Ameloblasts ; Fibrosarcoma ; Gingiva ; Humans ; Jaw ; Male ; Mandible ; Mouth Floor ; Neck ; Neoplasm Metastasis ; Odontogenic Tumors ; Recurrence ; Ulcer

Crohn's disease (CD) is a chronic, progressive, and disabling inflammatory bowel disease (IBD) with an uncertain etiopathogenesis. CD can involve any site of the gastrointestinal tract from the mouth to the anus, and is associated with serious complications, such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower compared with those in Western countries, but they have been rapidly increasing during the recent decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies have been applied for the treatment of this disease. Concerning CD management, there have been substantial discrepancies among clinicians according to their personal experience and preference. To suggest recommendable approaches to the diverse problems of CD and to minimize the variations in treatment among physicians, guidelines for the management of CD were first published in 2012 by the IBD Study Group of the Korean Association for the Study of the Intestinal Diseases. These are the revised guidelines based on updated evidence, accumulated since 2012. These guidelines were developed by using mainly adaptation methods, and encompass induction and maintenance treatment of CD, treatment based on disease location, treatment of CD complications, including stricture and fistula, surgical treatment, and prevention of postoperative recurrence. These are the second Korean guidelines for the management of CD and will be continuously revised as new evidence is collected.
Anal Canal ; Constriction, Pathologic ; Crohn Disease* ; Fistula ; Gastrointestinal Tract ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Korea ; Mouth ; Prevalence ; Recurrence

Crohn's disease (CD) is a chronic, progressive, and disabling inflammatory bowel disease (IBD) with an uncertain etiopathogenesis. CD can involve any site of the gastrointestinal tract from the mouth to the anus, and is associated with serious complications, such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower compared with those in Western countries, but they have been rapidly increasing during the recent decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies have been applied for the treatment of this disease. Concerning CD management, there have been substantial discrepancies among clinicians according to their personal experience and preference. To suggest recommendable approaches to the diverse problems of CD and to minimize the variations in treatment among physicians, guidelines for the management of CD were first published in 2012 by the IBD Study Group of the Korean Association for the Study of Intestinal Diseases. These are the revised guidelines based on updated evidence, accumulated since 2012. These guidelines were developed by using mainly adaptation methods, and encompass induction and maintenance treatment of CD, treatment based on disease location, treatment of CD complications, including stricture and fistula, surgical treatment, and prevention of postoperative recurrence. These are the second Korean guidelines for the management of CD and will be continuously revised as new evidence is collected.
Anal Canal ; Constriction, Pathologic ; Crohn Disease* ; Fistula ; Gastrointestinal Tract ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Korea ; Mouth ; Prevalence ; Recurrence

Patients with cardiac rupture due to blunt trauma have more than 50% mortality rate and most of them expire before they arrive at the hospital emergency room. Since patients typically present with cardiac tamponade, the diagnosis can be easily confirmed with physical examination, echocardiography, and chest CT scan. However, in our case of the massive hemothorax on right side without evidence of cardiac tamponade, the diagnosis for cardiac rupture does not seems to be easy. Therefore, we must assume the probability of cardiac rupture if we plan an explo-thoracotomy in a patients with massive right hemothorax without rib fracture. We describe two cases of cardiac rupture combined with pericardial laceration and right massive hemothorax by blunt chest trauma. The ruptured hearts of the patients were successfully closed using cardio-pulmonary bypass or cell saver system without detrimental sequelae.
Cardiac Tamponade ; Diagnosis ; Echocardiography ; Emergency Service, Hospital ; Heart ; Heart Rupture* ; Hemothorax* ; Humans ; Lacerations ; Mortality ; Physical Examination ; Rib Fractures ; Thorax* ; Tomography, X-Ray Computed

PURPOSE: To analyze the radioresponse of hepatocellular carcinomas (HCC), using accurate measurements of the tumor size in extrahepatic lymph node metastasis, and to obtain information for the future treatment of primary intrahepatic lesions. MATERIALS AND METHODS: Fifty-one extrahepatic lymph node metastases from primary HCCs, which could be treated by external radiotherapy alone, were included in this study. The radiation dose ranged from 30 to 51 Gy with fraction sizes of 2.0~3.0 Gy. Responses were determined by measuring the areas on CT scans 0, 1 and 3 months after the completion of radiotherapy. The median follow-up period of the surviving patients was 10 months. RESULTS: The overall response rate was 76%, and the important factors were; total dose of radiation, time dose fractionation (TDF) value and the biologically effective dose (BED). A dose of 45 Gy or higher showed an objective response rate of 93%, and if the TDF value was higher than 90, a similar result was observed. In about half (47%) of the patients the maximum response was observed at 3 months or later. The response duration was observable in 14 patients surviving 12 months or longer. Regrowth of irradiated lesions were observed in 4 (66.7%) patients among those who received less than 45 Gy, and in 4 (50%) among those who were treated with 45 Gy or more. There was a statistically significant difference in the survivals between the responders and non-responders (p=0.008). Gastrointestinal bleeding or ulceration was observed in 8 patients, including 3 with NCI common toxicity criteria grade III or higher. CONCLUSION: Radiotherapy was an effective palliative modality for extrahepatic metastasis in HCCs. A radiation dose of 45 Gy or higher (or a TDF value > or =90), was required for a major response.
Carcinoma, Hepatocellular ; Dose Fractionation ; Follow-Up Studies ; Hemorrhage ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Radiotherapy ; Tomography, X-Ray Computed ; Ulcer

