• Archives of Plastic Surgery
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• v.32 no.1
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• pp.76-84
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• 2005

Immediate breast reconstruction in breast cancer patients is universalized and now with a wide variety of methods to choose from, we can select a breast reconstruction method according to the patient's condition. Among these methods, immediate breast reconstruction with TRAM free flap is the most commonly used. Nipple reconstruction is usually performed as a secondary procedure, reconstructed. Nipple is reconstructed with contralateral nipple composite graft or with local flap. Areola is reconstructed with skin graft and tattooing. Therefore, to reconstruct complete breast, two or more staged operations are needed and are troublesome to both the surgeon and the patient. If we could reconstruct breast mound and nipple at same time, we would reduce the operative stages and heighten the patient's satisfaction. The author performed delayed or immediate breast reconstruction with TRAM free flap and nipple reconstruction at the same time. If the TRAM flap was to situate in the whole of the breast or at the center of the breast mound, nipple was reconstructed with a local flap from the TRAM flap. If the TRAM flap was not situated in center of breast mound, nipple was reconstructed with a local flap from remnant breast skin. Immediate nipple reconstructions in breast reconstruction consisted total of 22 cases. Among these, delayed breast reconstruction were 5 cases and immediate breast reconstruction were 17 cases. According to patient's condition and mastectomy method, nipple reconstruction method was selected; nipple reconstruction with contralateral nipple composite graft(3 cases); nipple reconstruction with remnant breast skin(6 cases); nipple reconstruction from flap margin(10 cases); nipple reconstruction with prefabricated nipple on flap(3 cases). Malposition of the reconstructed nipple was the most common and serious complication(6 cases). The other complications were atrophy of the nipple(1 case), and necrosis(1 case). Reconstruction of the breast and nipple at the same time can reduce the need of a secondary operation and use remnant skin or redundant flap tissue maximally. On the other hand, it must be considered that position and shape of nipple could be deformed, because the nipple reconstruction is performed before the shape of reconstructed breast settles completely. Prudent attention is needed, because the danger of complication is higher than delayed nipple reconstruction.

• Molecular & Cellular Toxicology
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• v.3 no.3
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• pp.198-207
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• 2007

[ $^{18}F$ ]-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) scan has been found to reflect tumor aggressiveness and prognosis in various types of cancer. In this study, the gene expression profiles of glial tumors were evaluated to determine whether glial tumors with high $^{18}F$-FDG uptake have more aggressive biological potential than with low uptake. Surgical specimens were obtained from the 12 patients with glial tumors (4 males and 8 females, age range 42-68 years). The tumor samples were divided into two groups based on the $^{18}F$-FDG uptake PET scan findings: high $^{18}F$-FDG uptake (n=4) and low $^{18}F$-FDG uptake (n=8). The pathological tumor grade was closely correlated with the $^{18}F$-FDG uptake pattern: Glial tumors with high $^{18}F$-FDG uptake were pathologically Edmondson-Steiner grade III, while those with low uptake were grade II. The total RNA was extracted from the frozen tissues of all glial tumors (n=12), and adjacent non-cancerous tissue (n=3). The gene expression profiles were evaluated using cDNA microarray. The glial tumors with high $^{18}F$-FDG uptake showed increase expression of 15 genes compared to those with low uptake (P<0.005). Nine genes were down-regulated. Gene expression is closely related to cell survival, cell-to-cell adhesion or cell spreading; therefore, glial tumors with high $^{18}F$-FDG uptake appear to have more aggressive biological properties than those with low uptake.

• Korean Journal of Clinical Laboratory Science
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• v.49 no.4
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• pp.470-476
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• 2017

Changes in the mammalian target of the rapamycin (mTOR) signaling proteins have been observed in many types of cancer. Accordingly, these proteins have recently become an exciting new target for molecular therapeutics. This study examined the expression of an activated mTOR signaling protein in patients with colorectal adenocarcinoma (CRAC) and colorectal adenoma lesion. Immunohistochemical analysis was performed on human CRAC and adenoma for the mTOR signaling components, including mTOR, phosphorylation, and activation of S6 kinase (p70-S6K), S6 ribosomal protein (S6), and eukaryotic initiation factor 4E-binding protein (4EBP1). A total of 100 cases with colorectal adenocarcinoma (CARC; N=40), adenoma with high-grade intraepithelial neoplasms (HIN; N=30), and adenoma with low-grade intraepithelial neoplasms (LIN; N=30) were enrolled in this study. p-mTOR expression was observed in 30 cases of the CRAC tissues (75%), 9 cases of adenoma with HIN (30%), and 2 cases of adenoma with LIN (7%). In addition, p-S6 expression was observed in 22 cases of CRAC tissues (55%), 8 cases of adenoma with HIN (27%), and 3 cases of adenoma with LIN (10%). A significant correlation was observed among the p-mTOR, p-S6 expression, and the adenoma-carcinoma sequence. Interestingly, the p-S6 protein was activated more in early CRAC than in advanced CRAC.

