• Radiation Oncology Journal
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• 제12권3호
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• pp.377-386
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• 1994

1989년에서 1993년까지 중앙 길 병원에서, 자궁경부암으로 수술후 국소재발하여 방사선치료를 시행한 28명의 환자를 대상으로, 치료성적, 예후인자 및 치료후 실패양상 등을 분석하였다. 8명은 질부에 국한된 재발을 보였으며, 나머지 19명은 골반부위를 침윤하는 양상을 보였다. 수쑬후 24개월 이내에 $82\%$가 재발을 보였으며, 완전관해율은 $64\%$였고, 그 중 $28\%$가 후속적 재발을 보였다. 모든 환자가 전 골반부위에 방사선 치료를 받았으며, 그 중 15명이 강내치료를 겸하였다. 치료에 대한 관해율은 재발된 암의 크기와 재발부위 그리고, 방사선 조사양과 관계있었다. 2년 생존율은 $43\%$였고, 무병생존율은 $31\%$였다. 원발병소의 크기, 초기치료등은 생존율에 영향을 끼치지 못하였으나, 임파선 전이 여부와 세포형 등은 유의한 영향을 미쳤다. 6개월 이내에 재발한 경우, 모두 2년 이내에 사망하였으며, 그 후 재발을 보인 경우는, 2년 생존율 $66\%$였다. 재발된 암의 크기가 5cm미만이었던 16명의 환자가가 $71\%$의 2년 생존율을 보인 반면, 5cm이상이었던 12명의 경우는 모두 2년이내 사망하였다. 질부에만 재발한 환자의 2년 생존율은 $100\%$였고, 골반부까지 침윤한 경우는 $20\%$였다. 질점막으로부터 1.0cm 깊이에 75Gy이상의 방사선 치료를 시행받은 경우가, 그 이하를 시행받은 경우보다 좋은 성적을 보였다. 강내치료를 시행받은 15명의 경우, 2년 생존율이 $67\%$였고, 그렇지 않은 경우는 $29\%$였다. 한편, 60.0Gy이하를 시행받은 9명 중 5명이 7개월 이내에 사망하였다. 완전관해를 보인 환자의 2년 생존율을 $83\%$였고, 고렇지 않은 경우는 1년 생존율이 $15\%$였다. 주 사망 원인은 폐전이었다. 좋은 관해율과 높은 생존율은 직접 관계가 있으며, 이를 위하여, 강내치료를 겸한 외부방사선치료가 충분한 조사양으로 시행되어야 하며, 근치적수술후 국소 재발된 자궁경부암의 경우, 생존율을 높이며 삶의 질을 높인다는 점에서 조기발견파 적극적인 방사선 치료가 절대적으로 필요함을 시사하였다.

• Advances in pediatric surgery
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• 제4권2호
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• pp.137-143
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• 1998

Intramuscular injection(IM) into the gluteal muscles is a common route of medication, but may lead to complications. A retrospective review of 32 patients who required surgical treatment for local complications of buttock injections in children was made at the Taegu Fatima Hospital during a seven-year nine-month period (March 1990 to December 1997). Local complications included acute inflammation, cellulitis and abscess(71.9 %), and fat necrosis(21.9 %), and injection granuloma(6.2 %). Over the half of injections were on the upper and outer quadrant of the buttock, but the other 43.7 % were in the upper and inner or lower and outer quadrant which are considered unsuitable sites for intramuscular injection. The majority of complications developed within fat tissue(90.6 %) rather than within muscle(9.4 %). Two-thirds of the patients were under 2 years of age, this suggests that it is technically difficult to accurately administer IM injections in small children because muscle mass is smaller compared to subcutaneous. In addition subcutaneous fat is more susceptible to chemical irritation. Staph. aureus was the predominant organism, isolated in 84.6 % of the patients with abscesses. Treatment consisted of needle aspiration, incision and drainage, curettage, or surgical excision. In conclusion, the major factor that contributes to complications following IM of the buttock appears to be the inadvertent intrafat rather than of IM injection. Accurate injection into the muscles based on a knowledge of pelvic anatomy as well as the potential complications is necessary to prevent complications.

• Tuberculosis and Respiratory Diseases
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• 제57권4호
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• pp.377-380
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• 2004

유미흉은 주로 악성종양에 의한 흉관의 폐쇄, 유미뇨는 림프관과 요관과의 누공형성이 주된 원인이다. 저자들은 유미흉의 원인으로 섬유육종에 의한 흉관폐쇄, 유미뇨의 원인으로 요로계와 림프관의 누공형성을 의심하였으나 검사상 증거를 찾을 수 없어 특발성 유미흉 및 특발성 유미뇨로 진단한 1예를 문헌고찰과 함께 보고하는 바이다.

