PURPOSE: To develop the dose volume histogram (DVH) management software which guides the evaluation of radiotherapy (RT) plan of a new case according to the biological consequences of the DVHs from the previously treated patients. MATERIALS AND METHODS: We determined the radiation pneumonitis (RP) as an biological response parameter in order to develop DVH management software. We retrospectively reviewed the medical records of lung cancer patients treated with curative 3-dimensional conformal radiation therapy (3D-CRT). The biological event was defined as RP of the Radiation Therapy Oncology Group (RTOG) grade III or more. RESULTS: The DVH management software consisted of three parts (pre-existing DVH database, graphical tool, and Pinnacle3 script). The pre-existing DVH data were retrieved from 128 patients. RP events were tagged to the specific DVH data through retrospective review of patients' medical records. The graphical tool was developed to present the complication histogram derived from the pre-existing database (DVH and RP) and was implemented into the radiation treatment planning (RTP) system, Pinnacle3 v8.0 (Phillips Healthcare). The software was designed for the pre-existing database to be updated easily by tagging the specific DVH data with the new incidence of RP events at the time of patients' follow-up. CONCLUSION: We developed the DVH management software as an effective tool to incorporate the phenomenological consequences derived from the pre-existing database in the evaluation of a new RT plan. It can be used not only for lung cancer patients but also for the other disease site with different toxicity parameters.
Humans ; Incidence ; Lung Neoplasms ; Medical Records ; Radiation Pneumonitis ; Retrospective Studies

The funding acknowledgment in this article was partially omitted as published.

PURPOSE: To assess the clinical pattern, the histopathological findings, the response to treatments, the recurrence pattern and the prognosis of malignant lymphoma in the ocular adnexa. METHODS: This study was performed on 22 total eyes from 17 patients who were diagnosed with ocular adnexal malignant lymphoma. We retrospectively analyzed the medical records for patient information including the histological classification based on age, the gender of each patient, the symptoms and signs at the initial diagnosis, the presence of binocular invasion, the findings of the surgical biopsy, the clinical stage of each patient's tumor, and the treatment methods used and their effectiveness. The mean follow-up period was 24.8 months. RESULTS: The mean age of patients studied was 46.8 years old. Six females and 11 males were included in the study. Fifteen cases consisting of 20 total eyes represented extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT). Five of seven patients (71.4%) whose lymphoma occurred within the conjunctiva relapsed after irradiation or chemotherapy, and four of the relapsed patients were salvaged with further therapy. CONCLUSIONS: Extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT) constituted 88.2% of all lymphomas involving the ocular adnexa. Lymphoma in the ocular adnexa responded well to conventional treatment, but the recurrence rate of lymphoma in the conjunctiva was significantly high.
Treatment Outcome ; Retrospective Studies ; Neoplasm Recurrence, Local ; Middle Aged ; Male ; Lymphoma, Mucosa-Associated Lymphoid Tissue/drug therapy/*pathology/radiotherapy/surgery/*therapy ; Humans ; Follow-Up Studies ; Female ; Eye Neoplasms/drug therapy/*pathology/radiotherapy/surgery/*therapy ; Combined Modality Therapy ; Biopsy ; Aged, 80 and over ; Aged ; Adult

No abstract available.
Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis*

OBJECTIVES: One hypothesis of obstructive sleep apnea syndrome (OSAS) is that long-standing snoring vibrations and hypoxia of the nerves cause a local neuropathy in the upper airway during sleep. The aim of this study was to investigate olfactory function in subjects comprising snorers and untreated subjects with OSAS, and to correlate data with polysomnographic parameters. METHODS: Sixty-nine patients were evaluated for snoring from January 2010 to December 2013. The mild group (apneahypopnea index [AHI]<15) consisted of 19 subjects, and the moderate-severe group (AHI≥15) consisted of 50 subjects. Exclusion criteria were conductive olfactory dysfunction, previous tonsil or soft palatal surgery, central sleep apnea, and medications that are known to affect peripheral nerves. Nocturnal polysomnography and olfactory function test such as Korean version of Sniffin’s stick test I, II (KVSS I, II) were performed. RESULTS: There was a significant difference in body mass index, average oxygen saturation (SaO2), lowest SaO2, average snoring duration, and KVSS I, II between the two groups. AHI was related to odor threshold score, and average SaO2 was related to odor discrimination score. But, odor identification score showed no relation with AHI and average SaO2 except for age. Average SaO2 and AHI were closely related to the function of smell. CONCLUSION: Hypoxia and low nasal airflow caused by OSAS may have an effect on the olfactory function. On comparison between the two groups, patients with a high AHI, especially those with OSAS, had an olfactory dysfunction. Also, low average oxygen is the main risk factor in determining the olfactory function. In people with OSAS, the possibility of olfactory dysfunction should be considered and an olfactory function test should be performed.
Anoxia ; Body Mass Index ; Discrimination (Psychology) ; Humans ; Odors ; Olfaction Disorders ; Oxygen ; Palatine Tonsil ; Peripheral Nerves ; Polysomnography ; Risk Factors ; Sleep Apnea Syndromes* ; Sleep Apnea, Central ; Sleep Apnea, Obstructive ; Smell ; Snoring ; Vibration

