• Radiation Oncology Journal
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• v.23 no.3
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• pp.161-168
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• 2005

Purpose: The changed expressions of $TGF-{\beta}1$, as a key cytokine in the fibrotic process, due to melatonin with potent antioxidative effects, were investigated in the irradiated lung using fibrosis-sensitive C57BL/6 mice. Materials and Methods: Female C57BL/6 mice were divided into control irradiation-only, and melatonin (300 mg/kg i.p. 1 hr before irradiation) pretreatment groups. The thoraces of the mice were irradiated with a single dose of 12 Gy. The mRNA expressions of $TGF-{\beta}1$ in the lung tissue 2 and 4 weeks after irradiation were quantified using semiquantitive RT-PCR, and the cellular origin and expression levels of $TGF-{\beta}1$ protein were identified using immunohistochemical staining. Results: The relative mRNA expression levels in the irradiation-only and melatonin pretreatment groups 2 and 4 weeks after irradiation were 1.92- and 1.80-fold (p=0.064) and 2.38- and 1.94-fold (p=0.004) Increased, respectively compared to those in the control group. increased expressions of $TGF-{\beta}1$ protein were prominently detected in regions of histopathologicai radiation injury, with alveolar macrophages and septal epithelial cells serving as important sources of $TGF-{\beta}1$ expression. At 2 and 4 weeks after irradiation, the expression levels of protein were $15.8\%\;vs.\;16.9\%$ (p=0.565) and $36.1\%\;vs.\;25.7\%$ (p=0.009), respectively. Conclusion: The mRNA and protein expressions of $TGF-{\beta}1$ in the lung tissue following thoracic irradiation with 12 Gy were significantly decreased by melatonin pretreatment at 4 weeks. These results indicate that melatonin may have a possible application as an antifibrotic agent in radiation-induced lung injury.

• Progress in Medical Physics
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• v.26 no.4
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• pp.234-240
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• 2015

The purpose of this study is to analyze dosimetric parameters of patient with large and pendulous breast receiving breast radiotherapy in the prone versus supine position. The patient underwent computed tomography simulation in both prone and supine position. The homogeneity index (HI), conformity index (CI), coverage index (CVI) to the left breast as planning target volume (PTV) and the doses to the lung, heart, and right breast as organ at risk (OAR) were compared by using dose-volume histogram. The lifetime attributable risk (LAR) according to the prone and supine position was measured for the lung and right breast. The HI, CI of the PTV decreased 21.7%, 6.49%, respectively and the CVI increased 10.8% with the prone position. The mean and maximum dose to the left lung decreased 91.6%, 87.0%, respectively and the volume parameters also decreased over 99% with the prone position. The parameters to the right lung were same regardless of the position. The mean and maximum dose to the heart decreased 51.6%, 14.2% with the prone position. But the mean and maximum dose to the right breast increased unlike the other OARs. The LARs to the lung decreased 80.3% (left), 24.2% (right) but the LAR to the right breast doubled with the prone position. The prone position is a favorable alternative for irradiation of breast in patients with large and pendulous breasts.

• Radiation Oncology Journal
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• v.25 no.2
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• pp.109-117
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• 2007

[ $\underline{Purpose}$ ]: To evaluate the incidences and potential predictive factors for symptomatic radiation pneumonitis (SRP) and radiographic pulmonary toxicity (RPT) following adjuvant radiotherapy (RT) for patients with breast cancer. A particular focus was made to correlate RPT with the dose volume histogram (DVH) parameters based on three-dimensional RT planning (3D-RTP) data. $\underline{Materials\;and\;Methods}$: From September 2003 through February 2006, 171 patients with breast cancer were treated with adjuvant RT following breast surgery. A radiation dose of 50.4 Gy was delivered with tangential photon fields on the whole breast or chest wall. A single anterior oblique photon field for supraclavicular (SCL) nodes was added if indicated. Serial follow-up chest radiographs were reviewed by a chest radiologist. Radiation Therapy Oncology Group (RTOG) toxicity criteria were used for grading SRP and a modified World Health Organization (WHO) grading system was used to evaluate RPT. The overall percentage of the ipsilateral lung volume that received ${\geq}15\;Gy\;(V_{15}),\;20\;Gy\;(V_{20})$, and $30\;Gy\;(V_{30})$ and the mean lung dose (MLD) were calculated. We divided the ipsilateral lung into two territories, and defined separate DVH parameters, i.e., $V_{15\;TNGT},\;V_{20\;TNGT},\;V_{30\;TNGT},\;MLD_{TNGT}$, and $V_{15\;SCL},\;V_{20\;SCL},\;V_{30SCL},\;MLD_{SCL}$ to assess the relationship between these parameters and RPT. $\underline{Results}$: Four patients (2.1%) developed SRP (three with grade 3 and one with grade 2, respectively). There was no significant association of SRP with clinical parameters such as, age, pre-existing lung disease, smoking, chemotherapy, hormonal therapy and regional RT. When 137 patients treated with 3D-RTP were evaluated, 13.9% developed RPT in the tangent (TNGT) territory and 49.2% of 59 patients with regional RT developed RPT in the SCL territory. Regional RT (p<0.001) and age (p=0.039) was significantly correlated with RPT. All DVH parameters except for $V_{15\;TNGT}$ showed a significant correlation with RPT (p<0.05). $MLD_{TNGT}$ was a better predictor for RPT for the TNGT territory than $V_{15\;SCL}$ for the SCL territory. $\underline{Conclusion}$: The incidence of SRP was acceptable with the RT technique that was used. Age and regional RT were significant factors to predict RPT. The DVH parameter was good predictor for RPT for the SCL territory while $MLD_{TNGT}$ was a better predictor for RPT for the TNGT territory.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.355-360
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• 2009

