PURPOSE: A new fiduciary plate and orientation marker have been devised to assist the quality assurance (QA) procedures for port films in radiation therapy department. The plate is used in conjunction with the film/cassette combination during weekly QA procedures, at Seoul National University Hospital (SNUH), in order to verify treatment fields in high energy radiation therapy. MATERIALS AND METHODS: A new fiduciary plate was fabricated using an acrylic plate, cerrobend, standard blocking tray and mercury. The acrylic plate had the dimension of 1x25x25 cm, with two fiduciary markers. The plate was rigidly attached onto the standard blocking tray, thus making it easier to set the fiduciary plate to the center of the radiation field of the linear accelerator. The plate had two 2-mm vertical and horizontal lines, with the minor scales in 2-cm steps. The orientation marker was a small mercury filled disk, which was inserted into the plate. RESULTS: The geometrical structure of the lines in the plate makes it easier to correlate two different images between the simulation and port films. The marker clearly indicated the orientation of the film, for example, the anterior, posterior, left, right and various oblique orientations, without the placement of a conventional orientation marker. Also, the new orientation marker could easily be applied to the simulator by placing the small orientation marker onto the image intensifier or in front of the film/cassette holder. CONCLUSIONSs: The new fiduciary plate appears to be useful in verifying the treatment fields, and the new orientation marker makes the film orientation simple, which is expected to lower the block fabrication errors.
Particle Accelerators ; Seoul ; Weights and Measures

BACKGROUND: The purpose of this study is to improve the quality of the diagnostic procedures in the preoperative evaluation so as to reduce the unnecessary thoracotomy and to ensure resectability in non-small cell lung cancer. MATERIAL AND METHOD: Of 616 patients who underwent thoracotomy for primary lung cancer from January 1990 to December 1996, 59 patients(9.6%) turned out to have inoperable lesions after the thoracotomy. We reprospectively reviewed the bronchoscopic findings, methods of tissue diagnosis, CT scans, pulmonary function test and lung perfusion scan, reasons for nonresectability, and adjuvant therapy, and then followed up on the survival rate after exploratory thoracotomy. RESULT: The cell types were squamous cell carcinoma in 38, adenocarcinoma in 15, large cell carcinoma in 3 and others in 3. Primary loci were RUL in 20, RML in 6, RLL in 8, LUL in 13, LLL in 4 and others in 8. The reasons for non-resectability were various; direct tumor invaison to mediastinal structures(n=41), seeding on pleural cavity(n=8), poor pulmonary function(n=2), invasions to extranodal mediastinal lymph node(n=2), technical non- resectability due to extensive chest wall invasion (n=3), small cell carcinoma (n=1), malignant lymphoma(n=1), and multiple rib metastases(n=1). In the follow-up of 58 patients, 1-year survival rate was 55.2% and 2-year survival rate was 17.2% and the mean survival time was 14 months. When compared according to cell types or postoperative adjuvant therapeutic modalities, no significant difference in the survival rates were found. The squamous cell carcinoma was frequently accompanied by local extension to contiguous structures and was the main cause of non-resectability. In adenocarcinoma, pleural seeding with malignant effusion was frequently encountered, and was the major reason for non-resectability. CONCLUSION: These data revealed that if appropriate preoperative diagnostic tools had been available, many unnecessary thoracotomies could have been avoided. Both the use of thoracoscopy in selected cases of adenocarcinoma and the more aggressive surgical approach to the locally advanced tumor could reduce the incidence of unnecessary thoracotomies for non-small cell lung cancers.
Adenocarcinoma ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Lung ; Lung Neoplasms ; Perfusion ; Respiratory Function Tests ; Ribs ; Survival Rate ; Thoracic Wall ; Thoracoscopy ; Thoracotomy* ; Tomography, X-Ray Computed

BACKGROUND: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. MATERIAL AND METHOD: The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60+/-9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. RESULT: The mean number of grafts was 3.2+/-1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13+/-20 hours after the operation. Mean duration of stay in intensive care unit was 49+/-46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70+/-1.36 pack/patient. CONCLUSIONS: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.
Angina, Stable ; Angina, Unstable ; Arrhythmias, Cardiac ; Arteries ; Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Coronary Vessels ; Delirium ; Diagnosis ; Female ; Femoral Artery ; Gastroepiploic Artery ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Mammary Arteries ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Operating Rooms ; Postoperative Complications ; Radial Artery ; Reoperation ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Surgical Procedures, Operative ; Thromboembolism ; Transplants*

