PURPOSE: This treatment planning study was undertaken to evaluate the impact of beam angle configuration of intensity-modulated radiotherapy (IMRT) on the dose of the normal liver in hepatocellular carcinoma (HCC). MATERIALS AND METHODS: The computed tomography datasets of 25 patients treated with IMRT for HCC were selected. Two IMRT plans using five beams were made in each patient; beams with equidistance of 72degrees (Plan I), and beams with a 30degrees angle of separation entering the body near the tumor (Plan II). Both plans were generated using the same constraints in each patient. Conformity index (CI), homogeneity index (HI), gamma index, mean dose of the normal liver (Dmean_NL), Dmean_NL difference between the two plans, and percentage normal liver volumes receiving at least 10, 20, and 30 Gy (V10, V20, and V30) were evaluated and compared. RESULTS: Dmean_NL, V10, and V20 were significantly better for Plan II. The Dmean_NL was significantly lower for peripheral (p = 0.001) and central tumors (p = 0.034). Dmean_NL differences between the two plans increased in proportion to gross tumor volume to normal liver volume ratios (p = 0.002). CI, HI, and gamma indices were not significantly different for the two plans. CONCLUSION: The IMRT plan based on beams with narrow separations reduced the irradiated dose of the normal liver, which would allow radiation dose escalation for HCC.
Carcinoma, Hepatocellular ; Humans ; Liver ; Radiotherapy, Intensity-Modulated ; Tumor Burden

No abstract available.
Acne Vulgaris* ; Hair Removal* ; Pigmentation Disorders*

We report a case of primary cutaneous cryptococcosis on the left knee of a 67 year-old woman. She had a large ulcerated and indurated plaque with yellowish purulent exudates on her left knee. A histopathological examination from the lesion showed numerous encapsulated, round spores. Cultures from the lesion showed the presence of Cryptococcus neoforrnans. This may have resulted from an immunosuppressive state due to long-term use of oral corticosteroids.
Adrenal Cortex Hormones ; Cryptococcosis* ; Cryptococcus ; Exudates and Transudates ; Female ; Humans ; Knee ; Spores ; Ulcer

OBJECTIVES: The purpose of this study was to evaluate the polymerization shrinkage stress among conventional methacrylate-based composite resins and a silorane-based composite resin. MATERIALS AND METHODS: The strain gauge method was used for the determination of polymerization shrinkage strain. Specimens were divided by 3 groups according to various composite materials. Filtek Z-250 (3M ESPE) and Filtek P-60 (3M ESPE) were used as a conventional methacrylate-based composites and Filtek P-90 (3M ESPE) was used as a silorane-based composites. Measurements were recorded at each 1 second for the total of 800 seconds including the periods of light application. The results of polymerization shrinkage stress were statistically analyzed using One way ANOVA and Tukey test (p = 0.05). RESULTS: The polymerization shrinkage stress of a silorane-based composite resin was lower than those of conventional methacrylate-based composite resins (p < 0.05). The shrinkage stress between methacrylate-based composite resin groups did not show significant difference (p > 0.05). CONCLUSIONS: Within the limitation of this study, silorane-based composites showed lower polymerization shrinkage stress than methacrylate-based composites. We need to investigate more into polymerization shrinkage stress with regard to elastic modulus of silorane-based composites for the precise result.
Composite Resins ; Elastic Modulus ; Light ; Polymerization ; Polymers ; Sprains and Strains

Duodenal abscess is a form of phlegmonous enterocolitis and is a rarely reported disease throughout the entire world. Duodenal abscess mostly develops from complications of duodenal ulcer perforation, and may result in a clinically fatal course because it is difficult to differentiate from some diseases such as gastric ulcer, gastric cancer, hepatobiliary disorders etc.. The therapeutic gold standard is surgical intervention including abscess removal and drainage. We experienced a case of duodenal abscess that expressed non-specific symptoms, weight loss and epigastric pain, and diagnosed by gastrointestinal endoscopy, abdominal computed tomography. We successfully treated it through surgical intervention with intravenous antibiotics.
Abscess ; Anti-Bacterial Agents ; Cellulitis ; Drainage ; Duodenal Ulcer ; Endoscopy, Gastrointestinal ; Enterocolitis ; Foreign Bodies ; Stomach Neoplasms ; Stomach Ulcer ; Weight Loss

