• Radiation Oncology Journal
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• v.32 no.1
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• pp.31-42
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• 2014

Purpose: To evaluate the usefulness of positron emission tomography/computed tomography (PET/CT) for field modification during radiotherapy in esophageal cancer. Materials and Methods: We conducted a retrospective study on 33 patients that underwent chemoradiotherapy (CRT). Pathologic findings were squamous cell carcinoma in 32 patients and adenocarcinoma in 1 patient. All patients underwent PET/CT scans before and during CRT (after receiving 40 Gy and before a 20 Gy boost dose). Response evaluation was determined by PET/CT using metabolic tumor volume (MTV), total glycolytic activity (TGA), MTV ratio (rMTV) and TGA ratio (rTGA), or determined by CT. rMTV and rTGA were reduction ratio of MTV and TGA between before and during CRT, respectively. Results: Significant decreases in MTV ($MTV_{2.5}$: mean 70.09%, p < 0.001) and TGA ($TGAV_{2.5}$: mean 79.08%, p < 0.001) were found between before and during CRT. Median $rMTV_{2.5}$ was 0.299 (range, 0 to 0.98) and median $rTGAV_{2.5}$ was 0.209 (range, 0 to 0.92). During CRT, PET/CT detected newly developed distant metastasis in 1 patient, and this resulted in a treatment strategy change. At a median 4 months (range, 0 to 12 months) after completion of CRT, 8 patients (24.2%) achieved clinically complete response, 11 (33.3%) partial response, 5 (15.2%) stable disease, and 9 (27.3%) disease progression. $SUV_{max}$ (p = 0.029), $rMTV_{50%}$ (p = 0.016), $rMTV_{75%}$ (p = 0.023) on intra-treatment PET were found to correlate with complete clinical response. Conclusion: PET/CT during CRT can provide additional information useful for radiotherapy planning and offer the potential for tumor response evaluation during CRT. $rMTV_{50%}$ during CRT was found to be a useful predictor of clinical response.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.392-395
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• 2011

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.

• Advances in pediatric surgery
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• v.19 no.2
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• pp.57-65
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• 2013

The entity of negative appendectomies still poses a dilemma in chlidren. Focused computed tomography (CT) scanning has become the diagnostic test of choice in many hospitals. However, the impact of CT scans on the diagnosis in children is unknown exactly. The purpose of this study was to critically evaluate CT scans for the evaluation of acute appendicitis in children, to review utilization of this diagnostic test in our appendicitis population and to determine if diagnostic accuracy has improved. A retrospective analysis of efficacy of CT scan for diagnosis of appendicitis in children was conducted. Children undergoing appendectomy for acute appendicitis were reviewed from 2007 to 2012. Perforation and negative appendectomy (removal of a normal appendix) rates were determined by the final pathologic report. Statistical comparison were made using the $x^2$ test and significance was assigned at p < 0.05. Five hundred four appendectomies were performed. Mean age was $10.1{\pm}3.21$ years, and 62.7% were boys. Overall, 308 children (61.1%) underwent CT scanning, 100 (19.8%) had US performed, and 97 (19.2%) had no radiographic study. A pathologically normal appendix was removed in 8.7% (27 of 308) of CT patients, 9.0% (9 of 100) of US patients, and 11.3% (11 of 97) of patients without a study. The frequency of CT scanning increased from 29.7% (27 of 91) of all children in 2007 to 75.6% (59 of 78) in 2012, whereas utilization of US decreased from 30.8% (28 of 91) to 11.5% (9 of 78). During this time period the difference in the negative appendectomy rate did change significantly from 14% to 6%. Liberal use of CT scans in diagnosing appendicitis in children has resulted in a decreased negative appendectomy rate.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.4
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• pp.709-717
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• 2007

Impaction of maxillary incisor is rare than the third molar and canine, but its rate is higher than the other anterior teeth due to frequent mesiodens, trauma and variation of root formation (root dilaceration etc.). It is often observed in the dental age of about eight years and over. It will be occurred that the space loss, midline deviation and cyst formation due to the impaction of maxillary incisor. So it is important to evaluate the precise location of impacted tooth and to make appropriate treatment plan. Treatment would be surgical extraction or expectation for spontaneous eruption. If the impacted tooth has no pathologic change and development of the root is favorable, orthodontic traction is recommended for recovery of function and esthetics. In these cases, we performed orthodontic traction for the eruption of impacted maxillary incisors, and obtained satisfactory results.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.13 no.2
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• pp.167-176
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• 1991

