• Journal of Chest Surgery
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• 제32권6호
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• pp.567-572
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• 1999

Background: Surgical correction of the full spectrum of esophageal atresia with tracheoesophageal fistula has improved over the years, but the mortality and morbidity assoiated with repair of these anomalies still remains high. Material and Method: We retrospectively analyzes 27 surgically treated patients with esophageal atresia and tracheoesophageal fistula at Dong-A University Hospital between January 1992 and March 1997. Result: There were 21 male and 6 female patients. Mean birth weight was 2.62$\pm$.385 kg(2.0~3.4 kg). Twenty- four(88.9%) had esophageal atresia with distal tracheoesophageal fistula, and 3(11.1%) had pure esophageal atresia. Four(14.8%) infants were allocated to Waterston risk group A, 18(66.7%) to group B, and 5(18.5%) to group C. In eighteen(66.7%) infants with associated anomalies, cardiovascular anomalies were the most common. Three had a gap length of 3.5 cm or greater(ultra-long gap) between esophageal segments, 7 had 2.0 to 3.5 cm(long gap), 8 had 1.0 to 2.0 cm(medium gap), and 9 had 1 cm or less(short gap) gap length. Among 27 neonates, 3 cases underwent staged operation, late colon interposition was done in 2, and all other 24 cases underwent primary esophageal anastomosis. Oerative mortality was 2/27(7.4%). Causes of death included acute renal failure(n=1), empyema from anastomotic leak(n=1), necrotizing enterocolitis(n=1), sepsis(n=1), insulin-dependent diabetus mellitus(n=1 . There were 4 anastomosis- related complications including stricture in 3, leakage in 1. Mortality was related to the gap length(p<.05). Conclusion: Although the complication rate associated with surgical repair of these anomalies is high, this does not always implicate the operative mortality. The overall survival can be improved by effective treatment for combined anomalies and intensive postoperatve care.

• Journal of the korean academy of Pediatric Dentistry
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• 제31권1호
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• pp.11-18
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• 2004

The eruption of permanent teeth represents the movement in the alveolar bone before appearance in oral cavity, to the occlusal plane after appearance in oral cavity, and additive movement after reaching th the occlusal plane. Tooth eruption is mostly controlled by genetic signals. The eruption stage is divided to preeruptive alveolar stage, alveolar bone stage, mucosal stage according to the process of growth and development. If the disturbance is occured in any stage of eruption, tooth does not erupt. The cause of eruption disturbance are ectopic position of the tooth germ, obstruction of the eruption path and defects in the follicle or PDL. In the treatment of eruption disturbance, surgical procedures are commonly used. There are three kind of surgical procedure ; surgical exposure, surgical repositioning, surgical exposure and traction Surgical exposure is basic procedure. This involves removal of mucosa, bone, lesion that are surrounding the teeth, dental sac when necessary to maintain a patent channel between the crown and the normal eruptive path into the oral cavity. To ensure this patency, many techniques including cementation of a celluloid crown, packing with gutta-percha or zinc oxide-eugenol, or a surgical pack, are used. When surgical exposure is conducted, operators should not expose any part of cervical root cement and not injure periodontium or root of adjunct tooth. After surgical exposure, tooth should be surrounded by keratinized gingiva. There is direct relationship between the extent of development of pathophysiologic aberrations and the intensity of the manipulative injury inflicted on the tooth by surgical treatment, so operator should consider this thing. In these cases, surgical exposure is conducted on Maxillary 1st milars that have a eruption disturbance and improve the eruption disturbance effectively.

• Radiation Oncology Journal
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• 제17권2호
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• pp.129-135
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• 1999

