No abstract available.
Postpartum Period* ; Pregnancy*

The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired.
Abdomen ; Bacteria ; Biopsy ; Busan ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colonoscopy ; Congenital Abnormalities ; Constipation ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Ileocecal Valve ; Incidence ; Inflammation ; Leukocyte Count ; Male ; Melena ; Occult Blood ; Tuberculosis* ; Ulcer

Endoscopic biliary stents provide effective palliation of malignant obstructive jaundice in patients who are not surgical candidates. Unfortunately the stents in current use have a tendency to block. The clogging phenomenon also severely restricts the value of stents in patients with benign strictures. We studied the mechanism of the occlusion of biliary stents to find ways to prevent it. We have examined 17 blocked stents by electron microscopy(EM), infrared absorption spectrophotometry, and bacteriological cultures. The mean time to stent clogging with 10 french stents was 131 days, and with 12 French stents was 143 days. The differece between the clogging time of the two stents was statistically not sigificant. Scanning EM showed that the internal surfaces of the stent were covered with bacteria embedded in a condensed fibrillar intercellular matrix. The bacteris form a surrounding fibrillar extracellular product which anchors them to the stent. Inorganic crystals were rarely seen, because they presumable dissolved during the fixing for EM. These EM findings are typical of a biofilm. As major components of the occluding material calcium bilirubinate was identified in 15 stents by infrared absorption spectrophotometry. 7 different microorgainsms were isolated from the 17 blocked biliary stents. 6 of the isolates were gram-negative, and 1 was gram-positive. The most frequently isolated genus was Escherichia, which was found in 8 stents, followed by proteus, Pseudomonas, and Morganella, which was found in 2 stents respectvely. We propose that stent colgging is initiated by bacterial adhesion and growth of a biofilm. The bacteria then deconjugate bilirubin in bile and the lumen is progressively occluded by deposition of calcium bilirubinate and further biofilm formation.
Absorption ; Bacteria ; Bacterial Adhesion ; Bile ; Bilirubin ; Biofilms ; Constriction, Pathologic ; Escherichia ; Humans ; Jaundice, Obstructive ; Microscopy, Electron* ; Morganella ; Proteus ; Pseudomonas ; Spectrophotometry ; Stents*

We report a case of acute graft-versus-host disease, which developed after bone marrow transplantation because of acute myelocytic leukemia in a 39-year old male, The pruritic, erythematous maculopapular eruptions began to developed on the perioral regions, and spreaded the face, the oral mucosa, both hands, and buttocks at the twenty fourth day after bone marrow transplanta.tion. The eruptions were confluent to form erythematous patches. Iistopathological findings show parakeratosis, lymphoid cell exocytosis, and papillary edema, lymphohistiocytic infiltration, and melanophage in the upper dermis, and basal vacuolation. He was treated systemically by methylprednisolone, and antilymphocytic globulin, and tapically by emollients and steroids.
Adult ; Bone Marrow ; Bone Marrow Transplantation ; Buttocks ; Dermis ; Edema ; Emollients ; Exocytosis ; Graft vs Host Disease* ; Hand ; Humans ; Leukemia, Myeloid, Acute ; Lymphocytes ; Male ; Methylprednisolone ; Mouth Mucosa ; Parakeratosis ; Steroids