Hamartomatous polyp is an uncommon lesion. Most of the gastric hamartomatous polyps occur in patients in their 40s because of polyposis coli. Gastric hamartomaotus polyps are usually asymptomatic, but they occasionally manifest with hematemesis or anemia. If they are congenital, then sessile polyps in children should be observed with some measurable frequency. However, many reports have revealed that if the polyp size is big and the risk of rebleeding is high, then ESD or surgical resection can be used to completely remove them. An inverted gastric hamartomatous polyp may have an early gastric cancer component. We report here on an unusual polyp in a 14-years male who presented with hematemesis. Those were about two 3 cm sized large polyps at the proximal antrum and mid body of the stomach, respectively. The polyps were successfully removed by an endoscopic mucosal resection and the lesions were diagnosed as gastric harmatomas.
Anemia ; Child ; Hematemesis ; Hemorrhage ; Humans ; Male ; Polyps ; Stomach ; Stomach Neoplasms

The purpose of treatment for metastatic spine tumor is to improve the quality of life. So, it is very important to carefully select the surgical candidates to prevent unnecessary surgery-related morbidity and mortality. For this purpose, the authors have surveyed 200 cases of spinal metastasis treated by radiotherapy alone or radiotherapy plus surgery to determine prognostic factors. In this study, we attempted to examine retrospectively the four factors, e.g.,primary tumor, pretreatment neurologic status, general condition and degree of cancer extension, affecting the prognosis of metastatic spine tumors. Each factor was ranked from 1 to 3 points according to the severity and the total score for each patient was obtained by adding the these points. As a result, it was found that the total score was highly correlated to the survival period. While the patients with a total score of 6 or lower survived 100 days or less, those of 10 or higher survived 300 days or more on average. Therefore, authors believe this scoring system would be helpful to the determine treatment modalities and the selection of the most suitable operative procedures.
Humans ; Mortality ; Neoplasm Metastasis ; Prognosis ; Quality of Life ; Radiotherapy ; Retrospective Studies ; Spine* ; Surgical Procedures, Operative

The authors present a series of 35 patients who underwent operation for metastatic spinal tumor. Patients were operated via anterior, posterior or posterolateral and combined anterior-posterior approach. The anterior approach was used in cases where there was no involvement of the posterior column, tolerable of a thoracotomy and involvement of three or less adjacent vertebral bodies. The posterior or posterolateral approach was used in cases with involvement of the posterior column, disease at two seperated locations, intolerable of a thoracotomy and involvement of three columns. The combined anterior-posterior approach was used when it was not enough to obtain stabilization with anterior or posterior approach alone and expected greater than 1 year life expectancy. Twenty-five(89%) of the 28 patients improved neurologically following surgery. Average neurologic improvement was 1.3 Frankel grade. Pain relief was obtained in twenty-six(93%) of the 28 patients. Recovery of spincter change was obtained twelve(80%) of the 15 patients. Two patients died postoperatively due to DIC and pneumonia. Prior to operation, selective spinal angiography and embolization were performed in nine patients with metastases from renal carcinoma, thyroid cancer and hepatoma to reduce intraoperative bleeding. The authors believe that the choice of surgical approach has to be individualized for each patient depending on extent and location of the tumor, general condition of patient, goal of therapy and life expectancy.
Angiography ; Carcinoma, Hepatocellular ; Dacarbazine ; Hemorrhage ; Humans ; Life Expectancy ; Neoplasm Metastasis ; Pneumonia ; Thoracotomy ; Thyroid Neoplasms

The authors present a series of 12 patients who underwent one-stage spondylectomy, vertebral reconstruction, posterior segmental stabilization for malignant metastatic disease. Major indication for this approach includes three column involvement or untolerable thoracotomy. This operative method involved the spondylectomy via a bilateral transpedicular or unilateral extracavitary approach, vertebral body reconstruction with methlymethacrylate (MMA), and posterior stabilization with sublaminar wiring in one stage. Postoperatively, all patients improved neurologically. Average neurologic improvement was 1.5 Frankel grade. Pain relief was obtained in all patients. Recovery of sphincter change was obtained 7(88%) of the 8 patients. One patient died postoperatively due to pneumonia. Spinal alignment was maintained in all. The major advantage of this approach is that circumferential decompression of the spine and stabilization can be obtained safely by one stage.
Decompression ; Humans ; Neoplasm Metastasis* ; Pneumonia ; Spine ; Thoracotomy

Papillary thyroid carcinoma and primary lung cancer have vastly different treatment approaches and prognosis. If lung mass is found in patients with papillary thyroid carcinoma, we have to be aware of the possibility of primary lung cancer especially when the lesion is not iodine-avid, or is not typical to metastatic thyroid carcinoma, or serum thyroglobulin is not elevated. Here we present two cases of non-small cell lung cancer masquerading as metastatic papillary thyroid carcinoma and think of the approach of the lung mass which is found in patients with papillary thyroid carcinoma.
Carcinoma ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung ; Lung Neoplasms ; Prognosis ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms