• Pediatric Infection and Vaccine
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• v.9 no.2
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• pp.222-229
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• 2002

Human infection with the lung fluke Paragonimus westermani has become rare in Korea. Human paragonimiasis is caused by eating raw fresh-water crayfishes or crabs infected with larval metacercariae. Recently, we experienced three cases of pulmonary paragonimiasis in a family. They ate raw fresh-water crayfishes that lived in a stream in Wolchulmountain. All the parients had hypereosinophilia and pulmonary infiltrates with pleural effusion or hydropneumothorax, which did not improve on antibiotics. Ingestion of raw crayfishes was a clue for paragonimiasis. Positive results were shown both on intradermal skin test and ELISA for Paragonimus westermani specific IgG. After treatment with praziquantel, the patients showed an improvement. This is the first familial human paragonimiasis, reported from Wolchulmountain in Chonnam Province where there had been no previous cases of paragonimiasis.

• Tuberculosis and Respiratory Diseases
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• v.58 no.1
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• pp.78-82
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• 2005

Propylthiouracil(PUT) is a drug which used at Grave's disease. But PTU has recently been observed to associated with antineutrophil cytoplasmic antibody(ANCA)-positive vasculitis resulting in, infrequently, diffuse alveolar hemorrhage. We report the case of a patient who developed diffuse pulmonary hemorrhage after she had been taking PTU for two years. She had received a diagnosis of Grave's disease at two years ago. The serologic study was positive for ANCA with myeloperoxidase(MPO) specificity. Bronchoalveloar lavage(BAL) fluid analysis revealed hemosiderinladen macrophages. Such findings suggested propylthiouracil-induced dffuse pulmonary hemorrhage associated with antineutrophil cytoplasmic antibody. To our knowledge, this represents the first documentation in a case of PTU-induced diffuse pulmonary hemorrhage in Korea.

• Tuberculosis and Respiratory Diseases
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• v.63 no.5
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• pp.449-453
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• 2007

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.

• Tuberculosis and Respiratory Diseases
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• v.59 no.5
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• pp.473-479
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• 2005

Background : A pulmonary embolism often presents with nonspecific symptoms and signs. However, a delayed diagnosis can result in catastrophic outcome. The majority of preventable deaths associated with a pulmonary embolism can be ascribed to a missed diagnosis rather than to the failure of existing treatments. Therefore, accurate and rapid diagnostic methods are essential for the management of a pulmonary embolism. The recent generation of multidetector-row spiral CT scanners appears to outperform other imaging modalities in detecting a central and peripheral pulmonary embolism. However, there are some variations in the interpretations of the findings between observers. This study examined the inter-observer differences of the diagnoses in patients with a pulmonary embolism. Method : 64 patients who were diagnosed with a pulmonary embolism either clinically or with spiral chest CT from 2002 to 2004, were included. Two thoracic radiologists interpreted the multidetector-row spiral CT in terms of the diagnosis of a pulmonary embolism and the location of the thrombus independently. Among 64 patients, 14 patients were excluded because there was no evidence of a pulmonary embolism or there was different interpretation of the pulmonary embolism between radiologists. A clinical diagnosis was based on "Rules for predicting the probability of embolism". Results : The mean score of the patients according to the Wells method was $3.91{\pm}0.30$ (0-9). The accordance of the radiologists was 95% in the main, 85% in the lobar, 91.2% in the segmental, and 96% in the sub-segmental pulmonary arteries. After excluding the negative interpretation from both radiologists, their agreement was 76.2%(${\kappa}.$ 0.83) in the main, 57.6%(${\kappa}.$ 0.63) in the lobar, 51.5%(${\kappa}.$ 0.63) in the segmental, and 34.6%(${\kappa}.$ 0.49) in the sub-segmental pulmonary arteries. Conclusion : Chest CT has been recently applied to patients suspected of having a pulmonary embolism. It was found that spiral CT is a rapid test for diagnosing a thrombus, and there was reliable accordance between the observers from the area of the large pulmonary arteries. However, there was a lack of agreement between the observers in diagnosing thrombi located distal to the sub-segmental arteries.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1132-1138
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• 2005

Purpose : The mucopolysaccharidoses (MPSs) are a heterogeneous group of lysosomal storage disorders. They are caused by a deficiency of the enzymes involved in the degradation of glycosaminoglycans. Early recognition is important because recombinant enzyme replacement therapy is now available for MPS. We studied the clinical characteristics of 80 MPS children with the object of determining the epidemiological, clinical and radiological features in Korean MPS children. Methods : Diagnosis of MPS was confirmed by skin fibroblast enzyme analysis in 80 patients between February 1995 and December 2004. Charts were retrospectively reviewed for clinical and radiological findings, as well as for intelligence and speech evaluations. Results : Hunter syndrome (MPS type II) was the most prevalent type, appearing in 51/80 cases (64 %), followed by Sanfilippo syndrome (MPS III-18%), Hurler syndrome (MPS I-15%), and Morquio syndrome (MPS IV-4%). The average age at diagnosis was 5.5 years (range 1 to 20), and the male-to-female ratio was 4.7 : 1. Typical radiographic changes were observed in 45/54 cases (83%). Mitral regurgitation was the most common cardiac defect. Moderate to profound mental retardation and hearing loss were present in 14/35 cases (56%) and 33/38 cases (82%), respectively. Four MPS II patients had bone marrow transplantation, with mixed outcomes. Five MPS I patients are currently on enzyme replacement therapy. Conclusion : Our study showed a high proportion of MPS II cases (64%), which may represent population variability. By studying the clinical features of these patients, we hope to alert pediatricians of the warning signs of MPS.

