• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.205-209
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• 2001

Purpose: Most cases of primary hyperparathyroidism are due to parathyroid adenoma or parathyroid hyperplasia. Parathyroid carcinoma is a very rare cause of hyperparathyroidism. Although the diagnosis of parathyroid carcinoma is usually established by pathologic criteria especially of vascular or capsular invasion, some clinical and biochemical features differentiate it from benign forms of hyperparathyroidism. We under-took a retrospective study in 6 patients with parathyroid carcinoma, with the aim of conveying experience from management for this rare cause of hyperparathyroidism. Methods: Clinical symptoms, biochemical laboratory, radiologic, and intraoperative findings, local recurrence and distant metastasis were analyzed in 6 patients diagnosed pathologically as a parathyroid carcinoma after operation from 1992 to 2001. Results: Mean age was 50.2 years (33.0-60.0 years) and male to female ratio was 1:1. Neck mass was found in 5 patients, multiple bone pain in 3 patients and renal stone in 1 patient. One case has suffered from chronic renal failure for 19 years. Although preoperative laboratory evaluations showed the aspects of hyperparathyroidism in all cases, mean serum calcium level was 11.2mg/dl(10.5-12.1mg/dl), slightly elevated. Laboratory values after surgery were within the normal range in 5 cases. However, in one case with chronic renal failure, serum PTH levels, serially checked, were above the normal range. Any of imaging methods failed to suggest a parathyroid carcinoma preoperatively. Parathyroid adenoma was suspected in 3 cases, thyroid cancer in the other cases before surgery. The extent of resection was radical resection of parathyroid lesion with more than unilateral thyroid lobectomy and central compartment neck node dissection and in 2 cases, the resection of recurrent laryngeal nerve or strap muscles was added. During follow-up period, any local or systemic recurrence were not evident in all the cases. Conclusion: Although parathyroid carcinoma is a rare disease and its preoperative diagnosis, in our experience, could not easily be made, the understanding of characteristic clinical and biochemical feature could help diagnosis at first surgery. Radical resection without remaining residual tumor is most important for the management of the parathyroid cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.2
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• pp.759-765
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• 2016

Background: Breast cancer is the most frequent cancer of women in Pakistan with the majority presenting with stage III or IV lesionsat initial diagnosis. Patient and health system related factors are well known determinants of delay in presentation and diagnosis. Additionally, breast cancer being a heterogeneous disease, the various molecular subtypes featuring different aggressiveness also need to be considered. The present study evaluated the association of stage at initial diagnosis of breast cancer with these two factors in local women at a tertiary level health care facility in Lahore, Pakistan. Materials and Methods: Patient and tumor features were recorded separately during diagnostic workup in Breast Clinics at INMOL and at Services Hospital, Lahore. Data were entered in MS Excel and analyzed by descriptive statistics and Chi-Square test. Results: Among the 261 patients, 64% were staged as late breast cancer (LBC), the mean age was 46.8 with standard deviation of 13 years. Some 92% had invasive ductal carcinoma (IDC), 61% had luminal types (LT) of non-aggressive tumor while 39% had the non-luminal types (NLT) of of HER2-enriched or basal aggressive tumors. While 70% of patients presented within one year of symptomatic disease (early report group "ERG"), 30% reported after a mean delay of 4 years with a standard deviation of 3.75 years. The stage distribution among ERG patients was not statistically different from those reporting late (P=0.123). Statistically larger proportion of patients with NLT presented as LBC as compared to the LT (P =0.034). Among the ERG, statistically different stage distribution of disease was observed for the NLT versus LT (P=0.047). Among those presenting late, this difference was insignificant (P=0.416). Conclusions: Breast cancer is a distinct disease in Pakistan with a high frequency of aggressive molecular types affecting younger women, with the majority presenting as LBC. Association of NLT with higher stage at diagnosis is statistically significant whereas time delay in diagnosis is not. Further research is required to define the risk profile and features in local patients. The burden of LBC can be reduced by promoting breast health awareness and by establishing easily accessible dedicated breast care set ups in the hospitals.

