• Tuberculosis and Respiratory Diseases
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• v.48 no.3
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• pp.357-364
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• 2000

Background : Complicated exudative pleural fluid collections have traditionally been treated by either closed tube thoracostomy drainage or by open surgical drainage. Complete drainage is important in order to control pleural sepsis, restore pulmonary function, and entrapment. Recently intracavitary fibrinolytic therapy has been advocated as a method to facillitate drainage of complicated exudative pleural effusion and to allow enzymatic debridemant of the restrictive fibrinous sheets covering the pleural surface. The purpose of this study is to prospectively evaluate the effects of image-guided catheter drainage with high dose urokinase(UK) instillation in the treatment of complicated pleural effusions. Patients : Twenty complicated pleural effusion patients that poorly respond to image-guided drainage were allocated to receive UK. There were 8 pneumonia and 12 tuberculosis. Methods : Drugs were diluted in 250 mL normal saline and were infused intrapleurally through the chest tube or pig-tail catheter in a daily dose of 250,000 IU of UK. Response was assessed by clinical outcome, fluid drainage, chest radiography, pleural ultrasound and/or computed tomography. Results : The mean UK instillation time was $1.63{\pm}0.10$. The mean volume drained UK instillation was $381.3{\pm}314.4\;mL$, and post-UK was $321.6{\pm}489.5\;mL$. The follow up duration after UK therapy was mean $212.9{\pm}194.5$ days. We had successful results in 19 cases (95.0%). There were 12 pleural thickenings (60.0%), 2 markedly decreased effusions (10.0%) and 5 cases of no thickening or effusion. There was recurrence after treatment in only one patient(5%) with complicated pleural effusiondue to tuberculosis. Conclusions : Image-guided drainage with high dose UK instillation (250,000 U/day) in complicated pleural effusion is a safe and more effective method than closed thoracostomy drainage. And this management, in turn, can obviate surgery in most cases.

• Tuberculosis and Respiratory Diseases
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• v.46 no.4
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• pp.542-547
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• 1999

Background: Decision in mediastinal lymph node involvement of lung cancer by CT scan is very important and valuable for the treatment planning and prognosis prediction. In general, long diameter of mediastinal lymph node more than 15mm is used as criterion of lung cancer involvement. Adenocarci-noma has a tendency of early distant metastasis and micrometastasis, so adenocarcinoma may involve lymph node earlier and cannot be detected before lymph nodes are enlarged enough. The authors tried to determine the difference between two size criteria(15mm, 10mm) in adenocarcinoma for the detection of cancer involvement. Methods: Numbers of sample are 60 cases(male 46, female 14, median age: 61.5 years). According to pathology, squamous cancer 41, large cell cancer 2, adenocarcinoma 17. According to TNM stage, I 23, III 24, IIIA 13. Results : Mean long diameter of lymph node involvement is 16.0($\pm8.0$) mm in non-adenocarcinoma group, and that of adenocarcinoma group is 12.0($\pm3.2$) mm(p<0.05). If long diameter of lymph node larger than 15mm as involvement criterion is applied, sensitivity, specificity, positive predictive index, negative predictive index, accuracy of nonadenocarcinoma group are 54%, 100%, 100%, 83%, 86%, and those of adenocarcinoma group are 43%, 90%, 75%, 69%, 71%. If long diameter of lymph node larger than 10mm as involvement criterion is applied, sensitivity, specificity, positive predictive index. negative predictive index. accuracy of nonadenocarcinoma group are 65%, 77%, 61%, 92%, 79%, and those of adenocarcinoma group are 100%, 80%, 78%, 100%, 88%. Conclusion: Long diameter of lymph node larger than 10mm is more valuable criterion as lymph node involvement in adenocarcinoma of lungs.

• Tuberculosis and Respiratory Diseases
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• v.48 no.3
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• pp.365-376
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• 2000

