Seventy-five patients with tumors of the head and neck treated with either radiation therapy alone or combined with surgery or chemotherapy were studied prospectively to evaluate the effects of radiation therapy to the neck on thyroid gland between September 1986 and October 1992. All patients were serially monitored for thyroid function tests before and after radiation therapy. Radiation dose to the thyroid gland ranged from 35 to 60 Gy with a median dose of 50 Gy. Median follow-up time was 30 months with a range of 11 to 85 months. The incidence of thyroid dysfunction was 40%; forty-five patients (60%) euthyroid, 2 patients (3%) clinical hypothyroidism, 27 patients (36%) subclinical hypothyroidism and 1 patient (1%) hyperthyroidism. No thyroid nodules or thyroid cancer were detected in any patients. Thyroid dysfunction appeared earlier in patients who underwent surgery than in those patients treated with radiation therapy alone or combination of chemotherapy and radiation therapy (p=0.0013). By multivariate analysis, risk factors that significantly influenced a higher incidence of thyroid dysfunction were female sex (p=0.0293) and combination of total larygectomy and radiation therapy (p=0.0045). In conclusion, evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests are recommended to detect thyroid dysfunction in time and thyroid hormone replacement therapy is recommended whenever thyroid dysfunction develops.
Drug Therapy ; Female ; Follow-Up Studies ; Head* ; Hormone Replacement Therapy ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Multivariate Analysis ; Neck* ; Prospective Studies ; Risk Factors ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule

This is a retrospective study of 62 patients with unresected squamous cell carcinoma of the esophagus treated by radiotherapy alone (25 patients) or combined chemotherapy and radiotherapy (37 patients). Of these, 14 of 25 patients treated by radiation therapy alone and 25 of 37 patients treated by combined chemotherapy and radiotherapy completed radiotherapy consisting of 55 to 60 Gy in 5 to 6 weeks and were analyzed for local control rate and survival rate. Follow up ranged from 6 days to 58 months. Three (8%) of 39 patients had a complete response, twenty-eight(72%) a partial reponse and eight(20%) minimal or no resonse. Overall median survival was 11 months for all stages. The 1 year and 2 year actuarial survival rates were 48.6% and 13% respectively. Age and stage had prognostic significances (p<0.05, p<0.05 respectively). The 1 year survival rate was 70.1% for stage I, 47.6% for stage II, and 28.4% for stage III. The median survival was 19 months for stage I, 11 months for stage II, 6 months for stage III, and 5.5 months for stage III with distant metastases. The 1 year survival rate of patients 55 years and above was 69.6%, 54 years and below was 0%. There was no significant difference in survival rate between treatment modalities, locations of tumor, and responses of tumor.
Carcinoma, Squamous Cell ; Drug Therapy* ; Esophageal Neoplasms* ; Esophagus ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Radiotherapy* ; Retrospective Studies ; Survival Rate

Acromegaly and hyperprolactinemia have been described in association with polyostotic fibrous dysplasia. The pathogenic mechanisms of this endocrinopathy are not clear. We experienced a 19-year-old male with hypersecretion of GH, hyperprolactinemia and fibrous dysplasia. He was referred for evaluation of suspected acromegaly. He had no skin pigmentation. Plasma GH, PRL, somatomedin-C, LH, FSH, testosterone, estradiol, progesterone, T3, T4, TSH and cortisol were measured. Among those, the levels of plasma GH, PRL and somatomedin-C were high. Serum alkaline phosphatase was increased. OGTT did not suppress plasma OH concentration and GH showed paradoxical response to TRH and LHRH. GH was suppressed after a test-dose of somatastatin and bromocriptine. Brain MRI demonstrated a mass lesion in sella turcica and another mass lesions in nasal cavity and posterior occipital bone. Whole body bone scan revealed increased uptake in skull, nasal bone, both 9th posterior rib, both femurs, both tibias, left scapular and pelvic bone. These fmdings were consistent with bone tumor such as fibrous dysplasia. We report a case with incomplete MeCune-Albright syndrome including acromegaly, hyperprolactinemia and polyostotic fibrous dysplasia.
Acromegaly ; Alkaline Phosphatase ; Brain ; Bromocriptine ; Estradiol ; Femur ; Fibrous Dysplasia, Polyostotic ; Glucose Tolerance Test ; Gonadotropin-Releasing Hormone ; Humans ; Hydrocortisone ; Hyperprolactinemia ; Magnetic Resonance Imaging ; Male ; Nasal Bone ; Nasal Cavity ; Occipital Bone ; Pelvic Bones ; Plasma ; Progesterone ; Ribs ; Sella Turcica ; Skin Pigmentation ; Skull ; Testosterone ; Tibia ; Young Adult

