Carbon Monoxide poisoning is one of the most serious Public health problems in Korea. The incidence rate officially reported has been known to be the highest in the world. This high incidence is mainly due to the wide prevalence of anthracite coal briquette as the domestic fuel for unique Korean heating system called "ondol." The coal briquette gas contains around 3-5% of Carbon Monoxide. A nation-wide effort to eliminate or reduce this serious hazards has produced little effect and the most hospitals are offering very ineffective measures such as oxygen inhalation through nasal catheter. Author has believed that this preventable accident should be approached by the secondary preventive measure because of our socio-economic status do not allow us optimistic results from primary preventive measure as far as the problem of CO poisoning is concerned. Author has treated 466 patients during 30 months period by Hyperbaric Oxygenation at Seoul National University Hospital. The results found are as follows. 1. Female has a higher incidence rate than male and the age group between 15-29 years showed highest incidence. 2. The recovery time depends on the time when the patients arrived at hospital. Earlier the arrival time, shorter the recovery time. 3. Some objective signs are representing typical physiological response to tissue hypoxia. 4. Therapeutic effectiveness of Hyperbaric Oxypenation is confirmed by such indices as recovery rate, Admission rate and average stay in hospital. Futher, these results are cocordant with other reports on the clinical value of Hyperbaric Oxygenation in the treatment of CO poisoning.
Anoxia ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Catheters ; Coal ; Female ; Heating ; Hot Temperature ; Humans ; Hyperbaric Oxygenation* ; Incidence ; Inhalation ; Korea ; Male ; Oxygen ; Poisoning* ; Prevalence ; Public Health ; Seoul

Carbon Monoxide poisoning is one of the most serious Public health problems in Korea. The incidence rate officially reported has been known to be the highest in the world. This high incidence is mainly due to the wide prevalence of anthracite coal briquette as the domestic fuel for unique Korean heating system called "ondol." The coal briquette gas contains around 3-5% of Carbon Monoxide. A nation-wide effort to eliminate or reduce this serious hazards has produced little effect and the most hospitals are offering very ineffective measures such as oxygen inhalation through nasal catheter. Author has believed that this preventable accident should be approached by the secondary preventive measure because of our socio-economic status do not allow us optimistic results from primary preventive measure as far as the problem of CO poisoning is concerned. Author has treated 466 patients during 30 months period by Hyperbaric Oxygenation at Seoul National University Hospital. The results found are as follows. 1. Female has a higher incidence rate than male and the age group between 15-29 years showed highest incidence. 2. The recovery time depends on the time when the patients arrived at hospital. Earlier the arrival time, shorter the recovery time. 3. Some objective signs are representing typical physiological response to tissue hypoxia. 4. Therapeutic effectiveness of Hyperbaric Oxypenation is confirmed by such indices as recovery rate, Admission rate and average stay in hospital. Futher, these results are cocordant with other reports on the clinical value of Hyperbaric Oxygenation in the treatment of CO poisoning.
Anoxia ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Catheters ; Coal ; Female ; Heating ; Hot Temperature ; Humans ; Hyperbaric Oxygenation* ; Incidence ; Inhalation ; Korea ; Male ; Oxygen ; Poisoning* ; Prevalence ; Public Health ; Seoul

PURPOSE: This study was undertaken to establish a Peyronie's disease model by using local injection of fibrin into the tunica albuginea. MATERIALS AND METHODS: Four-month-old male Sprague-Dawley rats were divided into three groups (n=12 per group): Gr I, age-matched control; Gr II, a single injection of fibrin (50 microliter each of human fibrin and thrombin solutions); and Gr III, repeated injections of fibrin (50 microliter each of human fibrin and thrombin solutions, days 0, 3, and 6, respectively) into the tunica albuginea. We evaluated penile curvature by the use of an artificial erection test with intracavernous injection of saline and erectile function by cavernous nerve electrical stimulation 30, 45, and 60 days (n=4 per time point) after treatment. The penis was then harvested and stained with Masson trichrome, hematoxylin-eosin, and antibody to phospho-Smad2. RESULTS: Whereas a single intratunical injection of fibrin induced fibrous scar in the tunica, which lasted up to 45 days and disappeared 60 days after injection, repeated injections of fibrin induced more pronounced tunical fibrosis, which lasted up to 60 days after injection. However, a single or repeated intratunical injection of fibrin did not induce significant penile curvature. The peculiar histological findings in group receiving a single or repeated intratunical injection of fibrin were infiltration of inflammatory cells, and increase of transnuclear expression of phospho-Smad2. CONCLUSIONS: Although a single or repeated administration of fibrin did not induce penile curvature, this model may contribute to further investigation of pathogenesis and development of potential therapeutics in Peyronie's disease.
Animals ; Caves ; Cicatrix ; Electric Stimulation ; Fibrin ; Fibrosis ; Humans ; Male ; Models, Animal ; Penile Induration ; Penis ; Rats ; Rats, Sprague-Dawley ; Thrombin