This is three case-reports of pleomorphic adenomas arising from one parotid gland and two minor salivary glands treated by total parotidectomy and complete enucleation. We conclude as follows : 1. During the parotidectomy, we tried to preserve the facial nerve by retrograde approach to the trunk from the mandibular branch where it passes over the posterior facial vein. Although the paresis of the lower lip following the operation was seen, it disappeared in about 3 months. 2. Microscopically, the tumor of the first patient (case 1) contained equally myxoid and cellular components and showed well encapsulation. 3. In the second patient (case 2), the tumor revealed large areas of hemorrhage, cystic change, dystrophic calcification and stromal hyalinization, but no definite evidence of carcinoma, therefore we labeled this tumer as "atypical mixed tumor". 4. In the third patient (case 3), the tumor showed principally myxoid component and incomplete capsule, but the tumor was well demarcated.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.3
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• pp.180-186
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• 2015

Purpose: Bile duct dilatation is a relatively common sonographic finding; nevertheless, its clinical significance in children is controversial because little research has been done in the area. Therefore, we investigated the natural course and clinical significance of biliary duct dilatation in children. Methods: We performed a retrospective study of 181 children (range, 1-day-old to 17-year-old) in whom dilatation of the intrahepatic duct and/or common hepatic duct and/or common bile duct was detected by abdominal ultrasonography at the Severance Children's Hospital between November 2005 and March 2014. We reviewed and analyzed laboratory test results, clinical manifestations, and clinical course in these patients. Results: Pediatric patients (n=181) were enrolled in the study and divided into two groups. The first group included 59 subjects, without definitive cause of bile duct dilatation, who did not require treatment; the second group included 122 subjects, with definitive cause of bile duct dilatation or underlying biliary disease, who did require treatment. In the first group, 24 patients (40.7%) showed spontaneous resolution of bile duct dilatation, 20 patients (33.9%) showed no change, and 15 patients (25.4%) were lost to follow-up. In the second group, 31 patients were diagnosed with choledochal cysts, and 91 patients presented with biliary tract dilatations due to secondary causes, such as gallbladder or liver disease, post-operative complications, or malignancy. Conclusion: Biliary dilatation in pediatric patients without symptoms, and without laboratory and other sonographic abnormalities, showed a benign clinical course. No pathologic conditions were noted on follow-up ultrasonography.

• Journal of Yeungnam Medical Science
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• v.29 no.2
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• pp.136-140
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• 2012

A 61-year-old male who complained of right upper quadrant pain was referred to the authors for evaluation after his computed tomography suggested biliary adenocarcinoma. The lesion consisted of multiple cysts with papillary mass and peri-ampullay mass. The patient underwent an operation due to a clinical suspicion of biliary cystadenocarcinoma, but the pathology confirmed biliary papillomatosis (BP) after diagnosing intrahepatic papillary neoplasm with high-grade dysplasia and invasive adenocarcinoma with papillary neoplasm from the distal common bile duct to the duodenum. BP is a disease characterized by multiple papillary masses. Its cause has yet to be discovered. It commonly manifests as bile duct dilation but rarely as a ductal cystic change. Under computed tomography or magnetic resonance imaging, both the BP and the cystic neoplasm can show bile duct dilation and a papillary mass, which makes their differential diagnosis difficult. A confirmative diagnosis can be made through a pathologic examination. BP is classified as a benign disease that can become malignant and may recur, though rarely. Its treatment of choice is surgical resection. Laser ablation or photodynamic therapy can be used for unresectable lesions. In the case featured in this paper, biliary papillomatosis was difficult to differentiate from cystic adenocarcinoma due to diffusely scattered multiple large cystic lesions in the liver, and it was histologically confirmed to have become malignant with cystic duct dilation after the operation. This case is reported herein with a literature review.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.3815-3819
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• 2012

The CD4+CD25+ regulatory T cell (Treg) is a special kind of T cell subset. Studies have showed that Treg cells are involved in a number of physiological processes and pathologic conditions such as autoimmune diseases, transplantation tolerance and cancer. Tregs with unique capacity for immune inhibition can impair anti-tumour immunity and help tumor cells to escape from immune surveillance. The aim of our study was to investigate whether Tregs are involved in hepatocellular carcinoma (HCC). A BABL/C mouse with HCC in situ model was established to evaluate the Treg existence in carcinoma tissues and the changes of Tregs in spleen using flow cytometry and immunohistochemistry methods. Granzyme B expression in carcinoma tissues was analyzed by immunohistochemistry to investigate the tumor local immune status.The proportion of CD4+CD25+/CD4+ spleen lymphocytes of tumor bearing mice ($18.8%{\pm}1.26%$) was found to be significantly higher than that in normal mice ($9.99%{\pm}1.90%$) (P<0.01 ). Immunohistochemistry of spleen tissue also confirmed that there was an increase in Treg in tumor-bearing mice, while in carcinomas it showed Treg cells to be present in tumor infiltrating lymphocyte areas while Granzyme B was rarely observed. Anti-tumour immunity was suppressed, and this might be associated with the increase of Tregs. Our observations suggest that the CD4+CD25+Treg/CD4+ proportion in spleen lymphocytes can be a sensitive index to evaluate the change of Tregs in hepatocellular carcinoma mice and the Treg may be a promising therapeutic target for cancer.

