• Proceedings of the Korean Institute Of Construction Engineering and Management
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• autumn
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• pp.265-270
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• 2002

Frequent design changes or unnecessary project executions due to illogical practice, lack of feasibility study and, hasty drive have raised problems of budget waste in Korean construction projects. Since the MOCT (Ministry of Construction & Transportation) published Master Plan for budget efficiency for government projects, there have been a lot of policy efforts for budget saving. However, it has been pointed out that cost management at the pre-construction phase, which greatly influences the cost still remains imperfect. The target cost for government clients is not being estimated reasonably, and cost controlling at the pre-construction phase is not yet being carried out properly for keeping the budget. Therefore, improved construction cost management at the pre-construction phase was proposed in this paper. The cost management systems of advanced countries were investigated for it, and the issues were drawn from the cost management systems of these countries. On the basis of the issues, the present conditions and problems of domestic construction cost management at the pre-construction phase were analyzed for suggestion.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.715-718
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• 2007

Neurogenic tumors of the brachial plexus are rare. An malignant schwannoma originates from the schwan cells or nerve sheath cells. Occasionally, schwannomas are associated with Von Rechlinghausen's disease, but this is rare. We were recently presented with a thirty-five year old female patient with a history of pulmonary tuberculosis about ten years prior. The patient also presented with a mass that has been slowly growing for one year. Onset of pain occurred six months after the tumor began to grow. The mass was $5{\times}7cm$ in size. The patient underwent on bloc resection of the tumor as the mass recurred twice in spite of postoperative radiotherapy.

• Korean Journal of Head & Neck Oncology
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• v.11 no.1
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• pp.41-46
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• 1995

The pectoralis major myocutaneous flap represents a major contribution to head and neck cancer reconstruction. Its advantages are improved viability, one-stage reconstruction, and carotid protection. The oropharyngeal defect especially tonsillar area reveals valley shaped one with loss of a wide mucosal area. Using pectoralis major myocutaneous flap to this defect is sometimes difficult due to its natural figure of bulkiness. This article reviews our experience with patients undergoing 14 pectoralis major myocutaneous flap in carcinoma of the tonsillar area. Complications and their incidences were I total loss, 3 marginal loss, 2 minor seperation of suture, I wound infection and 2 hematoma. Most of the complications did not require a second procedure for reconstruction. Bulkiness of the flap and gravity force to the upper suture line were thought to be causes of the complications. Modification of the flap design with bilobular figure was useful to reduce its bulkiness at the folding area. More stable suture around hard palate was needed to overcome seperation of the suture.

• Journal of radiological science and technology
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• v.30 no.3
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• pp.219-225
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• 2007

This study was performed for the purpose of providing basic data of the pelvic disorders through survey of the frequency of management of occurrence by major risk factor. Female pelvic mass was detected using sonography, and necessary data were collected from 604 female visitors to a obstetrics and gynecology hospital located at S-si. Female pelvic mass was uterus mass, ovarian mass, cervical cyst, endometrial disease. For the analysis, such variables as age, weight and frequency of pregnancy were chosen as risk factors. Results of the analysis and conclusions are as follows ; 1) The frequency of occurrence of the female pelvic mass is highest, as 38.9% of the component ratio, in the age of 35 to 54. It maintains high level of 35.8% even in the age of 55 and above. 2) The frequency of occurrence of the female pelvic mass increases in proportion as the weight and frequency of pregnancy increase. 3) The size of the uterus tumor has no statistical relationship with the risk factors, age, weight and frequency of pregnancy.

• Radiation Oncology Journal
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• v.20 no.4
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• pp.353-358
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• 2002