PURPOSE: We sought to evaluate the clinical outcomes of 3-dimensional conformal radiation therapy (3D-CRT) for portal vein tumor thrombosis (PVTT) alone in patients with advanced hepatocellular carcinoma. MATERIALS AND METHODS: We retrospectively analyzed data on 46 patients who received 3D-CRT for PVTT alone between June 2002 and December 2011. Response was evaluated following the Response Evaluation Criteria in Solid Tumors. Prognostic factors and 1-year survival rates were compared between responders and non-responders. RESULTS: Thirty-seven patients (80.4%) had category B Child-Pugh scores. The Eastern Cooperative Oncology Group performance status score was 2 in 20 patients. Thirty patients (65.2%) had main or bilateral PVTT. The median irradiation dose was 50 Gy (range, 35 to 60 Gy) and the daily median dose was 2 Gy (range, 2.0 to 2.5 Gy). PVTT response was classified as complete response in 3 patients (6.5%), partial response in 12 (26.1%), stable disease in 19 (41.3%), and progressive disease in 12 (26.1%). There were 2 cases of grade 3 toxicities during or 3 months after radiotherapy. Twelve patients in the responder group (15 patients) received at least 50 Gy irradiation, but about 84% of patients in the non-responder group received less than 50 Gy. The 1-year survival rate was 66.8% in responders and 27.4% in non-responders constituting a statistically significant difference (p = 0.008). CONCLUSION: Conformal radiotherapy for PVTT alone could be chosen as a palliative treatment modality in patients with unfavorable conditions (liver, patient, or tumor factors). However, more than 50 Gy of radiation may be required.
Carcinoma, Hepatocellular* ; Humans ; Palliative Care ; Portal Vein* ; Radiotherapy ; Radiotherapy, Conformal* ; Retrospective Studies ; Survival Rate ; Thrombosis*

PURPOSE: This study was performed to examine the neck failure patterns after a complete response (CR) to definitive radiotherapy for advanced head and neck cancer patients, as well as evaluate the clinical significance of the results of this study. MATERIALS AND METHODS: Between 1987 and 2008, the clinical data of patients who had been treated with radical radiotherapy for primary squamous cell carcinomas and enlarged cervical lymph nodes was analyzed retrospectively. Ultimately, the cases that showed CR of the cervical lymph node lesions to full-dose radiotherapy were included in this study. The recurrent rate and sites in the cervical lymphatic area were evaluated periodically by radiologic imaging studies, along with some factors which might have affected the rate of recurrence. RESULTS: A total of 73 patients who achieved CR in neck area after radiotherapy were included in this study. The rate of subsequent neck failure among those patients was 19.2%. There was only a 5.5% failure rate in the 55 patients who underwent radiotherapy in their primary site. Eighty percent of the recurrent cases were found within 3 years (median follow-up, 68 months). The majority of neck recurrent cases (47%) were accompanied with the failure of the primary lesions. The initial response of the primary site and the method of radiotherapy simulation were significant prognostic factors associated with the nodal recurrence rate. CONCLUSION: The recurrence rate of cervical nodes in patients with CR to radiotherapy in the primary site and neck area was about 5%. These patients could be followed up with close observation without a planned neck dissection.
Carcinoma, Squamous Cell ; Follow-Up Studies ; Head and Neck Neoplasms ; Humans ; Lymph Nodes ; Neck ; Neck Dissection ; Recurrence ; Retrospective Studies