• Korean Journal of Radiology
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• v.24 no.6
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• pp.553-563
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• 2023

Objective: Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging-derived tractography (DTI-t) contribute to the localization of language areas, but their accuracy remains controversial. This study aimed to investigate the diagnostic performance of preoperative fMRI and DTI-t obtained with a simultaneous multi-slice technique using intraoperative direct cortical stimulation (DCS) or corticocortical evoked potential (CCEP) as reference standards. Materials and Methods: This prospective study included 26 patients (23-74 years; male:female, 13:13) with tumors in the vicinity of Broca's area who underwent preoperative fMRI and DTI-t. A site-by-site comparison between preoperative (fMRI and DTI-t) and intraoperative language mapping (DCS or CCEP) was performed for 226 cortical sites to calculate the sensitivity and specificity of fMRI and DTI-t for mapping Broca's areas. For sites with positive signals on fMRI or DTI-t, the true-positive rate (TPR) was calculated based on the concordance and discordance between fMRI and DTI-t. Results: Among 226 cortical sites, DCS was performed in 100 sites and CCEP was performed in 166 sites. The specificities of fMRI and DTI-t ranged from 72.4% (63/87) to 96.8% (122/126), respectively. The sensitivities of fMRI (except for verb generation) and DTI-t were 69.2% (9/13) to 92.3% (12/13) with DCS as the reference standard, and 40.0% (16/40) or lower with CCEP as the reference standard. For sites with preoperative fMRI or DTI-t positivity (n = 82), the TPR was high when fMRI and DTI-t were concordant (81.2% and 100% using DCS and CCEP, respectively, as the reference standards) and low when fMRI and DTI-t were discordant (≤ 24.2%). Conclusion: fMRI and DTI-t are sensitive and specific for mapping Broca's area compared with DCS and specific but insensitive compared with CCEP. A site with a positive signal on both fMRI and DTI-t represents a high probability of being an essential language area.

• Tuberculosis and Respiratory Diseases
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• v.62 no.3
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• pp.192-196
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• 2007

Background: Right middle lobe syndrome (RMLS) is defined as transient or chronic and recurrent atelectasis of the right middle lobe. Although numerous conditions are associated with RMLS, there are very few recent reports in Korea. This study evaluated the causes of RMLS in a local tertiary hospitalover a period of 42 months. Method: Eighty-eight patients (M:F=64:22, mean age: $67.2{\pm}10.3years$), who had consistent chest radiography findings and underwent bronchoscopy in Gyeongsang University Hospital from January 2003 to July 2006, were enrolled in this study. The clinical characteristics and causes of RMLS in these patients were retrospectively reviewed. Results: The most common symptoms fo RMLS were cough, dyspnea and sputum. Tuberculosis was the most common cause (endobronchial tuberculosis in 22 and pulmonary tuberculosis in 1) The other causes were bronchial stenosis by benign fibrotic changes in 22 cases (25%), anthracofibrosis in 13 cases (14.8%), pneumonia in 11 cases (12.5%), lung cancer in 10 cases (11.4%), mucus impaction in 3 cases (3.4%), bronchiectasis in 2 cases (2.3%) and no demonstrable causes in 7 cases (8%). The bronchoscopy findings were mucosal edema with hyperemic changes in 38 cases (43.2%), mucosal edema with anthracotic pigmentation in 16 cases (18.2%), mucus impaction in 13 cases (14.8%), fibrotic stenosis in 13 cases (14.8%), a mass like lesion in 8 cases (9.1%), exudative necrotic material in 4 cases (4.5%), narrowing as a result of extrinsic compression in 2 cases (2.3%) and no demonstrable abnormalities in 12 cases (13.6%). Conclusion: Right middle lobe syndrome was observed more frequently in patients over the age of 65. The causes were mainly benign diseases with endobronchial tuberculosis being the most common.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.590-599
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• 1996