• Korean Journal of Biological Psychiatry
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• v.27 no.1
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• pp.1-8
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• 2020

Objectives In electroconvulsive therapy (ECT) research and practice, the precise determination of seizure duration is important in the evaluation of clinical relevance of the ECT-induced seizure. In this study, we have developed computerized algorithms to assess the duration of ECT-induced seizure. Methods Subjects included 5 males and 6 females, with the mean age of 33.1 years. Total 55 ECT sessions were included in the analysis. We analyzed the standard deviation of a finite block of electroencephalography (EEG) data and the change in the local slope of RR intervals in electrocardiography (ECG) signals during ECT-induced seizure. And then, we compared the calculated seizure durations from EEG recording (EEG algorithm) and ECG recording (ECG algorithm) with values determined by consensus of clinicians based on the recorded EEG (EEG consensus), as a gold standard criterion, in order to testify the computational validity of our algorithms. Results The mean seizure durations calculated by each method were not significantly different in sessions with abrupt flattened postictal suppression and in sessions with non-abrupt flattened postictal suppression. The intraclass correlation coefficients (95% confidence interval) of the three methods (EEG algorithm, ECG algorithm, EEG consensus) were significant in the total sessions [0.79 (0.70-0.86)], the abrupt flattened postictal suppression sessions [0.84 (0.74-0.91)], and the non-abrupt flattened postictal suppression sessions [0.67 (0.45-0.84)]. Correlations between three methods were also statistically significant, regardless of abruptness of transition. Conclusions Our proposed algorithms could reliably measure the duration of ECT-induced seizure, even in sessions with non-abrupt transitions to flat postictal suppression, in which it is typically difficult to determine the seizure duration.

• The Korean Journal of Physiology
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• v.17 no.2
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• pp.93-101
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• 1983

A possibility whether the appearance of adaptation to cold climate during winter could occur or not in Taegu area was evaluated by comparing the data obtained in winter with that obtained by the same method in summer. Circulatory response was induced by the immersion of one hand in the cold water. The systemic and local responses in the blood circulation from the immersed hand and the unimmersed opposite hand were observed simultaneously. In addition Galvanic skin resistance(GSR) that is influenced by the activity of autonomic nervous system and the vascular tonicity was recorded. The experiment was performed by examining sixty healthy college students in winter and fifty in summer, whose mean age was 21.0, mean weight $60.6{\pm}0.90\;kg(male)$ and $48.3{\pm}0.98\;kg(female)$. The cold stimulus was applied by immersing the left hand into the cold water of $5^{\circ}C$ for 3 minutes, and the response was observed on immersed left hand and unimmersed right hand simultaneously. The observation was made through determining mean blood pressure, heart rate, amplitude of photoelectric capillary pulse (APCP) and GSR. The results obtained are as follows: The mean blood pressure was elevated during the cold stimulation. The increase of blood pressure in summer was more remarkable than in winter. At the recovery period the blood pressure was decreased to the control level in winter but the decrease below the control level was observed in summer. The increase of heart rate in summer was more remarkable than in winter during the cold stimulation. At the recovery period heart rate in both winter and summer was decreased below the control level. During the cold stimulation the APCP was decreased on both hands in winter. However it was more prominent on left hand indicating additional direct cold effect on immersed hand. In summer, the decrease of APCP during immersion was less remarkable than that in winter, but the regain of APCP was faster than that in winter at the recovery period. And the prompt increase of APCP over the control level has been obtained at the 3 minutes of the recovery period. The GSR was remarkably increased on immersed hand but slightly decreased on unimmersed opposite hand during the cold stimulation. Thus the finding on immersed hand indicates that the local direct effect of cold water is more prominent than the systemic effect, where as the finding on unimmersed hand indicates that the circulatory response to painful stress elicited by the cold stimulation is more prominent than cold temperature itself. In summary, it seems that the systemic circulatory response to the local cold stimulation of the one hand is arised more from the secondary elicited pain sensation and less from the low water temperature. On the contrary to the report of Kim et $al^{39)}$, the adaptation phenomena in blood pressure to the relatively mild cold climate in winter was not observed in this study. The difference of circulatory response observed in this study between winter and summer may be due to the difference of the magnitude of subjective sensation of the cold water stimulation by the seasonal changes in air temperature.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.698-702
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• 2008

