• Journal of Radiation Protection and Research
• /
• v.41 no.3
• /
• pp.301-309
• /
• 2016

Background: A contamination screening process for the local population in radiation emergencies is discussed. Materials and Methods: We present an overview of the relevant Korean governmental regulations that underpin the development of an effective response system. Moreover, case studies of foreign countries responding to mass casualties are presented, and indicate that responses should be able to handle a large demand for contamination screening of the local public as well as screening of the immediate victims of the incident. Results and Discussion: We propose operating procedures for an off-site contamination screening post operated by the local government for members of the public who have not been directly harmed in the accident. In order to devise screening categories, sorting strategies assessing contamination and exposure are discussed, as well as a psychological response system. Conclusion: This study will lead to the effective operation of contamination screening clinics if an accident occurs. Furthermore, the role of contamination screening clinics in the overall context of the radiation emergency treatment system should be clearly established.

• Journal of agricultural medicine and community health
• /
• v.43 no.2
• /
• pp.74-84
• /
• 2018

Objectives: The purpose of this study is to compare the perceptions of the rural healthcare service improvement project' performance and reorganization of public health centers between project staffs and local residents. Methods: Data collection from this study was performed in 141 project areas using structured questionnaires. Data analysis was used in SPSS 22.0 version. Results: The public health center staffs were more positive about the items for improving health facilities than the local residents. Residents in the Si area generally perceived performance as more positive than residents in the Gun area, while public health center staffs in the Gun area perceived performance as more positive than public health center staffs in the Si area. Local residents expressed negative opinions about the reduction in the number of branches of public health clinics and health medical clinics. Conclusions: In conclusion, careful improvement projects for rural health care and the establishment of health care systems will be necessary, reflecting the opinions of local residents, along with a variety of regional characteristics.

• Radiation Oncology Journal
• /
• v.22 no.1
• /
• pp.11-16
• /
• 2004

Purpose: To evaluate the survival rate, local failure rate and patterns of failure, and analyze the prognostic factors affecting local relapse of ductal carcinoma in situ treated with breast conserving surgery and radiotherapy Materials and Methods: From June 1995 to December 2001, 96 patients with ductal carcinoma in situ treated with breast conserving surgery and radiotherapy were retrospectively analyzed. The operations were either local or wide excision in all patients, with an axillary lymph node dissection performed in some patients. Radiation dose to the whole breast was 50.4 Gy, over 5 weeks, with 1.8 Gy daily fractions, with additional doses ($10\~14$ Gy) administered to the primary tumor bed in some patients with close ($\leq$2 mm) or positive resection margin. The median follow-up period was 43 months (range $10\~102$ months). Results: The 5-year local relapse free survival and overall survival rates were 91 and $100\%$ respectively. Local relapse occurred in 6 patients ($6.3\%$). Of the 6 recurrences, one was invasive ductal cell carcinoma. With the exception of one, all patients recurred 2 years after surgery. There was no regional recurrence or distant metastasis. Five patients with local recurrence were salvaged with total mastectomy, and are alive with no evidence of disease. One patient with recurrent invasive ductal cell carcinoma will receive salvage treatment. On analysis of the prognostic factors affecting local relapse, none of the factors among the age, status of resection margin, comedo type and nuclear grade affected local relapse. Operation extent also did not affect local control (p=0.30). In the patients with close resection margin, boost irradiation to the primary tumor bed did not affect local control (p=1.0). Conclusions: The survival rate and local control of the patients with ductal carcinoma in situ treated with breast conserving surgery and radiotherapy were excellent. Close resection margin and boost irradiation to the primary tumor bed did not affect local relapse, but further follow-up with much more patients is needed.

• Radiation Oncology Journal
• /
• v.37 no.3
• /
• pp.224-231
• /
• 2019

Purpose: To investigate the patterns of recurrence in patients with neuroblastoma treated with radiation therapy to the primary tumor site. Materials and Methods: We retrospectively analyzed patients with high-risk neuroblastoma managed with definitive treatment with radiation therapy to the primary tumor site between January 2003 and June 2017. These patients underwent three-dimensional conformal radiation therapy or intensity-modulated radiation therapy. A total of 14-36 Gy was delivered to the planning target volume, which included the primary tumor bed and the selected metastatic site. The disease stage was determined according to the International Neuroblastoma Staging System (INSS). We evaluated the recurrence pattern (i.e., local or systemic), progression-free survival, and overall survival. Results: A total of 40 patients with high-risk neuroblastoma were included in this study. The median patient age was 4 years (range, 1 to 11 years). Thirty patients (75%) had INSS stage 4 neuroblastoma. At the median follow-up of 58 months, there were 6 cases of local recurrence and 10 cases of systemic recurrence. Among the 6 local failure cases, 4 relapsed adjacent to the radiation field. The other 2 relapsed in the radiation field (i.e., para-aortic and retroperitoneal areas). The main sites of distant metastasis were the bone, lymph nodes, and bone marrow. The 5-year progression-free survival was 70.9% and the 5-year overall survival was 74.3%. Conclusion: Radiation therapy directed at the primary tumor site provides good local control. It seems to be adequate for disease control in patients with high-risk neuroblastoma after chemotherapy and surgical resection.

