CT scans obtained on 15 patients of head and neck malignant tumors were evaluated for their utility in ratiotherapy treatment planning. To evaluate the advantage of incorporating CT scans in radiotherapy treatment planning of head and neck malignant tumors, the dose distributions of treatment plan with and without CT scan were compared in 15 patients. And then the dose distributions of the first and second treatment plan were compared. 1. Tumor extend and localization were clearly delineated on CT scan in 12 of 15 cases (80%), suggestive in 2 (13.3%), and not seen in only one (6.7%) which had been in the postoperative state. 2. Tumor coverage after CT scan was adequate in 14 of 15 cases (93.3%) and not in only one. In one case of inadequate tumor coverage the target volume lay inside the field but reached within 0.5cm of the field margin (marginal miss). 3. The volume of normal tissue irradiated was reduced after CT scan in 12 of 15 cases (80%), increased in 1 (6.7%) and not changed in 2 (13.3%). 4. We could maximize the local control of disease and minimize unnecessary morbidity by delineating the location and extent of tumor and normal tissue with CT for treatment plannings.
Head* ; Humans ; Neck* ; Radiotherapy* ; Tomography, X-Ray Computed

Malignant glaucoma is a disease process in which entire anterior chamber becomes uniformly shallow and elevates intraocular pressure. Classically, this has been described as limited to cases occurring following glaucoma surgery. Subsequently, association with trauma, inflammation, and the use of miotic agents, as well as spontaneous occurrence have also been noted. We have experienced one case of bilateral malignant glaucoma associated with ciliochoroidal detachment which was detected by ultrasoundbiomi-croscopy in a 55-year-old male. The episode followed the use of a strong miotic(pilocarpine hydrochloride 4%) and laser iridotomy for acute angle closure glaucoma. We report this case with review of available literature.
Anterior Chamber ; Glaucoma* ; Glaucoma, Angle-Closure ; Humans ; Inflammation ; Intraocular Pressure ; Male ; Middle Aged

99mTc-DMSA is a new renal scanning agent that provides a good quality of renal image as a result of preferential cortical accumulation and also makes feasible a quantitative assessment of separate kidney functions. Using 99mTc-DMSA renal scan. we evaluated renal functions in 26 patients who had unilateral non-functioning obstructed kidneys on intravenous pyelogram (IVP) and normal contralateral kidneys for recent 2 years and decided whether to perform surgeries for relief of obstructions or nephrectomies. In the patients who undertook surgeries for relief of obstructions for the recovery of renal functions, we compared renal functions of preoperative and postoperative obstructed kidneys. The results were as follows: 1. Etiologic diseases in 26 patients were urinary stones in 13. ureteropelvic junction obstructions in 7 and renal tuberculosis in 6. 2. Nephrectomies were performed in 13 patients who showed less than 15% of the total renal functions as determined by a preoperative 99mTc-DMSA scans. 3. Surgeries for relief of obstructions were performed in the other 13 patients for the recovery of the renal functions. The functions of the obstructed kidneys as determined by preoperative 99m Tc-DMSA scans were from 23% to 42% (mean 29.3%) and by postoperative 99mTc-DMSA scans were from 24% to 47 % (mean 34.4 %). The functions of the obstructed kidneys were recovered from 1% to 12% (mean 43.5 %) after surgeries for relief of obstructions. The follow-up periods were from 1 to 13 months (mean 6.6 month).
Follow-Up Studies ; Humans ; Kidney ; Nephrectomy ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Tuberculosis, Renal ; Urinary Calculi

BACKGROUND: Fosinopril is a new phosphorous containing angiotensin converting enzyme inhibitor. To assess the antihypertensive efficacy and safety of fosinopril, the clinical trial was done in patients with mild to moderate hypertension. METHODS: In 30 patients with mild to moderate essential hypertension, we administered fosinopril 10-20mg once daily for 10 weeks and checked their blood pressure every 2 weeks. RESULTS: The blood pressure decreased from 158+/-12.3/103.4+/-4.2mmHg to 139+/-7.5/88.4+/-5.9mmHg at the end of treatment(p<0.05). Heart rate did not change significantly during therapeutic period. Of 30 patients, the efficacy of fosinopril therapy disclosed 25 patients(83.7%) with normal diastolic pressure of more than 10mmHg decline of diastolic blood pressure. But two patients had no effects and three patients were not followed up. The adverse reactions due to fosinopril were reported in 3 patients(10%) with dry cough, 2 patients with palpitation(6.7%) and 1 patient with weakness(3.3%), but there were no patients who discontinued fosinopril due to adverse effect. CONCLUSION: Fosinopril has an excellent antihypertensive effect at low dosage as a first line antihypertensive agent or as a substituting agent for other antihypertensives in patients with mild to moderate essential hypertension.
Antihypertensive Agents ; Blood Pressure ; Cough ; Fosinopril* ; Heart Rate ; Humans ; Hypertension ; Peptidyl-Dipeptidase A

