• Progress in Medical Physics
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• v.26 no.4
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• pp.234-240
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• 2015

The purpose of this study is to analyze dosimetric parameters of patient with large and pendulous breast receiving breast radiotherapy in the prone versus supine position. The patient underwent computed tomography simulation in both prone and supine position. The homogeneity index (HI), conformity index (CI), coverage index (CVI) to the left breast as planning target volume (PTV) and the doses to the lung, heart, and right breast as organ at risk (OAR) were compared by using dose-volume histogram. The lifetime attributable risk (LAR) according to the prone and supine position was measured for the lung and right breast. The HI, CI of the PTV decreased 21.7%, 6.49%, respectively and the CVI increased 10.8% with the prone position. The mean and maximum dose to the left lung decreased 91.6%, 87.0%, respectively and the volume parameters also decreased over 99% with the prone position. The parameters to the right lung were same regardless of the position. The mean and maximum dose to the heart decreased 51.6%, 14.2% with the prone position. But the mean and maximum dose to the right breast increased unlike the other OARs. The LARs to the lung decreased 80.3% (left), 24.2% (right) but the LAR to the right breast doubled with the prone position. The prone position is a favorable alternative for irradiation of breast in patients with large and pendulous breasts.

• Radiation Oncology Journal
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• v.23 no.2
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• pp.123-130
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• 2005

Purpose: We wanted to improve the setup reproducibility of breast cancer patients when utilizing a commercially available breast board for radiation therapy. The breast board was modified by using a new head rest and 2 types of board fixation devices. Materials and Methods: A conventional head/neck rest was modified to be positioned in various slots of the breast board, and it was fabricated 1 cm thinner to provide more comfort to a patient when the patient's neck was rotated. This rest improves the uncertainty of the daily setup. Also, the sagging problems at the left and right sides became negligible with the two types of board fixation devices: (1) the stair type, and (2) the arm type. The first device consists of an upper/lower holder with 4 stair-types of grooves and 4 rectangular Inserts. In order to cover the whole range of vertical setup of the breast board, 4 rectangular inserts were needed, and each covered 10 steps. The arm-type fixation device was also fabricated and attached to the breast board, It had two aluminum bars that were fixed by utilizing a lock-type of screw. These devises were evaluated with two volunteers in order to prove the effectiveness of the improved setup accuracy. Results; The developed cranio-caudal fixation device demonstrated that it could reduce the cranio-caudal error by nearly $55\%$ compared to the old device. As for left-and-right inclination, the stair-type and arm-type fixation devices can reduce the relative inclination by nearly $80\%$ and $90\%$, respectively, compared to the breast board without the fixation device. Conclusion: It was verified that the developed devices were effective for positioning the patients and for avoiding inclination of the breast board.

• Asian-Australasian Journal of Animal Sciences
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• v.21 no.11
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• pp.1616-1623
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• 2008

This study was conducted to determine the effect of hot environment and dietary crude protein level (CP) on performance, carcass characteristics, meat visual quality, muscle chemical composition and malondialdehyde (MDA) concentration of tissues in broilers. Two hundred and sixteen 21-d old Arbor Acre broilers were used in a $4\times3$ factorial arrangement and randomly reared in 4 environmental chambers and fed on 3 diets with different CP levels for 3 weeks. The results showed: (1) when air temperature (AT) rose to $33^{\circ}C$, average daily feed intake, average daily gain, carcass weight, right breast meat weight, left thigh and drumstick meat weight decreased (p<0.05) and feed conversion rate decreased (p<0.05), but the ratio of carcass to live weight and of left thigh and drumstick meat weight to carcass weight increased (p<0.05). (2) There were significant differences in pH and shear force in breast meat, and shear force, L* and a* in thigh meat (p<0.01 or 0.05) among hot environments. Dietary CP level tended to affect breast meat pH and pH and L* of thigh meat (p<0.06 or 0.09). Compared to the normal temperature ($22^{\circ}C$), low temperature ($15^{\circ}C$) and hot humid (AT $33^{\circ}C$, relative humidity (RH) 80%) treatments significantly (p<0.05) decreased the tenderness of thigh meat. L* and a* value in thigh meat under high temperature treatments, regardless of RH, were higher (p<0.05) than those under normal temperature. (3) Protein content in breast and thigh meat of broilers fed under high temperature ($33^{\circ}C$) was lower (p<0.05) than that under $22^{\circ}C$, but fat content had an adverse change. High temperature ($33^{\circ}C$) increased the moisture of breast meat significantly (p<0.05). Protein content in breast meat increased significantly (p<0.05), in which fat content had an adverse change (p<0.05), when the dietary protein rose. (4) MDA concentration in liver and breast meat under hot humid (AT $33^{\circ}C$, RH 80%) treatment increased markedly (p<0.05). (5) High humidity could sharpen the bad effect of high temperature on performance, carcass yield and choice cuts, crude protein and moisture content in breast meat. It was concluded that a hot environment could affect the performance and meat quality of broiler chicks more significantly than CP level and that high humidity would aggravate the bad influence of high temperature on the broiler.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7467-7472
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• 2015