Background : Ever since Flexible Fiberoptic Bronchoscopy was introduced into clinical practice, it has played an important role in both diagnosis and therapy of respiratory diseases. Repeated bronchoscopic examinations is are not so uncommon. This study was designed prospectively to assess the clinical availability of the Repeated Flexible Bronchoscopy (RFB). Methods : Pre-established indications were as follows : 1) To confirm diagnosis or the cell type in proven malignancy 2) to diagnose or locate hemoptysis 3) to follow-up or confirm recurrence 4) to use in therapy. We performed RFB and analyzed the data in 156 patients during 28-month period. Results : The frequency of RFB was 23.0%. The indication for diagnosis or cell type of malignancy was 25 cases, of which 2 cases were confirmed by a third bronchoscopic examination and 3 cases by surgical procedures. Localization of the bleeding site was confirmed in 53.8%. RFB for small cell lung cancer yielded more information on residual or recurred lesion not apparent even with the CT scan in 30%. Previous cases of bronchostenosis due to endo-bronchial tuberculosis was shown to have worsened in 66.7%. Therapeutic manipulations were done in 126 cases, and bronchial suction was most common. Complications showed decreasing tendency with repeated examinations. Conclusion : The RFB for diagnosis or cell type of malignancy was useful in that comfirmation of diagnosis was possible in 85.7% of malignancy. More aggressive procedures should be employed including TBLB or TBNA. The RFB showed possible usefulness in the follow-up of patients with small cell lung cancer. For the patients with hemoptysis or endobronchial tuberculosis, the RFB did not the significance did not show significance because its results did not influence the diagnosis, therapy or clinical course.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.65-74
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• 1999

Background : Open lung biopsy(OLB) has conventionally been regarded as the gold standard for the diagnosis in interstitial lung disease. With recent advances in diagnostic technique such as high resolution computed tomography(HRCT), and transbronchial lung biopsy(TBLB) which provide relatively accurate diagnosis of ILD, it is necessary to reevaluate the role of these methods in the diagnosis of ILD. Methods: We carried out a retrospective analysis of nineteen patients who underwent OLB at Dankook University Hospital for the diagnosis of acute and chronic ILD, between May 1995 and June 1998. By reviewing the medical records, the demographic findings, underlying conditions, HRCT and TBLB findings, OLB diagnosis, therapy after OLB, and complication of OLB were evaluated. Results: Thirteen patients(68.4%) had chronic ILD(symptom duration over 2 weeks prior to OLB), and six patients(31.6%) had acute ILD(symptom duration less than 2 weeks). Specific diagnosis were reached in 92%(12/13) of chronic ILD(5 bronchiolitis obliterans organizing pneumonia(BOOP), 2 constrictive bronchiolitis, 3 usual interstitial pneumonia, 1 hypersensitivity pneumonitis, 1 eosinophilic pneumonia), and in all patients of acute ILD(5 acute interstitial pneumonia, 1 pneumocystis carinii pneumonia). HRCT were performed in all patients and a correct first choice diagnosis rate of HRCT was 42%(5/12) in chronic ILD. In chronic ILD patients, 62%(8/13) received specific therapy(steroid therapy in 7 patients and moving in one patient), after OLB, but in acute ILD, all patients received specific therapy(steroid therapy in 5 patients and steroid and antibiotic therapy in one patient) after OLB. The in-hospital mortality after OLB was 5.3%(1/19). Conclusion: OLB is an excellent diagnostic technique with relatively low complications in patients with ILD. Therefore OLB should be considered in patients with ILD when the specific diagnosis is important for the treatment, especially in patients with acute ILD.

• Radiation Oncology Journal
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• v.22 no.2
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• pp.130-137
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• 2004

Purpose : In radiotherapy for cervix cancer, both 3-dimensioal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) could reduce the dose to the small bowel (SB), while the small bowel displacement system (SBDS) could reduce the SB volume in the pelvic cavity. To evaluate the effect of the SBDS on the dose to the SB in 3D-CRT and IMRT plans, 3D-CRT and IMRT plans, with or without SBDS, were compared. Materials and Methods : Ten consecutive uterine cervix cancer patients, receiving curative radiotherapy, were accrued. Ten pairs of computerized tomography (CT) scans were obtained in the prone position, with or without SBDS, which consisted of a Styrofoam compression device and an individualized custom-made abdominal immobilization device. Both 3D-CRT, using the 4-field box technique, and IMRT plans, with 7 portals of 15 MV X-ray, were generated for each CT image, and proscribed 50 Gy (25 fractions) to the isocenter. For the SB, the volume change due to the SBDS and the DVHs of the four different plans were analyzed using palled t-tests. Results : The SBDS significantly reduced the mean SB volume from 522 to 262 cm$^{3}$ (49.8$\%$ reduction). The SB volumes that received a dose of 10$\~$50 Gy were significantly reduced in 3D-CRT (65$\~$80$\%$ reduction) and IMRT plans (54$\~$67$\%$ reduction) using the SBDS. When the SB volumes that received 20$\~$50 Gy were compared between the 3D-CRT and IMRT plans, those of the IMRT without the SBDS were significantly less, by 6$\~$7$\%$, than those for the 3D-CRT without the SBDS, but the volume difference was less than 1$\%$ when using the SBDS. Conclusion : The SBDS reduced the radiation dose to the SB in both the 3D-CRT and IMRT plans, so could reduce the radiation injury of the SB.

