OBJECTIVE: To define optimal method that calculate the safe direction of cervical pedicle screw placement using computed tomography (CT) image based three dimensional (3D) cortical shell model of human cervical spine.METHODS: Cortical shell model of cervical spine from C3 to C6 was made after segmentation of in vivo CT image data of 44 volunteers. Three dimensional Cartesian coordinate of all points constituting surface of whole vertebra, bilateral pedicle and posterior wall were acquired. The ideal trajectory of pedicle screw insertion was defined as viewing direction at which the inner area of pedicle become largest when we see through the biconcave tubular pedicle. The ideal trajectory of 352 pedicles (eight pedicles for each of 44 subjects) were calculated using custom made program and were changed from global coordinate to local coordinate according to the three dimensional position of posterior wall of each vertebral body. The transverse and sagittal angle of trajectory were defined as the angle between ideal trajectory line and perpendicular line of posterior wall in the horizontal and sagittal plane. The averages and standard deviations of all measurements were calculated.RESULTS: The average transverse angles were 50.60º±6.22º at C3, 51.42º ±7.44º at C4, 47.79º ±7.61º at C5, and 41.24º ±7.76º at C6. The transverse angle becomes more steep from C3 to C6. The mean sagittal angles were 9.72º ±6.73º downward at C3, 5.09º±6.39º downward at C4, 0.08º ±6.06º downward at C5, and 1.67º ±6.06º upward at C6. The sagittal angle changes from caudad to cephalad from C3 to C6.CONCLUSION: The absolute values of transverse and sagittal angle in our study were not same but the trend of changes were similar to previous studies. Because we know 3D address of all points constituting cortical shell of cervical vertebrae. we can easily reconstruct 3D model and manage it freely using computer program. More creative measurement of morphological characteristics could be carried out than direct inspection of raw bone. Furthermore this concept of measurement could be used for the computing program of automated robotic screw insertion.
Cervical Vertebrae ; Female ; Humans ; Image Processing, Computer-Assisted ; Methods ; Pedicle Screws ; Spine ; Volunteers

PURPOSE: The preoperative assessments of the depth of invasion in the rectal wall and the presence of lymph node metastasis are very important in determining the proper treatment modality for rectal cancer. The purpose of this study is to evaluate the accuracy of transrectal ultrasonography (TRUS) for preoperatively staging rectal cancer, as compared with computerized tomography (CT). METHODS: 62 patients who were diagnosed with rectal cancer were staged by using TRUS and CT, preoperatively. The ultrasnonographic tumor stage (uT), the US nodal stage (uN) and the computerized tomographic tumor stage (cT) and the CT nodal (cN) stage were investigated. The accuracy, sensitivity, specificity, PPV (Positive predictive value) and NPV (Negative predictive value) were calculated and compared with the pathologic staging. RESULTS: The accuracies of TRUS and CT in assessing the depth of rectal wall invasion were 82.2% and 79.0%, respectively. The sensitivity, specificity, PPV and NPV of TRUS were 68.1%, 81.9%, 70.4% and 85.4% and those of CT were 53.2%, 78.9%, 73.7% and 80.7%, respectively. The sensitivity of T1 was 77.8% with using TRUS and 33.3% with using CT, respectively. The incidence of over- and under-staging was 17.8% and 9.7% with using TRUS and 25.8% and 6.5% with using CT, respectively. The accuracies of TRUS and CT in assessing the involvement of lymph nodes were 62.4% and 68.8%, respectively. The incidence of over-staging for TRUS and CT was 41.9% and 21.0%, respectively. The incidence of under-staging for TRUS and CT was 20.1% and 25.8%, respectively. There was no meaningful factor influencing the accuracy of TRUS. CONCLUSION: TRUS is very useful tool for the preoperative assessment of the depth of rectal cancer invasion. However, the evaluation of lymph node involvement by TRUS has limitations.
Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Rectal Neoplasms ; Sensitivity and Specificity