Background: Breast cancer is known to be one of the most prevalent cancers among women in both developing and developed countries. The incidence of breast cancer in Pakistan has increased dramatically within the last few years and is the second country after Israel in Asia to have highest proportional cases of breast cancer. However, there are limited data for breast cancer available in the literature from Pakistan. Objectives: The study was conducted to bring to light the common clinical presentation of breast cancer and to evaluate the frequency of established risk factors in breast carcinoma patients and furthermore to compare the findings between premenopausal and postmenopausal women in Pakistan. Materials and Methods: A 6 months (from July 2012 to Dec 2012) cross sectional survey was conducted in Surgical and Oncology Units of Civil Hospital, Karachi. Data were collected though a well developed questionnaire from 105 female patients diagnosed with carcinoma of breast and analyzed using SPSS version 17. Institutional ethical approval was obtained prior to data collection. Results: Out of 105 patients, 43 were premenopausal and 62 were postmenopausal, 99 being married. Mean age at diagnosis was $47.8{\pm}12.4years$. A painless lump was the most frequent symptom, notived by 77.1%(n=81). Some 55.2% (n=58) patients had a lump in the right breast and 44.8%(n=47) in the left breast. In the majority of cases, the lump was present in upper outer quadrant 41.9% (n=44). Mean period of delay from appearance of symptoms to consulting a doctor was $5.13{\pm}4.8months$, from the shortest 1 month to the longest 36 months. Long delay (> 3 months) was the most frequent figure 41.9%. Considering overall risk factors most frequent were first pregnancy after 20 years of age (41%), physical breast trauma (28.6%), lack of breast feeding(21.9%), and early menarche <11 years (19%), followed by null parity (16.2%), consumption of high fat diet (15.2%), family history of breast cancer or any other cancer in first degree relatives (9.5% and 13.3%, respectively). Some of the less common factors were late menopause >54 years (8.6%), use of oral contraceptive pills (10.5%), use of hormone replacement therapy (4.7%),smoking (4.7%) and radiation (0.96%). Significant differences (p<0.005) were observed between pre and post menopausal women regarding history of physical breast trauma, practice of breast feeding and parity. Conclusions: A painless lump was the most frequent clinical presentation noted. Overall age at first child > 20 years, physical breast trauma, lack of breast feeding, early menarche <11 were the most frequent risk factors. Physical breast trauma, lower parity, a trend for less breast feeding had more significant associations with pre-menopausal than post-menopausal onset. Increase opportunity of disease prevention can be obtained through better understanding of clinical presentation and risk factors important in the etiology of breast cancer.