• Radiation Oncology Journal
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• v.16 no.3
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• pp.259-264
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• 1998

Purpose : This study was to evaluate the effectiveness of preoperative radiotherapy in maxillary sinus cancer. Materials and Methods : A retrospective analysis was done for 42 patients with maxillary sinus cancer who were treated with radiation with or without surgery from April 1986 to September 1996. There were 27 male and 15 female patients. Patients' age ranged from 24 to 75 years (median 56 years). Stage distribution showed 2 in T2, 19 in T3, and 21 in T4 lesions The histologic type was squamous cell carcinoma in 38, undifferentiated carcinoma in 1, transitional cell carcinoma in 1, and adenoid cystic carcinoma in 2 patients. All patients were treated with radiation initially with a dosage range of 50.4-70.2 Gy (median 70.2 Gy) before further evaluation of remnant disease. Eleven patients were given induction chemotherapy (2cycles of 5-fluorouracil and cisplatin) concurrently with radiotherapy. Six to eight weeks after radiotherapy with or without chemotherapy computerized tomography (CT) of paranasal sinus was taken to evaluate remnant disease. If the CT finding showed remnant disease, a Caldwell-Luc procedure was done to get the specimen of suspicious lesions. A radical maxillectomy was done if the specimen was proven to contain malignancy. In contrast periodic follow-up examination was done without any radical surgery if the tissue showed only granulation tissue. Follow-up period ranged from 3 to 92 months with a median 16 months. Results : Nine (21.4$\%$) patients showed complete response (CR) and 33 patients (78.6$\%$) showed persistent disease (PER) to initial radiotherapy. Among the 9 CR patients, 7 patients had no evidence of disease (NED), 1 patient had local failure, and 1 patient had regional failure. Among 33 PER patients, salvage total maxillectomy was done in 10 patients, and the surgery was not feasible or refused in 23 patients. Following the salvage radical surgery, 2 patients were NED and 8 patients were PER status. Overall and disease- free survival rate at 5 years was 23.1$\%$ and 16.7$\%$, respectively. The only factors associated with the overall survival rate was the response to radiotherapy (P<0.01). Conclusion : The only factors associated with the overall survival rate was the response to radiotherapy. We could omit a radical mutilating surgery by preoperative irradiation in 7 of 42 patients (21.4$\%$) so as to preserve their facial integrity.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.277-282
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• 2000

Purpose : Though It has been known that the to tolerance of the liver to external beam irradiation depends on the irradiated volume and dose, few data exist which Quantify this dependence. However, recently, with the development of three dimensional (3-D) treatment planning, have the tools to Quantify the relationships between dose, volume, and normal tissue complications become available. The objective of this study is to investigate the relationships between normal tissue complication probabili쇼 (WCP) and the risk of radiation hepatitis for patients who received variant dose partial liver irradiation. Materials and Methods : From March 1992 to December 1994, 10 patients with hepatoma and 10 patients with bile duct cancer were included in this study. Eighteen patients had normal hepatic function, but 2 patients (prothrombin time 73$\%$, 68$\%$) had mild liver cirrhosis before irradiation. Radiation therapy was delivered with 10MV linear accelerator, 180$\~$200 cGy fraction per day. The total dose ranged from 3,960 cGy to 6,000 cGy (median dose 5,040 cGy). The normal tissue complication probability was calculated by using Lyman's model. Radiation hepatitis was defined as the development of anicteric elevation of alkaline phosphatase of at least two fold and non-malignant ascites in the absence of documented progressive. Results: The calculated NTCP ranged from 0.001 to 0.840 (median 0.05). Three of the 20 patients developed radiation hepatitis. The NTCP of the patients with radiation hepatitis were 0.390, 0.528, 0.844(median : 0.58$\pm$0.23), but that of the patients without radiation hepatitis ranged fro 0.001 to 0.308 (median .0.09$\pm$0.09). When the NTCP was calculated by using the volume factor of 0.32, a radiation hepatitis was observed only in patients with the NTCP value more than 0.39. By contrast, clinical results of evolving radiation hepatitis were not well correlated with NTCP value calculated when the volume factor of 0.69 was applied. On the basis of these observations, the volume factor of 0.32 was more correlated to predict a radiation hepatitis. Conclusion : The risk of radiation hepatitis was increased above the cut-off value. Therefore the NTCP seems to be used for predicting the radiation hepatitis.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.91-98
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• 2014

