• Archives of Plastic Surgery
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• 제45권5호
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• pp.432-440
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• 2018

Background Adjuvant therapy after breast surgery, including tamoxifen or aromatase inhibitors, improves the postoperative outcomes and long-term survival of breast cancer patients. The aim of this study was to determine whether volume changes occurred in the contralateral breast during hormonal or other adjuvant therapies. Methods This study reviewed 90 patients who underwent unilateral breast reconstruction between September 2012 and April 2018 using tissue expanders and a permanent implant after the surgical removal of breast cancer. The volume of the contralateral breast was measured using a cast before the first (tissue expander insertion) and second (permanent implant change) stages of surgery. Changes in breast volume were evaluated to determine whether adjuvant therapy such as hormonal therapy, chemotherapy, and radiation therapy influenced the volume of the contralateral breast. Results The group receiving tamoxifen therapy demonstrated a significant decrease in volume compared with the group without tamoxifen (-7.8% vs. 1.0%; P=0.028). The aromatase inhibitor-treated group showed a significant increase in volume compared with those who did not receive therapy (-6.2% vs. 4.5%; P=0.023). There were no significant differences between groups treated with other hormonal therapy, chemotherapy, or radiation therapy. Conclusions Patients who received tamoxifen therapy showed a significant decrease in volume in the contralateral breast, while no significant change in weight or body mass index was found. Our findings suggest that we should choose smaller implants for premenopausal patients, who have a high likelihood of receiving tamoxifen therapy.

• Asian Pacific Journal of Cancer Prevention
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• 제16권12호
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• pp.4959-4964
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• 2015

Background: To assess the immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor-2 (HER2) neu receptor in breast cancer and their associations with various clinicopathological characteristics. Materials and Methods: This is a retrospective analysis of women who presented with primary, unilateral breast cancer in the Department of Medical Oncology at Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India during the period from January 2008 to December 2011. Data were retrieved from the medical records of the hospital including both early and locally advanced cancer cases. ER, PgR and HER2neu expression in these patients was assessed and triple negative patients were identified. Associations of triple negative and non-triple negative groups with clinicopathological characteristics were also evaluated. Results: A total of 1,284 women (mean age 52.1 years, 41.9% premenopausal) were included in the analysis. Hormone receptor positivity (ER and/or PgR) was seen in 63.4% patients, while 23.8% of tumors were triple negative. Only 23.0% were HER2 positive. Around 10.0% of tumors were both ER and HER2 positive. ER and PgR positivity was significantly associated with negative HER2 status (p-value <0.0001). Younger age, premenopausal status, higher tumor grade, lymph node negativity, advanced cancer stage, and type of tumor were strongly associated with triple negativity. Significantly, a smaller proportion of women had ductal carcinoma in situ in the triple negative group compared with the non-triple negative group (35.6% versus 60.8%, p-value<0.01). Conclusions: The present analysis is one of the largest studies from India. The majority of the Indian breast cancer patients seen in our hospital present with ER and PgR positive tumors. The triple negative patients tended to be younger, premenopausal, and were associated with higher tumor grades, negative lymph nodes status and lower frequency of ductal carcinoma in situ.

• Archives of Plastic Surgery
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• 제35권3호
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• pp.279-282
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• 2008

Purpose: It is known that the chronic absence of unilateral breast can cause spine curvature. The artificial breast manufactures take up the position of that possibility. This study was designed to evaluate the influence of the mastectomy on the spine and appearance of scoliosis among women who wanted delayed breast reconstruction. ted delayed breast reconstruction. Methods: The study population consisted of 47 women who underwent delayed breast reconstruction at our Department of Plastic Surgery from April 2001 to May 2007. The whole spine anteroposterior and lateral X-ray was taken to evaluate the Cobb's angle. As a general rule a Cobb angle of 10 is regarded as a minimum angulation to define scoliosis. We evaluated Cobb's angle and drew a correlation between the duration of the mastectomy state and the weight of the mastectomy specimen. Results: There were no family history of scoliosis, and no numbness or weakness in the upper or lower extremities. They had normal reflex and experienced no tenderness of the perispinal area. The Spearman Correlation Coefficient between Cobb's angle and the period that took time from the mastectomy to the X-rays and analysis between Cobb's angle and specimen weight was 0.032 and-0.115. there were no correlation between Cobb's angle and time, or between Cobb's angle and specimen weight. Conclusion: lthough the patients attribute their back pain and distorted posture to having received an one-sided mastectomy, it is unlikely that one-sided mastectomy causes spinal deformity and scoliosis.