• Journal of Sasang Constitutional Medicine
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• v.21 no.3
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• pp.1-16
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• 2009

1. Objectives: This research was proposed to find out the pathology of Soyangin in Sasang Constitutional Medicine(SCM). 2. Methods: The related contents of the pathology of Soyangin were selected in Je-Ma Lee's literatures such as "Dongmu-YuGo(東武遺稿)"(DYG), "Donguisusebowon-SaSangchobongyun(東醫壽世保元四象草本卷)"(DSS), "Donguisusebowon-GabObon(東醫壽世保元甲午本)"(DGO), "Donguisusebowon-ShinChukbon(東醫壽世保元辛丑本)"(DSC), and the research was written in order to find out the physiology and pathology of Soyangin in SCM. 3. Results and Conclusions: The chronical change of pathologic concept in Soyangin diseases as follows : Pathology in Soyangin diseases was much Hot Qi(熱氣), and more ascending Qi, less descending Qi in DYG, DSS. In "Discourse on the viscera and bowels" of DGO and DSC, Soyangin has a circulation of Water-Food Hot Qi of Spleen Group(脾黨) and Water-Food Cold Qi of Kidney Group(腎黨). Exterior Disease(表病) was the injury of Exterior-Qi such as mouth-hip Qi(口膀胱氣) by Anger-Nature-Qi(怒性氣), and Interior Disease(裏病) was the injury of Interior-Qi such as kidney-large intestine Qi(腎大腸氣) by Sorrow-Emotion-Qi(哀情氣). All diseases of Soyangin are caused by insufficient Cool Yin Qi(陰淸之氣) in Kidney Group(腎黨), so the pathology of Soyangin was focused on Requisite energy(保命之主) and each small viscera and bowels(偏小之臟). In this viewpoint, the schema of Soyangin diseases such as Soyangsangpoong-syndrome(少陽傷風證), Kyulhyung-syndrome(結胸證), Mangeum-syndrome(亡陰證), Hyungkyukyeol-syndrome(胸膈熱證), Sogal-syndrome(消渴證) and Eumhuoyeol-syndrome(陰虛午熱證) were designed to explain the mechanism of each syndrome.

• Journal of Technologic Dentistry
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• v.22 no.1
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• pp.153-178
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• 2000

Dental prosthetic restoration shows a big difference of cost per itemized unit depending on the size of dental labs, facility standard, manpower, and performance. Even the same dental labs have distinctive cost according to manufacturing performance, inflation, and the number of workers. However, in apite of such a change of circumstances, it appears to be quite stable in the relative cost per itemized unit unless the manufacturing trend of particular item changes dramatically. Therefore, if the relative number of cost per itemized unit, which is produced by costing, is indicated, we are able to utilize it effectively as a standard wage estimate. If the wage of dental prosthetic restoration is determined on the basis of cost, it is desirable that the relative value of cost and that of wage are identical. But, by means of comparative analysis, since the relative value of wage reveals mostly lower than that of cost depending on an item, it is considered that the wage is not reflecting the cost approproately. Due to the subdivision and the profession of medical technology, the new development of wage items for dental prosthetic restoration is required. This means that the need for the establishment of new wage items should be presented as the general concept of dental prothetic restroation changes and the level of pathologic technology increases. The current wage structure has differences in the degree of difficulty accroding to unit items and in the cost factors. Nevertheless, the differences are not reflected enough to the wage, so there is potential to lower the medical quality through the use of low-proce materials to avoid the increase of cost and the work process which skips a manufacturing step. The new items of dental prosthetic restoration also increases, but the development of proper numerical value system is not supported. Thus, the right proce is set mostly by applying to the wage of a similar item. Since most wages are established by an individual agreement between the dental clinic institute and the dental labs, the propriety of wage level lacks. Therefore, it is urgent to provide and promote the system of a fair work charge by a standard cost which can be applied to all medical institute.