Purpose : To investigate the clinical usefulness of a follow-up examination using serum squamous cell carcinoma antigen (SCC) for the early detection of recurrence in patients treated for conical squamous cell carcinoma. Materials and Methods : 20 patients who were treated for recurrent cervical squamous cell carcinoma between 1997 and 1998, who had experienced a complete remission after radiotherapy and who underwent an SCC test around the time when recurrence was detected, were included in this study. The levels of SCC were measured from the serum of the patients by immunoassay and values less than 2 ng/mL were regarded as normal. The sensitivity of the SCC test for use in the detection of recurrence, the association between the SCC values and the recurrence patterns and the tumor size and stage, and the temporal relation between the SCC increment and recurrence detection were evaluated. Results : The SCC values were above normal in 17 out of 20 patients, so the sensitivity of the SCC test for the detection of recurrence was $85\%$, and the mean and median of the SCC values were 15.2 and 9.5 ng/mL, respectively. No differences were observed in the SCC values according to the recurrence sites. For 11 patients, the SCC values were measured over a period of 6 months before recurrence was detected, and the mean and median values were 13.6 and 3.6 ng/mL, respectively. The SCC values of 7 patients were higher than the normal range, and the SCC values of the other 4 patients were normal but 3 among them were above 1.5 ng/mL. At the time of diagnosis, the SCC valuess were measured for 16 of the 20 recurrent patients, and the SCC values of the patients with a bulky tumor $(\geq4\;cm)$ or who were in stage IIb or III were higher than those of the patients with a non-bulky tumor or who were in stage Ib or IIa. Conclusion : The SCC test is thought to be useful for the early detection of recurrence during the follow up period in patients treated for cervical squamous cell carcinoma. When an effective salvage treatment is developed in the future, the benefit of this follow-up SCC test will be increased.

• Radiation Oncology Journal
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• v.19 no.4
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• pp.335-344
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• 2001

Purpose : The aim of this study was to clarify the role of VEGF expression as an independent prognostic factor and to identify the patients at high risk for poor prognosis in stage IB cervical cancer. Materials and methods : A total of 118 patients with stage IB cervical cancer who had radical hysterectomy and pelvic lymph node dissection were included in the study. All known high risk factors of the patients were pathologically confirmed from the surgical specimen. Of the 118 patients, n patients were treated with postoperative radiotherapy and/or chemotherapy. VEGF expression was examined using immunohistochemistry in formalin-fixed, paraffin-embedded specimens of post-hysterectomy surgical materials. A semiquantitative analysis was made using a scoring system of 0, +, ++, and +++ for increasing intensity of stain. We classified the patients with scores from 0 to ++ as low VEGF expression and the patients with a score of +++ as high VEGF expression. Results : Of the 118 patients, 35 patients $(29.7\%)$ showed high VEGF expression. Strong correlations were found between the high VEGF expression and both deep stromal invasion (p=0.01) and the positive pelvic node (p=0.03). The 5-year overall and disease-free survival rates for all 118 patients were $95.5\%\;and\;93.8\%$. The 5-year overall (p=0.03) and disease-free survival (p<0.001) rates were $98.5\%\;and\;100%$ for low VEGF expression (0, +, and ++) and $85.5\%\;and\;79.7\%$ for high VEGF expression, respectively. Pelvic and distant failures for low versus high VEGF expression were $1.2\%$ versus $17.1\%$, (p=0.001) and $0\%$ versus $14.3\%$ (p<0.001), respectively. In a Cox multivariate analysis of survival, the high VEGF expression (p=0.02) and the bulky mass (p=0.02) were significant prognostic factors for overall survival. The high VEGF expression (p=0.002), and bulky mass (p=0.01) demonstrated as significant prognostic indicators for disease free survival. Conclusion : These results showed that VEGF expression was a highly significant predictor for pelvic and distant failure and the most significant prognostic factor of overall and disease free survival for the patients with stage IB cervix cancer treated with radical surgery. We strongly suggest that the immune-histochemistry for VEGF expression be performed in a routine clinical setting in order to identify the patients at high risk for poor prognosis in early stage cervical cancer. Furthermore, postoperative and/or chemotherapy did not reduce the pelvic failure and distant metastasis. To improve the cure rate for the patients with high VEGF expression in stage IB cervical cancer, antiangiogenic therapy including anti-VEGF Ab may be new treatment option.