Purpose : This study evaluated early bowel complications in cervix cancer patients, following external radiotherapy (ERT and high dose rate intracavitary radiation (HDR ICR). Factors affecting the risk of developing early bowel complications and its incidence are analyzed and discussed Materials and Methods : The study is the retrospective review of 66 patients who received radiotherapy at Chungbuk National University Hospital from April 1994 to December 1998. The patients underwent 41.4 or 50.4 Gy ERT according to FIGO stage and tumor size, then A point dose was boosted to 71.4 or 74.4 Gy using a remotely controlled afterloading Buchler HDR ICR. The EORTC/RTOG morbidity criteria were used to grade early bowel complications, which are valid from day 1, the commencement of therapy, through day 90. The actuarial incidence, severity of complications were investigated and clinical pretreatment factors relevant to complications were found through univariate (Wilcoxon) and multivariate (Cox proportional hazard model) analysis. Results : Of the 66 patients, 30 patients (46$\%$) developed early bowel complications; 25 patients (38$\%$) with grade 1 or 2, 4 patients (0$\%$) with grade 3 and 1 patient (2$\%$) with grade 4. The complications usually began to occur 3 weeks after the commencement of radiotherapy. The actuarial incidence of early bowel complications was 41$\%$ at 10 weeks. The early bowel complications were associated significantly with an old age and a history of previous abdomino-pelvic surgery. All three patients who had a protracted overall treatment time (about 2 weeks) due to severe bowel complication, suffered from pelvic recurrences. Conclusion : Forty six percent of patients experienced early bowel complications, most of which were grade 1 or 2 and relieved spontaneously or by medication. The patients with an old age or a previous surgery have a high probability of early complications and they may be less compliant with planned radiotherapy. So more careful precaution is necessary for these patients.

• Radiation Oncology Journal
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• 제27권3호
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• pp.120-125
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• 2009

Purpose: We wanted to present the preliminary results of intensity-modulated radiotherapy (IMRT) for the treatment of tonsillar cancer. Materials and Methods: We retrospectively analyzed 12 patients who underwent IMRT for tonsillar cancer at Asan Medical Center between November 2002 and February 2007. Seven patients (58%) received definitive treatment, and five (42%) were treated in the postoperative setting. Among the definitively treated patients, 6 patients received cisplatin-based chemotherapy regimens. Simultaneous modulated accelerated radiation therapy (SMART) was used in nine patients. The prescribed dose was 72 Gy at 2.4 Gy/fraction for the definitively treated cases and 61.6 Gy at 2.2 Gy/fraction for the postoperative cases. The median follow-up period was 34 months. Results: All twelve patients completed treatment without interruption, and eleven showed a complete response. One patient had persistent loco-regional disease after treatment. The three-year estimates of loco-regional control, disease-free survival and overall survival were 91.7%, 91.7%, and 100%. The worst acute mucositis was Grade 1 in four patients, Grade 2 in five patients, Grade 3 in two patients and Grade 4 in one patient. Grade 3 xerostomia was observed in six patients. Conclusion: Intensity-modulated radiotherapy was shown to be a safe and effective treatment modality for tonsillar cancer. Further studies with a larger number of patients and a longer follow-up period are needed to evaluate the ultimate tumor control and late toxicity of IMRT for treating tonsillar cancer.

• Journal of Chest Surgery
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• 제36권2호
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• pp.91-97
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• 2003

With the advent of stage-adapted multimodal regiments for esophageal malignancy, accurate staging has become of utmost importance. Endoscopic ultrasono graphy(EUS) i.: a diagnostic method for the local staging of esophageal cancer, in particular for T and N evaluation. The aim of this study was to examine the diagnostic efficacy of the EUS and to evaluate the relation between prognosis and EUS findings. Material and Method : We reexamined the cases of 88 consecuitive patients who underwent transthroacic esophagectomy and cervical esophagogastrostomy for esophageal cancer from January 1991 to July 2001 We compared EUS findings, histological results and outcomes. Result : There were 83 male(94.3%) and 5 female. Median age was 61.3 years old. Overall staging accuracy were 59.0% for T staging and 76.0% for N staging, In early T staging group, the accuracy was 74.9% except 74 stage. However significant differences were not found in the ability of EUS-determined T-stage and N-Stage to predict survival. Multivariate analysis showed EUS-stage to predict survival. Conclusion : EUS provides a high degree of accuracy in assessing both T and N parameters in staging esophagal cancer. EUS should be performed in all patients with esophageal cancer, not only for staging before therapy, but also as a valuable method of determining prognosis.

