml and 7.1+/-0.5 respectively. Those in the gynecomastia group were 48.7+/-7.1 pg/ml, 4.3+/-0.3 ng/ml and 12.0+/-1.8 respectively. The differences between the two groups for the E2 to T ratio as well as the levels of E and T were not significant, though the average E2 level and the E2 to T ratio in the gynecomastia group were higher than those in the control group. The causes of gynecomastia varied according to the patient age. CONCLUSION: The differences of the E2 to T ratio, and the level of E2 and T in the patients with gynecomastia were not the only cause of gynecomastia, Thus, considerations need to be given to the changes of sexual hormones as well as associated diseases or drugs to enable better understanding of the causes of gynecomastia.

Stricture and Mass under Colonoscopy

No abstract available.

A Modified Quadrantectomy Through Circumareolar Incision for Patients with Breast Cancer / 한국유방암학회지

Bast conservation therapy has become an accepted method of primary treatment for the early stage breast cancer. The extent of local excision and skin incision has been in controversy, owing to the risk of local recurrence and cosmesis. To improve breast cometic apperance following quadrantectomy for breast cancer, authors propose a novel surgical technique that is carried out local excision through circumareolar skin incision, remodeling of breast ot replace the volum loss. Level I&II axillary dissection were performed and radiotherapy were followed. Twenty-one patients underwent the novel method for breast conserving surgery from September 1995 to October 1998 in the department of surgery at Soonchunhyang University Hospital. Cosmetic outcome was evaluated by means of panel assessment and breast retraction assessment (BRA). The mean age of patient was 43.3 years(30 to 67 years). The distribution of the 22 tumors were located in the right of 11, left of 9 and both breast of 1. The mean fumor size was 1.7 cm(0.5 to 2.8cm). The type of histology was 5 of ductal carcinoma in situ, 13 infiltrating ductal carcinoma, 2 of tubular carcinoma and 1 medullary carcinoma. Five of 22 patients had metastases in the axillary nodes. The cosmetic evaluation was performed by the 3 panelist who scored it a 5-panel scale (E0 to E4). Eighteen cases were scored as E0 (excellent, 81.8%), 1 case as E1 (good), 1 case as E2 (moderate) and 2 cases as E3 (bad) cosmetic results. BRA values were calculated by simple vector geometry employing the Pythagorean theorem, BRA values for the patients ranged 0.5 to 4.4 cm with a mean of 1.6 cm and for a group of 30 control women values ranged from 0.4 to 1.8 cm with mean value of 0.9 cm. When panel scores and BRA values were compared, 18 cases of excellent (E0) scoring had under the 3.5 cm of BRA value. One of two cases with bed (E3) score had over 3.5 cm of BRA vale. Eighteen cases who were less than 60 years old had satisfactory cosmetic results by panel scoring and BRA value. Twenty one cases who underwent a novel method for breast conserving therapy were considered as excellent and fair cosmetic results. It is concluded that the remodeling of breast following modified quadrantectomy through circumareolar skin incision is useful for preventing breast deformity.

A Clinical Study of Acute Appendicitis in Pregnancy

PURPOSE: Acute appendicitis is the most frequently encountering extrauterine surgical condition in pregnancy. Prompt diagnosis of acute appendicitis in pregnancy is not easy on the basis of clinlical findings, which may be obscured or altered by the presence of a gravid uterus. In most of cases, prompt diagnosis and early surgical intervention could result in optimal maternal and fetal outcomes. MATERIAL AND METHODS: We performed retrospective analysis of 20 cases, which were operated under the diagnosis of acute appendicitis in pregnancy from 1990 to 1995 at the department of surgery, Soonchunhyang University Hospital. RESULTS: 1) The incidence of the acute appendicitis in pregnancy was one per 742 deliveries and the diagnostic accuracy was 85%. 2) The majority of patiens was in the 3rd decade of age (76.5%). 3) Gestational stages at onset of symptom were first trimester in 6 patients (35.3%) and second trimester (52.9%) in most patients. 4) The majority of patients(82.4%) spent less than 24 hours preoperatively. 5) The symptoms in order of frequency were; abdominal pain (100%), nausea (70.5%), vomiting (41.1%), fever (23.5%), chill (11.8%), constipation (11.8%), diarrhea (5.9%). The maximal tenderness was noted on McBurney's point (29.4%) and above McBurney's point (58.8%) in most of patient. 6) The leukocyte counts were mostly in the range of 10,000 to 15,000 mm3 (47.1%) and 15,000 to 20,000 mm3 (35.3%). 7) Several types of incisions were employed: a McBurney incision was used in 8 cases (47.1%), a transverse incision in 8 cases (47.1%), and a low midline incision in 1 case (5.8%). A general anesthesia was done in 6 patients (35.3%), a spinal anesthesia done in 8 patients (47.1%), and an epidural anesthesia done in 3 patients (17.6%). A drain was placed intraabdominally in 2 cases. 8) Among 17 cases, three were reported as focal appendicitis (17.6%), ten as suppurative one (58.8%), one as ganagrenous one (5.9%) and three as perforated one (17.6%). 9) The postoperative complications included 1 wound infection and 4 artificial abortions. There was no maternal death, preterm labor, or spontaneous abortion. CONCLUSION: Despite of diagnostic obstacles due to pregnancy, acute appendicitis can be diagnosed without major difficulty. High index of suspicion is required during diagnostic procedures and prompt surgical intervention improves maternal and fetal outcomes...EABS:

A Clinical Study of Accessory Breast Tissue in Axillae

Accessory axillary breast tissue has received little attention in the surgical literature although it is not an uncommon kind of aberrant breast tissue. Twenty-six patients who have been treated with an exicision of accessory breast tissue from January 1988 to June 1995 at the Department of Surgery, College of Medicine, Soonchunhyang University were analyzed retrospectively. The age of the patients ranged from 18 to 58 years, median age, 34 years. All were female including two postmenopausal females. We observed a palpable mass in the left axillae in 6 patients, in the right axillae in 8 patients and in the both axilla in 12 patients. Of the 41 masses of 26 patients, 19 masses were located on tne anterior axillary line, 20 masses on the midlle axillary line and 2 masses on the posterior axillary line. The size of the accessory breast tissue ranged from 0.5 to 8cm, with a median of 3.4cm. The presenting symptoms were mass in all cases, pain in 12 cases, growing mass in 4 cases and redness in one case. Histological diagnosis of total 41 masses revealed 28 normal breast tissue, 9 fibrocystic disease, 1 ductal ectasia, 1 fibroadenoma, 1 fibrocystic disease with ductal ectasia and 1 infiltrating ductal carcinoma. There were no typical clinical characteristics for differential diagnosis preoperatively. Of a total of 38 excisional operations, 4 complications developed (two hematoma, one wound infection and one skin tag). The postoperative hospital stay ranged from 1 to 17 days. The accessory breast tissue might be regarded as a more important disease than before, because various pathologic changes could occur in it including malignant change. Early diagnosis and correct excision are usually recommended.