Background: Benign teratoma is mostly asymptomatic, but this tumor rarely ruptures into the adjacent structure such as the pleural space, pericardium, lung parenchyma or tracheobronchial tree. Thus, it is important to differentiate ruptured teratoma from unruptured teratoma. This study evaluated the difference between ruptured and unruptured benign teratoma. Material and Method: Twenty-four cases of surgically resected benign teratomas were reviewed retrospectively. The clinical symptoms, chest CT findings and operative findings of the ruptured teratoma were compared with those of the unruptured teratoma. Especially, the tumor size, wall thickness, location of the mass, internal septation, homogeneity, calcification and ancillary findings were evaluated on CT. Result: Of the 24 patients, 7 patients were diagnosed with ruptured teratoma. Severe symptoms were more commonly found for ruptured teratoma than for unruptured teratoma. The ruptured teratoma had a tendency to display calcification and such ancillary findings as collapse or consolidation of the lung parenchyma. For the ruptured teratoma, the resection was performed by sternotomy or thoracotomy, and more lung resection was included. Conclusion: Calcification within the mass and changes in the lung parenchyma on the preoperative CT findings can be diagnostic signs of a ruptured teratoma. The demonstration of ruptured teratoma is important not only for making the early diagnosis, but also for the surgical planning.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.732-738
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• 1999

Background: Video-assisted thoracoscopic surgery has become a standard therapy for several diseases such as pneumothorax, hyperhidrosis, mediastinal mass, and so on. These methods usually required single-lung ventilation with double-lumen endobronchial tube to collapse the lung under general anesthesia. However, risks of general anesthesia itself and single-lung ventilation must be considered in high-risk patients. Material and method: Between December 1997 and July 1998, eight high-risk patients (6: empyema, 1: intractable pleural effusion, 1: idiopathic pulmonary fibrosis) with underlying pulmonary disease and poor general condition were treated by video-assisted thoracoscopic surgerys under epidural anesthesia and spontaneous breathing. Result: Video-assisted thoracoscopic surgerys were successfully per formed in 7 patients. Conversion to general anesthesia was required in 1 patient because of decrease in spontaneous breathing. But, conversion to open decortication was not required. In two patients with chronic empyema, one patient required thoracoplasty as a second procedure and one patient required re-video-assisted thoracoscopic procedure due to a recurrence. The mean operative time was 31.8$\pm$15.2 minutes. No significant postoperative respiratory com plication was encountered. Conclusion: Video-assisted thoracoscopic surgerys can be per formed safely under epidural anesthesia for the treatment of empyema and diagnosis of pulmonary abnormalities in high-risk patients.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.468-473
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• 1993

Background: Recent advance in video technology, endoscopic equipments, and surgical techniques have expanded the use of thoracoscopy from diagnosis of the pleural diseases to treatment of the various intrathoracic diseases. Video Assisted Thoracoscopic Surgery(VATS) is a pretty new and fascinating thoracic surgical modality, and so we present our early VATS resuls. Methods: Using Video Thoracoscopic techniques in 30 patients for 10 months from July 1992 to April 1993, we had performed a variety of procedures. These incuded (1) bleb resections in 18 patients (19 cases), (2) mediastinal tumor excision in 4, (3) lung biopsies for parenchymal pulmonary disease in 3, (4) pleural biopasies in 3, (5) pleural tumor excision in 1, (6) and pleuropericardial window in 1. Results: There were no mortality associated with the procedures. We had minor 8 complications; prolonged air leak in 3 patients, prolonged serous drainage in 2, recurrence of pneumothorax in 1, Honer's syndrome in 1, and hoarseness in 1 patient. None of the 30 patients had reverted to the conventional full thoracotomies. Mean postoperative hospital stay of non-complicated pneumothoraces was about 5 days, which was a little shorter than conventional thoracotomy group. Conclusion: Though we had somewhat higher postoperative complication rate due to lack of experiences in the begining, we were able to convince that VATS had benifical value for patients; lesser postoperative pain, shorter hospitalization, quicker recovery time, and cosmetically superior scar. The role of VATS can be expanded to the diagnosis and treatment of various thoracic diseases, even to the cardiovascular diseases, with satisfactory outcome and less postoperative morbidity.