• 대한의용생체공학회:의공학회지
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• 제28권2호
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• pp.187-194
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• 2007

The purpose of this study is to determine the characteristics of ground reaction force(GRF) in golf swing for various slopes of flat lie and uphill lies of 5 and 10 degrees. Five right-handed professional golfers were selected for the experiment and the 7 iron club was used. We used four forceplates to measure GRF and synchronized with the three-dimensional motion analysis system. Results showed that slope did not affect the total time for golf swing, but the time until the impact had a tendency to slightly increase for the uphill lie(p<0.05). The medial-lateral GRF of the right foot increased toward the medial direction during back swing, but less increases were found with the angle of uphill lie(p<0.05). The GRF of the left foot increased rapidly toward the medial direction at the uncocking and the impact during down swing, but decreased with the increase in the angle of uphill lie(p<0.05). The anterior-posterior GRF of both feet showed almost the same for different slopes. With the slopes, the vertical GRF of the right foot increased, but the vertical GRF of left foot decreased(p<0.05). Uphill lies would have negative effect to provide the angular momentum during back swing, restricting pelvic and trunk rotations, and to provide the precise timing and strong power during down swing, limiting movements of body's center of mass. The present study could provide valuable information to quantitatively analyze the dynamics of golf swing. Further study would be required to understand detailed mechanism in golf swing under different conditions.

• Radiation Oncology Journal
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• 제12권3호
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• pp.369-376
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• 1994

This is a retrospective analysis of 64 patients who was treated with postoperative radiation therapy after radical hysterectomy and bilateral pelvic lymphadenectomy (53 patients) or total abdominal hysterectomy(11 patients) for uterine cervix cancer between May 1980 and September 1991 at the Department of Radiation Oncology, Kyung Hee University Hospital. Most patients were FIGO IB (31 Patients) and IIA (25 patients), and median period of follow-up was 5.1 years. Of these patients,24 received adjuvant whole pelvis irradiation of 6000 cGy and 40 received 5000-5500 cGy whole pelvis irradiation and/or intracavitary radiation (7 Patients). The actuarial overall and relapse free 5 year survival rate were $71.0\%$, $68.3\%$ respectively. The survival rates by stage were $79.1\%$ in stage I, and $61.2\%$ in stage II. Treatment failure was noted in 18 of 64 patients ($28.1\%$), Iocoregional failure in 8 ($12.5\%$), distant metastasis in 8 ($12.5\%$), paraaortic node metastasis in 1 and one patient and concurrent locoregional and distant metastasis. The univariate analysis of prognostic factors affecting to overall survival rate represented lymph node status, the number and site of metastatic lymph node, parametrial invasion, the thichness of cervical wall invasion, and size of cancer mass. Histology, vessel invasion, endometrial extension, hemoglobin level. resection margin status, age, radiation dose were not significant prognostic factors. Complication relating to operation and postoperative radiation were variable according to radiation therapy method: 6000 cGy RT group 8/24($33.3\%$), 5000-5500 cGy+ICR 3/7 ($42.9\%$), 5000-5500 cGy external RT only group 3/33 ($9.1\%$). In conclusion, the results suggest that postoperative radiotherapy is necessary in high risk patients for locoregional control and improving survival rate, and higher dose does not improve results but only increases complication.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7463-7466
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• 2015

Aims: To analyse the predictors of recurrence, disease free survival and overall survival in cases with endometrial cancer. Materials and Methods: A total of 152 women diagnosed with endometrial cancer were screened using a prospectively collected database including age, smoking history, menopausal status, body mass index, CA125, systemic disorders, tumor histology, tumor grade, lymphovascular space invasion, tumor diameter, cervical involvement, myometrial invasion, adnexal metastases, positive cytology, serosal involvement, other pelvic metastases, type of surgery, fertility sparing approach to assess their ability to predict recurrence, disease free survival and overall survival. Results: In ROC analyses tumor diameter was a significant predictor of recurrence (AUC:0.771, P<0.001). The optimal cut off value was 3.75 with 82% sensitivity and 63% specificity. In correlation analyses tumor grade (r=0.267, p=0.001), tumor diameter (r=0.297, p<0.001) and the serosal involvement (r=0.464, p<0.001) were found to significantly correlate with the recurrence. In Cox regression analyses when some different combinations of variables included in the model which are found to be significantly associated with the presence of recurrence, tumor diameter was found to be a significant confounder for disease free survival (OR=1.2(95 CI,1.016-1.394, P=0.031). On Cox regression for overall survival only serosal involvement was found to be a significant predictor (OR=20.8 (95 % CI 2.4-179.2, P=0.006). In univariate analysis of tumor diameter > 3.75 cm and the recurrence, there was 14 (21.9 %) cases with recurrence in group with high tumor diameter where as only 3 (3.4 %) cases group with smaller tumor size (Odds ratio:7.9 (95 %CI 2.2-28.9, p<0.001). Conclusions: Although most of the significantly correlated variables are part of the FIGO staging, tumor diameter was also found to be predictor for recurrence with higher values than generally accepted.

