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%), locoregional failure in 8(12.5%), distant metastasis in 8(12.5%), paraaortic node metastasis in 1 and one patient had 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 thickness 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 not improve results but only increases complication.
Cervix Uteri ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Pelvis ; Radiation Oncology ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Failure ; Uterine Cervical Neoplasms*

PURPOSE: PVP using a high-power potassium-titanly-phosphate(KTP) laser offers safe and efficacious surgical therapy for men with symptomatic BPH. To demonstrate its efficacy, safety and durability, we present the results of PVP for treatment of BPH with 12 month follow-up. MATERIALS AND METHODS: 104 consecutive men with symptomatic BPH underwent PVP with an 80 W KTP laser (Laserscope) between July 2003 and August 2004. All underwent preoperative and postoperative evaluation, including assessments of international prostate symptom score(IPSS), quality of life(QOL), peak urinary flow rate(Qmax), post-void residual volume(PVR), prostate specific antigen(PSA), and ultrasound prostate volume(PV). Secondary outcome parameters included surgical time, anesthesia, and length of catheterization. Follow-up assessment occurred at 1, 3, 6, and 12 months. Data were analyzed using the Wilcoxon signed rank test. RESULTS: Preoperative mean PV was 57.2+/-4.2 ml. PV decreased to 38.9, 35.4, 32.8 and 35.8 at 1, 3, 6 and 12 months (p <0.01 versus preoperative value). Mean improvements in IPSS, QOL, Qmax, and PVR at 12 months were 67%, 81%, 138% and 94%, respectively(p <0.001). Mean operative time was 26.3+/-15.0 minutes. Anesthesia included pudendal and prostatic block(n=102) and spinal anesthesia(n=2). Ninety-nine(95%) patients were treated as outpatients( <12 hrs) and the remaining 5 patients were admitted for 1 or 2 hospital days. Mean catheterization times were 9.8+/-3.1 hours(range 0~72), with 28(27%) patients not requiring a catheter post-operatively. Minor complications included mild hematuria lasting 3 weeks(3.8%), transient post-operative retention(2.9%), urge incontinence(1.9%), transient dysuria(25%), frequency(21.2%), urgency(17.3%) and retrograde ejaculation(41%). CONCLUSIONS: These results demonstrate that PVP is safe and efficacious for the treatment of symptomatic BPH. Long follow-up will further validate this new modality as the standard for surgical treatment of BPH.
Anesthesia ; Catheterization ; Catheters ; Follow-Up Studies ; Hematuria ; Humans ; Lasers, Solid-State* ; Male ; Operative Time ; Prostate ; Ultrasonography ; Volatilization*

A retrospective analysis was performed on 53 patients with brain malignant astrocytoma and glioblastoma multiforme treated with surgical resection and postoperative radiotherapy in the period between January 1980 and June 1991. There were 13 patients with malignant astrocytoma, 40 patients with glioblastoma multiforme. Survival rates were analyzed according to histologic grade, age, performance states, extent of surgical resection, tumor location, symptom duration, total radiation dose and addition of chemotherapy after radiation therapy. 5 year actuarial survival rate for malignant astrocytoma was 29.4%, for glioblastoma multiforme was 2.8%. Histologic grade, age, performance status, total radiation dose were statistitically significant prognostic factors.
Astrocytoma* ; Brain ; Drug Therapy ; Glioblastoma* ; Humans ; Radiotherapy* ; Retrospective Studies ; Survival Rate