• Radiation Oncology Journal
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• v.25 no.2
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• pp.70-78
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• 2007

[ $\underline{Purpose}$ ]: This study analyzed the tumor response, overall survival, progression free survival and related prognostic factors in patients with muscle invasive bladder cancer subjected to bladder preserving treatment. $\underline{Materials\;and\;Methods}$: Between August 1995 and June 2004, 37 patients with muscle invasive (transitional cell carcinoma, clinically stage T2-4) bladder cancer were enrolled for the treatment protocol of bladder preservation. There were 33 males and 4 females, and the median age was 67 years (range $38{\sim}86\;years$). Transurethral resection of the bladder (TURB) was performed in 17 patients who underwent complete resection. The median radiation dose administered was 64.8 Gy (range $55.8{\sim}67\;Gy$). The survival rate was calculated by the Kaplan-Meier method. $\underline{Results}$: An evaluation of the response rate was determined by abdomen-pelvic CT and cystoscopy at three months after radiotherapy. A complete response was seen in 17 patients (46%). The survival rate at three years was 54.7%, with 54 months of median survival (range $3{\sim}91$ months). During the study, 17 patients died and 13 patients had died from bladder cancer. The progression free survival rate at three years was 37.2%. There were 24 patients (64.9%) who had disease recurrence: 16 patients (43.2%) had local recurrence, 6 patients (16.2%) had a distant recurrence, and 2 patients (5.4%) had both a local and distant recurrence. The survival rate (p=0.0009) and progression free survival rates (p=0.001) were statistically significant when compared to the response rate after radiotherapy. $\underline{Conclusion}$: The availability of complete TURB and appropriate chemoradiotherapy were important predictors for bladder preservation and survival.

• Radiation Oncology Journal
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• v.23 no.1
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• pp.22-31
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• 2005

Purpose : To conduct a nationwide survey on the principals in radiotherapy for rectal cancer, and produce a database of Korean Patterns of Care Study. Materials and Methods : We developed web-based Patterns of Care Study system and a national survey was conducted using random sampling based on power allocation methods. Eligible patients were who had postoperative radiotherapy for rectal cancer without gross residual tumor after surgical resection and without previous history of other cancer and radiotherapy to pelvis. Data of patients were Inputted to the web based PCS system by each investigators in 19 institutions. Results : Informations on 309 patients with rectal cancer who received radiotherapy between 1998 and 1999 were collected. Male to female ratio was 59 : 41, and the most common location of tumor was lower rectum ($46\%$). Preoperative CEA was checked in $79\%$ of cases and its value was higher than 6 ng/ml in $32\%$. Pathologic stage were I in $1.5\%$, II in $32\%$, III in $53\%$, and IV in $1.6\%$. Low anterior resection was the most common type of surgery and complete resection was peformed in $95\%$ of cases. Distal resection margin was less than 2 cm in $30\%$, and number of lymph node dissected was less than 12 in $31\%$. Chemotherapy was peformed in $91\%$ and most common regimen was 5-FU and leucovorine ($59\%$). The most common type of field arrangement used for the initial pelvic field was the four field box (Posterior-Right-Left) technique ($65.0\%$), and there was no AP-PA parallel opposing field used. Patient position was prone in $81.2\%$, and the boost field was used in $61.8\%$. To displace bowel outward, pressure modulating devices or bladder filling was used in $40.1\%$. Radiation dose was prescribed to isocenter in $45.3\%$ and to isodose line in 123 cases ($39.8\%$). Percent delivered dose over $90\%$ was achieved in $92.9\%$. Conclusion : We could find the Patterns of Care for the radiotherapy in Korean rectal cancer patients was similar to that of US national survey. The type of surgery and the regimen of chemotherapy were variable according to institutions and the variations of radiation dose and field arrangement were within acceptable range.

