• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.5
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• pp.277-283
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• 2013

Purpose: Well vascularized pectoralis major myocutaneous flap (PMMF) had been a commonly used versatile flap in reconstructive oromaxillofacial surgery since the 1970s. However, after the advent of microvascular surgery in the 1980s, the PMMF was used less frequently. But, to date, PMMF has been useful and has some advantages such as covering wide defects, covering vital structures, back-up procedure in cases of free flap failure, and reconstruction for radiotherapy patients. The purpose of this study is to evaluate the role, indication, complications, functional, and aesthetic results of this flap in the era of free flap with a literature and chart review. Methods: A retrospective study was conducted of 16 oral cancer patients undergoing reconstructive surgery with PMMF for reconstruction of defects from 2001 to 2012 at Kyungpook National University Hospital. The male to female ratio was 10:6, with a mean age of 63 years (16~79 years). Basic demographic data, previous treatment history, indications, dimension of the flap, site of reconstruction, postoperative complications, and patients' final status were systemically analyzed from chart review. Results: The pathology of the disease included squamous cell carcinoma in the majority of cases (n=14). The remaining cases were fibrosarcoma and mucoepidermoid carcinoma. Of the 16 PMMF reconstructions, 13 flaps were applied as primary reconstructive procedures, whereas three flaps were; salvage; procedures (vascularized free flap failure). Twelve patients had complications such as wound dehiscence, infection, hematoma, fistula, flap bulkiness, and partial flap necrosis. The higher complication rates showed an association with utilization of the flap in preoperative radiotherapy cases. However, all patients were discharged without failure. Conclusion: In reconstructive oromaxillofacial surgery, the PMMF is still a useful flap for huge defects. In addition, the PMMF can be used as a salvage procedure after vascularized free flap failure and reconstruction for patients with a history of preoperative radiotherapy.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.185-189
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• 2001

Background: Cervical metastasis of unknown origin is defined as histologic evidence of malignancy in the cervical lymph nodes with no apparent primary site of origin for the metastatic tumor. Patients and Methods: A retrospective review of 20 cervical metastasis of unknown origin diagnosed and managed between january 1989 and December 1999 at the Korea University was undertaken to determine outcome. Patient age ranged 46 to 78 years (mean 60). There were 17 men and 3 women. The aim of this study is to ananlyze the diagnostic approach and the result of treatment of the cervical metastasis of unknown origin. Result: Histopathologically, squamous cell carcinoma (15 case, 75%) were the most common, followed by adenocarcinoma (4 case, 20%), undifferentiated carcinoma (1 case, 5%) According to the criteria of the AJCC on staging, N1 was 2 cases, N2a 2 cases, N2b 5 cases, N2c 1 cases, N3 10 cases. Overall survival rate for all patients at 2 years was 45% and 5 years 25%, and in the combination therapy(surgery and radiotherapy group (12 cases)) it was 67% and 34% respectively, high compared with other treatment modality such as surgery or radiotherapy alone. In extracapsular spread positive group, 5 year survival rate was 12%, but was 33% in the extracapsular spread negative group. Conclusion: With no stastatical significance, extracapsular spread group was poor outcome in our study. Combination of radiotherapy and surgery was more effective treatment result than surgery alone or radiotherapy alone in our study. But, overall prognosis of cervical metastasis of unknown origin was very poor despite aggressive treatment (5 year survival rate: 25%).

• Journal of Chest Surgery
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• v.16 no.2
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• pp.231-242
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• 1983

A clinical study was performed on 75 cases of the esophageal cancer and benign esophageal diseases experienced at Department of thoracic & cardiovascular surgery, School of Medicine, Keimyung University during 3 year period from 1978 to 1982. Of 75 cases of the surgical esophageal diseases, there were 35 patients of the esophageal cancer. 17 patients of benign esophageal stenosis, 10 patients of esophageal perforation, 4 patients of diverticulum. 3 patients of achalasia, 2 patients of congenital T-E fistula, one of upper esophageal web, one of esophageal foreign body, one of leiomyoma and patient of hemangioma. First, esophageal carcinoma was more frequent in men than in women by a ratio of five to one, and the peak incidence occurred in the 5th to 6th decade. Dysphagia was the most common symptom in 88.6 percent of our cases. The tumor was located mostly in the middle & the lower one third [91.4%]. The histological diagnosis was made in 35 cases. The squamous cell carcinoma was the most common [82.9%] and the rest was the adenocarcinoma in the lower one third [17.1%]. Thirty-five cases were operated and resection was feasible in the twenty-five patients [71.4%] with 2 cases of hospital mortality [5.7%]. All but two of the esophageal stenosis were caused by corrosive esophagitis and ages ranged from 7 to 70 years with average age of 32 years. Corrective operations were performed on 17 patients of esophageal stenosis of whom 12 patients had esophagocologastrostomy, 3 patients esophagogastrostomy and in non-corrosive esophageal stenosis one case and esophagoplasty and another case had release of external compression. There was one complication of stenosis of the esophageal perforation were traumatic in five cases, empyema in three cases, caustics in one case and postemetic in one case. 10 patients of the esophageal perforation underwent operation: primary closure in 5 cases, two staged colon interposition in 2, esophagogastrostomy in 1 and closed thoracotomy in 2 cases There were 2 complications of leakage of anastomosis sites in postoperative period. 4 patients of traction type of diverticulum underwent diverticulectomy & 3 patients of achalasia underwent modified Heller`s operation. 2 patients of congenital esophageal atresia had distal tracheoesophageal fistula & underwent one staged operation with the results of one death caused by pneumonia. Upper esophageal web had divulsion through the esophagoscope and foreign body in upper esophagus was removed through cervical esophagotomy. One case of leiomyoma in esophagus had esophagectomy and reconstruction with right colon. And one case of hemangioma in esophagus had esophagectomy & esophagogastrostomy.