In order to determine the value of induction chemotherapy (CT) for inoperable head and neck cancer, the authors conducted a retrospective study. Fifty-five patients were treated with CT and radiotherapy(RT)(CT + RT group). This group was compared with a group of 54 patients treated RT alone (RT alone group). The CT regimen used were CF (cis-platine + 5-FU), CVB(cyclophos-phamide + vincristine + bleomycin), CAP (cyclophosphamide + adriamycin + prednisolone) or PVBM(cis-platine + vincristine + bleomycin + methotrexate). Toxicity from induction chemotherapy was minimal, and toxicity was limited primarily to nausea and vomiting, mucositis and myelosuppression. The complete response (CR) rate to CT was 14.5% and the partial response (PR) rate was 47.3% for an overall major response rate of 61.8%. The major response rate at the completion of loco-regional therapy was 87.3% (48/55) with 32 CR (58.2%) and 16 PR (29.1%) for CT-RT group and 81.5% (44/55) with 27 CR(50.0%) and 17 PR (31.5%) for RT alone group (p=0.57). Median follow-up of CT-RT group was 17 months and 11 months for RT alone group. Median survival was 36 months for CT-RT group and 24 monts for RT alone group (p=0.3). The overall survival rate at 2 years, 3years and 5 years, respectively was 60.9%, 48.6% and 42.5% for CT-RT guoup, and 54.9%, 49.9% for RT alone group (p=0.33). Comparision between patients in both groups, stratified by overall stage, T and N stage, site, and pathology, all failed to show any significant difference in survival rates. We conclude that this retrospective study failed to demonstrate an advantage for induction chemotherapy in inoperable head and neck cancer.
Bleomycin ; Doxorubicin ; Follow-Up Studies ; Head and Neck Neoplasms* ; Head* ; Humans ; Induction Chemotherapy ; Mucositis ; Nausea ; Pathology ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Vincristine ; Vomiting

Between January 1985 and July 1592, 52 patients with locally advanced nasopharyngeal carcinoma were studied retrospectively for the effectiveness of sequential chemotherapy and radiation therapy. The male to female ratio was 3.3:1 with a median age of 41 years. Forty patients had squamous cell carcinoma and the remaining 12 had undifferentiated carcinoma. Seven patients had stage III disease and the remainder had stage IV disease at time of presentation. All patients were treated two courses of chemotherapy followed by radiation therapy Chemotherapy consisted of either CVB(cisplatin, vincristine and bleomycin) of CF(cisplatin and 5-FU). Total radiation dose to the primary site ranged from 6000 cGy to 7500 cGy. Neck nodes were given booster treatment to maximum of 7000 cGy, depending on the extent of disease. Local control, overall survival and disease-free survival rates were analyzed. The complete response(CR) rate to chemotherapy was 15%, and the partial response(PR) rate was 46% for overall major response rate of 61%. The CR rate was 87% after radiation therapy. Median follow-up time was 51 months. The overall survival and disease-free survival rates at 36 months were 54% and 49%, respectively. Median time to relapse was 15 months. The patterns of initial relapse in CR patients was as follows: locoregional failure only, 12 patients; distant metastasis only, 11; both, 2. Cox's multivariate regression model revealed that nodal status was the single most important independent prognostic factor influencing disease-free survival(p=0.001). Comparison of these results with other published reports with radiation therapy alone showed that a high rate of initial response to chemotherapy did not translate into local control or survival. At present time radiation therapy alone remains the standard treatment for locoregional cancer of the nasopharyngeal cancer. More controlled clinical trials must be completed before acceptance of chemotherapy as a part of treatment of advanced nasopharyngeal carcinoma.
Carcinoma ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Drug Therapy* ; Female ; Follow-Up Studies ; Humans ; Male ; Nasopharyngeal Neoplasms ; Neck ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Vincristine

PURPOSE: The present study is aimed to evaluate the combined effect of recombinant human bone morphogenetic protein 2 (rhBMP-2) and recombinant human vascular endothelial growth factor (rhVEGF) coated onto anodized implants on osseointeration. MATERIALS AND METHODS: Six New Zealand white rabbit were used in this study. Each animal received 4 implants that were either coated with rhBMP-2 and rhVEGF (Study group) or anodized implant (Control group) in both tibia. This was performed using a randomized split-mouth design. A total 24 implants were used. The implant stability quotient (ISQ) value using resonance frequency analyser and removal torque (RTQ) measurement were investigated at 2 and 8 weeks. The t-test was used for statistical analysis (alpha=.05). RESULTS: Control and study group showed good osseointegration at 8 weeks. The ISQ and RTQ values of study group were significant compared with the control group at 8 weeks (P<.05). However, No statistical significance was observed at 2 weeks (P>.05). CONCLUSION: It was concluded that rhBMP-2 with rhVEGF coated onto anodized implants can induce better osseointegration at late healing period.
Animals ; Bone Morphogenetic Protein 2 ; Humans ; New Zealand ; Osseointegration ; Pilot Projects ; Tibia ; Torque ; Vascular Endothelial Growth Factor A