• The Korean Journal of Emergency Medical Services
• /
• v.5 no.1
• /
• pp.177-198
• /
• 2001

The purpose of this research which was conducted by surveying the transfer consultation records from 360 medical institutions such as general hospitals, hospitals, clinics to the Emergency Medical Center at E University Hospital for six months(Jan. 1, 2000 - Jun. 30, 2000) are to standardize & complete transfer consultation record of hospitals at the 1st & 2nd referral level and to give patients transferred emergency medical center medical information services on a better quality. The conclusions and suggestions from this study were summarized as follows; (1) Examing the distribution of the referral medical consultation(transfer) sheet type, surgery part local clinic sheet types were 34.4%, medical part local clinic sheet types were 26.7%, undifferentiated local clinic sheet types were 23.9% and hospital level sheet types were 15.0%. (2) The items of the transfer consultation records had been standardized more than 75% in the order of patient's name, date, doctor's name, diagnosis, patient's status, impressions. (3) That the degree of recording completion on these items is in the order of patient's name, date, diagnosis, impressions was revealed. (4) Because the standardization and the degree of recording completion are very low in the patient's gender, age, address, electronic recording system was needed for more perfect input of initial patient informations. (5) This standardizing & complete recording on examination and medication will prevent re-examination and abuse of medication for patients transferred emergency medical center. (6) EMT Transfer System should be fixed in all medical institute for the standardizing & complete recording on care period and departure time will give many emergency patients the proper treatments at the proper time. (7) It was revealed that developing new standardized transfer consultation record & using electronic recording system are needed. (8) The complete recording & Fast Track System were needed for higher rate of bed operation at emergency medical center and more hospital profit.

• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
• /
• v.61 no.12
• /
• pp.702-704
• /
• 2018

The most common cause of treatment failure in oral cavity cancer is when it is found to have local recurrence, usually occurring in the ipsilateral cervical lymph node. On the contrary, it is extremely rare to find local recurrence in soft tissue metastasis (STM) in the contralateral neck. Furthermore, lung cancer and malignant lymphoma are most commonly confined to their primary sites. The poor general condition increases the likelihood of STM, which indicates bad prognosis. A 72-year-old man with a hard and fixed mass on the right submandibular space visited our clinic. He had received a wide excision with local flapreconstruction for squamous cell carcinoma in the left corner of lower lip 18 months ago. We performed the wide excision with bilateral selective neck dissection (I-III), and he was finally diagnosed as STM from contralateral lip cancer. We report this unique and rare disease entity with a literature review.

• Korean Journal of Radiology
• /
• v.23 no.11
• /
• pp.1078-1088
• /
• 2022

Objective: To develop and validate a model using radiomics features from apparent diffusion coefficient (ADC) map to diagnose local tumor recurrence in head and neck squamous cell carcinoma (HNSCC). Materials and Methods: This retrospective study included 285 patients (mean age ± standard deviation, 62 ± 12 years; 220 male, 77.2%), including 215 for training (n = 161) and internal validation (n = 54) and 70 others for external validation, with newly developed contrast-enhancing lesions at the primary cancer site on the surveillance MRI following definitive treatment of HNSCC between January 2014 and October 2019. Of the 215 and 70 patients, 127 and 34, respectively, had local tumor recurrence. Radiomics models using radiomics scores were created separately for T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE-T1WI), and ADC maps using non-zero coefficients from the least absolute shrinkage and selection operator in the training set. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of each radiomics score and known clinical parameter (age, sex, and clinical stage) in the internal and external validation sets. Results: Five radiomics features from T2WI, six from CE-T1WI, and nine from ADC maps were selected and used to develop the respective radiomics models. The area under ROC curve (AUROC) of ADC radiomics score was 0.76 (95% confidence interval [CI], 0.62-0.89) and 0.77 (95% CI, 0.65-0.88) in the internal and external validation sets, respectively. These were significantly higher than the AUROC values of T2WI (0.53 [95% CI, 0.40-0.67], p = 0.006), CE-T1WI (0.53 [95% CI, 0.40-0.67], p = 0.012), and clinical parameters (0.53 [95% CI, 0.39-0.67], p = 0.021) in the external validation set. Conclusion: The radiomics model using ADC maps exhibited higher diagnostic performance than those of the radiomics models using T2WI or CE-T1WI and clinical parameters in the diagnosis of local tumor recurrence in HNSCC following definitive treatment.