Although the incidence is very low, acute mechanical obstruction of the right coronary artery may occur as a cause of right ventricular failure during aortic surgery. In a 67-year-old woman with severe aortic regurgitation, acute right ventricular failure was noticed at the end of cardiopulmonary bypass weaning after an aortic valve replacement with a Hancock II 19 mm bioprosthesis. We suspected mechanical obstruction of the right coronary artery and consequent coronary artery bypass graft to the right coronary artery with right internal mammary artery was performed with success in weaning the bypass. On the postoperative 9th day, the right coronary angiogram revealed obstruction at proximal right coronary artery by plaque emboli. We herein report a clinical case in which the acute right ventricular failure occurred due to mechanical obstruction of the right coronary artery was recovered by coronary artery bypass graft to the right coronary artery.
Aged ; Aortic Valve Insufficiency ; Aortic Valve* ; Bioprosthesis ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels* ; Female ; Humans ; Incidence ; Mammary Arteries ; Transplants ; Weaning

PURPOSE: The authors evaluated the clinical results and prognosis after amputating the lower extremity due to diabetic foot. MATERIALS AND METHODS:From 1991 to 2003, the patients who had suffered amputation of his lower extremity due to diabetic foot ulcer were evaluated retrospectively. 79 patients were male and 6 patients were female. The author evaluated the patient who had the ipsilateral additional surgery, contralateral amputation, level of blood sugar, combined disease and mortality rate within 5 years from medical record. Statistical analysis was done by Chi-square test and Kaplan-Meier survival test. RESULTS:Mean age of patients who had first experienced amputation was 63.4 years old. The mean duration of diabetes until amputation was 14.5+/-7.5 years. Major amputations were 50 cases and minor amputations 35 cases. 20 patients (23.5%) were suffered ipsilateral secondary surgery including revised stump. Overall 5-year mortality rate was 18.8% (16 cases). Death rate within 1 year was 8.2% (7 cases), mortality rate within 3 years was 14.1% (12 cases). 5-year mortality rate after major amputation was 20% (10 cases) and after minor amputation was 17.1% (6 cases). It was statistically significant (p<0.05). Patient who underwent more than 2 combined vascular related disease had higher mortality rate than diabetic amputee without combined disease (p<0.05). CONCLUSION: Mortality rate after major amputation was significant higher than amputation after minor amputation in diabetic patients from our data.
Amputation ; Amputees ; Blood Glucose ; Diabetic Foot ; Female ; Humans ; Lower Extremity ; Male ; Medical Records ; Prognosis ; Retrospective Studies ; Ulcer

This is a case report of an operation for the pulmonary arteriovenous fistula supplied from the systemic arteries instead of the pulmonary artery. The operation of systemic arteriovenous pulmonary fistula has formidable technical challenges due to its extensive collateral circulations. A 16 year-old female patient, diagnosed as systemic arteriovenous fistula with multiple tortuous feeding vessels and with hereditary hemorrhagic telangiectasia, was initially managed with arterial embolization before the operation. A 15x8cm sized huge vascular malformation was removed by RML and RLL bilobectomy. During the operation, we encountered annoying massive bleeding and pulmonary congestion originated in its extensive collateral circulation. The patient was discharged after conservative management without specific problem on the 15th postoperative day. For the safe operation as well as good operative result, it seemed that meticulous ligation of the multiple collateral vessels should be performed prior to that of pulmonary veins.
Adolescent ; Arteries ; Arteriovenous Fistula* ; Collateral Circulation ; Estrogens, Conjugated (USP) ; Female ; Fistula ; Hemorrhage ; Humans ; Ligation ; Pulmonary Artery ; Pulmonary Veins ; Telangiectasia, Hereditary Hemorrhagic ; Vascular Malformations

A man visited the emergency room with a headache. Brain computed tomography showed aneurysmal subarachnoid hemorrhage (SAH) and multiple aneurysms. After aneurysm clipping surgery, the patient was discharged. After 5 days, he was admitted to the hospital with skin ulceration and was diagnosed with Behcet syndrome. An angiogram taken 7 weeks after aneurysmal SAH showed intracranial vasospasm. Because inflammation in Behcet syndrome may aggravate intracranial vasospasm, intracranial vasospasm after aneurysmal SAH in Behcet syndrome should be monitored for longer compared to general aneurysmal SAH.
Aneurysm* ; Behcet Syndrome* ; Brain ; Emergency Service, Hospital ; Headache ; Humans ; Inflammation ; Skin Ulcer ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial

BACKGROUND: The xenogenic or allogenic valves after in vitro repopulation with autologous cells or in vivo repopulation after acellularization treatment to remove the antigenicity could be used as an alternative to synthetic polymer scaffold. In the present study, we evaluated the process of repopulation by recipient cell to the acellularized xenograft treated with NaCl-SDS solution and grafted in the right ventricular outflow tract. MATERIAL AND METHOD: Porcine pulmonary valved conduits were treated with NaCl-SDS solution to make the grafts acellularized and implanted in the right ventricular outflow tract of the goats under cardiopulmonary bypass. After evaluating the functions of pulmonary valves by echocardiography, goats were sacrificed at 1 week, 1 month, 3 months, 6 months, and 12 months after implantation, respectively. After retrieving the implanted valved conduits, histopathologic examination with Hematoxylin-Eosin, Masson's trichrome staining and immunohistochemical staining was performed. RESULT: Among the six goats, which had been implanted with acellularized pulmonary valved conduits, five survived the expected time period. Echocardiographic examinations for pulmonary valves revealed good function except mild regurgitation and stenosis. Microscopic analysis of the leaflets showed progressive cellular in-growth, composed of fibroblasts, myofibroblasts, and endothelial cells, into the acellularized leaflets over time. Severe inflammatory response was detected in early phase, though it gradually decreased afterwards. The extracellular matrices were regenerated by repopulated cells on the recellularized portion of the acellularized leaflet. CONCLUSION: The acellularized xenogenic pulmonary valved conuits were repopulated with fibroblasts, myofibroblasts, and endothelial cells of the recipient and extracellullar matrices were regenerated by repopulated cells 12 months after the implantation. The functional integrity of pulmonary valves was well preserved. This study showed that the acellularized porcine xenogenic valved conduits could be used as an ideal valve prosthesis with long term durability.
Cardiopulmonary Bypass ; Cell Death ; Constriction, Pathologic ; Echocardiography ; Endothelial Cells ; Extracellular Matrix ; Fibroblasts ; Goats ; Heterografts ; Myofibroblasts ; Polymers ; Prostheses and Implants ; Pulmonary Valve ; Tissue Engineering ; Transplants*

A right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm is a very rare condition. This requires surgical treatment because of the possibility of rupture of aneurysm, heart failure and infective endocarditis. A 47 years old male patient with dyspnea on exertion for 3 months was diagnosed as having a right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm according to the CT and coronary artery angiography. We resected the aneurysm and performed a coronary artery bypass graft.
Aneurysm ; Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Dyspnea ; Endocarditis ; Fistula ; Heart Aneurysm ; Humans ; Male ; Rupture ; Transplants

BACKGROUND: We evaluated early and long-term results after heart transplantation (HTPL). METHODS: One hundred five consecutive patients (male:female=80:25) who underwent HTPL between 1994 and 2013 were enrolled. Based on the changes in immunosuppressive regimen, the study patients were divided into two groups. Early and long-term clinical outcomes were evaluated and compared between the patients who underwent HTPL before (group E, n=41) and after July 2009 (group L, n=64). The group L patients were older (p<0.001), had higher incidence of hypertension (p=0.001) and chronic kidney disease (p<0.001), and more frequently needed preoperative mechanical ventilation (p=0.027) and mechanical circulatory support (p=0.014) than the group E patients. RESULTS: Overall operative mortality was 3.8%, and postoperative morbidities included acute kidney injury (n=31), respiratory complications (n=16), reoperation for bleeding (n=15) and wound complications (n=10). There were no significant differences in early results except acute kidney injury between group E and group L patients. Overall survival rates at 1, 5, and 10 years were 83.8%, 67.7%, and 54.9%, respectively, with no significant difference between the two patient groups. Rejection-free rates at 1 and 5 years were 63.0% and 59.7%, respectively; rates were significantly higher in group L than in group E (p<0.001). CONCLUSION: Despite increased preoperative comorbidities, group L patients showed similar early and long-term outcomes and significantly higher rejection-free rates when compared with group E patients.
Acute Kidney Injury ; Comorbidity ; Heart Transplantation* ; Heart* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Mortality ; Renal Insufficiency, Chronic ; Reoperation ; Respiration, Artificial ; Survival Rate ; Transplantation ; Wounds and Injuries