PURPOSE: To evaluate the usefulness of positron emission tomography/computed tomography (PET/CT) for field modification during radiotherapy in esophageal cancer. MATERIALS AND METHODS: We conducted a retrospective study on 33 patients that underwent chemoradiotherapy (CRT). Pathologic findings were squamous cell carcinoma in 32 patients and adenocarcinoma in 1 patient. All patients underwent PET/CT scans before and during CRT (after receiving 40 Gy and before a 20 Gy boost dose). Response evaluation was determined by PET/CT using metabolic tumor volume (MTV), total glycolytic activity (TGA), MTV ratio (rMTV) and TGA ratio (rTGA), or determined by CT. rMTV and rTGA were reduction ratio of MTV and TGA between before and during CRT, respectively. RESULTS: Significant decreases in MTV (MTV2.5: mean 70.09%, p < 0.001) and TGA (TGA2.5: mean 79.08%, p<0.001) were found between before and during CRT. Median rMTV2.5 was 0.299 (range, 0 to 0.98) and median rTGA2.5 was 0.209 (range, 0 to 0.92). During CRT, PET/CT detected newly developed distant metastasis in 1 patient, and this resulted in a treatment strategy change. At a median 4 months (range, 0 to 12 months) after completion of CRT, 8 patients (24.2%) achieved clinically complete response, 11 (33.3%) partial response, 5 (15.2%) stable disease, and 9 (27.3%) disease progression. SUVmax (p = 0.029), rMTV50% (p = 0.016), rMTV75% (p = 0.023) on intra-treatment PET were found to correlate with complete clinical response. CONCLUSION: PET/CT during CRT can provide additional information useful for radiotherapy planning and offer the potential for tumor response evaluation during CRT. rMTV50% during CRT was found to be a useful predictor of clinical response.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Disease Progression ; Electrons ; Esophageal Neoplasms* ; Humans ; Neoplasm Metastasis ; Positron-Emission Tomography and Computed Tomography* ; Radiotherapy ; Retrospective Studies ; Tumor Burden

The surgical reconstruction of complex facial injuries have focused on the following; early one-stage repair, exposure of all fracture fragments, precise anatomic rigid fixation, immediate bone grafting, and definite soft tissue management were the main surgical procedures, as in other facial bone injuries. Complex facial bone fractures involving dentition should be managed by the same principles. However, conventional methods can not achieve accurate preinjury occlusion when there are unstable fracture segments, edentulous state, or complex palatal/maxillary and mandibular fractures. Seventeen patients were surgically reconstructed in conjunction with dental impression, model surgery, and fabrication of dental splints to establish better occlusion. Among the facial fractures that had the occlusal problem, maxillary/palatal fractures and complex mandibular fractures, were the major indications for fabrication of acrylic splints. During operation, fracture segments were reduced and repositioned according to dental wear facets of the prefabricated occlusal splint and then temporary intermaxillary fixations were performed. This allowed us to accomplish precise anatomical reduction and rigid intrenal fixations. The postoperative occlusions were acceptible and no complication occurred as direct effects of dental splint. We suggest that fabrication of an acrylic occlusal splint is necessary for the management of complex facial injuries involving dentition.
Bone Transplantation ; Dentition ; Facial Bones ; Facial Injuries* ; Humans ; Mandibular Fractures ; Occlusal Splints ; Splints* ; Tooth Wear

Conservative or surgical methods have been used for the treatment of fracture of mandibular subcondyle, but consensus has not been reached in regard to the proper management of this injury. Several problems related to the surgical procedure have led many surgeons to avoid surgical management of condylar fractures in favor of closed reduction and intermaxillary fixations. However, luxation of the condyle may lead to various long-term complications such as open bite on the contralateral side, dysfunction, deviation in opening and closing movements, as well as bone apposition leading to ankylosis. As a consequence, open reduction is preferable when the condyle is displaced. Various methods-for example, direct wiring technique, simple bone plating, dynamic compression plating-have been advocated for the treatment of fracture of mandibular subcondyle. Of such methods, a functionally-stable osteosynthesis can be achieved by compression osteosynthesis methods. Lag screw osteosynthesis is essentially a form of compression osteosynthesis in which the bone fragments are bound to one another as a result of traction from the screw. An advantage of compression osteosynthesis is that the end of a fractured bone can be maintained in an opposed position under pressure, and then primary bone healing occurs by direct osteoblastic activity within the fracture. As well, it obviates or reduces the need for maxillomandibular fixation, as well as the morbidity associated with conventional treatment methods such as facial nerve injury and bone resorption due to wide dissection. We have treated 9 cases of displaced subcondylar fractures of the mandible with the lag screw fixation system which is marketed by the Martin corporation. Mobilization and guidance of the jaw was begun from 7 or 10 days postoperatively. The radiologic and clinical evaluations showed good repositioning of the fragments and good occlusion postoperatively The disadvantage is that surgical procedures are relatively compound, and an additional procedure - removal of lag screw - is necessary after complete bone union. Lag screw osteosynthesis can be added as a another valid armament for plastic surgeons in the management of mandibular subcondyle fractures.
Ankylosis ; Bone Resorption ; Consensus ; Facial Nerve Injuries ; Jaw ; Jaw Fixation Techniques ; Mandible ; Open Bite ; Osteoblasts ; Traction