No abstract available.
Perfusion* ; Stomach Neoplasms* ; Stomach*

PURPOSE: To evaluate the CT findings of histologically confirmed endobrnchial tuberculosis(EBTB) and to access their diagnostic value by comparing with the bronchoscopic findings. MATERIALS AND METHOD: We evaluated retrospectively the CT findings of 25 patients(male : female=5 : 20) with EBTB, and classified them into 3 types by their characteristic features, which are compared with the brochoscopic findings. The 3 types of CT features were as follows ; type 1 : central mass-like lesion with coarse calcific spots associated with atelectasis, type 2: caseous pneumonia with air-bronchogram associated with atelecatasis, type 3 : irregularly distorted and narrowed bronchovascular changes. RESULTS: Comparing the characteristic CT findings with the bronchoscopic findings, they were as follows ; type 1 showed completely occluded lumen by caseous or scar-like tissue with severely swollenmucosa, type 2 showed very thick tenacious mucous plug with anthracotic pigmentation of mucosa, type 3 showed chronic inflammatory change of mucosa with severely deviated or septated bronchial lumen by out-growing caseousgranulation tissue. A tracheal tuberculosis without parenchymal lesion was noted and the bronchoscopy showed caseous materials along the tracheal lumen to the carinal level. CONCLUSION: The characteristic CT findings ofthe bronchial wall and the changes of the adjacent tissues are related to the tracheobronchial tuberculous involvement. CT is useful for diagnosis of the endobronchial tuberculosis.
Adult* ; Bronchoscopy ; Diagnosis ; Humans ; Mucous Membrane ; Pigmentation ; Pneumonia ; Pulmonary Atelectasis ; Tuberculosis* ; Tuberculosis, Pulmonary

The common sites of esophageal diverticula are the pharyngoesophageal junction, midesophagus and epiphrenic. The pathophysiological mechanisms of acquired esophageal diverticula are traction and pulsion forces. Traction diverticula of the midesophagus are usually asymptomatic, and found incidentally on an esophagogastroduodenoscopy or barium contrast esophagogram. Midesophageal traction diverticula are caused by inflammatory processes between the external wall of the esophagus and the adjacent structure. Pneumonia, bronchoesophageal fistula and gastrointestinal bleeding can occur due to an extension of inflammatory process into the lung or blood vessels. There are a few reports of midesophageal diverticular bleeding. We present a case of massive upper gastrointestinal bleeding from a traction diverticulum of the midesophagus that was successfully managed by endoscopic treatment.
Barium ; Blood Vessels ; Diverticulum* ; Diverticulum, Esophageal ; Endoscopy ; Endoscopy, Digestive System ; Esophagus ; Fistula ; Hemorrhage* ; Lung ; Pneumonia ; Traction*

OBJECTIVES: Endoscopic Ultrasonography (EUS) is widely used to diagnose upper gastrointestinal tract disease. In recent, it is reported that EUS is also goood diagnostic method to assess depth of invasion through rectal wall and lymph node involvement of rectal cancer. We performed EUS in preoperative rectal cancer patients and compared to post operative histologic findings to evaluate EUS diagnostic accuracy for rectal cancer staging system METHODS: 51 patients with rectal cancer were performed with EUS. They were diagnosed by endoscopic biopsy from August 1994 to June 1996 at Kangbuk Samsung Hospital. Their ages were 28 to 78 (mean: 55 years) and the male to female ratio was 2 : 1 (34/17). Olympus GF-UM3, EU-M3 EUS and 7.5/12 MHz transducer were utilized. EUS was performed by the deaerated water filling method. We have analyzed between preoperative EUS findings and postoperative biopsy findings in order to evaluate the accuracy of EUS. The accuracy of EUS was signified by percentage. RESULTS: 1) Endoscopic ultrasonographic accuracy for assessment of wall invasion of rectal cancer was as follows ; The accuracy of mucosal cancer was 50% (patient numbers of EUS diagnosis/patient numbers of histologic diagnosis: 2/4). Submucosal cancer was 100% (1/1). Muscularis propria cancer was 44% (4/9). The accuracy with penetration to subserosa (or perirectal fat tissue) was 97% (33/34). The accuracy with invasion to adjacent organ was 33% (1/3). The overall accuracy rate was 80% (41/51). 2) EUS accuracy of lymph node metastasis in rectal cancer was ; The sensitivity was 90% (patient numbers of EUS diagnosis/patient numbers of histologic diagnosis: 28/31). The specificity was 60% (12/20). 3) EUS diagnosis of modified Duke classification was ; The accuracy of A stage was 80% (patient numbers of EUS diagnosis/patient numbers of histologic dagnosis: 4/5). B1 stage was 60% (4/8). B2 stage was 33% (1/3). C1 stage was 0% (0/3). C2 stage was 86%(25/28). D stage was 33% (1/3). The overall accuracy rate was 69% (35/51). CONCLUSION: EUS is useful method to assess rectal cancer invasion through rectal wall and lymph node involvement. However, further refinements in instruments and the techniques is required for more improving diagnostic accuracy.
Biopsy ; Classification ; Diagnosis* ; Endosonography* ; Female ; Humans ; Lymph Nodes* ; Male ; Neoplasm Metastasis* ; Rectal Neoplasms* ; Sensitivity and Specificity ; Transducers ; Upper Gastrointestinal Tract ; Water