• Radiation Oncology Journal
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• v.14 no.2
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• pp.167-173
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• 1996

Purpose : This analysis was to evaluate the radiation dose around a tracheostoma and spinal cord in the case of advanced laryngeal cancers in which a total laryngectomy was done before radiotherapy. Materials and Methods : The radiation dose around a tracheostoma and spinal cord was measured by thermoluminescence and film dosimetry in the phantom, Radiotherapy treatment planning was done in 12 cases of advanced laryngeal cancer and compared with the measured dose in the phantom. Results : Mean spinal cord doses in the phantom by thermoluminescence dosimetry were $86.4\%$ (with a tracheostoma), $80.1\%$ (without a tracheostoma), and the difference was $6.3\%$. Mean spinal cord doses in the phantom by film dosimetry were $84.7\%$ (with a tracheostoma), $79.0\%$ (without a tracheostoma). and the difference were $5.7\%$. Calculated spinal cord doses in the phantom were $84.0\%$ (with a tracheostoma), $78.0\%$ (without a tracheostoma), and the difference was $6.0\%$. Mean calculated spinal cord doses in 12 patients were $83.1\%$ (with a tracheostoma), $76.9\%$ (without a tracheostoma). and the difference was $6.2\%$. Measured dose of lateral and posterior wall of the tracheostoma by film was low (depth of maximum dose = 12 mm). Conclusion : In the treatment planning of the advanced laryngeal cancers, the radiation dose of the tracheostoma and spinal cord should be evaluated and be followed by an appropriate management such as a bouls or a brachytherapy boost if the dose around the tracheostoma is low.

• Radiation Oncology Journal
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• v.17 no.1
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• pp.16-22
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• 1999

Purpose : This study was done to analyze prognostic factors and patterns of failure of patients with histologically confirmed adenocarcinoma of the uterine cervix. Materials and Methods : From June 1988 to December 1990, a retrospective analysis was undertaken for 45 patients who were treated with curative radiation therapy for adenocarcinoma of the uterine cervix at the department of Therapeutic Radiology of Keimyung University Hospital. According to FIGO staging classification, f2 patients were stage Ib, 9 patients were lla, 19 patients were IIB, and 5 patients were lIIb. Median age of the patients was 54 years. The radiation therapy consisted of a combination of external and intracavitary irradiation. Only the pelvis was treated for external irradiation, but 6 patients were treated with extended field irradiation including paraaortic nodes. Intracavitary irradiation was performed with high dose rate sources (Co-60). Neoadiuvant chemotherapy was undertaken for 10 patients. Median and maximum follow-up duration was 64 and 116 months, respectively. Results : The overall 5-year survival rate was 55.2$\%$, and the 5-year survival rates for stage Ib, IIa, IIb, and IIIb were 100$\%$, 50.8$\%$, 46.8$\%$, and 40$\%$ (3-year survival rate), respectively. Of the many clinicopathologic variables evaluated for prognosis, only the stage and the tumor size were significant prognostic factors. Statistically, pelvic failure rates for stage Ib, IIa, IIb, and IIIb were 0$\%$, 33.3$\%$, 57.9$\%$, and 60$\%$, respectively. Distant metastasis rates were 0$\%$, 33.3$\%$, 21.1$\%$, and 40$\%$ for stage Ib, IIa, IIb, and IIIb, respectively. Especially the 6 patients who were irradiated with extended field to treat the paraaortic nodes were free of distant metastasis all. But, 9 patients (23.1$\%$) of the 39 patients who were not irradiated the paraaortic nodes were suffered and expired from uncontrolled distant metastasis. Conclusions : As compared with other studies, the survival rates were similar, but distant metastasis rates including paraaortic nodes metastasis were likely somewhat higher than expected, especially for patients with stage II. So, we think that the effect of prophylactic paraaortic nodes irradiation should be studied prospectively, especially for patients with pelvic nodes involvement or advanced stage of disease.

• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.26-32
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• 2014

Purpose: As PET-MRI which has excellent soft tissue contrast is developed as integration system, many researches about clinical application are being conducted by comparing with existing display equipments. Because PET-MRI is actively used for head and neck cancer diagnosis in our hospital, lymph node metastasis before the patient's surgery was diagnosed and clinical usefulness of head and neck cancer PET-MRI scan was evaluated using pathological opinions and idiopathy surrounding tissue metastasis evaluation method. Materials and Methods: Targeting 100 head and neck cancer patients in SNUH from January to August in 2013. $^{18}F-FDG$ (5.18 MBq/kg) was intravenous injected and after 60 min of rest, torso (body TIM coil, Vibe-Dixon) and dedication (head-neck TIM coil, UTE, Dotarem injection) scans were conducted using $Bio-graph^{TM}$ mMR 3T (SIEMENS, Munich). Data were reorganized using iterative reconstruction and lymph node metastasis was read with Syngo.Via workstation. Subsequently, pathological observations and diagnosis before-and-after surgery were examined with integrated medical information system (EMR, best-care) in SNUH. Patient's diagnostic information was entered in each category of $2{\times}2$ decision matrix and was classified into true positive (TP), true negative (TN), false positive (FP) and false negative (FN). Based on these classified test results, sensitivity, specificity, accuracy, false negative and false positive rate were calculated. Results: In PET-MRI scan results of head and neck cancer patients, positive and negative cases of lymph node metastasis were 49 and 51 cases respectively and positive and negative lymph node metastasis through before-and-after surgery pathological results were 46 and 54 cases respectively. In both tests, TP which received positive lymph node metastasis were analyzed as 34 cases, FP which received positive lymph node metastasis in PET-MRI scan but received negative lymph node metastasis in pathological test were 4 cases, FN which received negative lymph node metastasis but received positive lymph node metastasis in pathological test was 1 case, and TN which received negative lymph node metastasis in both two tests were 50 cases. Based on these data, sensitivity in PET-MRI scan of head and neck cancer patient was identified to be 97.8%, specificity was 92.5%, accuracy was 95%, FN rate was 2.1% and FP rate was 7.00% respectively. Conclusion: PET-MRI which can apply the acquired functional information using high tissue contrast and various sequences was considered to be useful in determining the weapons before-and-after surgery in head and neck cancer diagnosis or in the evaluation of recurrence and remote detection of metastasis and uncertain idiopathy cervical lymph node metastasis. Additionally, clinical usefulness of PET-MRI through pathological test and integrated diagnosis and follow-up scan was considered to be sufficient as a standard diagnosis scan of head and neck cancer, and additional researches about the development of optimum MR sequence and clinical application are required.

• Tuberculosis and Respiratory Diseases
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• v.56 no.1
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• pp.18-28
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• 2004

Background : Many diseases like lung cancer and tuberculosis can involve cervical lymph node. Fine needle aspiration cytology(FNAC) was known as a useful screening test for the evaluation of enlarged lymph node. But the usefulness and limitations of FNAC according to disease category or physical characteristics of lymph node were not yet fully established. Methods : Retrospective analysis of three hundred forty two adult patients who performed FNAC due to enlarged cervical lymph nodes at the Seoul Municipal Boramae Hospital during the period from January 1999 to December 2002 and final diagnosis could be made by surgical biopsy, microbiology or clinical observation. Results : Among the 342 cases, 176(51.5 %) were finally diagnosed as benign nature ncluding reactive hyperplasia, Kikuchi's disease and acute suppuration. Eighty eight(25.7 %) were diagnosed as tuberculous lymphadenitis, 66(19.3 %) as metastasis, and 12(3.5 %) as lymphoma. Tuberculosis, metastasis, and lymphoma all showed significantly larger diameter, longer duration of lymph node enlargement. There were higher frequency of supraclavicular involvement in the cases of tuberculosis and metastasis. The overall diagnostic sensitivity of FNAC was 88.0 %, and 88.6 % in benign nature lesion, 77.3 % in tuberculosis, 90.1% in metastasis and 58.3 % in lymphoma. The diagnosis of tuberculosis was made by FNAC in 68 cases (77.3 %) among 88 cases. Lung cancer(43.9 percent) was most frequent cause of cervical lymph node metastasis. Diagnostic sensitivity of FNAC was significantly lower in the supraclavicular than other cervical lymph node(80 % vs. 91.3 %) and not correlated with disease nature, node size or number. Conclusion : Though FNAC was a reliable screening test for enlarged cervical lymph node enlargement, the diagnostic sensitivity was low in the case of lymphoma or when the enlarged lymph node was located at the supraclavicular area.