Volume replacement is a vital therapy in patient with circulatory shock, but the type of fluid that should be infused remains in controversy. This study is designed to compare the cardiopulmonary effects of a colloid solution and a crystalloid solution in dogs subjected to severe hemorrhagic shock. Twelve dogs were bled into shock and mean arterial pressure(MAP) were maintained at 60 mmHg for 1 hour followed by further hemorrhage to 40 mmHg for additional one hour, Animals were randomized to fluid challenge with 10% pentastarch(group P) or 0.9% normal saline(group S) to restore MAP. Complete hemodynamic and blood gas parameters and plasma lactate concentration were measured at pre-shock, during shock and after resuscitation for 2 hours. Cardiac function and hemodynamic stability were restored to higher level than the control level on the completion of fluid challenge with each type of solution, but hemodynamic parameters decreased as time goes after resuscitation. Especially in group S, hemodynamic parameters decreased more significantly and rapidly than group P. Considering the relation of left ventricular stroke work index(LVSWI) and pulmonary capillary wedge pressure(PCWP), the cardiac performance was well maintained to normal level in group P during post-resuscitation period, but rapidly deteriorated in group S. There was a significant increase in intrapulmonary shunt fraction with pentastarch that was maximal on the completion of fluid challenge but which normalized over the next 1 hour. Assessment of tissue perfusion was measured by mixed venous oxygen tension(PVO2) and plasma lactate concentration. In group P, PVO. was restored to higher than the control level and maintained to the cantrol level during post-resuscitation period, but in group S, it was not restored to control level at the completion of fluid challenge, moreover after then, it decreased progressively. Plssma lactate concentration was recovered to control level in group P at the completion of fluid challenge, but in group S, it was recovered lately. It means that tissue perfusion was more rapidly and effectively restored in group P than group S. In conclusion, infusion of pentastarch at severe hemorrhagic shock restored the hemodynamic parameter more rapidly and maintained cardiac performance more effectively during post-resuscitation period than normal saline. Infusion of pentastarch also maintained tissue perfusion more effectively but it increased intrapulmonary shunt fraction transiently.
Animals ; Capillaries ; Colloids ; Dogs ; Hemodynamics ; Hemorrhage ; Humans ; Hydroxyethyl Starch Derivatives* ; Lactic Acid ; Oxygen ; Perfusion ; Plasma ; Resuscitation* ; Shock* ; Shock, Hemorrhagic ; Stroke

The B-type gamma knife unit was installed at Kyung-Hee University Hospital in March 1992. The selective beam plugging method can be used to reduce the low percentage isodose profiles of normal sensitive organ and to codify the isodose cuties of treatment volume for better shaping of the target volume. For representing the changes of the law percentage isodose profiles, the variations of dose distribution for several cases were discussed in this paper. The film dosimetry was performed for the evaluation of calculated isodose profiles predicted by KULA dose planning system. The results were verified by RFA-3 automatic densitometry. The clinical application of selective beam shielding method was performed in 17 patients in 100 patients who have undergone gamma knife radiosurgery for a year. The calculated and the measured isodose profiles for the high percentage regions were well consistent with each other. When the target of pituitary tumor is macro-size, the selective beam shielding method is the most applicable method. When the target size, however, is small, the correct selection of the proper helmet size is very important. All patients were exposed almost about 3~12 Gy for brain stem, and 3~11.2 Gy for optic apparatus. It is recommended that the same or other plugging patterns with multiple isocenters should be used for protection of the radiosensitive normal structures with precise treatment of CNS lesions.
Brain Stem ; Densitometry ; Film Dosimetry ; Head Protective Devices ; Humans ; Jurisprudence ; Pituitary Neoplasms ; Radiosurgery