• Tuberculosis and Respiratory Diseases
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• v.49 no.3
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• pp.365-371
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• 2000

Nodular pulmonary amyloidosis is one of the rare manifestation of amyloid disease. It is known to be caused by amyloid L fibrils in the majority of cases. We experienced an unusual case of a forty-one year-old woman who was presented with multiple nodular lesion on the chest X-ray. CT-guided core needle biopsy, performed on the lesion, showed apple green birefringes, when stained Congo red and examined under polarized light, Ultrastructurally, there are randomly oriented, forming densed networks, and consists of fine, 7.5 to 10nm diameter, rigid, non-branching filaments of various lengths in electron-microscopic finding. We report a case of primary diffuse nodular pulmonary amyloidosis only localized in the lung, which was confirmed by CT guided core needle biopsy.

• Tuberculosis and Respiratory Diseases
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• v.56 no.2
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• pp.203-209
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• 2004

Background : Methotrexate (MTX) has been used to treat a wide range of malignant and benign diseases including osteosarcoma, advanced stage non-Hodgkin's lymphoma, psoriasis, severe rheumatoid arthritis, sarcoidosis, and Wegener's granulomatosis. MTX-induced lung injury occurs in up to 10% of treated patients. Although both acute and chronic presentations have been described, typical manifestation of MTX-induced lung injury is subacute with symptoms usually developing within several months after starting therapy. Nonspecific interstitial pneumonia (NSIP) is the most common histopathologic manifestation of MTX-induced lung disease, while bronchiolitis obliterans organizing pneumonia (BOOP) and diffuse alveolar damage (DAD) are less common. Granuloma formation is reported in 34.7%. In Korea, Two reports of MTX pneumonitis have been published. The one presented with NSIP and the other with DAD. We recently experienced a case of MTX pneumonitis with presentation of hypersensitivity pneumonitis.

• Radiation Oncology Journal
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• v.17 no.3
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• pp.203-208
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• 1999

Purpose : To evaluate whether spontaneous apoptosis has prognostic value among patients with squamous cell carcinoma of lung. Materials and Methods : Material from 19 patients who received thoracic irradiation between 1990 and 1994 was analyzed. Their stages were II (1), IIIa (8), IIIb (5), and IV (5). Patients were observed from 5 to 67 months (median : 17 months). The spontaneous apoptosis index (AI) and p53 mutation were measured by immunohistochemical stains. Results : AI was found to range from 0 to $1\%$ (median $0.4\%$). Patients with low AI ($AI{\leq}$median) had a much higher distant metastasis rate at diagnosis than patients with high AI. By analysis of prognostic factors for survival, M stage was significant in univariate analysis. AI, chemotherapy, M stage, T stage, and stage were significant in multivariate analysis. The correlation between the AI and p53 mutation was not seen. Conclusion : AI was related with distant metastasis at diagnosis and not with p53 mutation. Also low AI group tended to have shorter survival time than high AI group.

• Tuberculosis and Respiratory Diseases
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• v.59 no.4
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• pp.356-360
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• 2005

Background : This study examined the clinical utility of using indirect chest radiography during a physical examination of new conscripts for determine the presence of pulmonary tuberculosis. Methods : Over an eight-month period, this study examined 25386 people who underwent a physical examination after conscription. The abnormal findings on mass miniature radiography were followed-up using direct chest radiography. The positive predictive value of mass miniature radiography and direct chest radiography was compared. The incidence, degree of infiltration and clinical outcome of active pulmonary tuberculosis were also evaluated during a follow-up examination. Results : The positive rate of mass miniature radiography was 1.19% (n=302). Various lesions were identified: Parenchymal lesions (n=109), mediastinal lesions (n=6), cardiovascular lesions (n=45), pleural lesions (n=49), bony lesions (n=90) and miscellaneous lesions (n=7). The incidence of active pulmonary tuberculosis by mass miniature radiography was 0.26% (n=67). The first diagnosis was made in 50 people; active pulmonary tuberculosis (n=42), pneumonia (n=1), a mediastinal mass (n=1), a rib fracture (n=2) and a pneumothorax (n=4). Most cases of active pulmonary tuberculosis were mildly infiltrated and either improved or were cured by the follow-up examination. Conclusion : Although mass miniature radiography in a physical examination after conscription has limitations, but it is a useful means for detecting the presence of early disease, particularly in active pulmonary tuberculosis.