• The Korean Journal of Nuclear Medicine
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• v.29 no.4
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• pp.526-532
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• 1995

Introduction : $^{99m}Tc$-(V)-DMSA is a tumor seeking agent that has been used to image medullary carcinoma of thyroid, soft tissue sarcoma and lung cancer. This study was designed to assess the clinical role of $^{99m}Tc$-(V)-DMSA in the diagnosis of head and neck cancers. We has evaluated the diagnostic efficacy of planar and SPECT imaging using $^{99m}Tc$-(V)-DMSA. Patients and Method : Sixty-eight patients with head and neck mass were included in this study. All subjects were diagnosed by biopsy or surgery. Planar and SPECT images were obtained at 2 or 3 hour after intravenous injection of 740 MBq(20 mCi) $^{99m}Tc$-(V)-DMSA. Seventeen patients also underwent SPECT in aging using dual head camera. Result : The diagnostic sensitivity of $^{99m}Tc$-(V)-DMSA planar and SPECT imaging was 65% and 90%, and specificity was 80% and 66%, respectively. The sensitivity of planar imaging in squamous cell carcinoma was similar to overall sensitivity Six metastatic lesion were first diagnosed by scintigraphy. But benign lesions such as Kikuchi syndrome, tuberculous lymphadenitis also revealed increased uptake. Conclusion : $^{99m}Tc$-(V)-DMSA imaging seems to be a promising method in the evaluation of patients with head and neck mass. We recommend SPECT imaging to delineate anatomic localization of the lesion.

• Radiation Oncology Journal
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• v.16 no.3
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• pp.245-250
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• 1998

Purpose : This study was to evaluate survival, failure patterns, and prognostic factors of stage I squamous cell carcinoma of the glottic larynx after curative radiation therapy. Materials and Methods : A retrospective analysis was done for 57 patients with glottic cancer who were treated with curative radiation therapy from June 1985 to November 1992. There were 55 male and two female patients. Patients' age ranged from 17 to 71 years(median 39 years). Radiation therapy was delivered five times a week, 2 Gy daily, total 66 Gy using 6 MV X-ray. Results : Complete response(CR) was noted in 51 out of 57 patients (89.5%) and persistent disease (PER) in six out of 57 patients(10.5%). The disease-free survival rates at 3 and 5 years were 72.9% and 63.8%, respectively. Seven failures were observed among 51 CR patients during follow-up. Salvage total laryngectomy for six recurred patients and partial laryngectomy for one recurred patient were done with successful results, i.e., all of them were actually salvaged. Among six PER patients, salvage total laryngectomy for two patients and partial laryngectomy for two patients were done and two patients refused operation. Following salvage surgery for the four PER patients, three were salvaged and one failed locoregionally. Among the 13 failures 10(76.9%) were salvaged with surgery. The ultimate local control rate at 5 years was 92.3% and overall 47 out of 57 (82.5%) patients were able to preserve their larynx. The 5-year disease-free survival rates were 85.5% for posterior lesions, and 61.6% for anterior lesions(P<0.05). Cord mobility, involvement of anterior commissure, field size, and T stage did not impact on disease-free survival. Conclusion : Considering the high percentage of voice preservation with initial radiotherapy, radiotherapy should be the first choice in the treatment of stage 1 glottic carcinoma.

• Archives of Pharmacal Research
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• v.23 no.6
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• pp.605-612
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• 2000

