PURPOSE: We performed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. METHODS AND MATERIALS: One hundred and six patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (9 4%) and ranged from 1 month to 92 months (median; 6 months). RESULTS: The median age was 62 years old and male to female ratio was 104:2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was performed in 83%. Mean tumor dose delivered with curative aim was 58.6 Gy (55-70.8 Gy) and median duration o f the radiation therapy was 53 days. The median survival of all patients was 6 months and 1-year and 2-year overall survival rte was 27% and 12%, respectively. Improvement of dysphagia was obtained in most patients except fo 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32% (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30% respectively, while those of the nonresponder was 4 months and 0% respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 rnonths and 16% while those of the patients who could not tolerate regular diet was 3 months and 0%, respectively (p=0.004). The survival difference between the patients with 5 cm or less turnor length and those with more than 5 cm tumor length was rnarginally statistically significant (p=0.06). However, the survival difference according to the periesophageal invasion or mediastinal lymphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9%). CONCLUSION: The survival outcome for advanced esophageal cancer patients treated by external be am radiotherapy alone was very poor, In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.
Brachytherapy ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Diet ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Female ; Follow-Up Studies ; Gastrostomy ; Humans ; Lymphatic Diseases ; Male ; Middle Aged ; Multivariate Analysis ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Thorax ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND: The survival rate of children with neuroblastoma has been improved over 20 years, excluding the metastatic disease, in which it does not exceed 20% so far. New treatment modalities have been developed to improve the outcome in metastatic disease. Preoperative chemotherapy reduce the size, the vascularity and the adhesiveness, so increase the resectability of the primary tumor. This retrospective clinical study was designed to review the survival rate in neuroblastoma and to analyze the effect of preoperative chemotherapy in the view point of neoadjuvant therapy on long-term survival in advanced disease. METHODS: One hundred and thirty-four cases were reviewed from 135 patients with neuroblastoma registered at the Department of Pediatrics in Seoul National University Children's Hospital from January, 1985 till December, 1995. The survival rate was reviewed according to the stage. The age, sex of the patients, the stage, anatomical site of the tumor, the level of serum ferritin and neuron-specific enolase were analyzed for the risk factors on survival. RESULTS: Ranges of age at diagnosis were from 1 month to 166 months with the median of 39 months. Five year survival rates and five year disease-free survival rates were 100%, 100% in stage 1(n=5), 90.9%, 90.9% in stage 2(n=13), 43.4%, 40.6% in stage 3(n=19), 27.1%, 19.8% in stage 4(n=95) and 100%, 100% in stage 4S(n=2), respectively. In stage 3, five year survival rate was 52.5% in group receiving neoadjuvant chemotherapy, 28.6% in control group(P=0.02). Five year disease-free survival rate was also noted as 48.6%, 28.6% in each group(P=0.02). In stage 4, five year and ten year survival rates were 27.6%, 23.6% in group receiving neoadjuvant chemotherapy, 26.9%, 0% in control group(P=0.02). Five year and ten year disease-free survival rates were 14.3%, 14.3% in group receiving neoadjuvant chemotherapy, 20%, 0% in control group (P=0.11). In univariate analysis, the age, the stage, and the site of primary tumor appeared to affect the long-term survival. CONCLUSION: Neoadjuvant chemotherapy and delayed primary surgery contribute for advance in survival in advanced neuroblastoma via increasing the resectability of the primary tumor.
Adhesiveness ; Child ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Ferritins ; Humans ; Neoadjuvant Therapy ; Neuroblastoma ; Pediatrics ; Phosphopyruvate Hydratase ; Retrospective Studies ; Risk Factors ; Seoul ; Survival Rate

Pseudomeningocele after spine surgery can cause various symptoms, but it can also be silent. We experienced 3 cases of pseudomeningocele with different symptoms and we analyzed the characteristics of each case. A small pseudomeningocele without connection to the subarachnoidal space can show no symptoms. A pseudomeningocele with a small dural tear and it's abutted on the duramater at a small portion can produce sciatica and limitations of straight leg raising due to adhesion of the cauda equina around the dural tear. In addition, a large pseudomeningocele with a big dural and lamina defect can produce back tenderness furthermore, a patient with such a lesion can have low back pain and leg pain that are aggravated by an increment of abdominal pressure or by impact to the body and even by walking. Pseudomeningocele should be suspected when symptoms recur after spine surgery and especially in the case of dural tear during an operation
Cauda Equina ; Humans ; Leg ; Low Back Pain ; Sciatica ; Spine* ; Walking

No abstract available.
Mass Screening* ; Uterine Cervical Neoplasms*

Ninety patients of esophageal cancer treated with radiation since November 1985 to June 1990 at the Deprtment of Therapeutic Radiology, Chonnam University Hospital, were analysed retrospectively regarding survival. Seventy five patients (94.9%) revealed squamous cell carcinoma in its histologic type, and most ofpatients were in advanced stage with 25 patients (27.8%) of T2 and 64 patients (71.1%) of T3 Minimum follow up period was 12 months and median was 5 months. Overall actuarial 2 year survival rate was 11.6%. Two year survival rates according to the parameters such as treatment aim, T stage, site, length, radiation dose and response were compared and resulted that survival by tumor length only had statistically significant impact on survival of esophageal carcinoma.
Carcinoma, Squamous Cell ; Esophageal Neoplasms* ; Follow-Up Studies ; Humans ; Jeollanam-do ; Radiation Oncology ; Radiotherapy* ; Retrospective Studies ; Survival Rate

