We reviewed 56 patients who received mandibulotomy at Yonsei medical center between 1989 and 1999. We also analysed the complications associated with mandibulotomy and its contributing factors. The complications occur in 16 patients(28.6%) and are classified into two categories; intraoperative and postperative complications. Nonunion was observed in 5 patients and osteoradionecrosis in 5. The patients who received preoperative radiation therapy were more tend to develop nonunion and osteoradionecrosis. This study suggests the benefits of mandibulotomy as a surgical approach to oral cancer: 1. Paramedian osteotomy was recommended for preservation of neurovascular bundle and ease of surgical access. 2. By using thin saw blade, reapproximation was improved with minimal bone loss. 3. osteotomy on anterior mandible which lies outside the usual portals of radiation therapy decreases the incidence of osteoradionecrosis.
Humans ; Incidence ; Mandible ; Mouth Neoplasms* ; Osteoradionecrosis ; Osteotomy

Malignant tumors of the maxilla represent about 3-4% of head and neck malignant neoplasm and the origins are maxillary gingiva, hard palate and maxillary sinus. We are to investigate clinical features and results according to various treatment modalities of maxillary malignant tumor to get information for better treatment results. Sixty patients with malignant maxillary tumors treated at Yonsei medical center from 1992 to 1997 were studied retrospectively. They are evaluated according to clinical signs & symptoms, stages at first diagnosis, primary site, histopathologic features, treatment method, recurrence and survival rate with clinical records, biopsy results and CT radiograph. The most common primary site was maxillary sinus and most common histopathology was squamous cell carcinoma. The local recurrence rate was 18% at 5 years, neck failure was 3% and distant metastasis was 18%. Overall survival rate was 78% at 2 years and 69% at 5 years. Failure at primary site is the main problem in the curative treatment. So, to improve survival in these patients efforts should be directed toward improvement of local control.
Biopsy ; Carcinoma, Squamous Cell ; Diagnosis ; Gingiva ; Head ; Humans ; Maxilla* ; Maxillary Sinus ; Neck ; Neoplasm Metastasis ; Palate, Hard ; Recurrence ; Retrospective Studies ; Survival Rate

Of 14,682 samples of feces examined, 81.7% were positive for intestinal helminths. Trichocephalus trichiurus was observed most frequently, in 73.2%. Eight other species of helminths found were Ascaris lumbricoides, Hookworm, Trichostrongylus orientalis, Clonorchis sinensis, Tapeworm, Hymenolepis nana, Paragoniumus westermani and Enterobius vermicularis, listed in decreasing order. Double infections were found more frequently than single infections, and mixed infection of five or more species of helminths occurred in 0.2% Of 10,320 samples of feces examined, 22.3% were positive for intestinal protozoa, Entamoeba coli was observed most frequently, in 11.1%. Six other species, Endolimax nana, Giardia lamblia, Entamoeba histolytica, Iodamoeba butschlii, Chilomastix mesnill and lsospora hominis were found, in the order. It was noticed that E. histolytica was found more frequently in trichurial infection than with other helminths. Of 1,050 samples of sputum from the T. B. Clinic, 7.0% were positive for paragonimus eggs. Trichomonas vaginalis were found in 35.8%of 1,146 vaginal swabs examined. Seven cases of Plasmodium vivax infection were found among 140 suspected blood smears.
Incidence

