• Journal of Veterinary Clinics
• /
• v.37 no.3
• /
• pp.145-148
• /
• 2020

A 9-years old spayed female Maltese was referred for the treatment of mass on the right 1^st mammary gland and acute weight bearing lameness of right hindlimb. It was diagnosed as malignant mammary tumor and cranial cruciate ligament rupture of right stifle joint. Right upper regional mastectomy followed by cranial closing wedge osteotomy (CCWO) of the right tibia were planned for the present problems. Preanesthetic work-up did not show any remarkable abnormalities. Forty-five minutes after induction of anesthesia dobutamine was administered at a rate of 5 ㎍/kg/min by constant rate infusion due to gradual decrease of blood pressure below MAP 60 mmHg during surgical procedure. Despite of the increase of dobutamine infusion rate up to 20 ㎍/kg/min, blood pressure didn't recover. At the end of regional mastectomy generalized skin redness and eyelid edema were identified. Anesthesia was stopped and CCWO procedure was cancelled. To recover from the anaphylactic reactions dexamethasone and diphenhydramine were administered. After about one hour, the patient completely recovered from hypotension and anaphylactic reactions. After 4 weeks, intradermal skin test (IDST) was performed for all the drugs used during anesthesia. Only dobutamine showed positive reaction in IDST. Therefore, dobutamine was considered as the causative agent of anaphylaxis in this patient during the anesthesia. In case of perioperative anaphylactic reaction, postoperative investigation should be performed to identify causative agent and to provide safe recommendations for future anesthetic procedure.

• Archives of Plastic Surgery
• /
• v.41 no.5
• /
• pp.520-528
• /
• 2014

Background As the breast cancer incidence has increased, breast-conserving surgery has replaced total mastectomy as the predominant procedure. However, centrally located breast cancers pose significant challenges to successful breast-conserving surgeries. Therefore, we performed partial mastectomy and oncoplastic procedures on centrally located breast cancer as a means of partial breast reconstruction. The authors examined and evaluated the functional and aesthetic usefulness of this reconstruction method. Methods From January 2007 to June 2011, 35 patients with centrally located breast cancers who underwent various oncoplastic procedures based on the breast size and resection volume. The oncoplastic procedures performed included volume displacement surgical techniques such as purse-string suture, linear suture, and reduction mammaplasty. Other oncoplastic procedures included volume replacement procedures with an adipofascial, thoracoepigastric, intercostal artery perforator, thoracodorsal artery perforator, or latissimus dorsi flap. Results Mean patient age was 49 years, and mean follow-up period was 11 months. In cases of small to moderate-sized breasts and resection volumes <50 g, volume displacement procedures were performed. In cases of resection volumes >50 g, volume replacement procedures were performed. In cases of larger breasts and smaller resection volumes, glandular reshaping was performed. Finally, in cases of larger breasts and larger resection volumes, reduction mammaplasty was performed. This reconstruction method also elicits a high patient satisfaction rate with no significant complications. Conclusions In centrally located breast cancer, oncoplastic surgery considering breast size and resection volume is safe and provides appropriate aesthetic outcomes. Therefore, our method is advisable for breast cancer patients who elect to conserve their breasts and retain a natural breast shape.