There have been controversies on the effect of albumin in treating edema in nephrotic syndrome patients. We evaluated the additive diuretic effect of coadministration of furosernide with albumin in the six patients with nephrotic syndrome. We administered 160mg of furosemide intravenously for 1 hour with 100rnl of 20% albumin or 5% dextrose by random cross-over design. The urine and plasma furosemide concentrations were measured by HPLC. After the administration of furosemide alone, urine volume, urinary excretions of sodium and chloride were increased significantly compared to those of basal state (P<0.05). But, coadministration of furose-mide with albumin did not increase significantly the urine voume (2285+/-445ml vs. 3023+/-715ml), urinary excretions of sodium (194+/-58rnmol/day vs. 282+/-85 mmol/day) and chloride (213+/- 54mmoVday vs. 286+/- 74mmoVday) comparing to those of furosemide only cases. Addition of albumin to furosemide did not significantly changed pharmacokinetic parameters such as AUC (28.3+/-5.5ug/ml hr vs 36.0+/-6.7ug/ml hr), total plasma clearance (115+/-30mVmin vs 108+/-41ml/min), volume of distribution (0.13+/-0.02L/kg vs 0.10+/- 0.01L/kg), elirnination half life (1.4+/-0.3hr vs 1.5+/-0.3hr), and urine furosemide excretion (44+/-8% vs 43+ 10%). We concluded that albumin infusion did not enhance the diuretic action of furosemide pharmacodynamically and pharmacokinetically in patients with nephrotic syndrome.
Area Under Curve ; Chromatography, High Pressure Liquid ; Cross-Over Studies ; Diuretics ; Edema ; Furosemide* ; Glucose ; Half-Life ; Humans ; Nephrotic Syndrome* ; Pharmacokinetics ; Plasma ; Sodium

PURPOSE: Preoperative chemoradiotherapy is now widely accepted to treat rectal cancer; however, the prognosis for rectal cancer patients during and after chemoradiotherapy must be determined. The aim of this study was to evaluate the serial serum carcinoembryonic antigen (s-CEA) samples in patients with rectal cancer who underwent radical surgery after concurrent chemoradiotherapy (CRT). METHODS: This study evaluated 236 patients with rectal cancer who received preoperative CRT followed by curative surgery between June 2005 and June 2010. We measured the patient's s-CEA levels pre-CRT, post-CRT and post-surgery. Patients were classified into four groups according to their s-CEA concentrations (group 1, high, high, high; group 2, high, high, normal; group 3, high, normal, normal; group 4, normal, normal, normal). We analyzed the clinicopathologic factors and the outcomes among these groups. RESULTS: Of the 236 patients, 12 were in group 1, 31 were in group 2, 67 were in group 3, and 126 were in group 4. The 3-year disease-free survival rate in group 1 was poorer than those in group 3 (P = 0.007) and group 4 (P < 0.001). In a univariate analysis, type of surgery, clinical N stage, pathologic T or N stage, lymphovascular invasion, perineural invasion, and CEA group were prognostic factors. A multivariate analysis revealed that type of surgery, pathologic T stage, and lymphovascular invasion were independent prognostic factors; however, no statistical significance was associated with the CEA group. CONCLUSION: High pre-CRT, post-CRT, and post-surgery s-CEA levels in patients with rectal cancer were associated with high rates of systemic recurrence and poor survival. Therefore, patients with sustained high s-CEA levels during CRT require careful monitoring after surgery.
Carcinoembryonic Antigen ; Chemoradiotherapy ; Disease-Free Survival ; Humans ; Multivariate Analysis ; Prognosis ; Rectal Neoplasms ; Recurrence