Purpose: Basal cell carcinoma is one of the most common cancers in the western population and the annual incidence rate is still on an increasing course. In Asian countries such as Korea, the incidence of basal cell carcinoma is reported to be remarkably low but is estimated to be in a steep increase nowadays. This study was to analyze the recent clinical trends of basal cell carcinoma in Korea by reviewing a single institution's experience. Methods: Throughout an 11-year period, the surgical excision of 143 cases of basal cell carcinoma was performed in our department. General data of these cases such as the primary site of cancer, age and sex of the patient, operative methods, recurrence rate were reviewed retrospectively. Results: Among the 143 patients included in this study, 82 patients were men and 61 patients were women. The ages ranged from 27 to 89 years with a mean age of 64.0 years. The head and neck region was the most frequently involved primary site for the cancer as 95.1% of the total cases occurred in this area. Especially the nose and perinasal area were the most frequent region, which was followed by the periorbital area, cheek, and perioral area. During this study period, 9 cases showed recurrence of the cancer as the overall recurrence rate was 6.3%. Conclusion: Gradual increase in the incidence of basal cell carcinoma was demonstrated in this study. Basal cell carcinoma showed high incidence in the old-age population as 68.5% of the total patients were more than 60 years of age. High recurrence rate was noted in the nasal region especially after local flap reconstruction. A more cautious approach is to be required when handing such high risk lesions. Multiple factors such as extended life span, increased outdoor leisure activity and exposure to sunlight, higher accessibility to medical services and increased understanding of the public about skin cancer are assumed to be the main reasons for this increase of basal cell carcinoma.

• Women's Health Nursing
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• v.4 no.2
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• pp.145-161
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• 1998

This correlational study sought to find the relationship among women's health status and the level of importance & performance of postpartal care. One hundred thirty three women who live in Seoul and rural area including hospitalized in a general hospital and midwifery clinic were studied from 1st April, 1998 to 25th April, 1998 for 25 days. Data analysis consisted of frequency, percentage, Pearson Correlation Coefficiency, t-test, ANOVA and Sheffe test as a post hoc, using SPSS. The results of analysis were as follows ; mean age of respondents was 31.9 years and mean number of children was 1.8. The most of family type was nuclear family and lived int apartment. Mean frequency of pregnancy was 2.7 times and most women delivered at local clinic, general or University hospital. Mean period of after delivery was 53.7 month. The level of importance and performance of traditional postpartal care (Sanhujori) was more higher than hospital postpartal care. The level of importance, performance of postpartum care and health status had significant relationship. The higher level of importance was, & the higher level of performance was higher, and the higher degree of health status. The factors related to health status were postabortal sahujori period after abortion, nuclear family, the evaluation of sahujori, whether women and followed the caregiver's advice well or not and whether they have physical symptoms or not, at the level of $5{\sim}0.1%$ of significance statistically. The factors related to the level of importance of postpartal care were the number of child, present health status and health status of pre-post of delivery, deliver place and the opinion of effective postpartum care method at the level of $5{\sim}0.1%$ of significance statistically. The factors related to the level of performance of postpartal care were delivery place, the opinion of whether they can do at the hospital or not and whether they have physical symptom or not at the level of $1{\sim}0.1%$ of significance statistically. In conclusion, this finding reconfirmed the relationship among women's health status and the postpartal care. It provides a challenge to the health professional caregivers to research continually and repeatedly and confirm the conceptual model of Sanhujori, reestablish effective and integrative postpartal caring system which contains oriental and western paradigm for women's life long health toward the 21C.