PURPOSE: To evaluate safe access route and success rate of percutaneous drainage of pelvic fluid collection. MATERIALS AND METHODS: The 35 percutaneous drainages of pelvic fluid collection under the CT and fiuorosocpic guidance were done in 32 patients. The anterior transabdominal approach was done in 20 patients, while the nine patients used the transgluteal approach through greater sciatic foramen. Three patients , who had septated or noncommunicating abscesses, underwent drainage using both approaches. The catheter was removed when the patient's symptom and laboratory data were improved or the amount of drainage and the size of fluid collection were markedly reduced. Success, partial success and failure were classified. RESULT: The causes of fluid collection were complication of intraabdominal operation in 27 patient. The diagnosis after drainage included abscess(21), Ioculated ascites(6), and hematoma(4). The 27 cases(30 procedure) were treated successfully and the mean duration of catheter insertion was 10 days. The partial successes were two cases(2 procedures), which had palliative purpose. Three cases(3 procedures) were failed, which were multiple Ioculated ascites of pancreatic origin(2) and recurrent abscess(I). The significant complication during the procedure or drainage was not noted. CONCLUSION: The percutaneous drainage .under CT and fluoroscopy was effective technique for the management of pelvic. fluid collection, using anterior transperitoneal and transgluteal route through greater sciatic foramen.
Abscess ; Ascites ; Catheters ; Diagnosis ; Drainage* ; Fluoroscopy ; Humans

A method for exact evaluation of ligament integrity of the knee joint would be of clinical importance from the diagnostic point of view as well as from the desire to introduce objective measurement of stability either pre-and postoperatively, or before and after conservative treatment. Assessment of the posterior cruciate injury has been considered by numerous authors over the past decades. Even stress machine, such as Gonylaxometer, knee ligament arthrometer(KT-l000) and Genucome, have many problems such as soft tissue error, expansiveness and low popularity. Generally, orthopedic surgeons use passive tests, in which the displacing force is applied externally, to evaluate the integrity of the ligaments of the knee. Posterior tibial displacement of knee was measured at quadriceps neutral angle using a specially designed frame which minimized the rotational error to negate the quadriceps pulling effect. Posterior displacement of both sides of knee was measured in 15 patients who had posterior cruciate ligament injury and 40 adults who had normal knee. The following results were obtained. l. In the normal knee, the mean score of posterior tibial displacement was 3.0875mm in left, 2.8125mm in right each other and there was a mean of 1.05mm posterior displacement of tibia compared to the contralateral knee(range: 0–2.5mm). 2. More than 6mm displacement of lateral femoral condyle compared to the uninjured knee suggested posterior cruciate ligament injury. 3. This radiological measurement seems very efficient in detecting the posterior cruciate ligament instability of knee because of its simplicity, inexpensiveness and easy reproducibility with minimal error.
Adult ; Humans ; Knee ; Knee Joint ; Ligaments ; Methods ; Orthopedics ; Posterior Cruciate Ligament ; Surgeons ; Tibia

A few cases of reticulate acropigmentary disorders have been reported in Korea. Most of them were reticulate acropigmentation of Kitamura, but not acropigmentation symmetrica of Dohi. A 21 year-old male patient diagnosed as acropigmentation symmetrica of Dohi had been previously treated with various treatment methods unsuccessfully. Re-treatment with the Q-switched alexandrite laser(755 nm, 100nsec) showed a temporary improvement but a relapse of the lesion was experienced again. We describe a case of acropigmentation symmetrica of hi treated with the Q-switched alexandrite laser.
Humans ; Korea ; Lasers, Solid-State* ; Male ; Recurrence