PURPOSE: 3D conformal radiotherapy, the optimum dose delivered to the tumor and provided the risk of normal tissue unless marginal miss, was restricted by organ motion. For tumors in the thorax and abdomen, the planning target volume (PTV) is decided including the margin for movement of tumor volumes during treatment due to patients breathing. We designed the respiratory gating radiotherapy device (RGRD) for using during CT simulation, dose planning and beam delivery at identical breathing period conditions. Using RGRD, reducing the treatment margin for organ (thorax or abdomen) motion due to breathing and improve dose distribution for 3D conformal radiotherapy. MATERIALS AND METHODS: The internal organ motion data for lung cancer patients were obtained by examining the diaphragm in the supine position to find the position dependency. We made a respiratory gating radiotherapy device (RGRD) that is composed of a strip band, drug sensor, micro switch, and a connected on-off switch in a LINAC control box. During same breathing period by RGRD, spiral CT scan, virtual simulation, and 3D dose planing for lung cancer patients were performed, without an extended PTV margin for free breathing, and then the dose was delivered at the same positions. We calculated effective volumes and normal tissue complication probabilities (NTCP) using dose volume histograms for normal lung, and analyzed changes in doses associated with selected NTCP levels and tumor control probabilities (TCP) at these new dose levels. The effects of 3D conformal radiotherapy by RGRD were evaluated with DVH (Dose Volume Histogram), TCP, NTCP and dose statistics. RESULTS: The average movement of a diaphragm was 1.5 cm in the supine position when patients breathed freely. Depending on the location of the tumor, the magnitude of the PTV margin needs to be extended from 1 cm to 3 cm, which can greatly increase normal tissue irradiation, and hence, results in increase of the normal tissue complications probability. Simple and precise RGRD is very easy to setup on patients and is sensitive to length variation (+2 mm), it also delivers on-off information to patients and the LINAC machine. We evaluated the treatment plans of patients who had received conformal partial organ lung irradiation for the treatment of thorax malignancies. Using RGRD, the PTV margin by free breathing can be reduced about 2 cm for moving organs by breathing. TCP values are almost the same values (4-5% increased) for lung cancer regardless of increasing the PTV margin to 2.0 cm but NTCP values are rapidly increased (60-70% increased) for upon extending PTV margins by 2.0 cm. CONCLUSION: Internal organ motion due to breathing can be reduced effectively using our simple RGRD. This method can be used in clinical treatments to reduce organ motion induced margin, thereby reducing normal tissue irradiation. Using treatment planning software, the dose to normal tissues was analyzed by comparing dose statistics with and without RGRD. Potential benefits of radiotherapy derived from reduction or elimination of planning target volume (PTV) margins associated with patient breathing through the evaluation of the lung cancer patients treated with 3D conformal radiotherapy.
Abdomen ; Diaphragm ; Humans ; Lung ; Lung Neoplasms ; Radiotherapy ; Radiotherapy, Conformal* ; Respiration ; Supine Position ; Thorax ; Tomography, Spiral Computed

PURPOSE: In order to improve dose homogeneity and to reduce acute toxicity in tangential whole breast radiotherapy, we evaluated two treatment techniques using multiple static fields or universal compensators. MATERIALS AND METHODS: 1) Multistatic field technique : Using a three dimensional radiation treatment planning system, Adac Pinnacle 4.0, we accomplished a conventional wedged tangential plan. Examining the isodose distributions, a third field which blocked overdose regions was designed and an opposing field was created by using an automatic function of RTPS. Weighting of the beams was tuned until an ideal dose distribution was obtained. Another pair of beams were added when the dose homogeneity was not satisfactory. 2) Universal compensator technique : The breast shapes and sizes were obtained from the CT images of 20 patients who received whole breast radiation therapy at our institution. The data obtained were averaged and a pair of universal physical compensators were designed for the averaged data. DII (Dose Inhomogeneity Index : percentage volume of PTV outside 95-105% of the prescribed dose), Dmax (the maximum point dose in the PTV) and isodose distributions for each technique were compared. RESULTS: The multistatic field technique was found to be superior to the conventional technique, reducing the mean value of DII by 14.6% ( p value<0.000) and the Dmax by 4.7% ( p value<0.000). The universal compensator was not significantly superior to the conventional technique since it decreased Dmax by 0.3% ( p value=0.867) and reduced DII by 3.7% ( p value=0.260). However, it decreased the value of DII by maximum 18% when patients' breast shapes fitted in with the compensator geometry. CONCLUSION: The multistatic field technique is effective for improving dose homogeneity for whole breast radiation therapy and is applicable to all patients, whereas the use of universal compensators is effective only in patients whose breast shapes fit inwith the universal compensator geometry, and thus has limited applicability.
Breast* ; Humans ; Radiotherapy