• The Korean Journal of Nuclear Medicine
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• v.33 no.6
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• pp.466-474
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• 1999

Purpose: The purpose of this study was to evaluate the diagnostic accuracy of [$^{18}F$]FDG PET in the diagnosis of recurrent head and neck cancer after the completion of surgery and radiotherapy in patients with head and neck cancers. Materials and Methods: In fifty-nine patients with head and neck cancers whole body [$^{18}F$]FDG PET studies were performed. According to the different therapeutic modalities, patients were divided into four groups (Group I; pre-treatment, Group II: surgery, Group III; radiotherapy, Group IV; both surgery and radiotherapy). [$^{18}F$]FDG PET images were compared with clinical, CT and histopathologic findings. Results: for detection of metastatic lymph nodes in 14 patients of pre-treatment group (group I), the sensitivity and specificity of PET were 100% (10/10) and 75% (3/4), and those of CT were 80% (8/10) and 100% (4/4). For detection of recurrence in 45 patients of post-treatment group, overall sensitivity and specificity of PET were 96.2% (25/26) and 78.9% (15/19) [(100% and 75% in group II, 80% and 10% in group III, and 100% and 100% in group IV)] without significant difference from pre-treatment group (P>0.1). In detecting recurrence, the sensitivity and specificity of [$^{18}F$]FDG PET were 90.9% (10/11) and 20% (1/5) in 16 patients who underwent [$^{18}F$]FDG PET within 2 months after the completion of treatment. The specificity of these patients was significantly lower than that of 29 patients (100% of sensitivity and specificity) who underwent [$^{18}F$]FDG PET 2 months after treatment (p<0.05). Conclusion: [$^{18}F$]FDG PET is an accurate diagnostic modality for the detection of recurrence in head and neck cancer. Post-therapy [$^{18}F$]FDG PET should be obtained at least 2 months after the completion of surgery or radiotherapy.

• Radiation Oncology Journal
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• v.12 no.2
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• pp.165-173
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• 1994

Purpose : Metastatic cancer to the brain is a major problem for the patients with bronchogenic carcinoma, and most of these patients have a limited survival expectancy. To increase tumor control and / or to decrease late morbidity with possible shortening in over-all treatment period, multiple daily fraction technique for brain metastasis was performed. The author reperesented the results of accelerated fractionation radiotherapy in patients with brain metastases from non-small cell lung cancer. Materals and Methods : Twenty-six patients with brain metastases from non-small cell lung cancer between 1991 and 1993 received brain radiotherapy with a total dose of 48 Gy, at 2 Gy per fraction, twice a day with a interfractional period of 6 hours, and delivered 5 days a week. The whole brain was treated to 40 Gy and boost dose escalated to 8 Gy for single metastatic lesion by reduced field. Twenty-four of the 26 patients completed the radiotherapy. Radiotherapy was interupted in two patients suggesting progressive intracerebral diseases. Results : This radiotherapy regimen appears to be comparable to the conventional scheme in relief from symptoms. Three of the 24 patients experienced nausea and or vomiting during the course of treatment because of acute irradiation toxicity. The author observed no excessive toxicity with escalating dose of irradiation. An increment in median survival, although not statistically significant(p>0.05), was noted with escalating doses(48 Gy) of accelerated fractionation(7 months) compared to conventional treatment(4.5 months). Median survival also increased in patients with brain solitary metastasis(9 months) compared to multiple extrathoracic sites(4 months), and in patients with good performance status(9 months versus 3.5 months), they were statistically significant (p<0.01). Conclusion : The increment in survival in patients with good prognostic factors such as controlled primary lesion, metastasis in brain only and good perfomance status appeared encouraging. Based on these results, a multi-institutional prospective randomized trial should be initiated to compare the twice-a-day and once-a-day radiotherapy schemes on patients with brain metastasis with careful consideration for the patients' quality of life.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.1
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• pp.27-32
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• 2008

Purpose: To evaluate the clinical results of the patients who underwent radiofrequency thermal shrinkage (RFTS) for treatment of anterior cruciate ligament (ACL) laxity after ACL reconstruction. Material and Methods: From October 1999 to March 2006, we performed 133 cases of ACL reconstruction. Among them we experienced 16 patients who had the laxity of reconstructed ACL in second look arthroscopy. Mean follow-up was 20.4 months. Mean age was 33.5 years. 12 cases were male and 4 cases were female. The elongated ACL were treated by bipolar radiofrequency energy with an output of grade II. Subjective and objective parameters were utilized in analyses, such as: the mean range of motion, Lysholm knee score, Tegner activity score, Lachman test, IKDC score. Wilcoxon signed-rank test was used to perform the data analysis. P<0.05 was considered to be statistically significant. Results: Postoperative mean Lysholm knee score (preop: $82.2{\pm}5.2(77{\sim}85))$ (P=0.04), postop: $85.2{\pm}4.8$(82-90)) and anterior displacement by the Telos stress test (preop: $5.4{\pm}4.6(3{\sim}10)mm$, postop: $2.1{\pm}1.9(0{\sim}4)mm)$ (P=0.02), Lachman's test, and IKDC scores (P=0.04) demonstrated significant differences statistically compared to the preoperative. There were no statistical differences in mean range of motion, Tegner activity scale. Conclusions: Arthroscopic shrinkage for the ACL laxity after ACL reconstruction with radiofrequency device showed good clinical results and was applicable operative technique.