• Archives of Reconstructive Microsurgery
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• 제5권1호
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• pp.80-91
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• 1996

A free rectus abdominis flap can include a variable amount of muscle length depending on recipient site requirements. There is also great flexibility in flap design in terms of size, orientation of its axis, and the level of its location over the muscle. It is safe to design the skin island across the midline. Though skin islands designed over the most inferior portion of the abdomen have not always proved reliable when based on the superior epigastric artery, free flaps based on the inferior pedicle can be successfully designed in this area. As free flap based on the inferior epigastric vessels, this flap has been useful for large head and neck defects following ablative procedures, for facial contour restoration as a buried flap, for upper extremity defects, for lower extremity defects such as coverage of grade III tibial fractures and for breast reconstruction. A free rectus abdominis muscle or myocutaneus flap was used in 8 patients. The operations were performed between Sep. of 1994 and April of 1996. The patients were tongue cancer 1 case, chronic facial palsy 1 case, unilateral breast reconstruction 1 case, upper and lower extremity injury 5 cases. The free rectus abdominis muscle flaps were 4 cases and the free myocutaneous flaps were 4 cases. There was no failure of the flap, except one partial necrosis. One case of the skin grafts on the muscle flap was regrafted. One case of reoperation due to venous thrombosis was performed. In tongue cancer patient, a orocutaneous fistula was occurred, but conservative treatment and secondandry skin graft were done. In conclusion, a free rectus abdominis flap has many advantages such as a long and constant pedicle, easy dissection, enough soft tissue available, scar on the donor site to be hiddened, no need for changing position. So we think that this flap is the most useful one for small or moderate sized defects on the various sites.

• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3595-3600
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• 2016

Background: To investigate the association between preoperative pathological Ki-67 labeling index and serum tumor marker cancer antigen 15-3 (CA 15-3) with clinic-pathological parameters and treatment outcomes in early breast cancer. Materials and Methods: A retrospective study at 4 cancer centers in Saudi Arabia and Egypt was performed. Data were collected for female patients diagnosed with unilateral early breast cancer between March 2010 and October 2013. Cases treated with neoadjuvant chemotherapy (NACT) followed by surgery and radiotherapy were included. NACT included 6-8 cycles of anthracycline and taxane based regimens. Trastuzumab and hormonal treatments were added according to HER2 and hormone receptor status. Baseline serum CA15.3 and pathological Ki67 levels were evaluated and correlated with disease free survival (DFS) and overall survival (OS). Results: A total of 280 pts was included. The median age was 49 years (38-66 y) and median overall survival was 35 (20-38) months (mo). Estrogen receptors (ER), progesterone receptors (PR) and HER 2 receptors were positive in 233 (83.2%), 198 (70%) and 65 cases (23.2%), respectively. High preoperative Ki67 and CA15.3 were noted in 177 (63.2%) and 131 (46.8%). A total of 45 (16%) patients had distal or local recurrence and 24 (8.6%) died of their disease. Most of the relapsed cases had high preoperative Ki-67 (n=41, 91%) and CA15.3 (n=28, 62%) values. All of the patients who died had a high Ki-67 but CA15.3 was high in 9 (37%) only. Mean DFS/OS in patients with high preoperative Ki-67 was 32 months /32 months as compared to 37 months/35 months in those with normal Ki-67 (p<0.001). Correlation of preoperative CA15.3 and survival was statistically not significant. Conclusions:Preoperative Ki-67 can be a predictive and prognostic marker. Higher levels are associated with poor DFS and OS in patients with early BC.