Background : Bronchial artery embolization has been established as an effective means to control hemoptysis, especially in patients with decreased pulmonary function and those with advanced chronic obstructive pulmonary disease. We evaluated the effect of arterial embolization in immediate control of massive hemoptysis and investigated the clinical and angiographic characteristics and the course of patients with reccurrent hemoptysis after initial succeseful embolization. Another purpose of this study was to find predictive that cause rebleeding after bronchial artery embolization. Method : We reviewed 47 cases that underwent bronchial artery embolization for the management of massive hemoptysis, retrospectively. We analyzed angiographic findings in all cases before bronchial artery embolization and also reviewed the angiographic findings of patients that underwent additional bronchial artery embolization for the control of reccurrent hemoptysis to find the clauses of rebleeding. Results : 1) Underlying causes of hemoptysis were pulmonary tuberculosis(n=35), bronchiectasis(n=5), aspergilloma(n=2), lung cancer(n=2), pulmonary A-V malformation(n=1), and unknown cases(n=2). 2) Overal immediate success rate was 94%(n=44), an6 recurrence rate was 40%(n=19). 3) The prognostic factors such as bilaterality, systemic-pulmonary artery shunt, multiple feeding arteries and degree of neovascularity were not statistically correlated with rebleeding tendency (p value>0.05). 4) At additional bronchial artery embolization, Revealed recannalization of previous embolized arteries were 14/18cases(78%) and the presence of new deeding arteries was 8/18cases(44%). 5) The complications(31cases, 66%) such as fever, chest pain, cough, voiding difficulty, paralytic ileus, motor and sensory change of lower extremity, atelectasis and splenic infarction were occured. Conclusion : Recannalization of previous embolized arteries is the major cause of recurrence after bronchial artery embolization. Despite high recurrence rate of hemoptysis, bronchial artery embolization for management of massive hemoptysis is a effective and saute procedure in immediate bleeding control.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2004.11a
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• pp.122-125
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• 2004

In radiotherapy of tumors in liver, enough planning target volume (PTV) margins are necessary to compensate breathing-related movement of tumor volumes. To overcome the problems, this study aims to obtain patients' body movements by using a moving phantom and an ultrasonic sensor, and to develop respiration gating techniques that can adjust patients' beds by using reversed values of the data obtained. The phantom made to measure patients' body movements is composed of a microprocessor (BS II, 20 MHz, 8K Byte), a sensor (Ultra-Sonic, range 3 cm ${\sim}$3 m), host computer (RS232C) and stepping motor (torque 2.3Kg) etc., and the program to control and operate it was developed. The program allows the phantom to move within the maximum range of 2 cm, its movements and corrections to take place in order, and x, y and z to move successively. After the moving phantom was adjusted by entering random movement data(three dimensional data form with distance of 2cm), and the phantom movements were acquired using the ultra sonic sensor, the two data were compared and analyzed. And then, after the movements by respiration were acquired by using guinea pigs, the real-time respiration gating techniques were drawn by operating the phantom with the reversed values of the data. The result of analyzing the acquisition-correction delay time for the three types of data values and about each value separately shows that the data values coincided with one another within 1% and that the acquisition-correction delay time was obtained real-time (2.34 ${\times}$ 10$^{-4}$sec). This study successfully confirms the clinic application possibility of respiration gating techniques by using a moving phantom and an ultra sonic sensor. With ongoing development of additional analysis system, which can be used in real-time set-up reproducibility analysis, it may be beneficially used in radiotherapy of moving tumors.

• Food Science and Preservation
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• v.24 no.1
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• pp.27-35
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• 2017

Microbiological, physicochemical, and organoleptic properties of fresh-cut vegetables (FVs), carrots, green peppers, cherry tomatoes, and paprika after X-ray irradiation were evaluated to verify food quality suitable for the immune-depressed patients. Total concentrations of aerobic bacteria in non-irradiated samples, except for cherry tomatoes, were 1.63-3.34 log CFU/g. Irradiation dose exceed 0.4 kGy was used for carrots and green peppers whereas the sterilization dose of 0.2 kGy was used for both cherry tomatoes and paprika. A dose of 0.4 kGy was tentatively determined as the minimum allowable dose for sterilization of the FVs, based on $D_{10}$-values of X-ray irradiation (0.11-0.32 kGy) for Escherichia coli, Listeria monocytogenes, and Salmonella Typhimurium inoculated on the samples. With respect to the physiological properties, only hardness was significantly decreased as the absorbed dose increased; however, there were no significant differences in hardness of the sterilized samples using X-rays at 0.4 kGy compared with those of non-irradiated samples (p<0.05). Moreover, overall acceptance scores of the sterilized FVs were higher than 5.0 points on a 7-point scale, indicating a good organoleptic quality. In a survey on preference of hospitalized patients with cancer (n=50), the average scores for the sterilized FVs, except for carrots, were higher than 4.0 points. In conclusion, it is considered that the FVs, except for carrots, sterilized using X-rays at 0.4 kGy could be served to immune-depressed patients as hygienically safe foods with acceptable organoleptic properties.

