Four patients were treated who had limited flexion of the hips and various degrees of contracture of the abduction and external rotator muscles because of fibrosis of the gluteus maximus muscle. Each patient had a typical restriction of motion such that an affected hip could not be flexed in the usual sagittal plane, but had to be flexed in abduction. Genetic, congenital and postnatal factors have been suggested as the cause of fibrosis of gluteus maximus muscle. Three of the 4 patients reported here are of congenital origin and another one is of postnatal factor repeated intramuscular injections. Excellent correction of the hip contracture was achieved in all patients by division of the fibrotic bands.
Contracture ; Fibrosis ; Hip Contracture ; Hip ; Humans ; Injections, Intramuscular ; Muscles

A pelvic mass in women may be gynecologic in origin or it may arise from the urinary tract or bowel. Nonovarian or nongynecologic conditions may be confused with uterine or ovarian mass. The rare congenital megaureter should always be kept in mind as a possible cause of a pelvic mass. Congenital megaureter showed various clinicopathological features and frequently associated with ipsilateral or controlateral upper tract anomalies. Early meticulous imaging surgical correction will lead to excellent result. We experienced a rare case of blind ending megaureter which was suspected adnexal tumor in twenty seven-year-old woman. Here we present the case with brief review of literatures.
Female ; Humans ; Urinary Tract

In case of soft-tissue defects with bone and tendon exposure on foot, ankle and lower leg, it is often impossible to achieve wound closure by a simple skin graft. The sural artery flap is a fasciocutaneous flap supplied by the sural artery that accompanies the sural nerve and connects with a septocutaneous perforator of the peroneal artery via a suprafascial network of vessels. For the coverage of the defects, we operated 30 cases using modified superficial sural fasciocutaneous island flap based on the proximal or distal. and we covered convoluted wound site with this flap with plicated fascia. We reconstruct complicated skin defects on the foot region(13) and the distal portion of the leg(17). The size of flap varied from 3 x 4 cm2 to 10 x 9 cm2. All 30 flaps survived completely, but minor complications, such as venous congestion, hematoma disappeared after a few days. The main advantage of this flap is a constant and reliable blood supply without sacrifice of a major artery. but disadvantage of this flap is hypoesthesia at the lateral part of the foot. In conclusion, dissection of the superficial sural fasciocutaneous island flap is quite easy and requires less time, and involves less risk to the patient. The nonbulky fasciocutaneous island flap appearance particularly indicated small to medium sized defects with or without convoluted wound surface. The contours of the recipient and donor sites are acceptable aesthetically.
Ankle ; Arteries ; Fascia ; Foot ; Hematoma ; Humans ; Hyperemia ; Hypesthesia ; Leg ; Skin ; Sural Nerve ; Tendons ; Tissue Donors ; Transplants ; Wounds and Injuries

BACKGROUND: Chemotherapy with 5-fluorouracil (5-FU) has been one of the mainstay in breast cancer treatment. The effects of high dose 5-FU on cell cycle regulation were studied in breast caner cells. METHODS: A breast cancer cell line MCF-7 was used. Protein expressions of G1/S cyclins, p21(Waf1/Cip1), cdk2, E2F1 and retinoblastoma were tested by western blot analysis. Immunoprecipitation and immune complex kinase assay were done for the assessment of E2F1/RB interacton and the activity of cdk2 respectively. RESULTS: p21(Waf1/Cip1) expression was barely detectable in control cells. With addition of 5-FU level of p21(Waf1/Cip1) were induced and cyclin D3 level was decreased as cell growth decreases. In accordance with increased expression of p21(Waf1/Cip1), cyclin E-associated cdk2 kinase activity was reduced. Retinoblastoma protein (RB) became dephosphorylated and E2F-1 binding activity with RB was increased. CONCLUSION: In this situation of high concentration of 5-FU breast cancer cells tend to be G1/S cell cycle arrested. Overexpression of p21(Waf1/Cip1) and dephosphorylation of RB may mediate the effectss of 5-FU by inhibiting E2F-1 activity, which contributes to G1/S cell cycle arrest. These results could be an indicating landmark for further study of high dose chemotherapy with 5-FU.
Antigen-Antibody Complex ; Blotting, Western ; Breast Neoplasms* ; Breast* ; Cell Cycle Checkpoints ; Cell Cycle* ; Cell Line* ; Cyclin D3 ; Cyclins ; Drug Therapy ; Fluorouracil* ; Immunoprecipitation ; Phosphotransferases ; Retinoblastoma ; Retinoblastoma Protein

Carcinoid-type tumorlets of the lung are nodular microscopic proliferation of round and spindle-shaped small cells which originated from bronchial or bronchiolar Kulchitsky-type neuroendocrine cells, which are usually encountered as an incidental finding during microscopic examination of the lungs at autopsy or surgically removed for bronchiectasis or other reasons. We report one case of carcinoid-type tumorlets in the lung which was surgically removed from a patient who had bronchiectasis, and the cells of tumorlets showed immunohistochemical reactivities for markers of epithelial and neuroendocrine differentiation.
Autopsy ; Bronchiectasis ; Humans ; Incidental Findings ; Lung* ; Neuroendocrine Cells