• Archives of Plastic Surgery
• /
• v.45 no.3
• /
• pp.229-238
• /
• 2018

Background Nipple-sparing mastectomies (NSMs) are increasingly performed to obtain the best aesthetic and psychological outcomes in breast cancer treatment. However, merely preserving the nipple-areolar complex (NAC) does not guarantee a good outcome. Darkly pigmented NACs and a tendency for poor scarring outcomes are particular challenges when treating Asian patients. Herein, we review the reconstructive outcomes following NSM at Singapore General Hospital. Methods All breasts reconstructed following NSM over an 11-year period from 2005 to 2015 were reviewed. Information was collected from the patients' records on mastectomy indications, operative details, and complications. Patient satisfaction, breast sensation, and aesthetic outcomes were evaluated in 15 patients. Sensation was quantified using the Semmes-Weinstein monofilament test. Results A total of 142 NSMs were performed in 133 patients for breast cancer (n=122, 85.9%) or risk reduction (n=20, 14.1%). Of the procedures, 114 (80.2%) were autologous reconstructions, while 27 (19.0%) were reconstructions with implants. Complications occurred in 28 breasts (19.7%), with the most common complication being NAC necrosis, which occurred in 17 breasts (12.0%). Four breasts (2.8%) had total NAC necrosis. The overall mean patient satisfaction score was 3.0 (good). The sensation scores were significantly diminished in the skin envelope, areola, and nipple of breasts that had undergone NSM compared to non-operated breasts (P<0.05). Half of the subset of 15 patients in whom aesthetic outcomes were evaluated had reduced nipple projection. Conclusions Immediate reconstruction after NSM was performed with a low complication rate in this series, predominantly through autologous reconstruction. Patients should be informed of potential drawbacks, including NAC necrosis, reduced nipple projection, and diminished sensation.

• The Korean Journal of Nuclear Medicine
• /
• v.38 no.4
• /
• pp.311-317
• /
• 2004

Purpose: The purpose of this study was to determine the utility of tumor marker CA 15-3 in the following: the diagnosis of breast cancer relapse after curative mastectomy, and the differentiation or the value of tumor marker by site of metastases. Materials and Methods: Two hundred two patients (median age 48 years) with breast cancer included in the follow-up after curative mastectomy. The tumor marker CA 15-3 was determined by IRMA (CIS BIO INTERNATIONAL, France). Test values > 30 U/ml were considered elevated (positive). Results: Among 202 patients, recurrent diseases were found in 16 patients. CA 15-3 was elevated in 5 of 16 patients with recurrences. There was no false-positive patient who had elevated CA 15-3. Sensitivity and specificity of CA 15-3 for detection of breast cancer recurrence were 31%, and 100%. CA 15-3 was elevated in all of the 4 patients with liver metastases. CA 15-3 was elevated in none of the patients who relapsed with metastasis to bone-only or contralateral breast-only. Conclusion: The tumor marker CA 15-3 in the detection of breast cancer relapse after curative mastectomy is specific, but not sensitive. However, it is useful to rule out liver metastases of breast cancer, which indicates bad prognosis.

• Radiation Oncology Journal
• /
• v.36 no.4
• /
• pp.285-294
• /
• 2018

Purpose: To determine the necessity of postmastectomy radiotherapy (PMRT) and which regions would be at risk for recurrence, we evaluated local and regional recurrence in breast cancer patients with 1-3 positive nodes and a tumor size of <5 cm. Materials and Methods: We retrospectively analyzed data of 133 female breast cancer patients with 1-3 positive nodes, and a tumor size of <5 cm who were treated with mastectomy followed by adjuvant systemic therapy between 2007 and 2016. The median follow-up period was 57 months (range, 12 to 115 months). Most patients (82.7%) were treated with axillary lymph node dissection. Adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy were administered to 124 patients (93.2%), 112 (84.2%), and 33 (24.8%), respectively. The most common chemotherapy regimen was anthracycline and cyclophosphamide followed by taxane (71.4%). Results: Three patients (2.3%), 8 (6.0%), and 12 (9.0%) experienced local, regional, and distant failures, respectively. The 5-year cumulative risk of local recurrence, regional recurrence, distant metastasis, and disease-free survival was 3.1%, 8.0%, 11.7%, and 83.4%, respectively. There were no statistically significant clinicopathologic factors associated with local recurrence. Lymphovascular invasion (univariate p = 0.015 and multivariate p = 0.054) was associated with an increased risk of regional recurrence. Conclusion: Our study showed a very low local recurrence in patients with 1-3 positive nodes and tumor size of <5 cm who were treated with mastectomy and modern adjuvant systemic treatment. The PMRT volume need to be tailored for each patient's given risk for local and regional recurrence, and possible radiation-related toxicities.