Green tea polyphenols (GTP) have been demonstrated to suppress tumorigenesis in several chemical-induced animal carcinogenesis models, and predicted as promising chemopreventive agents in human. Recent studies of GTP extracts showed the involvement of mitogen-activated protein kinases (MAPKs) in the regulation of Phase II enzymes gene expression and induction of apoptosis. In the current work we compared the biological actions of five green tea catechins: (1) induction of ARE reporter gene, (2) activation of MAP kinases, (3) cytotoxicity in human hepatoma HepG2-C8 cells, and (4) caspase activation in human cervical squamous carcinoma HeLa cells. For the induction of phase IIgene assay, (-)-epigallocatechin-3-gallate (EGCG) and (-)-epicatechin-3-gallate (ECG) potently induced antioxidant response element (ARE)-mediated luciferase activity, with induction observed at 25 $\mu\textrm{m}$with EGCG. The induction of ARE reporter gene appears to be structurally related to the 3-gallate group. Comparing the activation of MAPK by the five polyphenols, only EGCG showed potent activation of all three MAPKs (ERK, JNK and p38) in a dose- and time-dependent manner, whereas EGC activated ERK and p38. In the concentration range of 25 $\mu\textrm{m}$ to 1 mM, EGCG and ECG strongly suppressed HepG2-ARE-C8 cell-growth. To elucidate the mechanisms of green tea polyphenol-induced apoptosis, we measured the activation of an important cell death protein, caspase-3 induced by EGCG, and found that caspase-3 was activated in a dose- and time-dependent manner. Interestingly, the activation of caspase-3 was a relatively late event (peaked at 16 h), whereas activation of MAPKs was much earlier (peaked at 2 h). It is possible, that at low concentrations of EGCG, activation of MAPK leads to ARE-mediated gene expression including phase II detoxifying enzymes. Whereas at higher concentrations of EGCG, sustained activation of MAPKs such as JNK leads to apoptosis. These mechanisms are currently under investigation in our laboratory. As the most abundant catechin in GTP extract, we found that EGCG potently induced ARE-mediated gene expression, activated MAP kinase pathway, stimulated caspase-3 activity, and induced apoptosis. These mechanisms together with others, may contribute to the overall chemopreventive function of EGCG itself as well as the GTP.

• Tuberculosis and Respiratory Diseases
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• v.53 no.1
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• pp.46-51
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• 2002

Numb chin syndrome is a rare clinical manifestation, characterized by focal sensory loss and paresthesia of the chin. It is more often associated with cancer than with benign disorders, and can be the first manifestation of a cancer. A 60-year-old man presented with focal numbness of right chin and gingiva for 10 days. Chest computed tomograghy showed a 3 cm sized mass on the distal left main- stem bronchus. Squamous cell carcinoma was diagnosed on bronchoscopic biopsy. However, bony metastasis of mandible was not evident on reontgenogram, CT scan, bone scintigram and positron emission tomography. Despite the chemotherapy with three cycles of paclitaxel and cisplatinum, the cancer was progressed and pain on the right chin was developed 4 months later. Bone scintigram showed multiple bony metastasis including mandible. Here we report this case with a brief review of the appropriate literature.

• Tuberculosis and Respiratory Diseases
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• v.39 no.1
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• pp.55-61
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• 1992

Background: The lung is the most common site of metastasis and usually it manifests as a single or multiple nodules in chest X-ray. But less commonly the cancer spreads through the lymphatics and X-ray shows diffuse reticulonodular densities. Sometimes, patient is presented with respiratory symptoms only with interstitial lung infiltration before the signs of primary tumor and in that cases, the differential diagnosis with other interstitial lung disease is required. We have experienced 5 such cases, who were diagnosed as lymphangitic carcinomatosis by transbronchial lung biopsy. Methods: Clinical manifestation, pulmonary function test, modified thin section CT, bronchoalveolar lavage and transbronchial lung biopsy were done. Results: The primary tumor was gastric cancer in 3, lung cancer in 2. Pulmonary function test showed restrictive pattern with low DLco in 2 patients and obstructive pattern in one. Bronchoalveolar lavage showed lymphocytosis in 4 patients and malignant cells were found in one patient. Transbronchial lung biopsy revealed malignant cells localized to the lymphatics (peribronchial, perivascular and perialveolar). Cell type was adenocarcinoma in 4 and squamous cell carcinoma in one. Conclusion: Rarely lymphangitic carcinomatosis can be presented as diffuse interstitial lung disease and easily diagnosed by transbronchial lung biopsy.

• Tuberculosis and Respiratory Diseases
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• v.65 no.2
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• pp.105-109
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• 2008

Background: Fascin is an actin-bundling protein that plays an important role in cellular motility. Fascin is normally expressed in the neuronal and mesenchymal cells and its expression is low or absent in the epithelia. However, an overexpression of fascin has been linked to the invasive behavior of some neoplasms such as breast, stomach and ovarian tumors. In this study, we evaluated the expression of fascin and its prognostic significance in stage I non-small cell lung cancer (NSCLC). Methods: Immunohistochemical staining for fascin was performed on the paraffin-embeded tissue sections of 81 cases of resected NSCLC. Staining of more than 5% of the tumor cells was recorded as positive immunoreactivity. Results: Fascin expression was seen in 73% (59/81) of the cases and this was more frequently seen in squamous cell carcinoma than in adenocarcinoma (93% vs 42%). There were no significant correlations of fascin immunoreactivity with tumor recurrence and overall survival. Conclusion: The expression rate of fascin was relatively high in NSCLC, but this was without prognostic significance. The exact clinical role of fascin should be defined through further investigations.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.766-775
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• 1997

Background : Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 per cent of all malignancies of the respiratory tract. Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. Method : We have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking and respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. Results : Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then stridor or wheezing, cough. and sputum in order. The routine chest roentgenographic examinations were not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with sec and ACC were 5 months and 24.9 months respectively. We had bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression. Conclusion : We would like to perform more comprehensive diagnostic tools(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumorse(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax and waning of dyspnea according to changes of position, 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.