• Radiation Oncology Journal
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• v.18 no.1
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• pp.17-25
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• 2000

Purpose : To evaluate the side effects, pattern of failure, and survival rate according to the sequence of postoperative adjuvant radiotherapy and chemotherapy, patients with stages II and III rectal cancer who had undergone curative resection were randomized to 'early radiotherapy group (arm I)' or' late radiotherapy group (arm II)', then we intend to determine the most effective sequence of the radiotherapy and chemotherapy. Materials and Methods . From January 1996 to March 1999, 313 patients with curatively resected stages II and III rectal cancer have been randomized to' early' or' late' radiation therapy group and received combined chemotherapy (5-FU 375 mg/m$^{2}$/day, ieucovorin 20 mg/m$^{2}$, IV bolus daily Dl-5, 8 cycles) and radiation therapy (whole pelvis with 45 Gy/25 fractions/s weeks). Arm I received radiation therapy from day 1 with first cycle of chemotherapy and arm II received radiation therapy from day 57 with third cycle of chemotherapy after completion of first two cycles. Preliminary analysis was peformed with 228 patients registered up to Jun 1998. Two out of the 228 patients were excluded because of double primary cancer. Median follow-up period was 23 months. Results :Local recurrence occurred in 11 patients (9.7$\%$) for arm I and 9 patients (8$\%$) for arm 11. There was no significant difference between both groups ( p=0.64). However, distant metastasis was found in 22 patients (19.5$\%$) for arm I and 35 patients (31.0$\%$) for arm II and which showed statistically significant difference between the two groups ( p=0.046). And neither 3-year disease-free survival (70.2$\%$ vs 59.2$\%$, p=0.2) nor overall survival (89.4$\%$ vs 88.0$\%$, p=0.47) showed significant differences. The incidence of leukopenia during radiation therapy and chemotherapy was 78.3$\%$ and 79.9$\%$ respectively but leukopenia more than RTOG grade 3 was only 2.1$\%$ and 6.0$\%$ respectively. The incidence of diarrhea more than 10 times per day was significantly higher in the patients for arm I than for arm II (71.2$\%$ vs 41.6$\%$, p=0.02) but this complication was controlled with supportive cares. Conclusion : Regardless of the sequence of postoperative adjuvant radiation therapy and chemotherapy after curative resection for rectal cancer, local recurrence rate was low with combined chemoradlotherapy. But distant metastasis rate was lower in early radiation therapy group than in late radiation therapy group and the reason is unclear. Most patients completed these treatments without severe complication, so these were thought to be safe treatments but the treatment compliance should be improved.

• Journal of Nutrition and Health
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• v.53 no.3
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• pp.271-287
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• 2020

Purpose: Variations in the iodine contents of foods is critical for estimating the iodine intake. This study aimed to update the iodine database of common Korean foods and evaluated the iodine intake in Korean adults. Methods: A list of 855 Korean foods was selected for the updated iodine database. The updated database was established with Version 1 and 2 by applying an average or minimum value for the imputed values. The iodine intake was estimated in 5,927 Korean adults using the data from the 2013-2015 Korea National Health and Nutrition Examination Survey. Results: The analytical values in the updated database were 166 (19.4%), followed in order by 318 (37.2%), 247 (28.9%), and 124 (14.5%) for the adapted, imputed, and missing values, respectively. The median of dietary iodine intake was 352.1 ㎍/day (± 2,166.1) and 343.4 ㎍/day (± 2,161.9) in Version 1 and 2 among the total population. The contribution rates of each food group to the iodine intake were 55.7% for seaweeds, which showed a similar trend in Version 2. When subjects were divided by consumption of seaweeds, the median iodine intake was 495.7 ㎍ in the consumer group, which was almost double (241.2 ㎍) that of the non-consumer group. The proportion of subjects who consumed below the Estimated Average Requirement of iodine was 11.0% in the non-consumer group. In contrast, 11.6% in the consumer group of seaweed consumed above the Upper Level of iodine. When the dietary iodine and urinary iodine were examined, the regression coefficient was 0.11718 in Version 1 and 0.11512 in Version 2 after adjusting for age and sex. Conclusion: This study presented the variation of iodine intake in Korean adults by applying different versions of the iodine database. As the iodine intake can vary due to the highly variable concentrations in the major food sources, an iodine database is necessary to be monitored, and caution should be taken when the database is used in research.