• Journal of Veterinary Clinics
• /
• v.24 no.3
• /
• pp.331-336
• /
• 2007

Mammary gland tumors are the most common neoplasms occurring in female dogs. The treatments of mammary gland tumors are surgery, chemotherapy, hormonal therapy and radiational therapy, but surgical removal remains widely accepted treatment option for mammary gland tumors. The purpose of this study is to evaluate clinical outcomes of dogs which are performed surgical excision. Medical records were reviewed for dogs(79 cases) with mammary gland tumors treated surgically at Veterinary Medical Teaching Hospital in Seoul National University from 2001 to 2005. While 49 cases(62.0%) were benign, 30 cases(38.0%) were malignant tumors. The mean age of these dogs was 10.4 years old(range $1{\sim}16$ years). The maximal diameter of malignant tumors were various, whereas most of the benign tumors were smaller than 3cm(36 cases, 73.5%). In 12 cases(15.2%), regional lymph nodes were enlarged and lymph nodes of 3 cases had resected surgically. The performed techniques were total mastectomy, regional mastectomy, simple mastectomy, lumpectomy and unilateral mastectomy in order. Twenty-eight cases(35.4%) had postoperative complications consisted of recurrence of tumors, necrosis, dehiscence, delayed healing and edema of limbs. The recurrence rates of benign and malignant mammary gland tumors were 8 cases(16.3%) and 6 cases(20.0%). Metastasis rate was 7 cases(8.9%). Although postoperative complications were no remarkable difference in recurrence rates among surgical techniques in this study, other complications such as edema of limbs, necrosis, dehiscence and delayed healing were remarkable difference as surgical techniques. Therefore, this result suggest that choice of appropriate surgical techniques should be determined according to each patient's physical status and characteristics of tumors.

• PNF and Movement
• /
• v.18 no.1
• /
• pp.1-10
• /
• 2020

Purpose: This study was conducted to examine the effects of a PNF intervention using elastic bands on edema, range of motion (ROM), and pain in post-mastectomy patients with upper limb lymphedema, according to their hand grip type. Methods: The subjects were 14 female patients who were at Stage II lymphedema after undergoing mastectomy for Stage II breast cancer. They were randomly divided into an experimental group (n =7) and a control group (n = 7). Both groups participated in a treatment program four times (one time under the therapist's instructions and three times as self-exercise) a week for 4 weeks. Both groups repeated an upper limb PNF pattern exercise for 30 min using elastic bands after receiving a manual lymph drainage treatment for 1 hour. Here, subjects in the experimental group performed the PNF exercise with an open-hand grip by putting their hands into the loops of elastic bands and keeping their fingers spread out. Subjects in the control group performed the PNF exercise with a closed-hand grip by holding the loops of elastic bands with their fingers. In both groups, the subjects' edema, ROM, and pain levels were measured before the intervention and 2, 3 and 4 weeks after the intervention. Results: As a result of the experiment, both groups demonstrated edema reductions, ROM increases, and pain reductions in four areas of the upper limbs. Notably, the experimental group exhibited larger ROM increases in flexion, extension, and abduction as well as greater edema and pain reductions than the control group. In particular, the most significant effects were found in the elbow of the four upper limb areas for edema reductions and in extension for ROM increases. Conclusion: The present study indicates that exercise therapy-based approaches using elastic bands in post-mastectomy patients with upper limb lymphedema can have different effects depending on the type of hand grip (open or closed), which is the body's most distal part. Therefore, these approaches should be based on the conditions of the distal parts of the patient's body for their effective applications in clinical practice.