• Journal of Korean Neurosurgical Society
• /
• v.38 no.1
• /
• pp.35-40
• /
• 2005

Objective : Limited data are available concerning the outcome of the patients with atypical meningioma due to lack of the studies with large series. The authors review atypical meningioma retrospectively and analyzed various parameters concerning its outcome. Methods : Of the 866 meningioma patients treated between 1990 and 2003, pathologically proven 54 atypical meningiomas were reviewed. Various factors of the patients were analyzed, and surgical specimens were re-examined blindly by neuropathologist without any patient information. Extent of surgical resection was determined according to Simpson's classification by reviewing the chart and postoperative scan if possible. Results : Twenty-three [42.6%] had local recurrences during the follow-up, of which 13 [32.5%] of 40 complete excisions and 10 [71.4%] of 14 incomplete excisions. The median time to recurrence was 47 months, and the overall 3-, 5-, and 10-year local control rates were 62.4%, 41.5%, and 31.1%, respectively. Five [9.3%] died during follow-up period. The mean survival time was 123months, and the overall 3-, 5-, and 10-year survival rates were 94.2%, 87.2%, and 78.5%, respectively. The extent of surgical excision was the most significant prognostic factor not for survival but for local control [p=0.2179 and 0.0005, respectively]. Extracranial metastasis was not seen in our cases. Conclusion : Complete surgical excision is the most important factor in improving local control. Careful long-term follow-up is mandatory because atypical meningioma shows a broad range of aggressiveness and natural history.

• Journal of Korean Neurosurgical Society
• /
• v.54 no.2
• /
• pp.107-111
• /
• 2013

Objective : We investigated the effectiveness of stereotactic gamma knife Radiosurgery (GKR) for radioresistant brain metastases with the impact upon histology. Methods : Between April 2004 and May 2011, a total of 23 patients underwent GKR for 67 metastatic brain tumors from 12 renal cell cancers, 5 sarcomas and 6 melanomas. The mean age was 56 years (range, 18 to 79 years). Most of the patients were classified as the Radiation Therapy Oncology Group recursive partitioning analysis class II (91.3%). The synchronous metastasis was found in 6 patients (26.1%) and metachronous metastasis in 17 patients (73.9%). We analyzed the local control rate, intracranial progression-free survival (PFS) and overall survival (OS). Results : The mean tumor volume for GKR was 2.24 cc and the mean prescription dose was 19.4 Gy (range, 10 to 24) to the tumor margin. Out of metachronous metastases, the median duration to intracranial metastasis was 3.3 years in renal cell cancer (RCC), 2.4 years in melanoma and 1.1 years in sarcoma (p=0.012). The total local control rate was 89.6% during the mean 12.4 months follow-up. The six-month and one-year local control rate was 90.2% and 83% respectively. Depending on the pathology, the control rate of RCC was 95.7%, sarcoma 91.3% and melanoma 80.5% during the follow-up. The common cause of local failure was the tumor bleeding in melanoma. The median PFS and OS were 5.2 and 8.4 months in RCC patients, 6.5 and 9.8 months in sarcoma, and 3.8 and 5.1 months in melanoma. Conclusion : The GKR can be one of the effective management options for the intracranial metastatic tumors from the radioresistant tumors. The melanoma showed a poor local control rate compared to other pathologies because of the hemorrhage.

• Archives of Plastic Surgery
• /
• v.39 no.4
• /
• pp.376-383
• /
• 2012

Background No consensus has been reached regarding the outcome of management of local recurrence after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. This study demonstrated the presentation, management, and outcomes of local recurrence after immediate TRAM breast reconstruction. Methods A comparison was conducted among 1,000 consecutive patients who underwent immediate breast reconstruction with a pedicled TRAM flap (TRAM group) and 3,183 consecutive patients who underwent only modified radical mastectomy without reconstruction (MRM group) from January 2001 to December 2009. The presentation, treatment, and outcome including aesthetics and overall survival rate were analyzed. Results Local recurrences occurred in 18 (1.8%) patients (TRAM-LR group) who underwent TRAM breast reconstruction and 38 (1.2%) patients (MRM-LR group) who underwent MRM only (P=0.1712). Wide excision was indicated in almost all the local recurrence cases. Skin graft was required in 4 patients in the MRM-LR group, whereas only one patient required a skin graft to preserve the mound shape in the TRAM-LR group. The breast mound was maintained in all 17 patients that survived in the TRAM-LR group even after wide excision. The overall survival rate was 94.4% in the TRAM-LR group and 65.8% in the MRM-LR group (P=0.276). Conclusions Local recurrence after immediate TRAM flap breast reconstruction could be detected without delay and managed effectively by multiple modalities without reducing overall survival rates. Breast mound reconstruction with soft autologous tissue allowed for primary closure in most of the cases. In all of the patients who survived, the contour of their reconstructed breast remained.