Gastric mucosa shows continuous changes in surface epithelium as well as inflammatory reaction by various substances from the outside and their metabolic products. Gastric mucosal lesions are proven to be associated with bacterial infection by the discovery of Heliobacter pylori(H. pylori) and many studies about histopathologic changes of gastric mucosa associated H. pylori infection has been advanced. It is known that H. pylori associated gastritis displays surface foveolar epithelial changes, such as cytoplasmic vacuolation, mucin loss, juxtaluminal cytoplasm erosion, epithelial denudation, and mucosal irregularity. There have been many studies that H. pylori infection is associated with intestinal metaplasia, gastric dysplasia, and carcinoma. Also chronic H. pylori infection with its induction of gastric lymphoid follicle has been implicated as a precursor of gastric lymphoma of the unique B-cell type that arises from mucosa-associated lymphoid tissue(MALT). However, these gastric mucosal changes are also observed in gastritis with other causes. In this study, we aimed to define specific histopathiologic findings associated with H. pylori infection. A total of 463 gastric biopsy specimens were reviewed. They were Helicobacter-associated gastritis and were divided as many (MH), a few (AH), and no (NH), according to the number of H. pylori. 210 (MH), 131 (AH), and 122 (NH) biopsy specimens were included. Lymphocytes, plasma cells in lamina propria, eosinophils and neutrophils in surface epithelium and crypt as well as lamina propria were graded from 0 to 3. Surface epithelial changes including cytoplasmic vacuolation, mucin loss, juxtaluminal erosion, epithelial denudation and mucosal irregrarity were observed in 200 of 210 cases(95%) in MH group, 34 of 131 cases(26%) in AH group, and 6 of 122 cases(5%) in NH group. This result indicates there is significant difference in surface epithelial changes according to the number of H. pylori(p<0.001). Severity of eosinophil, neutrophil, lymphocyte, and plasma cell infiltration is increased in proportion to the number of H. pylori. Especially, neutrophilic infiltration is not identified in 95 of 122 cases(78%) in NH group, whereas MH group shows severe infitration (grade 3) in 127 of 210 cases(61%), and no (grade 0) in 11 of 210 cases(5%). This data well explains that the severity of neutrophil infiltration is associated with, the degree of H. pylori infection in chronic active gastritis, with statistical significance. The prevalence of lymphoid follicle formation was 17 of 120 cases(14%) in NH group, 24 of 131 cases(18%) in AH group, and 52 of 210 cases(25%) in MH group. This shows that lymphoid follicle formation correlates with the number of H. pylori, but without statistical significance. The prevalence of intestinal metaplasia in NH, AH, and MH was 43 of 122 cases(35%), 46 of 131 cases(35%), and 69 of 210 cases(33%), showing no association between intestinal metaplasia and H. pylori. In summary, H. pylori associated gastritis dispays characteristic histopathological changes in gastric mucosa, in which surface epithelial changes and various inflammatory infiltrates are increased in proportion to the number of H. pylori. Especially vacuolization of surface foveolar epithelium, cryptitis, and crypt abscess are specific findings of H. pylori associated gastritis.
Biopsy

No abstract available.

No abstract available.
Humans

Great strides have been made not only in the research of the endogenous electrical signals,but also in the clinical application on nonunions using exogenous electrical signals. We measured human skin steady state potentials on the anteromedial surface of the twenty-eight left proximal tibiae and investigated intraosseous induced potentials created by a capacitively coupled signal applied on the proximal tibia of ten rabbits' right hind limbs. Following results were observed: 1. Human skin epiphysio-metaphyseal and epiphysio-diaphyseal potential differences in resting state were 116.1±11.7µV, and 120.5±29.4µV, respectively(P> 0.05), while those in full weight bearing were 310.3±169.4µV, and 404.2±154.1µV, respectively (P<0.05). 2. Skin steady state potentials were affected by muscle contraction and load bearing. 3. Thraugh a sequence of applied voltage of 2, 5, 10, 20, and 30 volts peak to peak, linear increase in the intraosseous induced potentials were produced. 4. Intraosseous induced potentials increased, although their increasing rates being decelerated, with increasing frequencies of 2, 20, 60, 120, and 200 KHz. 5. Higher intraosseous induced potentials were produced,as conductive jelly was applied between the capacitor plates and skin.
Extremities ; Humans ; Muscle Contraction ; Skin ; Tibia ; Weight-Bearing