Sclerotherapy has been demonstrated as an effective and minimally invasive procedure for varicose veins of the lower limbs, which can be performed on an out-patient basis. Between March 2000 and August 2001, we reviewed 138 patients who had been diagnosed as chronic venous disease in our hospital, and treated and evaluated a total of 32 limbs in 21 patients with primary varicose veins. There were 18 women and 3 men whose age was ranging from 31 to 55 years old, with a mean of 41.7 years. Eleven of 21 patients had bilateral involvement of lower extremity. Sclerodex (Sclerosant) was administered for telangiectasia less than 1 mm and reticular vein less than 4 mm, and Thromboject (Sodium Tetradecyl Sulfate) was for reticular vein more than 4 mm. Two types of operations were stripping of saphenous vein (6 cases) and high ligation (18 cases). All patients were cosmetically satisfied with the results. Minor complications after injection such as 7 cases (21.9 %) of erythema, 5 cases(15.6 %)of bullae, 4 cases (12.5 %)of thrombosis were occurred. However, no permanent change such as skin necrosis and pigmentation were appeared. Systemic responses such as dizziness or sweating were not observed in anyone. Sclerotherapy should improve both the safety and efficacy of the treatment of varicose vein. Our study suggests that the careful evaluation before planning the treatment of varicose vein is important for exact choice of patients and proper results.
Dizziness ; Erythema ; Extremities ; Female ; Humans ; Ligation ; Lower Extremity ; Male ; Middle Aged ; Necrosis ; Outpatients ; Pigmentation ; Saphenous Vein ; Sclerotherapy* ; Skin ; Sweat ; Sweating ; Telangiectasis ; Thrombosis ; Varicose Veins* ; Veins

BACKGROUND: Many types of cancer become resistant to current chemotherapeutic and radiotherapeutic intervention. To overcome this situation application of gene therapy by the introduction of suicide genes followed by their prodrugs may be promising. A viral enzyme, Herpes simplex thymidine kinase (HSV-tk), which converts ganciclovir from an inactive prodrug to a cytotoxic agent by phosphorylation, are being actively investigated for use in gene therapy for cancer. The purpose of this study was to determine whether combining prodrug-activating gene therapy and irradiation might result in enhanced antitumor effects. METHODS: The HSV-tk gene was cloned into the retroviral vector, pLXSN and established the clones producing retroviruses carrying the HSV-tk gene. The carcinoma cell line, HCT116 and Huh-7 were transduced with high-titer recombinant retroviruses. These cell lines were treated with ganciclovir before or after irradiation for the defining combinational effect of suicide gene therapy and radiotherapy. RESULTS: The titers of cloned PA3 17 amphotropic retroviruses ranged from 4 to 6 X 10(6) CFU/ml . After selectional periods, the expression of HSV-tk was confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR). The growth of cells expressing HSV-tk was inhibited as increase of GCV dose after 48 hr and the growth inhibitory effect of GCV was much higher after 72 hr. When the cells transduced with HSV-tk gene were exposed to radiation, the growth inhibitory effect of GCV was significantly increased, as compared with non-transduced parental cells. CONCLUSIONS: The result s suggest that the addition of HSV-tk gene therapy to standard radiation therapy may improve the effectiveness of treatment for solid tumors.
Cell Line ; Clone Cells ; Ganciclovir* ; Genetic Therapy ; Herpes Simplex* ; Humans ; Parents ; Phosphorylation ; Polymerase Chain Reaction ; Prodrugs ; Radiotherapy ; Retroviridae ; Simplexvirus* ; Suicide ; Thymidine Kinase* ; Thymidine* ; Zidovudine