• Tuberculosis and Respiratory Diseases
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• v.53 no.5
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• pp.550-560
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• 2002

Background : Lung cancer is the leading cause of cancer-related mortality in both men and women. Although most cases of lung cancer occur in the sixty to eight decades of life, 5 to 10% are diagnosed at a young age. There are characteristic features in young patients with lung cancer that differ from those in older patients with lung cancer. The purpose of this study was to determine if the basal characteristics and survival in young patients with lung cancer differed from those of old patients. Methods : We retrospectively reviewed the medical records of 94 young patients who were under 45 years of age and compared them with 1,728 old patients (= 46 years of age) in 4 medical schools at Daegu, between August 1986 and July 1995. Results : Significantly more female patients and adenocarcinomas were found in the young patients group. when compared to the old patients. Cough and sputum were the most frequent presenting symptom in both age groups. This was followed by chest discomfort, dyspnea and hemoptysis. The rates of smoking was significantly lower in the young patients. There was no statistical difference in the severity of the disease in terms of staging between the two age groups. Young patients received treatment more frequently than the older patients. The location of the primary tumors was equally frequent in both the upper and lower lobe. However, the survival was bettrer in the young patients(median survival time, 67.3 weeks), when compared to the old patients (median survival time, 26.8 weeks) (p<0.05). Conclusion : Females and adenocarcinoma patients were predominant in young patients with lung cancer. The young patients appeared to have significantly better prognosis.

• Clinical and Experimental Pediatrics
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• v.50 no.2
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• pp.182-189
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• 2007

Purpose : The primary purpose of this study was to evaluate the growth and neuropsychologic function following treatments for pediatric hematologic and oncologic diseases. Healthy monozygotic twins served as ideal controls for comparison to exclude possible confounding factors. Methods : Seven children treated with various hematologic and oncologic diseases were included in the study: acute lymphoblastic leukemia (ALL; n=2), Diamond-Blackfan anemia twins (n=2), and aplastic anemia (n=3). The median age at the diagnosis was 5.2 (0.3-15) years. The median duration of follow-up was 7.2 (4.9-10) years. Controls were healthy monozygotic twins. Growth was measured and the percentile channels were evaluated sequentially for patients. The K-WISC III was applied and compared in 5 pairs of patients and controls. Results : Similar growth profiles were noted for the twins. The percentiles at diagnosis was 3-10 in 3, 25-50 in 2, and 50-75 in 2 cases. All patients stayed in their growth percentiles through follow-up, except for 1 patient who became obese. For IQ tests, the mean behavioral, verbal and full scale IQ scores of patients were 88.0, 93.8, and 89.8, respectively, and those from their corresponding controls were 92.2, 97.0, and 91.7 (P>0.05). However, 2 children who were treated for ALL had lower IQ scores. Conclusion : Similar growth profiles were observed in the monozygotic twins in terms of height and weight. The IQ scores of patients were similar to those of monozygotic twins. However, prophylactic CNS-directed therapy for leukemia might adversely affect the IQ scores. A further prospective study on larger number of twins is warranted.