A 5-year-old male patient was admitted due to fever, and right upper abdominal pain for 2 weeks. He showed severe right upper quadrant tenderness on palpation, hepatomegaly 5 cm below the right costal margin, no mass, and no splenomegaly. On biochemical studies, ALT was 380IU/ml, AST 462IU/ml, alkaline phosphatase 1,069IU/ml, GTP 239IU/ml, and total bilirubin 2.1mg/dl. Endoscopic retrograde cholangiopancreatography (ERCP) showed cylindrical dilatations of CBD and cystic dilatations with strictures of extrahepatic and both bilateral intrahepatic bile ducts (choledochal cyst type IVa) with multiple stones in the CBD and extra- and intrahepatic bile ducts. Endoscopic sphincterotomy (EST) and stone extraction with basket and balloon were performed successfully. The bile was severely purulent and the stones were pigment stones. Klebsiella pneumoniae were dominantly grown on bile culture. An endoscopic nasobiliary drainage (ENBD) tube was inserted to treat biliary sepsis. The bile ducts were irrigated with tobramycin-mixed normal saline twice a day for 2 week, when ALT, AST, total bilirubin and liver size were normalized and no more bacteria was grown on bile culture. The clinical symptoms were improved just after the therapeutic ERCP. There was no side effect by ERCP, EST and ENBD.
Abdominal Pain ; Alkaline Phosphatase ; Bacteria ; Bile ; Bile Ducts ; Bile Ducts, Intrahepatic ; Bilirubin ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis* ; Choledochal Cyst* ; Choledocholithiasis* ; Constriction, Pathologic ; Dilatation ; Drainage* ; Fever ; Guanosine Triphosphate ; Hepatomegaly ; Humans ; Klebsiella pneumoniae ; Liver ; Male ; Palpation ; Sepsis ; Sphincterotomy, Endoscopic ; Splenomegaly

Radiation-induced liver disease (RILD) has been characterized as a veno-occlusive disease with anicteric elevation of alkaline phosphatase (ALP). However, some RILD patients present with elevated transaminase levels rather than with anicteric elevation of ALP, and these findings are common in the Asia-Pacific region where hepatitis B virus (HBV) infection is associated with 70~90% of hepatocelluar carcinoma (HCC) cases. In addition, the development of RILD is more common in patients with hepatitis B virus-related HCC. These findings indicate that susceptibility to RILD might be different in HBV carriers and non-carriers, and moreover, RILD in patients with HBV-related HCC might be associated with another unique pathogenesis such as HBV reactivation. However, HBV reactivation after hepatic irradiation has been reported in only a few studies. This study reports three cases of HBV reactivation after hepatic tomotherapy for management of HCC.
Alkaline Phosphatase ; Carcinoma, Hepatocellular ; Hepatitis ; Hepatitis B ; Hepatitis B virus ; Humans ; Liver Diseases

The precise role of radiotherapy for low grade gliomas including the optimal radiation dose and timing of treatment remains unclear. The information given by a retrosepctive analysis may be useful in the design of prospective randomized studies looking at radiation dose and time of surgical and radiotherapeutic treatment. The records of 56 patients (M:F=29:27) with histologically verified cerebral low grade gliomas(47 cases of grade 1 or 2 astrocytomas and 9 oligodendrogliomas) diagnosed between 1979 and 1989 were retrospectively reviewed. The extent of surgical tumor removal was gross total or radical subtotal in 38 patients(68%) and partial or biopsy only in the remaining 18 patients(32%). Postooperative radiation therapy was given to 36 patients(64%) of the total 56 patients with minimum dose of 5000 cGy (range=1250 to 7220 cGy). The 5-and 10-year survival rates for the total 56 patients were 44% and 32% respectively with a median survival of 4.1 years. According to the histologic grade the 5- and 10-year survivals were 52% and 35% for the 24 patients respectively with grade I astrocytomas compared to 20% and 10% for the 23 patients with grade II astrocytomas. Survival of oligodendroglioma patients was greater than those with astrocytoma (65% vs 36% at 5 years), and the difference was also remarkable in the long term period of follow up (54% vs 23% at 10 years). Those who received high-dose radiation therapy (> or =5400 cGy) had significant better survival than those who received low-dose radiation(< 5400 cGy) or surgery alone (p<0.05). The 5-and 10-year survival rates were, respectively 59% and 46% for the 23 patients receiving high-dose radiation, 36% and 24% for the 13 patients receiving low-dose radiation, and 35% and 26% for the 20 patients with surgery alone. Survival rates by the extent of surgical resection were similar at 5 years (46% vs 41%), but long term survival was quite different (p<0.01) between total/subtotal resection and partial esection/biopsy (41% and 12%, resepctively). Previously published studies have identified important prognostic factors in these tumor : age, extent of surgery, grade, performance status, and duration of symptoms. But in our cases statistical analysis revealed that grade I histology (p<0.025) and young age (p<0.001) were the most significant good prognostic variables.
Astrocytoma ; Biopsy ; Brain Neoplasms ; Follow-Up Studies ; Glioma ; Humans ; Oligodendroglioma ; Radiotherapy* ; Retrospective Studies ; Survival Rate