• Journal of Korean Traditional Oncology
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• v.25 no.1
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• pp.1-9
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• 2020

Objective: The purpose of this study is to report improvement of symptoms after lobectomy of male breast cancer lung metastasis treated with Korean Medicine based Integrative Cancer Treatment (ICT). Methods: A male left breast cancer patient diagnosed with metastasis on lung at July 2019. After Video assisted thoracic surgery (VATS) left lower lobe (LLL) lobectomy and En bloc wedge resection the patient visited the Daejeon korean medicine hospital of Daejeon university East West Cancer Center (EWCC) to treat operation-site (op-site) pain, dysphagia, anorexia with Korean Medicine Treatment. The patient was treated with Korean Medicine based ICT for an approximately 20 days. The clinical outcomes were measured by National Cancer Institute Common Terminology Criteria for Adverse Event (NCI-CTCAE), Numeral rating scale (NRS) and Eastern Cooperative Oncology Group (ECOG). The safety of treatment was verified by blood tests. Results: After treatment, op-site pain was improved from NRS 9 to 6, dysphagia and anorexia were relieved from NRS 9 to 2. And ECOG score of the patient was improved from grade 2 to 1. Conclusion: This case study suggests that Korean Medicine based ICT may help to improve post operative sequelae in metastatic lung cancer patient.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.85-88
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• 2011

Purpose: Takotsubo cardiomyopathy is a relatively uncommon type of stress-induced cardiomyopathy characterized by transient left ventricular regional wall motion abnormalities. Emotional and physical stresses play a key role in this type of cardiomyopathy in postmenopausal women. The current hypothesis is that the syndrome represents a form of catecholamine surge due to stress or epinephrine-mediated acute myocardial stunning. Methods: A 44-year-old woman had suffered premature ventricular contraction following a cardiogenic shock during a breast augmentation surgery under enflurane anesthesia and tumescent solution infiltration. She was treated with cardiopulmonary resuscitation at a local clinic. Then she was brought to the Emergency Department of the authors' hospital. Results: The woman's echocardiogram showed an ejection fraction of 20~25% with associated basal hyperkinesis and left ventricular apical ballooning. The patient was admitted to the ICU and required inotropic support for two weeks. The patient's condition dramatically improved, and her ejection fraction returned to 70%. Conclusion: It is believed that there were multiple triggering factors of the onset of Takotsubo cardiomyopathy in the woman's social and family history, including infiltration of a large volume of the tumescent solution and VPCs induced by enflurane anesthesia without premedication. The importance of careful history-taking, careful pre-operative consultation on psychological suffering especially for breast surgery, premedication before surgery, patient reassurance, and post-operative psychosocial and emotional assistance was again seen in this case.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.1
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• pp.11-15
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• 2008

Purpose: The goal of radiation treatment is to deliver a prescribed radiation dose to the target volume accurately while minimizing dose to normal tissues. In this paper, we comparing the dose distribution between three dimensional conformal radiation radiotherapy (3D-CRT) and helical tomotherapy (TOMO) plan for partial breast cancer. Materials and Methods: Twenty patients were included in the study, and plans for two techniques were developed for each patient (left breast:10 patients, right breast:10 patients). For each patient 3D-CRT planning was using pinnacle planning system, inverse plan was made using Tomotherapy Hi-Art system and using the same targets and optimization goals. We comparing the Homogeneity index (HI), Conformity index (CI) and sparing of the organs at risk for dose-volume histogram. Results: Whereas the HI, CI of TOMO was significantly better than the other, 3D-CRT was observed to have significantly poorer HI, CI. The percentage ipsilateral non-PTV breast volume that was delivered 50% of the prescribed dose was 3D-CRT (mean: 40.4%), TOMO (mean: 18.3%). The average ipsilateral lung volume percentage receiving 20% of the PD was 3D-CRT (mean: 4.8%), TOMO (mean: 14.2), concerning the average heart volume receiving 20% and 10% of the PD during treatment of left breast cancer 3D-CRT (mean: 1.6%, 3.0%), TOMO (mean: 9.7%, 26.3%) Conclusion: In summary, 3D-CRT and TOMO techniques were found to have acceptable PTV coverage in our study. However, in TOMO, high conformity to the PTV and effective breast tissue sparing was achieved at the expense of considerable dose exposure to the lung and heart.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.51-63
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• 2019