PURPOSE: Hurthle cell carcinoma (HCC) of the thyroid gland is a rare disease that represents 3% of all thyroid carcinomas. HCC has been known as a more aggressive disease than the usual differentiated thyroid carcinoma. However, the biologic behavior and optimal treatment have come under considerable debate in recent years. This study was performed to evaluate the clinicopathologic features and treatment outcome of HCC. METHODS: From April 1986 to August 2006, 18 patients with HCC and 216 patients with pure follicular carcinoma (PFC) underwent thyroidectomy at our institutions with a mean follow-up of 114 (range: 6~253) months. The clinicopathologic characteristics and treatment outcome of each group were compared, and the prognostic factors for disease-free survival were analyzed. RESULTS: There were 14 women and 4 men with a mean age of 50 (range: 26~76) years. Compared with PFC patients, all of clinicopathologic features of HCC patients were different (gender, age, tumor size, multifocality, angioinvaion, invasion to adjacent structures, the subclassification and initial distant metastasis), but the high incidence of bilaterality was similar to the PFC patients (P<0.0001). The cause- specific survival (CSS) rates at 10 years were 83.4% in the HCC patients and 89.3% in the PFC patients (P=0.702). Older age (greater than 45) (P=0.0125) and initial distant metastasis (P<0.0001) in the HCC patients, and an older age (P<0.0001), male gender (P=0.0039), angioinvasion (P= 0.0122), invasion to adjacent structures (P<0.0001), a widely invasive type (P=0.004) and initial distant metastasis (P<0.0001) in the PCC patients were independent prognostic factors for survival. CONCLUSION: After accounting for important biologic behaviors, patients with HCC had similar clinicopathologic characteristics and prognosis compared with that of the PFC patients. Therefore, HCC should be managed using the same treatment strategy as PFC.
Accounting ; Adenocarcinoma, Follicular ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Neoplasm Metastasis ; Prognosis ; Rare Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Outcome

MMP-2 and MMP-9, type IV collagenases which degrade basement membrane, have been known to play important roles in invasion and metastasis of tumor cells, In addition, they seem to be involved in cell differentiation, apoptosis, angiogenesis and immunity, etc. We immunohistochemically examined epithelial and stromal expressions of MMP-2 and MMP-9 in irritation fibroma, oral leukoplakia, and oral squamous cell carcinoma (OSCC) and have some results as follows: 1. Irritation fibromas, oral leukoplakias and OSCCs mostly showed increased expression of MMP-2 and MMP-9 in the epithelium and connective tissue compared with normal mucosa. 2. There was a significant difference in the epithelial expression of MMP-2 and MMP-9 between irritation fibroma and oral leukoplakia. 3. There was a significant difference in the epithelial and stromal expression of MMP-2 and MMP-9 between irritation fibroma and OSCC. 4. There was a significant difference in the stromal expression of MMP-9 between oral leukoplakia and OSCC. We concluded that rritation fibroma, oral leukoplakia and OSCC have somewhat different characteristics of MMP-2 and MMP-9 expressions, which perhaps result from different pathogenesis.
Apoptosis ; Basement Membrane ; Carcinoma, Squamous Cell* ; Cell Differentiation ; Collagenases ; Connective Tissue ; Epithelium ; Fibroma* ; Leukoplakia, Oral* ; Mucous Membrane ; Neoplasm Metastasis

Spontaneously ruptured renal cell carcinoma (RCC) in end-stage kidney disease is very rare. Preoperative diagnosis is difficult because of the relatively small tumor size, associated hematoma, and surrounding acquired cysts. Two middle-aged men who were maintained on hemodialysis (HD) for over 10 years suddenly developed flank pain during HD. Computed tomography scans revealed an enhancing ruptured renal mass in one patient, and no obvious tumor lesion except for a hematoma in the other, both of which were later confirmed as RCCs by pathologic specimens.
Carcinoma, Renal Cell ; Flank Pain ; Hematoma ; Humans ; Kidney Failure, Chronic ; Male ; Renal Dialysis ; Rupture

PURPOSE: We studied whether the illumination had an influence on the identification of the location of the lacrimal sac and the success rate of endoscopic endonasal dacryocystorhinostomy (DCR). METHODS: Endoscopic endonasal DCR was performed on 85 eyes of 80 patients who had obstruction of nasolacrimal system without illumination. RESULTS: In all patients, identification of the location of the lacrimal sac by detecting the probe tip or the lacrimo-maxillary suture line was accomplished, without illumination. Final success rate was 87.1% in illuminator non-using group. CONCLUSIONS: We considered that endoscopic endonasal DCR without illumination, in the knowledge of lacrimal sac, ethmoid anatomy, and anatomical variations, was a non-invasive, efficient, and satisfactory method.
Dacryocystorhinostomy* ; Humans ; Lighting ; Sutures