• Journal of Periodontal and Implant Science
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• v.36 no.2
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• pp.461-471
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• 2006

In order to achieve a satisfactory esthetic result of periodontal surgery or implant in maxillary anterior area, periodontists must be aware of normal alveolar bone anatomy. The purpose of this study was to evaluate the relationship of alveolar bone morphology to tooth shape and form. 78(mean age : 25 yrs) periodontally healthy volunteers participated in this study. Two maxillary central incisor and one lateral incisor were selected to study. With minimal local anesthesia, gutta-percha cone inserted to labial gingival sulcus of selected teeth just after bone sounding with periodontal probe. Metal ball (4mm diameter) attached to palatal fossa of central incisor. Then, periapical radiograph was taken according to long cone paralleling technique. After film scan, labial alveolar bone profile reproduced along interproximal bone and apical ends of gutta-percha cones on computer screen. By utilizing computer program, the distance from height of interproximal bone to the labial bone crest in central incisor-central incisor and central incisor-lateral incisor area was measured and converted to real distance by using vertical length of metal ball on film. After measuring crown length & width of central incisor, the 10 individuals ranked lowest GW/L ratio (crown width/length ratio) and the 10 ranked highest were selected as having a long-narrow(group N), or a short-wide(group W) form of the central incisors. Means of the distance from height of interproximal bone to the labial bone crest of group N, W were calculated and compared by means of independent t-test. The results were as follows: 1. Mean distance from the height of the interproximal bone to the labial bone crest was $3.5{\pm}0.7mm$ between two central incisor, and $2.8{\pm}0.6mm$ between central and lateral incisor. 2. Mean GW/L ratio of group N was 0.57, and group W was 0.8. Mean distance from the height of the interproximal bone to the labial bone crest of group N was higher than group W in both measured area(measurements of group N, W were $3.9{\pm0.2mm$ and $3.5{\pm}0.2mm$ between two central incisor, $3.0{\pm}0.2mm$ and $2.8{\pm}0.2mm$ between central and lateral incisor), but there were no statistically significant differences when the groups were compared. Within the limits of the present study, there was a tendency that subjects with long-narrow teeth have more scalloped alveolar bone profile than subjects with short-wide teeth in upper anterior area, but no statistically significant differences were found.

• Korean Journal of Radiology
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• v.23 no.8
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• pp.828-834
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• 2022

Objective: This study aimed to assess the outcomes of outpatient day-care management of unruptured intracranial aneurysm (UIA), and to present the risks associated with different management strategies by comparing the outcomes and adverse events between outpatient day-care management and management with longer admission periods. Materials and Methods: This retrospective cohort study used prospectively registered data and was approved by a local institutional review board. We enrolled 956 UIAs from 811 consecutive patients (mean age ± standard deviation, 57 ± 10.7 years; male:female = 247:564) from 2017 to 2020. We compared the outcomes after embolization among the different admission-length groups (1, 2, and ≥ 3 days). The outcomes included pre- and post-modified Rankin Scale (mRS) scores and rates of adverse events, cure, recurrence, and reprocedure. Events were defined as any cerebrovascular problems, including minor and major stroke, death, or hemorrhage. Results: The mean admission period was 2 days, and 175 patients (191 aneurysms), 551 patients (664 aneurysms), and 85 patients (101 aneurysms) were discharged on the day of the procedure, day 2, and day 3 or later, respectively. During the mean 17-month follow-up period (range 6-53 months; 2757 patient years), no change in post-mRS was observed compared to pre-mRS in 99.6% of patients. Cure was achieved in 95.6% patients; minimal recurrence that did not require re-procedure occurred in 3.5% patients, and re-procedure was required in 2.3% (22 of 956) patients due to progressive enlargement of the recurrent sac during follow up (mean 17 months, range, 6-53 months). There were eight adverse events (0.8%), including five cerebrovascular (two major stroke, two minor strokes and one transient ischemic stroke), and three non-cerebrovascular events. Statistical comparison between groups with different admission lengths (1, 2, and ≥ 3 days) revealed no difference in the outcomes. Conclusion: This study revealed no difference in outcomes and adverse events according to the admission period, and suggested that UIA could be managed by outpatient day-care embolization.