PURPOSE: This study was performed to objectively evaluate the rate of tumor response to hypofractionated radiotherapy for advanced squamous cell carcinomas of the head and neck. MATERIALS AND METHODS: Thirty-one patients with advanced squamous cell carcinoma of the head and neck, who were treated by hypofractionated radiotherapy with 3 Gy per fraction for palliative purpose between 1998 and 2008, were reviewed retrospectively. Every tumor-volume was measured and evaluated from CT (computed tomography) images obtained before and 2~3 months after radiotherapy. The radiation toxicity was assessed during and after radiotherapy. A statistical analysis was performed to investigate overall survival, progression-free survival, and the prognostic factors for survival and response. RESULTS: The median age of the study patients was 70 years. In addition, 85% of the patients were in stage 4 cancer and 66.7% had an ECOG performance status of 1~2. The mean tumor-volume was 128.4 cc. Radiotherapy was administered with a total dose of 24~45 Gy (median: 36 Gy) over 10~25 days. Twenty-nine patients were treated with 30 Gy or more. The observed complete response rate was 12.9% and the partial response rate was 61.3%. Median survival time was 8.9 months and the 1-year progression-free survival rate was 12.9%. The treatment response rate was confirmed as a prognostic factor in the rate of survival. The primary site, stage, tumor-volume, radiotherapy field and overall radiation-dose showed a significant relationship with survival and treatment response. No grade 4 toxicity was observed during and after radiotherapy. CONCLUSION: There was an objective tumor-regression in about 74% of patients treated by hypofractionated radiotherapy. Further evaluation is needed to select the appropriate fraction-size and patient who may require the additional radiotherapy.
Carcinoma, Squamous Cell ; Disease-Free Survival ; Head ; Head and Neck Neoplasms ; Humans ; Neck ; Retrospective Studies

PURPOSE: To examine the feasibility of the treatment planning for minimizing carotid artery dose in the radiotherapy of early glottic cancer. MATERIALS AND METHODS: From 2007 to 2010, computed tomography simulation images of 31 patients treated by radiotherapy for early glottic cancer were analyzed. The virtual planning was used to compare the parallel-opposing fields (POF) with the modified oblique fields (MOF) placed at angles to exclude the ipsilateral carotid arteries. Planning target volume (PTV), irradiated volume, carotid artery, and spinal cord were analyzed at a mean dose, V35, V40, V50 and with a percent dose-volume. RESULTS: The beam angles were arranged 25 degrees anteriorly in 23 patients and 30 degrees anteriorly in 8 patients. The percent dose-volume of PTV shows no statistical difference. Conversely, the cumulative percent dose-volume of carotid artery shows the significant difference (p<0.001). The mean doses of carotid artery were 38.5 Gy for POF and 26.3 Gy for MOF and the difference was statistically significant (p=0.012). Similarly, V35, V40, and V50 also showed significant differences between POF and MOF. CONCLUSION: The modified oblique field was respected to prevent a carotid artery stenosis and reduce the incidence of a stroke based on these results.
Carotid Arteries ; Carotid Stenosis ; Humans ; Incidence ; Spinal Cord ; Stroke

PURPOSE: This study was performed to determine the prognostic factors influencing relapse pattern, overall and disease-free survival in patients treated with postoperative radiotherapy for endometrial carcinoma. MATERIALS AND METHODS: The records of 54 patients with endometrial adenocarcinoma treated postoperative radiotherapy at Pusan National University Hospital between April 1992 and May 2003 were reviewed retrospectively. Median age of the patients was 55 (range 35~76). The distribution by surgical FIGO stages were 63.0% for 0Stage I, 14.8% for Stage II, 22.2% for Stage III. All patients received postoperative external radiotherapy up to 41.4~54 Gy (median: 50.4 Gy). Additional intravaginal brachytherapy was applied to 20 patients (37.0% of all). Median follow-up time was 35 months (5~115 months). Significant factors of this study: histologic grade, lymphovascular space invasion and myometrial invasion depth were scored (GLM score) and analyzed. Survival analysis was performed using Kaplan-Meier method. The log-rank test was used for univariate analysis and the Cox regression model for multivariate analysis. RESULTS: 5-year overall and disease-free survival rates were 87.7% and 87.1%, respectively. Prognostic factors related with overall and disease-free survival were histologic grade, lymphovascular space invasion and myometrial invasion according to the univariate analysis. According to the multivariate analysis, lymphovascular space invasion was associated with decreased disease-free survival. GLM score was a meaningful factor affecting overall and disease-free survival (p=0.0090, p=0.0073, respectively) and distant recurrence (p=0.0132), which was the sum of points of histologic grade, lymphovascular space invasion and myometrial invasion. Total failure rate was 11% with 6 patients. Relapse sites were 2 para-aortic lymph nodes, 2 lungs, a supraclavicular lymph node and a vagina. CONCLUSION: The prognosis in patients with endometrial carcinoma treated by postoperative radiotherapy was closely related with surgical histopathology. If further explorations confirm the system of prognostic factors in endometrial carcinoma, it will help us to predict the progression pattern and to manage.
Adenocarcinoma ; Brachytherapy ; Busan ; Disease-Free Survival ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Lung ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Vagina