From December 1989 to February 1993, 108 patients with Non-Small Cell Lung Cancers(NSCLC) were studied retrospectively to evaluate radiotherapeutic significance of serum levels of NSE. We considered elevated serum neuron specific pathologic evaluation revealed 86 squamous cell carcinomas, 11 adenocarcinomas, 3 large cell carcinomas, 3 mucoepidermoid carcinomas, and 5 unknown pathology. Eight patients had stageI, 40 stage III A, and 60 stageIII B. S-NSE level greater than 15 ng/ml was considered as elevated, and below this considered as normal. All patients received radiotherapy as primary treatment modality. The responders to radiotherapy had significantly higher mean S-NSE level than on-responders (28.5 ng/ml vs 20 ng/ml, p=0.01). Overall 2-year survival rate (YSR) was 23.6%. According to radiotherapy response, 2 YSR for patients with CR, PR, and NR were 39.2%, 28.6%, and 6.2% respectively (p=0.001). 2 YSR for patients with elevated and normal S-NSE were 14.6% and 31.7%(p=0.02). The patients with NR showed no difference in survival according to S-NSE level. When we considered all patients, S-NSE level showed no significant impact on response. But for squamous cell cardinomas alone, patients with elevated S-NSE had more patients with higher nodal stage. Based on our and other data, NSCLSC with neuroendocrine features have different response to treatment and clinical behavior compared to other NSCLSC. Thus, this subgroup may need different treatment modality, and S-NSE level may have prognostic significance.
Adenocarcinoma ; Carcinoma, Large Cell ; Carcinoma, Mucoepidermoid ; Carcinoma, Squamous Cell ; Humans ; Lung Neoplasms* ; Lung* ; Neurons ; Pathology ; Phosphopyruvate Hydratase ; Radiotherapy ; Retrospective Studies ; Survival Rate

Pathological wear across the entire dentition causes problems such as collapsed occlusal plane, reduced vertical dimension, anterior premature contact, inadequate anterior guidance, and tooth migration, thereby induce symptoms such as temporomandibular joint disorder, reduced masticatory efficiency, and tooth hypersensitivity. For the treatment of patients with excessive wear, evaluation of vertical dimension should be preceded along with analysis of the cause. The patient in this case was a 45-year-old female with a history of orthognathic surgery. Through clinical examination, radiographic examination, and model analysis, overall tooth wear, interdental spacing in the anterior maxillary region, retruded condylar position, and insufficient interocclusal space for prosthetic restoration were confirmed. Full mouth rehabilitation with increased vertical dimension was planned, the patient’s adaptation to the new vertical dimension was evaluated with a removable occlusal splint and temporary prosthesis, and cross-mounting was performed based on the temporary restoration to fabricate the definitive zirconia prosthesis, maintaining the adjusted vertical dimension. It showed satisfactory functional and esthetic results through stable restoration of the occlusal relationship.

PURPOSE: The aim of this study was to evaluate the sensitivity and specificity of ultrasonography of suspected ileocolic intussusception performed by emergency medicine (EM) residents who participated in a 2-hour focused ultrasound training program for intussusception. METHODS: This was a 16-month retrospective, observational study. Pediatric patients with suspected ileocolic intussusception who underwent ultrasound performed by second or third year EM residents were included in the study. The gold standard was a diagnostic work-up performed by a radiologist or clinical follow-up, compared with the results of ultrasonography performed by EM residents. RESULTS: A total of 38 patients were enrolled. The sensitivity of ultrasound performed by emergency medicine residents for prediction of ileocolic intussusception was 92.86%(66.13% to 99.82%), the specificity was 91.67%(73.00% to 98.97%), the positive likelihood ratio was 11.14(2.93 to 42.34), and the negative likelihood ratio was 0.08(0.01 to 0.52). CONCLUSION: Emergency residents can identify ileocolic intussusceptions with only minimal training, which could substitute for ultrasonography performed by radiologists when they are not immediately available.
Emergencies ; Emergency Medicine ; Follow-Up Studies ; Humans ; Intussusception ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: The purpose of this study was to investigate the effects of implant collar design on marginal bone change and soft tissue response by an animal test MATERIALS AND METHODS: Two types of Implant (Neobiotech Co. Seoul, Korea) that only differs in collar design were planted on two healthy Beagle dogs. The implants were divided into two groups, the first group with a beveled collar (Bevel Group) and the second group with "S" shaped collar (Bioseal group). Standardized intraoral radiographs were used to investigate the mesio-distal change of the marginal bone. Histological analysis was done to evaluate the bucco-lingual marginal bone resorption and the soft tissue response adjacent to the implant. Mann-Whitney test was done to compare the mesio-distal marginal bone change at equivalent time for taking the radiographs and the tissue measurements between the groups. RESULTS: Radiographic and histological analysis showed that there was no difference in marginal bone change between the two groups (P>.05). Histological analysis showed Bioseal group had more rigid connective tissue attachment than the Bevel group. There was no difference in biological width (P>.05). Bevel group showed significantly longer junctional epithelium attachment and Bioseal group showed longer connective tissue attachment (P<.05). CONCLUSION: For three months there were no differences in marginal bone change between the Bevel group and the Bioseal group. As for the soft tissue adjacent to the implant, Bioseal group showed longer connective tissue attachment while showing shorter junctional epithelium attachment. There were no differences in biologic width.
Animals ; Bone Resorption ; Connective Tissue ; Dogs ; Epithelial Attachment ; Plants ; Root Canal Filling Materials