PURPOSE: The c-met protein, known as the hepatocyte growth factor (HGF) receptor, is a transmembrane 190 kDa heterodimer having tyrosine kinase activity, and it is encoded by the c-met oncogene. The HGF/c-met signaling pathway has been shown to demonstrate various cellular responses including mitogenic, proliferative, morphogenic and angiogenic activities. Although HGF and c-met are known to be expressed in a variety of organs and they play important roles in signal transduction, studies on its expression and its correlation to the clinicopathological parameters of breast cancer are very rare. METHODS: In this study, we examined the c-met mRNA and the c-met protein expression by utilizing RT-PCR and immunohistochemical methods for 50 cases of invasive ductal carcinomas (IDCs) and 20 cases of normal breast tissues. RESULTS: The c-met mRNA amplification was detected in 35 cases of IDCs (70%), but not in the normal tissues. The c-met protein overexpression was detected in 27 cases of IDCs (54%) and 2 cases of normal breast tissue (10%). Both the mRNA amplification and protein overexpression rates were significantly higher in tumor than in the normal breast tissue. The c-met mRNA amplification showed a tendency to increase in an invasive cancer and nodal metastasis. The c-met protein overexpression was significantly correlated with the well differentiated grade of tumor and it showed a tendency to decrease in the metastatic tumors. The concordance between both the mRNA amplification and protein expressions were not observed. CONCLUSION: These results suggest that the HGF/c-met signal pathway may be associated with the development of breast cancer. c-met mRNA amplification may play important roles both in tumor progression and metastasis. c-met protein overexpression may contribute to the morphogenesis of well-differentiated tumor.
Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Hepatocyte Growth Factor ; Morphogenesis ; Neoplasm Metastasis ; Oncogenes ; Protein-Tyrosine Kinases ; RNA, Messenger ; Signal Transduction

Membranous nephropathy (MGN) is a common cause for nephrotic syndrome in adults. Renal failure usually develops gradually in patients with MGN and rapid deterioration of renal function is a rare complication. Moreover, the development of crescentric glomerulonephritis (CGN) as a cause of acute renal failure (ARF) in patients with preexisting MGN is very rare. We report 20-year-old male patient with MGN who presented with ARF due to superimposed CGN. He had been diagnosed as idiopathic MGN and his renal function was maintained within normal range. After 13 months of conservative treatment, ARF was developed and renal biopsy was performed to differentiate the possible causes of ARF. Renal biopsy revealed diffuse crescents formation on preexisting MGN. Anti-GBM antibody and ANCA were not detected. This patient was treated with combination therapy including methylprednisolone pulse therapy followed by high dose steroid and cyclophosphamide. His renal function was improved significantly 2 weeks after treatment. In conclusion, when unexplained ARF in patient with MGN develops, prompt investigation for superimposed conditions including CGN is necessary and repeat renal biopsy should be considered.
Acute Kidney Injury ; Adult ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Cyclophosphamide ; Glomerulonephritis* ; Glomerulonephritis, Membranous* ; Humans ; Male ; Methylprednisolone ; Nephrotic Syndrome ; Reference Values ; Renal Insufficiency ; Young Adult

POEMS syndrome is a rare paraneoplastic syndrome, which includes polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes due to plasma cell (PC) neoplasm. Diagnosis of this disease is challenging because of its rarity and complex clinical manifestations. We attempted to identify the key clinical features and characteristic bone marrow (BM) findings of POEMS syndrome, by reviewing the medical records and BM analyses of 24 Korean patients. Frequent clinical manifestations included polyneuropathy (100%), monoclonal gammopathy (100%), organomegaly (92%), extravascular volume overload (79%), and endocrinopathy (63%). The BM analyses revealed mild PC hyperplasia (median PCs: 5.5%) and frequent megakaryocytic hyperplasia (88%), megakaryocyte clusters (88%), and hyperlobation (100%). Flow cytometry of BM aspirates using CD138/CD38/CD45/CD19/CD56 showed normal (67%, 4/6) or neoplastic PC immunophenotypes (33%, 2/6). A diagnosis of POEMS syndrome must be considered when a patient suspected of having PC dyscrasia shows the above clinical presentation and BM findings.
Bone Marrow ; Diagnosis ; Flow Cytometry ; Humans ; Hyperplasia ; Medical Records ; Megakaryocytes ; Paraneoplastic Syndromes ; Paraproteinemias ; Plasma Cells ; POEMS Syndrome ; Polyneuropathies ; Skin