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

OBJECTIVES: The aim of this study was to know differences of characteristics between presenile and senile patients who were consulted to the department of psychiatry during medical-surgical admission. METHODS: The demographic and clinical data obtained from the medical records of psychiatric consultation in the presenile inpatients with age 50 to 64 years(N=162) and those of the senile inpatients with age over 65 years(N=171) were reviewed and compared. RESULTS: 1) The most common chief complaints for psychiatric consultation in presenile patients were somatic symptoms, anxiety and sleep disturbance in order, while cognitive decline, clouded consciousness and depressed mood were most common in senile patients with statistical significance. 2) The most frequent psychiatric diagnoses after consultation in presenile patients were delirium, mood disorder and substance use disorder in order, while delirium, mood disorder and major neurocognitive disorder were most frequent in senile patients with statistical significance. 3) There were no significant difference in numbers of physical illnesses, while numbers of therapeutic drugs for them were more in senile patients. CONCLUSIONS: Our study found significant differences between presenile and senile patients on psychiatric symptoms and diagnoses in geropsychiatric consultation. Therefore, more subdivided age-specific approach seems to be needed for the geropsychiatric consultation activities.
Anxiety ; Consciousness ; Delirium ; Diagnosis ; Humans ; Inpatients* ; Medical Records ; Mood Disorders ; Substance-Related Disorders

PURPOSE: Our objective was to evaluate mammographic findings of breast cancer in men. MATERIALS AND METHODS: This study includes 9 man with breast cancer diagnosed pathologically by radical mastectomy. Clinical and pathologic data were obtained by review of patients' medical record. Mammograms were analysed retrospectively. RESULTS: Of the 9 patients, eight had masses with spiculated margin or schirrous pattern with irregular margin. One patient had no specific evidence of breast cancer mammographically. Microcalcifications were seen in three patients, these calcifications were irregular in shape and were clustered. Of the 8 cases, four patients had the masses at the right breast, four at the left breast. Locations of breast cancer were subareolar(n=4) and were eccentric(n=4) from the nipple. The most common location was the upper outer quadrant. On histologic evaluation, 7 cases were infiltrating ductal carcinomas, one case was mucinous adenocarcinoma, and the remainder was proved as combined form of intraductal and infiltrating ductal carcinoma. Axillary lymph node metastasis were found in 4 cases. CONCLUSION: Mammographic findings of male breast carcinoma were that of subareolar or eccentrically located mass. Calcifications were same to the patterns of calcification as female breast cancer.
Adenocarcinoma, Mucinous ; Breast ; Breast Neoplasms ; Breast Neoplasms, Male* ; Carcinoma, Ductal ; Female ; Humans ; Lymph Nodes ; Male ; Male* ; Mastectomy, Radical ; Medical Records ; Neoplasm Metastasis ; Nipples ; Retrospective Studies

PURPOSE: Our objective was to evaluate mammographic findings of breast cancer in men. MATERIALS AND METHODS: This study includes 9 man with breast cancer diagnosed pathologically by radical mastectomy. Clinical and pathologic data were obtained by review of patients' medical record. Mammograms were analysed retrospectively. RESULTS: Of the 9 patients, eight had masses with spiculated margin or schirrous pattern with irregular margin. One patient had no specific evidence of breast cancer mammographically. Microcalcifications were seen in three patients, these calcifications were irregular in shape and were clustered. Of the 8 cases, four patients had the masses at the right breast, four at the left breast. Locations of breast cancer were subareolar(n=4) and were eccentric(n=4) from the nipple. The most common location was the upper outer quadrant. On histologic evaluation, 7 cases were infiltrating ductal carcinomas, one case was mucinous adenocarcinoma, and the remainder was proved as combined form of intraductal and infiltrating ductal carcinoma. Axillary lymph node metastasis were found in 4 cases. CONCLUSION: Mammographic findings of male breast carcinoma were that of subareolar or eccentrically located mass. Calcifications were same to the patterns of calcification as female breast cancer.
Adenocarcinoma, Mucinous ; Breast ; Breast Neoplasms ; Breast Neoplasms, Male* ; Carcinoma, Ductal ; Female ; Humans ; Lymph Nodes ; Male ; Male* ; Mastectomy, Radical ; Medical Records ; Neoplasm Metastasis ; Nipples ; Retrospective Studies