Neuronal migration disorders (NMD's) are a rare group of developmental structural lesions characterized by disorganization of cortical architecture with aberrant columnar and laminar arrangement, often causing intractable seizures. During September 1994 to February 1995, we operated on six patients with NMD to treat intractable seizures, Male female ratio of these 6 patients was 2:4 and mean age at seizure onset was 14 years old(range 6-28 years), indicating early onset of epilepsy. Mean age at seizure surgery was 29 years old(range 23-41 years), and mean follow-up duration after operation was 4 months(range 3-6 months). In their past medical history, three patients had experienced febrile seizure at pediatric age, and one of them had a history of anoxic damage during delivery. Following preoperative localization, the lesion was removed completely in five patients. In the other one patient part of the lesion was located the speech and motor area, leading to partial removal. On histologic examination, two of them showed cortical dysplasia and the other four revealed microdysgenesis. During follow-up for six months, five patients were free of seizure and in the other one patient, whose lesion was removed incompletely, the frequency of seizure decreased by 95%.
Epilepsy* ; Female ; Follow-Up Studies ; Humans ; Male ; Malformations of Cortical Development ; Neuronal Migration Disorders* ; Neurons* ; Seizures ; Seizures, Febrile

OBJECTIVE: Although it is well known that cerebral sinus thrombosis or resection of large cerebral veins during surgery may cause venous hypertension, often leading to brain edema and intracerebral hemorrhage and the outcome is widely variable with symptoms from headache to coma, the pathophysiology of cerebral venous circulatory disturbance is poorly understood. The purpose of this study was to investigate the pathophysiological change of cerebral venous circulatory disturbance by measurement of intracranial pressure, regional cerebral blood flow and cerebral water content, and histological examination for extravasation of Evans blue dye and cerebral edema for 2 hours after occlusion of the superior sagittal sinus and diploic veins in cats. METHODS: Thirty five cats were divided into 4 groups: (1) control group, 5 cats with sham operation, (2) experiment group I, 10 cats with occlusion at the anterior 1/3 of the superior sagittal sinus, (3) experiment group II, 10 cats with occlusion at the middle 1/3 of the superior sagittal sinus, (4) experiment group III, 10 cats with occlusion at the posterior 1/3 of the superior sagittal sinus. RESULTS: The results were as follows: 1) After occlusion of the superior sagittal sinus, intracranial pressure was elevated with increased cerebral water content and regional cerebral blood flow was reduced in all experiment groups. The degree of their changes was the least in experiment group I, the most in experiment group III, and intermediate in experiment group II. 2) Extravasation of the Evans blue dye was not observed in any experiment groups 120 minutes after occlusion of the superior sagittal sinus. 3) On the histological examination, pericellular edematous change of the brain was observed in all experiment groups 120 minutes after occlusion of the superior sagittal sinus. The degree of edema also showed similar pattern in magnitude to that of changes of other parameters. CONCLUSION: These results suggest that occlusion of the middle or posterior 1/3 of the superior sagittal sinus could bring a significant harmful effect to the cerebral hemodynamics, leading to secondary brain injury and the hydrostatic edema is responsible for the cerebral swelling in early stage after occlusion of the superior sagittal sinus.
Animals ; Brain ; Brain Edema* ; Brain Injuries ; Cats* ; Cerebral Hemorrhage ; Cerebral Veins ; Coma ; Edema ; Evans Blue ; Headache ; Hemodynamics ; Hypertension ; Intracranial Pressure* ; Sinus Thrombosis, Intracranial ; Superior Sagittal Sinus* ; Veins