PURPOSE: Neoadjuvant chemoradiotherapy applied to the locally advanced rectal cancer reduces local recurrence and improves survival. We assessed tumor regression grade (TRG) and its influence on survival in rectal cancer patients treated with chemoradiotherapy followed by surgical resection. METHODS: We studied 108 patients that were seen at our hospital between August 2004 and December 2008. Patients received preoperative chemoradiotherapy consisting of 5-fluorouracil and leucovorin by continous infusion during the first and fifth week, delivered with concurrent pelvic radiation of 50.4 Gy, followed by radical surgery at 6-8 weeks. The TRG was determined by the amount of fibrosis in the tumor embedding area and was divided into 5 grades based on the relative amount of fibrosis. We analyzed all preoperative clinicopathologic factors, postoperative pathologic stages, TRG and prognosis, retrospectively. RESULTS: Downstaging of rectal cancer through neoadjuvant chemoradiotherapy occurred in 64 (59%) patients. The numbers of total regressions (TRG4), good regressions (TRG3), moderate regressions (TRG2), minor regressions (TRG1), and no regression (TRG0) were 19 (18%), 65 (60%), 17 (16%), 6 (5%), and 1 (1%) respectively. The TRG was inversely correlated with perineural invasion and lymphovascular invasion (P = 0.008, P = 0.032). The local recurrence rate declined as the tumor regression grade increased (P = 0.032). The 19 patients with TRG4 had a better three-year disease free survival than the 89 patients with TRG0-3 (P = 0.034). The 16 patients with pathologic complete remission (pCR) had a better three-year disease free survival than the 92 patients with non-pCR (P = 0.025). CONCLUSION: Higher TRG after preoperative chemoradiotherapy for rectal cancer closely correlates with better survival and low local recurrence. The TRG is considered to be a significant prognostic factor.
Chemoradiotherapy ; Disease-Free Survival ; Fibrosis ; Fluorouracil ; Humans ; Leucovorin ; Prognosis ; Rectal Neoplasms ; Recurrence ; Retrospective Studies

Situs inversus totalis is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. A 41-yr-old woman, who had an ulcerating cancer on the rectum, was found as a case of situs inversus totalis. We present an overview of the operative technique for the first documented laparoscopic total mesorectal excision of a rectal cancer in the patient with situs inversus totalis. Careful consideration of the mirror-image anatomy permitted a safe operation using techniques not otherwise different from those used for the general population. Therefore, curative laparoscopic surgery for rectal cancer in this patient is feasible and safe.
Adult ; Female ; Humans ; Laparoscopy/*methods ; Mesocolon/*surgery ; Rectal Neoplasms/diagnosis/*surgery ; Rectum/*surgery ; Situs Inversus/*complications/*surgery

PURPOSE: The present study aimed to investigate the safety and the feasibility of laparoscopic colorectal surgery performed by a surgeon during a learning period. METHODS: Between April and December 2008, 101 consecutive patients with colorectal cancers underwent laparoscopic surgery by one colorectal surgeon who previously had no experience with laparoscopic colorectal surgery. Standard laparoscopy with a lymphadenectomy using a 5-port technique was performed according to the tumor location. The patients were divided into two chronological groups: 50 cases early in learning period (early cases) and 51 cases later in the learning period (late cases). RESULTS: The operations were 29 right hemicolectomies, 9 left hemicolectomies, 18 anterior resections, 35 low anterior resections, 6 intersphincteric resections, 2 abdominoperineal resections, and 2 Hartmann's operation. There were 7 conversions (6.9%). The median operating time was 205 (range, 95-385) min, and the median blood loss was 258 (50-800) mL. The median times to flatus per anus and to feeding of soft diet were 2 (1-5) and 4 (2-13) days, respectively. The median hospital stay was 9 (6-27) days. There were 21 postoperative complications, including 7 anastomotic complications (3 leakages, 3 abscesses, and 1 stenosis). The median number of lymph nodes harvested was 20 (4-65). The operating time, blood loss, and complication rates were significantly decreased in the late group. CONCLUSION: Our initial experience with laparoscopic colorectal surgery appears to have acceptable perioperative results and short-term oncologic outcomes, which improved with the experience of the surgeon.
Abscess ; Anal Canal ; Colorectal Neoplasms ; Colorectal Surgery ; Diet ; Flatulence ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Postoperative Complications