Purpose : To compare the dosimetry for the left breast cancer treatment between three dimensional conformal radiation radiotherapy (3D-CRT) and Hybrid planning and to estimate usefulness of Hybrid planning Materials and Methods : Five patients with left breast cancer were included in the study. They were planned using several different radiotherapy techniques including: 1)open rectangular field, 2)tangential wedge-based field 3)field in field, 4)hybrid planning(energy, wedge combine). For each patient planning was using Light Speed RT-16 CT and PINNACLE planning system-ver.9.2. Hybrid plan was made using same system and using the same targets and optimization goals. We comparing the Homogeneity Index(HI), normal organs at the does-volume histogram(DVH) Results : In all plans, the Homogeneity Index(HI) of Hybrid planning was significantly better than other. Dose comparison of HI= 2D-RT:38.32, TW:38.32, FIF:29.22, HYBRID:30.57. 2D-RT, TW, FIF Hybrid$V_{75_-lung}$=112.33, 125.14, 121.3, 123.78. $V_{50_-lung}$=155.43, 159.62, 157.96, 159.06. $V_{25_-lung}$=199.86, 200.22, 198.65, 200.31. $V_{50_-heart}$=26.07, 27.1, 26.85, 27.17 $V_{30_-heart}$=33.71, 34.37, 34.15, 34.65 Conclusion : In summary, 3D-CRT, Hybrid planning techniques were found to have acceptableCTV coverage in our study. However the Hybrid planning increased radiation dose exposure to normal tissue. If you apply for treatment of inhomogeneity areas like lung, For best results will be achieved.

• The korean journal of orthodontics
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• v.36 no.6
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• pp.412-421
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• 2006

Objective: The result of finite element analysis depends on material properties, structural expression, density of element, and boundar or loading conditions. To represent proper elastic behavior, a finite element model was made using Hounsfield unit (HU) values in CT images. Methods: A 13 year 6 month old male was used as the subject. A 3 dimensional visualizing program, Mimics, was used to build a 3D object from the DICOM file which was acquired from the CT images. Model 1 was established by giving 24 material properties according to HU. Model 2 was constructed by the conventional method which provides 2 material properties. Protraction force of 500g was applied at a 45 degree downward angle from Frankfort horizontal (FH) plane. Results: Model 1 showed a more flexible response on the first premolar region which had more forward and downward movement of the maxillary anterior segment. Maxilla was bent on the sagittal plane and frontal plane. Model 2 revealed less movement in all directions. It moved downward on the anterior part and upward on the posterior part, which is clockwise rotation of the maxilla. Conclusion: These results signify that different outcomes of finite element analysis can occur according to the given material properties and it is recommended to use HU values for more accurate results.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.401-408
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• 1997

Background : Pulmonary sequestration is a rare congenital malformation, which is manifested by formation of nonfunctioning lung tissue lacking normal communication with the tracheobronchial tree. The preoperative diagnostic rate has been relatively low, and without consideration of pulmonary sequestration, unexpected bleeding from aberrant vessels may be a serious problem during the operation. The purpose of our study is to describe the clinical features of pulmonary sequestration based on a review of 15 cases treated by operation. Method : Fifteen patients with pulmonary sequestration who had undergone surgical treatment from 1991 through May 1996 at Yongdong Severance Hospital and Severance Hospital were reviewed retrospectively. Results : The mean age of the patients was 22.5 years (range 5~57), and male to female ratio was 9 : 6. Clinical presentations varied from recurrent respiratory infections such as fever, cough, and sputum or chest pain to no symptom. The chest simple X-rays showed multicystic shadow(10/15) and solid mass-like shadow(5/15). The chest CT scans, done in twelve cases, showed multicystic lesion with or without lung infiltration(8/12), solid mass-like lesion(4/12), The chest MRIs, done in three cases, revealed the aberrant arteries originating from descending aorta(2/3). Aortograms, done in four cases, showed the aberrant arteries originating from descending thoracic aorta(2/4), abdominal aorta(I/4), and intercostal artery(1/4). and the venous returns were via the pulmonary veins. Pulmonary sequestration was considered preoperatively in six patients of fifteen. Other preliminary diagnosis were lung tumor(3/15), lung abscess(21/15), bronchiectasis(2/15), and mediastinal tumor(2/15). In the operative findings, twelve cases were of intralobar type and three cases of extralobar type. The left lower lobe was most often affected(9/15) and one extralobar sequestration was in the pericardium. The aberrant arteries originated from descending thoracic aorta(6/15), abdominal aorta(1/15), internal thoracic arteries (2/15), intercostal artery(1/15), pericardiophrenic artery(1/15), but in four cases, the origins could not be defined. There was no mortality or complication postoperatively. Conclusion : In our study, preoperative diagnostic rate was relatively low, and clinical features were similar to previous reports. Preoperative vigorous diagnostic approach including aortography is strongly advocated not only for its diagnostic value, but also for accurate localization of the aberrant vessels, which is major concern to surgical procedure.