• Radiation Oncology Journal
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• 제22권2호
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• pp.155-163
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• 2004

Purpose : To confirm the reproducibility of in vivo transmission dosimetry system and the accuracy of the a1gorithms for the estimation of transmission dose in head and neck radiation therapy patients. Materials and Methods : From September 5 to 18, 2001, transmission dose measurements were peformed when radiotherapy was given to brain or head and neck cancer patients. The data of 35 patients who were treated more than three times and whose central axis of the beam was not blocked were analyzed in this study. To confirm the reproducibility of this system, transmission dose was measured before dally treatment and then repetitively every hour during the treatment time, with a field size of 10$\times$10 cm$^{2}$ and a delivery of 100 MU. The accuracy of the transmission dose calculation algorithms was confirmed by comparing estimated dose with measured dose. To accurately estimate transmission dose, tissue inhomogeneity correction was done. Results : The measurement variations during a day were within $\pm$0.5$\%$ and the dally variations in the checked period were within $\pm$ 1.0$\%$, which were acceptable for system reproducibility. The mean errors between estimated and measured doses were within $\pm$5.0$\%$ in Patients treated to the brain, $\pm$2.5$\%$ in head, and $\pm$ 5.0%$\%$in neck. Conclusion : The results of this study confirmed the reproducibility of our system and its usefulness and accuracy for dally treatment. We also found that tissue inhomogeneity correction was necessary for the accurate estimation of transmission dose in patients treated to the head and neck.

• Radiation Oncology Journal
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• 제14권3호
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• pp.211-219
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• 1996

Purpose : Hysterectomy without lymph node dissection was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was performed inadvertently on patients who were thought to have benign or premalignant conditions preoperatively. We analysed radiotherapy results of such patients to evaluate survival rates, failure patterns and prognostic factors according to various conditions. Materials and Methods : Sixty one patients undergoing hysterectomy in the presence of invasive cervical carcinoma were reviewed retrospectively. Preoperative diagnosis were carcinoma in situ (38 cases), severe dysplasia (2), myoma (6), uterine bleeding (4), uterine prolapse (2). and early invasive cervix cancer (10) (One patient had myoma and carcinoma in situ coincidently). Patients received postoperative megavoltage radiotherapy from August 1985 to December 1993, and minimum follow-up period was 24 months. Eight patients received ICR only, 6 patients ICR and external radiation, and 47 patients received external radiation therapy only. Results : Overall 5-year survival rate and relapse-free survival rate werer $83.8\%$, $86.9\%$ respectively. For patients with retrospective stage IA, IB, IIB (gross residual after surgery), and vaginal cuff recurrence were $90.9\%$, $88.8\%$, $38.4\%$, and $100\%$ respectively There were 8 cases of treatment failure, most of them (5/8) were in patients with gross residual disease, other patients were full thickness involvement of cervix wall (2/8) except one. Patients with early vaginal cuff recurrence and microinvasive cervical cancer (stage IA) had no treatment related failure Prognostic factors affecting survival by univariate analysis were status of residual disease, tumor histology and retrospective stage. Conclusion : Adjuvant radiotherapy appeared to be effective treatment method for patients with presumed stage IA, IB and early local recurrent disease after inadvertent hysterectomy Survivals for patients with gross disease remained after inappropriate hysterectomy was poor, So, early cancer detection and Proper management with precise pretreatment s1aging is necessary to avoid inadherent hysterectomy especially in the cases of gross residual disease.

• Radiation Oncology Journal
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• 제16권3호
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• pp.251-258
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• 1998