• Radiation Oncology Journal
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• v.26 no.1
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• pp.45-55
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• 2008

Purpose: This study evaluates the association of estrogen receptor(ER), progesterone receptor(PR), Her-2, COX-2, and survivin with the clinicopathological features and outcomes in young Korean women with breast cancer using recently developed tissue microarray(TMA) technology. Materials and Methods: A cohort of 212 young patients with breast cancer diagnosed at the age of 45 years or younger from March 1994 to August 2005, were enrolled in this study. The age range of patients was $23{\sim}45$ years(median age, 39 years). The minimum and median follow-up periods were 24 months and 60 months, respectively. Serial sections of primary tumors were processed by the use of a TMA for immunohistochemical staining for five biomarkers. The correlation of these five biomarkers and the clinicopathological features and outcomes were analyzed by statistical methods. Results: The majority of the patients were stage T1(90 patients) or T2(101 patients), and 105 patients(49.5%) had an axillary node metastasis. The 5-year overall and relapse free survival rates for all of the patients were 90.4% and 82.3%, respectively, and 36 patients had a locoregional or distant metastasis as a first event. Positive expression of ER, PR, Her-2, COX-2, and survivin was determined in 38.2%, 45.3%, 25.9%, 41.5%, and 43.4%, of the tumor samples, respectively. Tumor stage, nodal status, age, as well as expression of ER, PR, and HER-2 status were significantly associated with the disease free survival rate. Tumor stage, nodal status, as well as expression of ER, PR, and HER-2 were significantly related with the overall survival rate. Expression of COX-2 and survivin were not single independent prognostic factors for the disease free and overall survival rate although co-expression of HER-2 and COX-2 had a tendency as a poor prognostic factor. By multivariate analysis, only T stage and lymph node status were significant prognostic factors, and ER status was a marginally significant prognostic factor(p=0.075). Conclusion: Expression of ER, PR and HER-2 were significant prognostic factors for the relapse free and overall survival rate. Expression of COX-2 and survivin were not prognostic factors for young women with breast cancer.

• Pediatric Infection and Vaccine
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• v.16 no.2
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• pp.142-149
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• 2009

Purpose : The aim of this study was to determine the diagnostic value of serum procalcitonin (PCT) compared with that of C-reactive protein (CRP) and the total white blood cell count (WBC) in predicting bacterial infections in febrile infants<6 months of age. Methods : A prospective study was performed with infants <6 months of age who were admitted to the Department of Pediatrics with a fever of uncertain source between July and September 2008. Spinal taps were performed according to clinical symptoms and physical examination. Serum PCT levels were measured using an enzyme-linked fluorescent assay. Results : Seventy-one infants (mean age, 2.62 months) were studied. Twenty-six infants (36.6%) had urinary tract infections (UTIs), and 22 infants (31.0%) had viral meningitis. The remaining infants had acute pharyngitis (n=1), herpangina (n=1), upper respiratory tract infections (n=7), acute bronchiolitis (n=8), acute gastroenteritis (n=4), and bacteremia (n=2). The median WBC and CRP levels were significantly higher in infants with UTIs than in infants with viral meningitis. However, there were no differences in the median PCT levels between the groups (0.14 ng/mL vs. 0.11 ng/mL, P=0.419). The area under the receiver operating characteristic curve was 0.792 (95% CI, 0.65-0.896) for WBC, 0.77 (95% CI, 0.626-0.879) for CRP, and 0.568 (95% CI, 0.417-0.710) for PCT. An elevated WBC count (>11,920/${\mu}L$) and an increased CRP level (>1.06mg/dL) were significant predictors of UTIs based on multiple logistic regression analysis. Conclusion : Serum PCT concentrations should be interpreted with caution in infants <6 months of age with a fever of uncertain source.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.297-303
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• 1997