• Radiation Oncology Journal
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• v.22 no.4
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• pp.316-324
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• 2004

Purpose : In radiotherapy of tumors in liver, enough planning target volume (PTV) margins are necessary to compensate breathing-related movement of tumor volumes. To overcome the problems, this study aims to obtain patients' body movements by using a moving phantom and an ultrasonic sensor, and to develop respiration sating techniques that can adjust patients' beds by using reversed values of the data obtained. Materials and Methods : The phantom made to measure patients' body movements is composed of a microprocessor (BS II, 20 MHz, 8K Byte), a sensor (Ultra-Sonic, range $3\~3$ m), host computer (RS232C) and stepping motor (torque 2.3 Kg) etc., and the program to control and operate it was developed. The program allows the phantom to move within the maximum range of 2 cm, its movements and corrections to take place In order, and x, y and z to move successively. After the moving phantom was adjusted by entering random movement data (three dimensional data form with distance of 2 cm), and the phantom movements were acquired using the ultra sonic sensor, the two data were compared and analyzed. And then, after the movements by respiration were acquired by using guinea pigs, the real-time respiration gating techniques were drawn by operating the phantom with the reversed values of the data. Results : The result of analyzing the acquisition-correction delay time the three types of data values and about each value separately shows that the data values coincided with one another within $1\%$ and that the acquisition-correction delay time was obtained real-time $(2.34{\times}10^{-4}sec)$. Conclusion : This study successfully confirms the clinic application possibility of respiration gating techniques by using a moving phantom and an ultrasonic sensor. With ongoing development of additional analysis system, which can be used in real-time set-up reproducibility analysis, it may be beneficially used in radiotherapy of moving tumors.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.159-193
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• 2015

Owing to causes such as population aging, increased use of various medical devices, long-term hospitalization of various patients with reduced immune function such as cancer, diabetes, and organ transplant patients, and the growing size of hospitals, hospital infections are continuing to increase. As seen in the MERS crisis of 2015, hospital infections have become a social and national problem. In order to prevent damage due to such hospital infections, it is necessary to first strictly implement measures to prevent hospital infections, while, on the other hand, providing proper relief of damage suffered due to hospital infections. However, the mainstream attitude of judicial precedents relating to hospital infection cases has been judged to in fact shift responsibility over damages due to hospital infections on the patient. In light of the philosophy of the damage compensation system, whose guiding principle if the fair and proper apportionment of damages, there is a need to seek means of drastically relaxing the burden of proof on the patient's side relative to conventional legal principles for relaxing the burden of proof, or the theory of de facto estimation. In relation to such need, the German civil code (Burgerliches Gesetzbuch), which defines contracts of medical treatment as typical contracts under the civil code, and has presumption of negligence provisions stipulating that, in cases such as hospital infections which were completely under the control of the medical care providers, if risks in general medical treatment have been realized which cause violations of the life, body, or health of patients, error on the part of the person providing medical care is presumed, was examined. Contracts of medical treatment are entered into very frequently and broadly in the everyday lives of the general public, with various disputes owing thereto arising. Therefore, it is necessary to, by defining contracts of medical treatment as typical contracts under the civil code, regulate the content of said contracts, as well as the proof of burden when disputes arise. If stipulations in the civil code are premature as of yet, an option may be to regulate through a special act, as is the case with France. In the case of hospital infection cases, it is thought that 'legal presumption of negligence' relating to 'negligence in the occurrence of hospital infections,' which will create a state close to equality of arms, will aid the resolution of the realistic issue of the de facto impossibility of remedying damages occurring due to negligence in the process of occurrence of hospital infections. Also, even if negligence is presumed by law, as the patient side is burdened with proving the causal relationships, such drastic confusion as would occur if the medical care provider side is found fully liable if a hospital infection occurs may be avoided. It is thought that, alongside such efforts, social insurance policy must be improved so as to cover the expenses of medical institutions having strictly implemented efforts to prevent hospital infections in the event that they have suffered damages due to a hospital infection accident, and that close future research and examination into this matter will be required.