The treatment of patients with severe periodontitis should be proceeded step-bystep through an accurate diagnosis of each patients’ individual tooth and with a strategic treatment plan. Implant-supported fixed prosthetic restoration has the advantage of high patient satisfaction and stable vertical dimension compared to the removable partial denture. However, multiple teeth defect areas lacking hard tissue may be disadvantageous in aesthetic failure and longer treatment time. In addition, it takes a certain period of time to manufacture and install a conventional fixed prosthesis, and during this process, the provisional prosthesis must satisfy the mechanical, biological, and aesthetic requirements of teeth. The purpose of this article is to describe the fabrication of implant-supported fixed prosthesis through a step-by-step approach in a partially edentulous patient.

BACKGROUND: It is well known that a lacunar infarction may develop by an atherosclerosis of the large intracranial arteries at the site of the perforating arteries. However, their frequency, clinical, and radiological findings have rarely been described. METHODS: Carotid angiograpies were carried out in 26 Korean patients with lacunar infarctions in the carotid arterial territory. They all had classical lacunar symptoms with a computed tomogram (CT) or a magnetic resonance image (MRI) evidence of a small infarction. A transesophageal echocardiography (TEE) was carried out in fifteen patients when either an angiography result was normal, the potential source of cardioembolism was suggested, or no other atherothrom-botic causes of stroke were found. Tc-99m single positron emission computed tomograms (SPECT) were performed in nine patients. We divided patients into two groups; one for patients with MCA occlusive lesion, and another for those without it. The clinical and radiological features were compared between the two groups. RESULTS: Twenty patients (77%) demonstrated abnormal angiographic findings. Fourteen of them showed atherosclerotic changes in the proximal MCA at the site of the orifice of the lenticulostriatal arteries, while another three showed stenosis in the intracranial portion of the internal cerebral artery (ICA), and the other three in the extracranial ICA. Among six patients with normal angiograms, a TEE demonstrated embolic sources of embolism in two patients. The temporal profile and findings of MRI and SPECT in patients with MCA stenosis differed from those with ICA stenosis or normal angiograms. Unstable temporal profiles exclusively occurred in patients with MCA stenosis. The most patients with conglomatory aggregations of the lacune in a MRI showed MCA lesions. The SPECT findings were even more characteristic in that patients with MCA lesions showed relatively large areas of decreased perfusion. CONCLUSIONS: The atherosclerotic diseases at the orifice of the lenticulostri-atal arteries were the most common causes of lacunar infarctions in the carotid artery territory. They were clearly different from those without MCA occlusive lesions in terms of preceding transient ishemic attacks, unstable temporal profiles, uni-lateral multiple lacunes with conglomatory MRI findings, and widespread perfusion defects SPECT.
Angiography ; Arteries ; Atherosclerosis ; Carotid Arteries* ; Cerebral Arteries ; Constriction, Pathologic* ; Echocardiography, Transesophageal ; Electrons ; Embolism ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Perfusion ; Stroke ; Stroke, Lacunar* ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. METHODS: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. RESULTS: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. CONCLUSIONS: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.
Arthrography* ; Dislocations ; Follow-Up Studies ; Humans ; Incidence ; Joint Instability ; Recurrence ; Retrospective Studies ; Shoulder*