Purpose : To evaluate the prognostic factors for disease-free survival and long-term results of radiotherapy for pituitary adenoma. Methods and Materials : The study involved a retrospective review of out-come in a series of 27 patients with pituitary adenoma, between 1984 and 1995 at Paik hospital. The study included 20 patients treated with surgery and postoperative radiotherapy and 7 with radiotherapy alone. The patients were followed for 12-146 months (median : 97 months). Seventeen were men and 10 were women. The numbers of functioning and nonfunctioning pituitary adenorna were 22 and 5 respectively and those of microadenoma and macroadenoma were 4 and 23 respectively. The radiation doses of 5040-5580cGy (median : 5040cGy) were deliverd over 5-7 weeks, using 4MV LINAC. The prognostic factors were analyzed by log-rank test. Results: For radiation therapy alone, the 5YSR was 100% and progression free survival rate was 85.8%, The tumor was controlled in 6/7 (85.8%). For surgery and postoperative radiotherapy. the 5YSR, progression free survival rate and local control rate were 95%, 84.8%, and 89.5% respectively. The parameters of tumor size, hormone secretion, radiation dose. radiotherapy field size were evaluated in a uni- and multivariate analysis and all the factors were not statisticaIty significant (P>0.05). Eleven of 12 (92%) with visual field defect experienced normalization or improvement, and 5 for 7 evaluabie patients with hyperprolactinoma achived normalization in 4 and decrement in S patients. Only 2 patients developed mild degree of Panhypopituitarism. Conclusion: The radiotherapy appears to be effective in controiling clinical symptoms and signs resulting from pituitary adenoma. Local control rate with radiotherapy alone or with surgery and postoperative radiotherauy was comparable. There was a trend toward high recurrence rate in Patients with nonfunctioning or prolactin secretion tumor and larger radiation field sizes.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1062-1068
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• 1997

From August 1989 to January 1996, a total of 105 cases of bidirectional Glean operations have been done as the interim stage for the patien s with some risk of univentricular correction at Sejong General Hospital. From December 1992, we started the conversion to Fontal operations for them, and 42 cases underwent Fontal-stage operation till February 1996. Their diagnoses were univentricular heart in 19(right ventricular type : 14), tricuspid atresia 11, double outlet of right ventricle 9, and others in 3 cases. The median age of bidirectional Glerln-stage operation was 12.5 months(range 2 months to 8 years) and Fontan-stage operation was at 59.6 months of median age(range 1 year 5 months to ,9 year 7 months). The mean waiting interval between the two operations was 33.88 $\pm$ 17.85 months with a range of 10 months to 6 years 3 months. During the waiting periods, 18 patients developed significant systemic-pulmonary collaterals andfor systemic verso-veno collateral channels. There were 5 hospital deaths after operations due to low cardiac output in 4 and sepsis in one. Most of the Fontal-stage operations were done by the late al tunneling with Core-Tex tube graft patch and fenestrated with the size of 2.5 ~6 mm. All the patients were followed-up(7 months to 4 years 2 months, mean 21.97$\pm$10.82 months) and there were 5 late deaths(postoperatively 6 months to 2 years) due to thromboembolism in 1, after heart transplantation 1, plastic bronchitis 1, protein loosing enteropathy 1, and pneumonia in 1. Dividing the patients by the waiting interval of 2 years, the early correction to Fontal group (N=16) showed the better results(hospital mortality 1116, late mortality 1116, significant collateral development 2/16) compared to the other group(N=26) (4/26, 4/26, 16/26). In conclusion, after the bidirectional Glean-stage operation successfully got rid of the previous risk factors, we recommand to do the Fontan-stage operation no later than 2 years of interval.

• Radiation Oncology Journal
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• v.13 no.3
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• pp.243-252
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• 1995