• 대한기관식도과학회지
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• 제17권2호
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• pp.83-88
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• 2011

Robotic thyroidectomy has been developed to minimize neck scarring, and several authors have described its feasibility and safety, and have reported surgical outcomes comparable with conventional open thyroidectomy. The da Vinci surgical system robot provides a three-dimensional $10-12{\times}$magnified view of the surgical area. It also provides hand-tremor filtration, fine motion scaling, and precise and multi-articulated hand-like motions. Recently, robotic technology has also been applied to lateral compartment neck dissection in thyroid cancer. We have developed a new novel selective neck dissection procedure by a gasless unilateral axillo-breast (GUAB) approach with a da Vinci Surgical System for well-differentiated thyroid carcinoma to avoid a long visible neck scar. Based on our early experience, robotic selective neck dissection by GUAB approach is a safe, feasible and cosmetically excellent procedure. It can be an alternative to conventional open surgery in the highly selected patients with well-differentiated thyroid carcinoma. The oncologic safety of robotic selective neck dissection should be verified with long-term follow-up data.

• Radiation Oncology Journal
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• 제38권1호
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• pp.68-76
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• 2020

Purpose: The present study was conducted to compare dosimetric parameters for the heart and left lung between free breathing (FB) and deep inspiration breath hold (DIBH) and determine the most important potential factors associated with increasing the lung dose for left-sided breast radiotherapy using image analysis with 3D Slicer software. Materials and Methods: Computed tomography-simulation scans in FB and DIBH were obtained from 17 patients with left-sided breast cancer. After contouring, three-dimensional conformal plans were generated for them. The prescribed dose was 50 Gy to the clinical target volume. In addition to the dosimetric parameters, the irradiated volumes and both displacement magnitudes and vectors for the heart and left lung were assessed using 3D Slicer software. Results: The average of the heart mean dose (D_mean) decreased from 5.97 to 3.83 Gy and V₂₅ from 7.60% to 3.29% using DIBH (p < 0.001). Furthermore, the average of D_mean for the left lung was changed from 8.67 to 8.95 Gy (p = 0.389) and V₂₀ from 14.84% to 15.44% (p = 0.387). Both of the absolute and relative irradiated heart volumes decreased from 42.12 to 15.82 mL and 8.16% to 3.17%, respectively (p < 0.001); however, these parameters for the left lung increased from 124.32 to 223.27 mL (p < 0.001) and 13.33% to 13.99% (p = 0.350). In addition, the average of heart and left lung displacement magnitudes were calculated at 7.32 and 20.91 mm, respectively. Conclusion: The DIBH is an effective technique in the reduction of the heart dose for tangentially treated left sided-breast cancer patients, without a detrimental effect on the left lung.

• Tuberculosis and Respiratory Diseases
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• 제42권2호
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• pp.156-164
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• 1995

연구배경: 전이성 흉막선암은 악성 경과를 취하고, 고령인 경우가 많고, 그 외에 경제적 이유 등으로 인하여 적극적인 진단 및 치료가 환자에게 실질적인 도움이 될 지 의문이다. 이에 저자들은 우리 나라에서의 전이성 흉막선암 환자들의 임상경과를 관찰하여 진단적 검사및 수기시행의 의미, 치료의 효과, 예후 등을 판정하고자 본 연구를 시행하였다. 방법: 1990년 1월부터 1994년 12월에 걸쳐 전주 예수병원 방문 환자 중 흉수 세포진(106명) 혹은 흉막생검(22명)에서 전이성 흉막선암으로 확진되었던 환자 113명을 대상으로 후향적으로 조사하였다. 결과 1) 전체 113명 중 남자 59명(52.2%), 여자 54명(47.8%) 이었고, 평균 연령은 $57.4{\pm}12.1$세 였다. 2) 원발병소는 전체적으로 폐암 46.9%(53/113), 위암 20.4%(23/113), 유방암 11.5%(13/113) 순이었고, 원발병소를 규명하지 못한 경우가 6.2%(7/113) 있었으며, 남자는 폐암(55.9%, 20/59), 위암(28.8%, 17/59), 여자는 폐암(37.0%, 20/54), 유방암(24.1%, 13/54)이 많았다. 3) 임상증상은 호흡곤란(69%), 기침(61%), 흉통(50%), 체중감소(50%), 식욕부진(49%), 객담(43%), 권태(30%) 등의 순이었다. 4) 흉수 소견은 94.4%(102/108)가 삼출성, 36~53%(39~58/109)가 혈성, 74.3%(84/113)가 일측성이었고, 백혈구 중 임파구가 $71{\pm}27%$로 우세하였다. 5) 66명 중 40명(60.6%)에서 CEA치가 흉수 혹은 혈청에서 10ng/ml 이상으로 증가하였고, 60명 중 57명(95%)에서 흉수 ADA치가 40 U/L 미만이었다. 6) 수술적요법을 제외한 여러 가지 치료가 시행되었으나 생존기간 연장의 효과가 있었는지는 의문이다. 7) 평균 생존기간은 $12.7{\pm}13.5$주였다. 결론: 이상의 연구로 볼 때, 이 질환은 아직 효과적인 치료법이 없고, 매우 악성경과를 취하는 질환이기 때문에 적극적인 검사 및 진단 수기의 진행은 특이적인 치료가 가능한 원발병소의 조기 발견과 치료 및 예방 등에 목적을 두어야 할 것이며, 생존기간의 연장 및 생존기간동안 삶의 질을 향상시키기 위한 노력도 병행되어야 할 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제59권1호
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• pp.93-96
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• 2005