Backgound: The placement of stents in coronary arteries has been shown to reduce acute closure and restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the subacute stent thrombosis and hemorrhagic complications associated with the anticoagulant regimen. It's known that the complete stent deployment with high pressure inflation and new antiplatelet agents are effective in reduction of subacute thrombosis and hemorrhage. So we evaluated initial results (success and complication rate) after high pressure-stent deployment with new anticoagulation protocol. METHODS: One hundred and ninety one patients with 201 lesions were treated with 231 stents of various types. The high pressure balloon inflation and antiplatelets agents were used in all cases. Final high pressure balloon inflation guided by IVUS were performed in 23 consecutive cases with incomplete stent deployment according to angiographic findings. RESULTS: 1) The indications of stenting (n=210) were De novo in 124 (59%), bailout procedure in 57 (27%), suboptimal result after PTCA in 19 (8%), and restenosis after PTCA in 14 (6%). The location of lesions were LAD in 101, RCA in 67, circumflex in 28, ramus intermedius in 3, and LMT artery in 2 lesions. Angiographic morphologic characteristics were type A in 2, type B in 158 (B1: 57, B2: 101), and type C in 22 lesions. 2) The angiographic and clinical success rate was 96% (192/201) and 92% (186/201) respectively. 3) In angiographic analysis, the baseline average reference vessel dirmeter was 3.33+/-0.35 mm. Baseline minimum lumen diameter (MLD) was 0.58+/-0.29 mm, with baseline percent diameter stenosis of 82.86+/-8.64%. The final stent diameter was 3.37+/-0.29 mm, with mean final percent stenosis of 0.63+/-8.25. The mean MLD after stenting was significantly increased (p<0.001). The mean MLD within stent increased 14%, from 2.91+/-0.39 mm at the nominal balloon inflation (inflation pressure=7 atm) to 3.37+/-0.29 mm at high pressure balloon inflation (inflation pressure <0A65B>12atm) (p<0.001). The length of lesions in GR I (cook), GR II, and Micro II stents were significantly longer than ones in PS, Cordis, Wiktor, Nir (p<0.001). 4) In intravascular ultrasound analysis, the mean lumen CSA at the tightest point within stent increased 11%, from 8.4+/-2.4 mm2 at the intial intravascular ultrasound to 9.4+/-2.1 mm2 at the final intravascular ultrasound (p<0.001). 5) The procedural and postprocedural complications were 2 acute closures associated with AMI and emergent CABG, 1 subacute closure which was revascularized by bail out stenting, 5 major hemorrhage requiring transfusion associated with 1 CVA and 2 metabolic acidosis induced by acute renal failure, and 5 death. CONCLUSION: The high pressure stent deployment procedure and new anticoagulation protocol associating tidopidine and aspirin without coumadin or prolonged heparin infusion allow us to obtain an acceptably low subacute thrombosis or bleeding complication rate. These results are encouraging and allow a wide use of coronary stenting.
Acidosis ; Acute Kidney Injury ; Angioplasty, Balloon ; Arteries ; Aspirin ; Constriction, Pathologic ; Coronary Vessels* ; Hemorrhage ; Heparin ; Humans ; Inflation, Economic ; Platelet Aggregation Inhibitors* ; Stents* ; Thrombosis ; Ultrasonography ; Warfarin

Coronary stent embolization is a rare event but may result in clinically relevant cardiac ischemia or peripheral embolization during the procedure. We report a case of systemic embolizations of two coil stents during the primary PTCA in acute myocardial infarction, who were treated successfully with a double wire helix technique and a gooseneck snare. Although in our experience this rare complication did not produce any clinical complications, care should be taken to prevent this possibility, especially in patients with significant vessel tortuosity, calcification, total occlusion, or mild stenosis proximal to the target lesion.
Constriction, Pathologic ; Humans ; Iliac Artery* ; Ischemia ; Myocardial Infarction ; SNARE Proteins ; Stents*

The incidence of anterior cruciate ligament (ACL) injuries among female ballet dancers is much lower than among female soccer players, there is currently little research examining the landing error scoring system (LESS) of female ballet dancers and female soccer players. The purpose of this study was to investigate the LESS during drop vertical jump on ACL injury risk factors in female ballet dancers and female soccer players. Thirteen professional female ballet dancers and elite female soccer players participated in the study. Independent sample t-test was used to compare the LESS score between the groups with Bonferroni collection. The elite female soccer player group showed significantly higher stance width-wide, foot position-toe out, symmetric initial foot contact, overall impression and total LESS score than those of the professional ballet dancers.
Anterior Cruciate Ligament* ; Female* ; Foot ; Humans ; Incidence ; Risk Factors* ; Soccer*