PURPOSE: To explore a 3D conformal radiotherapy technique for a posterior fossa boost, and the potential advantages of a prone position for such radiotherapy. MATERIALS AND METHODS: A CT simulator and 3D conformal radiotherapy planning system was used for the posterior fossa boost treatment of a 13-year-old medulloblastoma patient. He was placed in the prone position and immobilized with an aquaplast mask and immobilization mold. CT scans were obtained of the brain from the top of the skull to the lower neck, with IV contrast enhancement. The target volume and normal structures were delineated on each slice, with treatment planning performed using non-coplanar conformal beams. RESULTS: The CT scans, and treatment in the prone position, were performed successfully. In the prone position, the definition of the target volume was made easier due to the well enhanced tentorium. In addition, the posterior fossa was located anteriorly, and with the greater choice of beam arrangements, more accurate treatment planning was possible as the primary beams were not obstructed by the treatment table. CONCLUSION: A posterior fossa boost, in the prone position, is feasible in cooperating patients, but further evaluation is needed to define the optimal and most comfortable treatment positions.
Adolescent ; Brain ; Carboxymethylcellulose Sodium ; Fungi ; Head* ; Humans ; Immobilization ; Masks ; Medulloblastoma ; Neck* ; Prone Position ; Radiotherapy ; Radiotherapy, Conformal ; Skull ; Tomography, X-Ray Computed

Campomelic dysplasia (CD; OMIM #114290), a rare form of congenital short-limbed dwarfism, is due to mutations in SOX9, a member of the SOX (SRY-related HMG box) gene family. Multiparous mother at 38 weeks' gestation delivered a 3,272 g baby boy with characteristic phenotypes including bowing of the lower limbs, a narrow thoracic cage, 11 pairs of ribs, hypoplastic scapulae, macrocephaly, flattened supraorbital ridges and nasal bridge, cleft palate, and micrognathia. He underwent a tracheostomy at the age of three months for severe laryngomalacia after a number of repeated hospitalizations due to respiratory problems and died at the age of four months from progressive respiratory failure. He was diagnosed as having CD based on a novel frameshift mutation (p.Gln458ArgfsX12) in the SOX9 gene, the mutation which has not yet been reported in Korea.
Campomelic Dysplasia/*diagnosis/genetics/radiography ; Disorders of Sex Development/genetics ; Frameshift Mutation ; Humans ; Infant ; Male ; Respiratory Insufficiency/complications ; SOX9 Transcription Factor/*genetics ; Sequence Analysis, DNA

PURPOSE: To establish and verify the proper and the practical IMRT (Intensity-modulated radiation therapy) patient QA (Quality Assurance). MATERIALS AND METHODS: An IMRT QA which consists of 3 steps and 16 items were designed and examined the validity of the program by applying to 9 patients, 12 IMRT cases of various sites. The three step QA program consists of RTP related QA, treatment information flow QA, and a treatment delivery QA procedure. The evaluation of organ constraints, the validity of the point dose, and the dose distribution are major issues in the RTP related QA procedure. The leaf sequence file generation, the evaluation of the MLC control file, the comparison of the dry run film, and the IMRT field simulate image were included in the treatment information flow procedure QA. The patient setup QA, the verification of the IMRT treatment fields to the patients, and the examination of the data in the Record & Verify system make up the treatment delivery QA procedure. RESULTS: The point dose measurement results of 10 cases showed good agreement with the RTP calculation within 3%. One case showed more than a 3% difference and the other case showed more than 5%, which was out side the tolerance level. We could not find any differences of more than 2 mm between the RTP leaf sequence and the dry run film. Film dosimetry and the dose distribution from the phantom plan showed the same tendency, but quantitative analysis was not possible because of the film dosimetry nature. No error had been found from the MLC control file and one mis-registration case was found before treatment. CONCLUSION: This study shows the usefulness and the necessity of the IMRT patient QA program. The whole procedure of this program should be performed, especially by institutions that have just started to accumulate experience. But, the program is too complex and time consuming. Therefore, we propose practical and essential QA items for institutions in which the IMRT is performed as a routine procedure.
Film Dosimetry ; Humans

BACKGROUND: We investigated whether the cardiovascular responses to intubation change as a function of the time elapsed in patients with spinal cord injury. METHODS: One hundred and fifty eight patients with traumatic complete spinal cord injury were grouped according to the time elapsed after injury (less than and more than 4 wks) and the level of injury (above C7, T1-T4, and below T5). There were six groups: acute quadriplegia (n = 28), chronic quadriplegia (n = 29), acute high paraplegia (n = 8), chronic high paraplegia (n = 11), acute low paraplegia (n = 29) and chronic low paraplegia (n = 53). Twenty-five patients with no spinal cord injury served as controls. Systolic arterial blood pressure (SAP), heart rate, and plasma concentrations of catecholamines were measured. RESULTS: The intubation did not affect SAP in acute and chronic quadriplegics, but significantly increased SAP in the other groups. The magnitude of peak increase was less in acute high paraplegics (P<0.05), but comparable in chronic high paraplegics, and acute and chronic low paraplegics to that of the controls. Heart rates were significantly increased in all groups. However, the magnitude of this increase was smaller in acute quadriplegics and in acute high paraplegics than in the controls (P<0.05). Plasma concentrations of norepinephrine increased in all groups except in acute quadriplegics (P<0.05). The magnitude of this increase was attenuated in chronic quadriplegics, accentuated in acute low paraplegics, and similar in acute and chronic high paraplegics and in chronic low paraplegics versus the controls. CONCLUSIONS: The cardiovascular and plasma catecholamine responses to endotracheal intubation may differ according to the time elapsed and the affected level in patients with complete spinal cord injuries.
Arterial Pressure ; Catecholamines ; Heart Rate ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Norepinephrine ; Paraplegia ; Plasma ; Quadriplegia ; Spinal Cord Injuries* ; Spinal Cord* ; Tachycardia