Purpose : Intraluminal high dose rate brachytherapy is an accepted treatment for the tumors of GI tract. However, there is only some limited clinical data for intraluminal high dose rate brachytherapy for the tumors of GI tract. Materials and Methods : Between February 1991 and July 1993, 18 Patients who have the tumors of GI tract (esophageal cancer-8 cases, rectal cancer-10 cases) were treated with high dose rate Iridium-192 afterloading system (Microselectron-HDR, Nucletron CO, Netherland) at the department of therapeutic radiology, St. Mary's hospital, Catholic university medical college. Age range was 47-87 years with a mean a9e 71 years. All patients were treated with intraluminal high dose rate brachytherapy within two weeks after conventional external radiation therapy and received 3-5 Gy/fraction 3-4 times per week to a total dose 12-20 Gy (mean 17 Gy). Standard fractionation and conventional dose were delivered for external radiation therapy. Total dose of external radiation therapy ranged 41.4-59.4 Gy (mean 49.6 Gy). Median follow up was 19 months Results : The analysis was based on 18 patients, The complete response and partial response in esophageal cancer was similar (38%). Two year rates for survival and median survival were 13% and 10 months, respectively. Among 10 patients of rectal cancers, partial response was obtained in 6 patients (60%). There was no complete response in the patients with rectal cancer, but good palliative results were achieved in all patients. Conclusion : Although the number of patients was not large and the follow-up period was relatively short, these findings suggested that intraluminal high dose rate brachytherapy could be useful in the treatment of the patients with advanced tumors of GI tract.

• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1143-1153
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• 1998

Background : Recent outbreaks of pulmonary disease due to drug-resistant strains of Mycobacterium Tuberculosis have resulted in significant morbidity and mortality in patients worldwide. We reviewed our experience to evaluate the effects of pulmonary resection on the management of multidrug-resistant tuberculosis. Method : A retrospective review was performed of 41 patients undergoing pulmonary resection for multidrug-resistant tuberculosis between January 1993 and December 1997. We divided these into 3 groups according to the radiologic findings : (1) patients who have reasonably localized lesion (Localized Lesion Group ; LLG) (2) patients who have cavitary lesions after pulmonary resection on chest roentgenogram (Remained Cavity Group : RCG) (3) patients who have Remained infiltrative lesions postoperatively (Remained infiltrative group : RIG). We evaluated the negative conversion rate after resection and overall response rate of the groups. Then they were compared with the results of the chemotherapy on the multi drug-resistant tuberculosis which has been outcome by Goble et al. Goble et al reported that negative conversion rate was 65% and overall response rate, 56% over a mean period of 5.1 months. Results : Seventy five point six percent were men and 24.4% women with a median age of 31 years (range, 16 to 60 years). Although the patients were treated preoperatively with multidrug regimens in an effort to reduce the mycobacterial burden, 22 of 41 were still sputum culture positive at the time of surgery. 20 of 22 patients(90.9%, p<0.01) responded which is defined as negative sputum cultures within 2 months postoperative. Of 26 patients with the sufficient follow up data, 19 have Remained sputum culture negative for a mean duration of 25.7 months (73.1%, p<0.05). The bulk of the disease was manifest in one lung, but lesser amounts of contralateral disease were demonstrated in 15, consisted of 8 in RIG and 7 in RCG, of 41. 12 of 12 patients (100%, p<0.01) who were sputum positive at the time of surgery in LLG converted successfully. 14 of 15 patients (93.3%, p<0.05) with the follow up have completed treatment and not relapsed for a mean period of 25. 7 months. The mean length of postoperative drug therapy of LLG was 12.2 months. In RIG, postoperative negative conversion rate was 83.3% which was not significant statistically. There was a statistical significance in overall response rate (100%, p<0.05) of RIG for a mean period of 24.4 months with a mean length of postoperative chemotherapy, 11.8 months. In RCG a statistically lower overall response rate (14.3%, p<0.01) has been revealed for a mean duration of follow up, 24.2 months. A negative conversion rate of RCG was 75% which was not significant statistically. Conclusion : Surgery plays an important role in the management of patients with multidrug-resistant Mycobacterium tuberculosis infection. Aggressive pulmonary resection should be performed for resistant Mycobacterium tuberculosis infection to avoid treatment failure or relapse. Especially all cavitary lesions on preoperative chest roentgenogram should be resected completely. If all of them could not be resected perfectly, you should not open the thorax.