• 한국운동역학회지
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• 제27권2호
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• pp.133-140
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• 2017

Objective: The purpose of this study was to determine the relationship between center of pressure (CoP) and local stability of the lower joints, which was calculated based on approximate entropy (ApEn) during walking in elderly women. Method: Eighteen elderly women were recruited (age: $66.4{\pm}1.2yrs$; mass: $55.4{\pm}8.3kg$; height: $1.56{\pm}0.04m$) for this study. Before collecting data, reflective marker triads composed of 3 non-collinear spheres were attached to the lateral surface of the thigh and shank near the mid-segment to measure motion of the thigh and shank segments. To measure foot motion, reflective markers were placed on the shoe at the heel, head of the fifth metatarsal, and lateral malleolus, and were also placed on the right anterior-superior iliac spine, left anterior-superior iliac spine, and sacrum to observe pelvic motion. During treadmill walking, kinematic data were recorded using 6 infrared cameras (Oqus 300, Qualisys, Sweden) with a 100 Hz sampling frequency and kinetic data were collected from a treadmill (Instrumented Treadmill, Bertec, USA) for 20 strides. From kinematic data, 3D angles of the lower extremity's joint were calculated using Cardan technique and then ApEn were computed for their angles to evaluate local stability. Range of CoP was determined from the kinetic data. Pearson product-moment and Spearman rank correlation coefficient were applied to find relationship between CoP and ApEn. The level of significance was determined at p<.05. Results: There was a negative linear correlation between CoP and ApEn of hip joint adduction-abduction motion (p<.05), but ApEn of other joint motion did not affect the CoP. Conclusion: It was conjectured that ApEn, local stability index, for adduction/abduction of the hip joint during walking could be useful as a fall predictor.

• Asian Pacific Journal of Cancer Prevention
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• 제15권14호
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• pp.5811-5814
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• 2014

Background: To investigate abnormal cervical histopathology (ACH) from hysterectomy specimens with normal preoperative Papanicolaou (Pap) smears. Materials and Methods: Medical records from May 2009 to April 2012 were retrospectively reviewed of subjects from whom hysterectomy specimens were taken in Thammasat University Hospital. All had normal preoperative Pap smears. ACH was the primary outcome. A p-value less than 0.05 was considered significant. A total of 483 subjects with an average age of 50.5 years were recruited. Benign cases of enlarged uterus and pelvic mass were present in 94% (430/483). Endometrial and ovarian cancer were found at 6.2 and 4.7%, respectively. In hysterectomy specimens there were 19 (4%) cases of ACH. Silent ACH with benign disease, endometrial and ovarian cancers were 1.2% (5/430), 33.3% (10/30) and 17.4% (4/23), respectively. The negative predictive value (NPV) and false negative rate of Pap smears were 96 and 4%, respectively. ACH in malignant cases were 27.9% (12/43) and 20% (2/10) in adequate (APS) and inadequate (IPS) Pap collection groups, respectively. ACH in benign condition were 0.68% (2/292) and 2.2% (3/138) in APS and IPS, respectively. ACH was more often found in hysterectomy specimens with indication of malignancy than benign conditions with statistical significance. One third of preoperative stage I endometrial cancer cases had cervical involvement. Conclusions: Silent ACH in normal preoperative Pap smear was 4 %. Inadequate Pap smear collection is still the major problem in this study. Reducing inadequate Pap smear collection could reduce the false negative rate.

• Journal of Trauma and Injury
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• 제31권2호
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• pp.103-106
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• 2018

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of -86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

• Annals of Coloproctology
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• 제34권6호
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• pp.317-321
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• 2018

Purpose: We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). Methods: Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. Results: Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was $66.91{\pm}11.15years$, and the median body mass index was $24kg/m^2$ (range, $20-35kg/m^2$). The median tumor distance from the anal verge was 8 cm (range, 4-12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. Conclusion: These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.