Granulomatosis with polyangiitis (GPA) is a disease characterized by a granulomatous necrotizing vasculitis of the small vessels, along with the presence of antineutrophil cytoplasmic antibody (ANCA), serologically. GPA is a multisystem disease, in which the diagnosis is frequently based on respiratory and renal manifestations, with rare breast invasion. To date, several cases of breast invasion by GPA have been published, and most cases have been positive for ANCA. However, ANCA-negative forms of breast invasion by GPA are extremely rare and have not been reported in Korea thus far. Therefore, we report a case of ANCA-negative GPA in a 70-year-old woman, who was initially presented with a localized palpable mass in the left breast.
Aged ; Antibodies ; Antibodies, Antineutrophil Cytoplasmic ; Breast* ; Cytoplasm* ; Diagnosis ; Female ; Humans ; Korea ; Vasculitis

PURPOSE: We prospectively investigated clinical changes and long-term outcomes after administration of the drugs recommended by the Age-Related Eye Disease Study-2 to patients with intermediate age-related macular degeneration (AMD). METHODS: This prospective multicenter study enrolled 79 eyes of 55 patients taking lutein and zeaxanthin. The primary endpoint was contrast sensitivity; this was checked every 12 months for a total of 36 months after treatment commenced. The secondary endpoints were visual acuity, central macular thickness, and drusen volume; the latter two parameters were assessed using spectral domain optical coherence tomography. RESULTS: The mean patient age was 72.46 ± 7.16 years. Contrast sensitivity gradually improved at both three and six cycles per degree. The corrected visual acuity was 0.13 ± 0.14 logMAR and did not change significantly over the 36 months. Neither the central macular thickness nor drusen volume changed significantly. CONCLUSIONS: Contrast sensitivity markedly improved after treatment, improving vision and patient satisfaction. Visual acuity, central retinal thickness, and drusen volume did not deteriorate. Therefore, progression of AMD and visual function deterioration were halted.
Contrast Sensitivity ; Eye Diseases ; Humans ; Lutein ; Macular Degeneration ; Patient Satisfaction ; Prospective Studies ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Acuity ; Zeaxanthins

BACKGROUND AND OBJECTIVES: Cyclin-dependent kinase inhibitor (CDKI) is known to play an important role in oncogenesis, but its clinical effect in head and neck cancer has not been reported yet. This study was designed to evaluate the correlation between the pattern of expression in p16 and p21, and tumor progress in laryngeal squamous cell carcinoma. MATERIALS AND METHOD: Paraffin-embedded tissue specimens from 54 patients, who were operated for laryngeal squamous cell carcinoma between Dec. 1990 and Apr. 1997, were immunohistochemically stained for p16 and p21 protein. The clinical features from these patients were retrospectively evaluated. RESULTS: In p16, the proportion of early T stage (T1, T2) and early N stage (N0) was relatively larger in the diffusely staining type than in the other staining pattern; but, the correlation between expression of p16 and T N stage was not significant (p=0.07, 0.65). In p21, proportion of early T stage (T1, T2) and early N stage (N0) was relatively larger in the diffusely staining type than in the other staining pattern; and again, the correlation between expression of p21 and T N stage was not significant (p=0.06, 0.10). CONCLUSION: Other factors were suggested to be strongly related to the clinical aspects of laryngeal squamous cell carcinoma, such as N stage and T stage than p16 and p21. Further study will be needed to understand the role of p16, p21 in oncogenesis of laryngeal squamous cell carcinoma.
Carcinogenesis ; Carcinoma, Squamous Cell* ; Genes, Tumor Suppressor ; Head and Neck Neoplasms ; Humans ; Phosphotransferases ; Retrospective Studies