저자들은 좌안의 시력 저하를 주소로 내원한 52세의 남자 환자에서 안구를 비롯한 간과 뇌 등에 전이성 병변을 동반한 세기관지폐포암 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제51권2호
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• pp.170-180
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• 2008

목 적 : 몇몇 항생제가 저산소성 허혈성 뇌 손상에서 뇌 보호 효과를 가진 것으로 밝혀졌지만 아직까지 그 기전에 대해 잘 알려지지 않고 있다. 최근 아미노글루코사이드 계열의 항생제인 G418(geneticin)이 항고사에 의한 암세포 생존을 증가 시키는 것으로 알려졌으며 본 연구는 G418이 주산기 저산소성 허혈성 뇌손상에서 세포 고사를 억제함으로서 뇌 보호 효과를 나타내는지를 알아보고자 하였다. 방 법 : 임신 18일된 백서의 대뇌피질 신경세포를 배양하여 정상산소 상태군와 저산소 상태군으로 나누고, 두 군을 각각 대조군과 G418 $10{\mu}g/mL$으로 처리한 군으로 나누어서 TUNEL 분석과 caspase 3에 대한 면역조직생화학검사를 하였고, 생후 7일된 신생 백서의 좌측 총경동맥을 결찰 후 절단하고 저산소 상태를 유도하여 G418을 저산소 상태 유도 전 30분과 유도 후 30분에 복강 내로 $0.1{\mu}g/kg$ 투여하고 7일 후에 희생시켜 H&E 염색과 caspase-3에 대해 Western blot과 real-time PCR를 하였다. 결 과 : TENEL 분석상 정상산소 상태군과 저산소 상태군 모두에서 대조군보다 G418 투여군에서 통계학적으로 유의하게 고사세포가 감소되었다(P<0.01). Caspase-3에 대한 면역조직화학검사에서 저산소 손상 전에 G418을 투여한 군에서 손상 후에 투여한 군보다 Caspase-3 발현이 적게 나타났다. 저산소 손상 7일 후에 얻은 신생 백서 뇌의 육안적 관찰과 H & E 염색에서 저산소 상태군의 뇌 용적이 정상산소 상태군의 경우보다 감소된 것을 알 수 있었고, 저산소 손상 전에 G418을 투여한 군에서 손상 후에 투여한 군보다 뇌 조직의 손상이 더 적은 것을 볼 수 있었다. Bax/Bcl-2, caspase-3에 대해 Western blot과 real-time PCR 한 경우에 G418 투여한 군에서 Bax/Bcl-2 비율과 caspase-3 발현이 감소되었다. 결 론 : 주산기 저산소성 허혈성 뇌 손상에서 G418는 뇌 조직의 고사를 억제함으로서 뇌보호 효과를 나타내었다.