• Journal of Korean Neurosurgical Society
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• v.67 no.5
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• pp.560-567
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• 2024

Objective : We investigated how treating large brain metastasis (LBM) using 2-day fraction Gamma Knife radiosurgery (GKRS) affects tumor control and patient survival. A prescription dose of 10.3 Gy was applied for 2 consecutive days, with a biologically effective dose equivalent to a tumor single-fraction dose of 16.05 Gy and a brain single-fraction dose of 15.12 Gy. Methods : Between November 2017 and December 2021, 42 patients (mean age, 68.3 years; range, 50-84 years; male, 29 [69.1%]; female, 13 [30.9%]) with 44 tumors underwent 2-day fraction GKRS to treat large volume brain metastasis. The main cancer types were non-small cell lung cancer (n=16), small cell lung cancer (n=7), colorectal cancer (n=7), breast cancer (n=3), gastric cancer (n=2), and other cancers (n=7). Twenty-one patients (50.0%) had a single LBM, 19 (46.3%) had a single LBM and other metastases, and two had two (4.7%) large brain metastases. At the time of the 2-day fraction GKRS, the tumors had a mean volume of 23.1 mL (range, 12.5-67.4). On each day, radiation was administered at a dose of 10.3 Gy, mainly using a 50% isodose-line. Results : We obtained clinical and magnetic resonance imaging follow-up data for 34 patients (81%) with 35 tumors, who had undergone 2-day fraction GKRS. These patients did not experience acute or late radiation-induced complications during follow-up. The median and mean progression-free survival (PFS) periods were 188 and 194 days, respectively. The local control rates at 6, 9, and 12 months were 77%, 40%, and 34%, respectively. The prognostic factors related to PFS were prior radiotherapy (p=0.019) and lung cancer origin (p=0.041). Other factors such as tumor volumes, each isodose volumes, and peri-GKRS systemic treatment were not significantly related to PFS. The overall survival period of the 44 patients following repeat stereotactic radiosurgery (SRS) ranged from 15-878 days (median, 263±38 days; mean, 174±43 days) after the 2-day fraction GKRS. Eight patients (18.2%) were still alive. Conclusion : Considering the unsatisfactory tumor control, a higher prescription dose should be needed in this procedure as a salvage management. Moreover, in the treatment for LBM with fractionated SRS, using different isodoses and prescription doses at the treatment planning for LBMs should be important. However, this report might be a basic reference with the same fraction number and prescription dose in the treatment for LBMs with frame-based SRS.

• Korean Journal of Head & Neck Oncology
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• v.34 no.2
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• pp.23-28
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• 2018

Background/Objectives: Adenoid cystic carcinoma is the second most common salivary carcinoma. It occurs commonly in the submandibular gland, sublingual gland and minor salivary gland. Local recurrence and distant metastasis are the leading cause of death. The aim of this study was to evaluate long-term oncologic outcomes of patients with head and neck adenoid cystic carcinoma focusing on distant metastasis. Materials & Methods: We retrospectively studied 39 patients who were diagnosed with and treated for adenoid cystic carcinoma of the head and neck from December 1996 to May 2018. The clinicopathologic characteristics of patients such as age, sex, primary site and TNM stage, and treatment methods, recurrence and distant metastasis after treatment, survival rate, and treatment method for recurrence were analyzed. Results: Of 39 patients, 18 were males and 21 were females, and the mean age was $5.9{\pm}14.4$ (28-89) years. The most common primary site was oral cavity (12 cases), and followed by sino-nasal cavity (11 cases), parotid gland (5 cases), and etc. For treatment, 17 patients underwent surgery alone, 16 received surgery with postoperative radiation therapy, and 3 patients received radiation therapy only. Three patients refused any further treatments. Recurrence occurred in 15 patients. The most common site of recurrence was the lung. The mean time to recurrence was 31.7 months. The 5 and 10 years' overall survival rate was 79.3% and 74%, respectively. The 2 and 5 years' overall survival rate was 69.6% and 62.6% in patients with distant metastasis. Conclusion: Distant metastasis is an important prognostic factor in adenoid cystic carcinoma, and eventually one third of patients have distant metastasis, especially in the lung. An appropriate treatment for lung metastasis is necessary because some patients with pulmonary metastasis survive for a quite long time.