OBJECTIVE: Although middle cerebral artery (MCA) aneurysms are less amenable to coil embolization, an increasing number of studies support favorable endovascular treatment for them. The purpose of this study is to compare the outcomes of two different treatments (surgery versus coiling) and evaluate the benefits of surgical clipping for MCA aneurysms. METHODS: Here we retrospectively analyzed the outcomes of 178 ruptured and unruptured MCA aneurysms treated in patients between September 2008 and April 2012. Parameters assessing treatment outcomes include degree of aneurysm occlusion, presence of regrowth, clinical status, and complications. RESULTS: Among 178 MCA aneurysms, 153 were treated surgically. After a mean follow-up of 12 months, the surgery group showed a clinically significant complete occlusion rate (98%) compared with the coiling group (56%) (p<0.001). Follow-up radiologic evaluation showed a higher regrowth rate (four of 16 cases) in the coiling group than in the surgery group (one of 49 cases) (p=0.003). There was no statistically significant difference in favorable clinical outcome rate between the two groups. The procedure-related permanent morbidity and mortality rates were 2% (three of 153 cases) in the surgery group and 0% (0 of 25 cases) in the coiling group. CONCLUSION: Compared to endovascular treatment, surgical neck clipping for both ruptured and unruptured MCA aneurysms results in a significantly higher complete obliteration rate and less regrowth. Therefore, even in this endovascular era, we still recommend surgical clipping as the primary treatment option for MCA aneurysms rather than coil embolization.
Aneurysm* ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Mortality ; Neck* ; Retrospective Studies ; Surgical Instruments

PURPOSE: The prognosis of periampullary cancer varies with its origin and early diagnosis influences outcome. Endoscopic ultrasound, computed tomography, fine needle aspiration, and fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸FDG-PET/CT) are helpful for diagnosis. This study evaluates the diagnostic efficacy of ¹⁸FDG-PET for preoperative periampullary tumors.METHODS: A series of 100 patients undergoing ¹⁸FDG-PET/CT before surgical resection of periampullary tumors between March 2011 and February 2019 were enrolled. Maximum standardized uptake value (SUVmax) and carbohydrate antigen 19-9 (CA19-9) levels were compared with pathohistological confirmation of periampullary tumors.RESULTS: The SUVmax and uptake range varied with the origin of the periampullary tumors. The SUVmax was not available for 17 of the 42 pancreas tumors, three of 30 common bile duct tumors, and four of 18 ampulla of Vater tumors. The median SUVmax was 0.0 in benign tumors and 5.05 in malignant tumors. The mean SUVmax was 4.1±5.6 in pancreatic tumors, 3.9±2.4 in ampulla of Vater, and 6.0±3.7 in common bile duct. The SUVmax was higher in common bile duct tumors than others. CA19-9 level was of diagnostic value in pancreatic tumor patients. The median CA19-9 levels were 7.64 U/mL (range, 2.71–45.05 U/mL) in benign tumors and 91.97 U/mL (range, 26.91–276.60 U/mL) in cancers patients.CONCLUSION: Preoperative SUVmax and CA19-9 level were of diagnostic value for periampullary tumors originating in the pancreas.
Ampulla of Vater ; Biopsy, Fine-Needle ; CA-19-9 Antigen ; Common Bile Duct ; Diagnosis ; Early Diagnosis ; Fluorodeoxyglucose F18 ; Humans ; Pancreas ; Pancreatic Neoplasms ; Prognosis ; Ultrasonography