Purpose: Radiation therapy for breast cancer should consider the change in breast shape due to breathing and swelling. In this study, we evaluate the benefit of using virtual bolus for IMRT of left breast cancer. Materials and methods: 10 patients with early breast cancer who received radiation therapy after breastconserving surgery compared the VMAT and IMRT plans using the virtual bolus method and without using it. The first analysis compared the V95%, HI, CI of treatment volume, Dmean, V5, V20, V30 of ipsilateral lung, and Dmean of heart in VMAT plan made using the virtual bolus method(VMAT_VB) to the plan without using it(VMAT_NoVB) in case there is no change in the breast. In IMRT, the same method was used. The second analysis compared TCP and NTCP based on each treatment plan in case there is 1cm expansion of treatment volume. Result: If there is no change in breast, V95% in VB Plan(VMAT_VB, IMRT_VB) and NoVB Plan(VMAT_NoVB, IMRT_NoVB) is all over 99% on each treatment plan. V95% in VMAT_NoVB and VMAT_VB is 99.80±0.17% and 99.75±0.12%, V95% in IMRT_NoVB and IMRT_VB is 99.67±0.26% and 99.51±0.15%. Difference of HI, CI is within 3%. OAR dose in VB plan is a little high than NoVB plan, and did not exceed guidelines. If there is 1cm change in breast, VMAT_NoVB and IMRT_NoVB are less effective for treatment. But VMAT_VB and IMRT_VB continue similar treatment effect compared in case no variation of breast. Conclusion: This study confirms the benefit of using a virtual bolus during VMAT and IMRT to compensate potential breast shape modification.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.773-775
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• 2006

Purpose: The sternalis muscle is an accessory muscle of the anterior chest wall. This is a rare anatomic variant reported in approximately 8 percent of the population, with variation among races. While several anatomic studies of the sternalis muscle exist, nothing in the literature addresses the implications of this muscle on staged breast reconstruction with implant. Methods: We encountered two consecutive patients with a left sternalis muscle who underwent immediate staged breast reconstruction with a tissue expander. We offer a strategy for dealing with this rare, but known, anatomic variant during staged implant reconstruction. Firstly, recognizing the presence of a sternalis muscle mandates the elevation of the pectoralis major muscle and the sternalis muscle in continuity. Secondly, slight modifications must be made during the submuscular dissection to create a properly placed pocket for the tissue expander. Results: While our encounters with this anatomic variant are few, our experiences with two consecutive patients illustrate that the reconstructive surgeon must be familiar with the sternalis muscle and be prepared to adapt his or her technique for tissue expander placement when faced with this accessory muscle. Conclusion: To date, no reports exist in the literature describing the operative implications of this anatomic variant. We offer our technique for dealing with this accessory muscle during staged implant reconstruction of the breast.

• The Korean Journal of Cytopathology
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• v.8 no.2
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• pp.164-169
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• 1997

A case of plasmacytoma of the ovary and breast, which developed in a patient with a solitary plasmacytoma in the lumbar vertebra for nine months, was diagnosed cytologically and histologically. Enlargement of the right ovary and multiple palpable masses in the right and left breast were already present at six months after the diagnosis of vertebral solitary plasmacytoma. At eight months, plasma cell leukemia developed, and nine months the enlarged both ovaries, replaced by yellowish-gray solid tumors showed infiltration of immature plasma cells. The cytologic features of the ovarian tumors were same with those of the breast tumor. The tumor cells were of predominantly immature plasma cells with one or more nuclei. Some mature plasma cell had an eccentric nucleus with single nucleolus and peripherally clumped chromatin. Binucleated or multinucleated giant cells were often present. Histologically, sheets of poorly differentiated plasmacytoid tumor cells were separated by strands of hyaline fibrous tissue. On immunohistochemical stains, the tumor cells showed strong reactivity for lambda-light chain but no reaction for kappa-light chain, cytokeratin, or leukocyte common antigen.