• Archives of Reconstructive Microsurgery
• /
• v.24 no.1
• /
• pp.28-31
• /
• 2015

A case report of a patient who developed radiation-induced sarcoma in the left chest wall is presented. The patient had partial mastectomy and adjuvant radiation therapy (total dose, 5,220 cGy) and chemotherapy. Five years later, she visited with rapidly growing mass with central ulceration in the irradiated chest wall. The mass was diagnosed as malignant fibrous histiocytoma. The chest wall mass resected en bloc ($23{\times}18cm$) including five consecutive ribs. After the defected thoracic cage was reinforced using a polytetrafluoroethylene patch, omental flap and split thickness skin graft was done for soft tissue coverage. We applied negative pressure wound closer system for effective suction of omeantal exudate. The wound healed without complications. The patient suffered no perioperative pulmonary complications. Pulmonary function tests showed no significant changes. Each of Gore-Tex, omental flap, negative pressure wound therapy and skin graft is widely used method. However, If these methods are used in combination, we can reconstruct the large defect of chest wall including multiple ribs without any repiratory function problems.

• Journal of Chest Surgery
• /
• v.23 no.1
• /
• pp.95-106
• /
• 1990

Between May 1979 and April 1989, 213 patients with esophageal injuries visited the Department of the Thoracic and cardiovascular surgery Department, Yonsei University College of Medicine. There were 159 non perforated esophageal injuries accompanied by hematemesis, and 54 perforated esophageal injuries. The causes of non perforated esophageal injuries were Mallory-Weise Syndrome [%], corrosive esophagitis [54], esophageal carcinoma [4], foreign bodies [2], sclerotherapy due to esophageal varices [3]. The causes of perforated esophageal injuries were esophageal anastomosis[13], malignancies[17], esophagoscopy or bougienage[5], chest trauma[5], foreign bodies[5], paraesophageal surgery[3], others[6] In esophageal perforation due to foreign bodies, esophagoscopy or bougienage, there were 6 cervical esophageal perforations and 9 thoracic esophageal perforations. There were no mortalities in the treatment of the cervical esophageal perforations and 5 deaths resulted in the treatment of 9 thoracic esophageal perforations. And four of six patients with thoracic esophageal perforations died in the initiation of treatment over 24 hours, after trauma. There were another 12 deaths in the patients with chest trauma, malignancies or chronic inflammation except esophageal injuries due to foreign bodies or instruments during the hospital stay or less than 30 days after esophageal injuries. One patient with esophageal carcinoma died due to bleeding and respiratory failure after irradiation. Another patient with esophago gastrostomy due to esophageal carcinoma died of sepsis due to EG site leakage. One patient with a mastectomy due to breast cancer followed by irradiation died of sepsis due to an esophagopleural fistula. Two patients with Mallory-Weiss syndrome died; of hemorrhagic shock in one and of respiratory failure due to massive transfusion in the other. One patient with TEF died of respiratory failure and another died of pneumonia and respiratory failure. One patient with esophageal perforation due to blunt chest trauma died of brain damage accompanied with chest trauma.

• Perspectives in Nursing Science
• /
• v.12 no.2
• /
• pp.115-123
• /
• 2015

Purpose: This study aimed to investigate the quality of patient-centered nursing care (PCNC) among women with breast cancer at a cancer center in Seoul, Korea. Methods: In a cross-sectional survey design, 223 women with breast cancer were recruited from the oncology surgery unit. The Korean version of the oncology patients' perceptions of the quality of nursing care scale, which is conceptualized in four sub-dimensions (individualization, proficiency, responsiveness, and coordination) was used for measurement. Data were analyzed using descriptive statistics and ANOVA. Results: The participants were all women, with a mean age of 51.3 years. The mean score of PCNC was high and significantly different from each other according to age group. Breast cancer women, who had mastectomy, were satisfied highly in terms of proficiency and responsiveness care, but less satisfied with individualization and coordination care than those of other women. Conclusion: The findings of this study show the quality of cancer nursing care, especially focusing on patient-centeredness, can be measured from the patients'perspective. The individualized and coordinated nursing care is considered to be the core of quality cancer care implying patient-centeredness. Based on the findings of this study, more research is necessary to explore the patients' view of quality cancer care and to test the effects of PCNC within the context of comparative effectiveness.