OBJECTIVE: To investigate whether patterns of dysphagia were associated with the location of the brain lesion and clinical factors in subacute stroke patients. METHOD: One hundred and seventy-eight first-ever subacute stroke patients who underwent videofluoroscopic swallowing study (VFSS) from January 2006 to April 2012 were enrolled in the present study. Swallowing-related parameters were assessed by VFSS. The location of brain lesions were classified into the cortical, subcortical, and brain stem. The degree of cognitive impairment and the independency of activities of daily living were assessed by the Korean version of mini-mental status examination and Korean version of modified Barthel index (K-MBI). Aphasia and hemineglect were assessed by Korean version of Western aphasia battery and line bisection test. These data were collected via retrospective chart review. RESULTS: A reduced laryngeal elevation and prolonged pharyngeal delay time were associated with brain stem lesion. Other swallowing parameters were not associated with lesion topology. Pyriform sinus residue was associated with the presence of aphasia and low K-MBI scores. Prolonged pharyngeal delay time was associated with the patient's age, type of stroke and brain stem lesion. CONCLUSION: Pyriform sinus residue was associated with clinical factors such as aphasia and K-MBI scores rather than with the location of brain lesion. However, reduced laryngeal elevation and prolonged pharyngeal delay time were predominant in brain stem lesions.
Activities of Daily Living ; Aphasia ; Brain Stem ; Brain* ; Deglutition Disorders ; Deglutition* ; Humans ; Pyriform Sinus ; Retrospective Studies ; Stroke*

OBJECTIVE: To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in stroke patients, and to assess the difference in swallowing function between stroke patients with COPD (COPD group) and stroke patients without COPD (control group). METHODS: The subjects included 103 stroke patients. They underwent the pulmonary function test and were assigned to either the COPD group or the control group. Their penetration-aspiration scale (PAS) scores and functional dysphagia scale scores were compared by performing a videofluoroscopic swallowing study. The intergroup differences in lip closure, bolus formation, mastication, and the oral transit time, laryngeal elevation, cricopharyngeal dysfunction, oronasal regurgitation, residue in pyriform sinus and vallecula, pharyngeal transit time, aspiration, and esophageal relaxation were also compared. RESULTS: Thirty patients were diagnosed with COPD. The COPD group showed statistically higher PAS scores (4.67+/-2.15) compared to the control group (2.89+/-1.71). Moreover, aspiration occurred more frequently in the COPD group with statistical significance (p<0.05). The COPD group also showed higher occurrence of cricopharyngeal dysfunction, albeit without statistical significance. CONCLUSION: This study shows that a considerable number of stroke patients had COPD, and stroke patients with COPD had higher risk of aspiration than stroke patients without COPD.
Deglutition Disorders ; Deglutition* ; Humans ; Lip ; Mastication ; Prevalence ; Pulmonary Disease, Chronic Obstructive* ; Pyriform Sinus ; Relaxation ; Respiratory Aspiration ; Respiratory Function Tests ; Stroke*

PURPOSE: The purpose of this prospective multi-institutional study was to evaluate the nutritional status of patients undergoing radiotherapy (RT) for treatment of head and neck, lung, or gastrointestinal cancer. MATERIALS AND METHODS: A total of 1,000 patients were enrolled in this study at seven different hospitals in Seoul, Korea between October 2009 and May 2010. The nutritional status of patients after receiving 3 weeks of RT was evaluated using subjective global assessment (SGA). The nutritional status of each patient was rated as well nourished (A), moderately malnourished (B), or severely malnourished (C). RESULTS: The mean age of patients in this study was 59.4 +/- 11.9 years, and the male to female ratio was 7:3. According to the SGA results, 60.8%, 34.5%, and 4.7% of patients were classified as A, B, or C, respectively. The following criteria were significantly associated with malnutrition (SGA B or C; p < 0.001): loss of subcutaneous fat or muscle wasting (odds ratio [OR], 11.473); increased metabolic demand/stress (OR, 8.688); ankle, sacral edema, or ascites (OR, 3.234); and weight loss > or =5% (OR, 2.299). CONCLUSION: SGA was applied successfully to assess the nutritional status of most patients. The prevalence of malnutrition in a radiation oncology department was 39.2%. The results of this study serve as a basis for implementation of nutrition intervention to patients being treated at radiation oncology departments.
Animals ; Ankle ; Ascites ; Edema ; Female ; Head ; Humans ; Korea ; Lung ; Male ; Malnutrition ; Muscles ; Neck ; Nutrition Assessment ; Nutritional Status ; Prevalence ; Prospective Studies ; Radiation Oncology ; Subcutaneous Fat ; Weight Loss