PURPOSE: The purpose of this retrospective study was to evaluate the efficacy and feasibility of short-course hypofractionated radiotherapy (RT) for the palliation of uterine cervical cancer. MATERIALS AND METHODS: Seventeen patients with cancer of the uterine cervix, who underwent palliative hypofractionated 3-dimensional conformal radiotherapy between January 2002 and June 2012, were retrospectively analyzed. RT was delivered to symptomatic lesions (both the primary mass and/or metastatic regional lymph nodes). The total dose was 20 to 25 Gy (median, 25 Gy) in 5 Gy daily fractions. RESULTS: The median follow-up duration was 12.2 months (range, 4 to 24 months). The median survival time was 7.8 months (range, 4 to 24 months). Vaginal bleeding was the most common presenting symptom followed by pelvic pain (9 patients). The overall response rates were 93.8% and 66.7% for vaginal bleeding control and pelvic pain, respectively. Nine patients did not have any acute side effects and 7 patients showed minor gastrointestinal toxicity. Only 1 patient had grade 3 diarrhea 1 week after completion of treatment, which was successfully treated conservatively. Late complications occurred in 4 patients; however, none of these were of grade 3 or higher severity. CONCLUSION: Short-course hypofractionated RT was effective and well tolerated as palliative treatment for uterine cervical cancer.
Cervix Uteri ; Diarrhea ; Female ; Follow-Up Studies ; Humans ; Palliative Care ; Pelvic Pain ; Radiotherapy* ; Radiotherapy, Conformal ; Retrospective Studies ; Uterine Cervical Neoplasms* ; Uterine Hemorrhage

PURPOSE: This study was carried out to confirm clinical values and limitations of postoperative radiotherapy for hypopharyngeal carcinoma, to evaluate various prognostic factors which may affect to the treatment results and to use these results as fundamental data for making a new treatment strategy. METHODS AND MATERIALS: A retrospective analysis was performed on 64 previously untreated patients with squamous cell carcinoma of the hypopharynx, seen between 1988 and 1999 at Pusan National University Hospital. Most of patients were treated by laryngopharyngectomy and neck dissection followed by conventional fractionated postoperative radiotherapy on surgical bed and cervical nodal areas. RESULTS: The five-year overall survival rate and cause-specific survival rate were 42.2 percent and 51.6 percent, respectively. Univariate analysis of various clinical and pathologic factors confirmed the overall stage, TN-stage, secondary primary cancers, surgical positive margin, nodal extracapsular extension, total radiation doses as significant prognostic factors of hypopharyngeal carcinomas. But in multivariate analysis, TN-stage, surgical positive margin and extracapsular extesion were only statistically significant. CONCLUSION: In resectable cases of hypopharyngeal carcinoma, combined surgery and postoperative radiotherapy obtained good treatement results, even though sacrificing the function of larynx and pharynx. But in advanced and unresectable cases, with respect to survivals and quality of life issues, we were able to confirm some limitations of combined therapy. So we recommend that comparative studies of recent various chemo-radiotherapy methods and advanced radiotherapy techniques with these data should be needed.
Busan ; Carcinoma, Squamous Cell ; Humans ; Hypopharynx ; Larynx ; Multivariate Analysis ; Neck Dissection ; Pharynx ; Quality of Life ; Radiotherapy* ; Retrospective Studies ; Survival Rate