PURPOSE: Planning target volume (PTV) for tumors in abdomen or thorax includes enough margin for breathing-related movement of tumor volumes during treatment. Depending on the location of the tumor, the magnitude of PTV margin extends from 10 mm to 30 mm, which increases substantial volume of the irradiated normal tissue hence, resulting in increase of normal tissue complication probability (NTCP). We developed a simple and handy method which can reduce PTV margins in patients with liver tumors, respiratory motion reduction device (RRD). MATERIALS AND METHODS: For 10 liver cancer patients, the data of internal organ motion were obtained by examining the diaphragm motion under fluoroscope. It was tested for both supine and prone position. A RRD was made using MeV-Green and Styrofoam panels and then applied to the patients. By analyzing the diaphragm movement from patients with RRD, the magnitude of PTV margin was determined and dose volume histogram (DVH) was computed using AcQ-Plan, a treatment planning software. Dose to normal tissue between patients with RRD and without RRD was analyzed by comparing the fraction of the normal liver receiving to 50% of the isocenter dose. DVH and NTCP for normal liver and adjacent organs were also evaluated. RESULTS: When patients breathed freely, average movement of diaphragm was 12+/-1.9 mm in prone position in contrast to 16+/-1.9 mm in supine position. In prone position, difference in diaphragm movement with and without RRD was 3+/-0.9 mm and 12 mm, respectively, showing that PTV margins could be reduced to as much as 9 mm. With RRD, volume of the irradiated normal liver reduced up to 22.7% in DVH analysis. CONCLUSION: Internal organ motion due to breathing can be reduced using RRD, which is simple and easy to use in clinical setting. It can reduce the organ motion-related PTV margin, thereby decrease volume of the irradiated normal tissue.
Abdomen ; Carcinoma, Hepatocellular* ; Diaphragm ; Humans ; Liver ; Liver Neoplasms ; Prone Position ; Respiration ; Supine Position ; Thorax

Rupture limited to the lobar bronchus from blunt trauma is especially rare, and the symptoms are light so diagnosis is difficult. In a patient who visited the hospital complaining of shortness of breath after falling down, atelectasis continued in the chest x-ray. Four days after visiting the hospital, a left upper lobar bronchial rupture was diagnosed through a bronchoscopy and 3 dimensional chest computerized tomography. When diagnosis is delayed in the case of a rupture limited to the lobar bronchus, bronchial obstruction can occur from the formation of granulation tissue, so regular monitoring is important. Therefore, when atelectasis continues after blunt trauma, it is important to differentially diagnose a lobar bronchial rupture through tests such as bronchoscopy.
Bronchi ; Bronchoscopy ; Diagnosis ; Dyspnea ; Granulation Tissue ; Humans ; Lung Injury ; Pulmonary Atelectasis* ; Rupture* ; Thorax

A Clinical analysis was carried out with 340 cases of craniocerebral injuries under 15 years of age, admitted at the Department of Neurosurgery, Seoul National University Hospital in 12 years between Jan., 1987 and Dec., 1969. The matrial was classified four groups according to main lesions, i.e. (1) mild cerebral contusion without skull fractures. (2) moderate or severe cerebral contusion without skull fractures. (3) various types of skull fractures. (4) intracranial hemorrhagic lesions, representing such lesions as follows: a. epidural hematoma, b. subdural hematoma, c. subdural hygroma, d. intracerebral hematoma, e. traumatic subarachnoid hemorrhage. The results were as follows: 1) The age incidence was greatest in 6 years of age, and 120 cases (32.6% of the total) were included in the age group between four and six. 2) Males outnumbered females by almost 2 to 1. 3) The accident occurred mostly between 1 p.m. and 4 p.m. in a day. 4) The craniocerebral injuries were caused by traffic accident(173 cases; 50.8%), falls from heights(108 cases; 31.8%), hit(55 cases; 10.9%), firearms(2 cases; 0.6%) and birth injury (2 cases; 0.6%). 5) Early convulsion was the frequent symptom in the age group between 2 and 7. It was felt that convulsions frequently occurred in epidural and subdural hematoma patients. 6) Forty eight per cent of patients had no deterioration of consciousness on admission examination. 7) Epidural hematoma was the common finding in most of the depressed skull fracture cases. 8) The location of skull fractures in the order of frequency were parietal, temporal, frontal and occipital bone. 9) The epidural hematoma was most common lesion in the 13 to 15 year-old group. 10) The over-all mortality rate was 7.1%. In the surgical group(79 cases) the operative mortality was 11.4%(9 cases): the mortality rate of the subdural hematoma, 25.0%(3 cases); the epidural hematoma, 11.1%(2 cases); the compound depressed fracture, 7.8%(2 cases). In the non-surgical group(261 cases) it was 5.8%. The mortality rate of those who and been unconscious after injuries was significantly high(75.0%). 11) The period of hospitalization was two weeks on an average.
Adolescent ; Birth Injuries ; Child* ; Consciousness ; Contusions ; Craniocerebral Trauma* ; Female ; Hematoma ; Hematoma, Subdural ; Hospitalization ; Humans ; Incidence ; Infant* ; Male ; Mortality ; Neurosurgery ; Occipital Bone ; Rabeprazole ; Seizures ; Seoul ; Skull Fracture, Depressed ; Skull Fractures ; Subarachnoid Hemorrhage, Traumatic ; Subdural Effusion

No abstract available.
Cystitis* ; Ultrasonography*