Purpose : This study was performed to analyze the factors affecting local control in malignant tumors of the parotid gland treated with surgery and postoperative radiation. Materials and methods : Twenty-six patients were treated for malignant tumors of the parotid gland from 1986 to 1995 at Department of Therapeutic Radiology, Chonnam University Hospital. Age of the patients ranged from 14 to 72 years (median : 55 years). Histologically 10 patients of mucoepidermoid carcinoma, 7 of squamous cell carcinoma, 4 of acinic cell carcinoma, 4 of adenoid cystic carcinoma and 1 of adenocarcinoma were treated. Total parotidectomy was performd in 15 of 26 patients, superficial in 7, subtotal in 4. Facial nerve was sacrificed in 5 patients. Postoperatively 4 patients had residual disease, 4 had positive resection margin. Radiation was delivered through an ipsilateral wedged pair of photon in 11 patients. High energy electron beam was mixed with photon in 15 patients. Electron beam dose ranged from 900 cGy to 3800 cGy (median 1700 cGy). Total radiation dose ranged from 5000 cGy to 7560 cGy (median : 6020 cGy). Minimum follow-up period was 2 years. Local control and survival rate were calculated using Kaplan-Meier method. Generalized Wilcoxon test and Cox proportional hazard model were used to test factors affecting local control. Results : Five (19$\%$) of 26 patients had local recurrence. Five year local control rate was 77$\%$. Overall five year survival rate was 70$\%$. Sex, age, tumor size, surgical involvement of cervical lymph node, involvement of resection margin, surgical invasion of nerve, and total dose were analyzed as suggested factors affecting local control rate. Among them patients with tumor size less than 4 cm (p=0.002) and negative resection margin (p=0.011) were associated with better local control rates in univariate analysis. Multivariate analysis showed only tumor size factor is associated with local control rate (p=0.022). Conclusion : This study suggested that tumor size is important in local control of malignant tumors of parotid gland.

• Clinical and Experimental Pediatrics
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• 제49권2호
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• pp.167-172
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• 2006

Purpose : Palpable lymph nodes are common in the pediatric population, and most of them are either inflammatory or congenital. As the diagnostic evaluation, fine needle aspiration cytology (FNAC) is known to be more convenient and economical than tissue biopsy. We evaluated the usefulness of FNAC in children and adolescents. Methods : Four hundred and thirteen FNAC samples(M : F=1 : 1.15) were retrospectively analyzed in patients who were brought to Inha University Hospital, from August 1999 to August 2004. Results : The most common age group was 16-20 years of age(N=148, 35.8 percent). The cervical area was the most frequently involved site(N=310, 75 percent). Non-specific lymphadenitis was the most common(N=227, 54.9 percent), followed by the benign neoplasm(N=59, 14.2 percent). Malignant tumors were 18 cases(4.3 percent), and congenital diseases were found in 10 cases(2.4 percent). In inflammatory lesions, tuberculous lymphadenitis(N=22, 5.3 percent) was the most common with a histologic sensitivity of 90.9 percent. The peripheral blood and serologic studies were non-specific. Fifty nine percent(N=244) of lymphadenitis improved without specific management. Antibiotics were prescribed in 15.2 percent of lymphadenitis and lymphadenectomy was performed in 12.6 percent. Conclusion : Most of the enlarged lymph nodes in children and adolescents were benign. These results show FNAC is a safe, rapid and reliable diagnostic procedure for the appropriate differential diagnosis of enlarged lymph nodes in children and adolescents.

• Tuberculosis and Respiratory Diseases
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• 제47권4호
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• pp.525-532
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• 1999

The parathyroid hormone related protein (PTHrP) is the most common causative peptide of humoral hypercalcemia of malignancy. In contrast, the serum level of parathyroid hormone (PTH) is low to undetectable in the majority of patients with malignancy associated hypercalcemia. Few cases exist in which the production and secretion of PTH by malignant nonparathyroid tumors have been authenticated. To our knowledge, there is very rare case in which a nonparathyroid tumor expressed simultaneously both the PTH and PTHrP. We report a case of squamous cell carcinoma of the lung with hypercalcemia which presented with simultaneous elevation of serum PTH and PTHrP. Severe hypercalcemia (serum calcium, 7.5 mEq/L) was found in a 65-year-old man who had a squamous cell carcinoma of the lung without any bony metastasis and detectable parathyroid abnormalities on isotope scintigraphy. The serum level of intact parathyroid hormone (PTH) con centration was markedly elevated as measured in two site radioimmunoreactive PTH assays (intact PTH 150 pg/mL ; normal 9~55). The serum level of a PTHrP was also increased as measured in C-terminal region specific radioimmunoassay (PTHrP 99.1 pmol/L; normal 13.8~55.3). There are no evidences of coincidental primary hyperparathyroidism in parathyroid MIBI scan and other imaging studies including neck ultrasonography and computed tomography. These results suggest that simultaneous elevation of serum PTH and PTHrP in this patient can be caused by production of both PTHrP and PTH in other nonparathyroid lesions such as squamous cell carcinoma.