Aspergillus Infection is a major cause of mortality in individuals with depressed cell-mediated immunity. Despite therapy with intravenous amphotericin B and oral antifungal agents, high mortality has been reported among heart transplant recipients. We experienced two cases of pulmonary aspergillosis among 15 cases of heart transplantation cases. Both cases were similiar in terms of age, time of diagnosis, diagnosis, and medication. Percutaneous needle aspiration biopsy revealed Aspergillus fumigatus in both cases. The first case showed multiple aspergilloma on both lung fields and were treated by IV Amphotericin B and oral itraconazole. After completion of treatment, the lesion completely disappeared and he has been followed up for more than one year in his good condition. The second case showed a single nodule on his right lower lung field and were treated by both medication and surgery. The patient recovered well and had been doing well until 4th postoperative month when he developed humoral rejection and expired.
Amphotericin B ; Antifungal Agents ; Aspergillosis ; Aspergillus ; Aspergillus fumigatus ; Biopsy, Needle ; Diagnosis ; Heart ; Heart Transplantation ; Humans ; Immunity, Cellular ; Itraconazole ; Lung ; Mortality ; Needles ; Pulmonary Aspergillosis* ; Transplantation

For applying the quality assurance (QA) of volumetric modulated arc therapy (VMAT) introduced in Eulji Hospital, we classify it into three different QA steps, treatment planning QA, pretreatment delivering QA, and treatment verifying QA. These steps are based on the existing intensity modulated radiation therapy (IMRT) QA that is currently used in our hospital. In each QA step, the evaluated items that are from QA program are configured and documented. In this study, QA program is not only applied to actual patient treatment, but also evaluated to establish a reference of clinical acceptance in pretreatment delivering QA. As a result, the confidence limits (CLs) in the measurements for the high-dose and low-dose regions are similar to the conventional IMRT level, and the clinical acceptance references in our hospital are determined to be 3 to 5% for the high-dose and the low-dose regions, respectively. Due to the characteristics of VMAT, evaluation of the intensity map was carried out using an ArcCheck device that was able to measure the intensity map in all directions, 360degrees. With a couple of dosimetric devices, the gamma index was evaluated and analyzed. The results were similar to the result of individual intensity maps in IMRT. Mapcheck, which is a 2-dimensional (2D) array device, was used to display the isodose distributions and gave very excellent local CL results. Thus, in our hospital, the acceptance references used in practical clinical application for the intensity maps of 360degrees directions and the coronal isodose distributions were determined to be 93% and 95%, respectively. To reduce arbitrary uncertainties and system errors, we had to evaluate the local CLs by using a phantom and to cooperate with multiple organizations to participate in this evaluation. In addition, we had to evaluate the local CLs by dividing them into different sections about the patient treatment points in practical clinics.
Humans ; Radiotherapy, Intensity-Modulated

In order to verify exact dose distributions in the state-of-the-art radiation techniques, a newly designed three-dimensional dosimeter and technique has been took strongly into consideration. The main purpose of our study is to verify the optimized parameters of polymer gel as a real volumetric dosimeter in terms of the various study of MRI. We prepared a gel dosimeter by combing 8% of gelatin, 8% of MAA, and 10 mM of THPC. We used a Co-60 gamma-ray teletherapy unit and delivered doses of 0, 2, 4, 6, 8, 10, 12, and 14 Gy to each polymer gel with a solid phantom. We used a fast spin-echo pulse to acquire the characterized T2 time of MRI. The signal noise ratio (SNR) of the head & neck coil was a relatively lower sensitivity than the body coil; therefore the dose uncertainty of head & neck coil would be lower than body coil's. But the dose uncertainty and resolution of the head & neck coil were superior to the body coil in this study. The TR time between 1,500 ms and 2,000 ms showed no significant difference in the dose resolution, but TR of 1,500 ms showed less dose uncertainty. For the slice thickness of 2.5 mm, less dose uncertainty of TE times was at 4 Gy, as well, it was the lowest result over 4 Gy at TE of 12 ms. The dose uncertainty was not critical up to 6 Gy, but the best dose resolution was obtained at 20 ms up to 8 Gy. The dose resolution shows the lowest value was over 20 ms and was an excellent result in the number of excitation (NEX) of three. The NEX of two was the highest dose resolution. We concluded that the better result of slice thickness versus NEX was related to the NEX increment and thin slice thickness.
Animals ; Comb and Wattles ; Gelatin ; Head ; Neck ; Noise ; Organophosphorus Compounds ; Polymers ; Uncertainty

To report cases of metastasectomy for metastatic gynecologic malignancies, we reviewed the medical records of all patients who have undergone metastasectomy for metastatic gynecologic malignancies in Center for Uterine Cancer from June 2001 to October 2002. Six patients were identified with median age of 55 years (range 52-66 years). The metastatic sites and primary sites were as follows: 3 liver metastasis from ovary; 1 abdominal wall metastasis from uterus (endometrial cancer), 1 brain metastasis from ovary, 1 lung metastasis from uterus (sarcoma). The median disease free interval was 48 months (range 10 months-13 years). There was no perioperative mortality. Postoperative morbidity was tolerable with 1 case of bile leakage. In three patients with hepatectomy, one patient was dead of disease after 15 months, one patient is alive with disease at 20 months of follow up, one patient have no evidence of recurrence at 7 months follow up. The patient with brain metastasis was dead due to lung metastsis after 9 months later postoperatively. Remaining two patients with abdominal wall and lung metastasis have no evidence of tumor recurrence at 4, 7 months follow up respectively. Metastasectomy for metastatic gynecologic malignancies can be performed safely and may help prolong survival in carefully selected patients.
Abdominal Wall ; Bile ; Brain ; Female ; Follow-Up Studies ; Hepatectomy ; Humans ; Liver ; Lung ; Medical Records ; Metastasectomy ; Mortality ; Neoplasm Metastasis ; Ovary ; Recurrence ; Uterine Neoplasms ; Uterus

Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals is a rare and complex lesion in which great morphologic variability exists regarding the sources of pulmonary blood flow. We report a case of this disease with no true central pulmonary arteries in a 9-month-old-boy successfully treated by one-stage complete unifocalization and repair from a midline sternotomy approach.
Heart Septal Defects, Ventricular* ; Pulmonary Artery ; Pulmonary Atresia* ; Sternotomy