PURPOSE: This study was performed to compare the clinical characteristics of 2009 pandemic influenza A(H1N1) [A(H1N1) pdm09] and seasonal influenza A infection in the pediatric cancer patients. METHODS: A retrospective review was performed in the pediatric cancer patients who had confirmed A(H1N1)pdm09 infection at Samsung Medical Center from August 2009 to February 2010. For the comparison, the medical records of pediatric cancer patients with seasonal influenza A from January 2000 to May 2009 were reviewed retrospectively. RESULTS: Eighty-two A(H1N1)pdm09 infections were confirmed in the pediatric cancer patients. Ten patients (12.2%) developed complicated clinical course by lower respiratory infections or extrapulmonary infections; 4 pneumonia, 1 bronchitis, 1 pericarditis with pneumonia, 1 encephalitis with pneumonia, 2 meningitis and 1 pericarditis. Three patients received mechanical ventilator and ICU care. Three pediatric cancer patients (3.7%) died. The risk factors related to complicated A(H1N1)pdm09 infections were date of infection (44-45th week 2009) and nosocomial infection. When comparing with previous seasonal influenza A infections, more prompt and aggressive antiviral therapy was given in A(H1N1)pdm09 infections. CONCLUSION: The A(H1N1)pdm09 infections caused a various clinical manifestations including fatal cases in pediatric cancer patient during pandemic season. There was no significant difference in clinical course between influenza A(H1N1)pdm09 and seasonal influenza A infections except the antiviral treatment strategy.
Bronchitis ; Child ; Cross Infection ; Encephalitis ; Humans ; Influenza, Human ; Medical Records ; Meningitis ; Pandemics ; Pericarditis ; Pneumonia ; Respiratory Tract Infections ; Retrospective Studies ; Risk Factors ; Seasons ; Ventilators, Mechanical

PURPOSE: We reviewed the treatment outcomes and prognostic factors for patients with anal canal carcinoma who were treated with curative intent chemoradiotherapy (CRT) at Severance Hospital from 2005 to 2011. MATERIALS AND METHODS: Data for 38 eligible patients treated during this period were reviewed. All patients were treated with curative intent using radiotherapy (RT) with (n = 35) or without concomitant chemotherapy (n = 3). Among 35 patients who received CRT, most of the chemotherapeutic regimens were either 5-fluorouracil (5-FU) plus mitomycin C (23 patients) or 5-FU plus cisplatin (10 patients). Recurrence-free survival (RFS), colostomy-free survival (CFS), overall survival (OS), and locoregional control (LRC) rates were calculated using the Kaplan-Meier method and survival between subgroups were compared using the log-rank test. Cox's proportional hazard model was used for multivariate analysis. RESULTS: Over a median follow-up period of 44 months (range, 11 to 96 months), 3-year RFS, CFS, OS, and LRC were 80%, 79%, 85%, and 92%, respectively. In multivariate analysis, tumor size >4 cm was an independent predicting factor for poorer RFS (hazard ratio [HR], 6.35; 95% confidence interval [CI], 1.42 to 28.5; p = 0.006) and CFS (HR, 6.25; 95% CI, 1.39-28.0; p = 0.017), while the presence of external iliac lymph node metastasis was an independent prognosticator for poorer OS (HR, 9.32; 95% CI, 1.24 to 70.3; p = 0.030). No treatment-related colostomies or deaths occurred during or after treatment. CONCLUSION: Curative intent CRT resulted in excellent outcomes that were comparable to outcomes in previous randomized trials. No severe treatment-related toxicities were observed.
Anal Canal ; Anus Neoplasms ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Cisplatin ; Colostomy ; Fluorouracil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mitomycin ; Multivariate Analysis ; Neoplasm Metastasis ; Proportional Hazards Models

OBJECTIVE: The purpose of this study is to evaluate the effectiveness and safety of aerobic exercise program in cardiac patients. METHOD: Twenty patients participated in 6 weeks of aerobic exercise with telemetry monitoring as an outpatient rehabilitation program. For the comparison of physiologic changes, we used graded exercise test (GXT) by means of modified Bruce protocol before and in 6 weeks after aerobic exercise training. Exercise prescription for cardiac rehabilitation was composed of intensity, mode, frequency and duration. By use of EKG telemetry and monitoring of blood pressure and Borg RPE (ratings of perceived exertion) scale, we were monitored patients status during exercise. RESULTS: In six weeks after aerobic exercise training, the hemodynamic and metabolic responses were improved and statistically significant parameters were as follows: exercise time, maximal METs, resting heart rate, maximal heart rate, submaximal rate pressure product, maximal expired volume, maximal oxygen consumption rate and anaerobic threshold. CONCLUSION: We concluded that six week cardiac rehabilitation program is useful and safe to improve the aerobic capacity for cardiac patients.
Anaerobic Threshold ; Blood Pressure ; Electrocardiography ; Exercise Test ; Exercise* ; Heart Rate ; Hemodynamics ; Humans ; Outpatients ; Oxygen Consumption ; Prescriptions ; Rehabilitation ; Telemetry

PURPOSE: Before we report the results of curative radiotherapy in cervix cancer patients, we review the significance and safety of our dose specification methods in the brachytherapy system to have the insight of the potential predictive value of doses at specified points. MATERIALS AND METHODS: We analyze the 45 cases of cervix cancer patients treated with intracavitary brachytherapy. In the lateral simulation film we draw the isodose curve and observe the absorbed dose rate of point A, the reference point of bladder(SBD) and rectum(SRD). In the sagittal view of pelvic MRI film we demarcate the tumor volume(TV) and determine whether the prescription dose curve of point A covers the tumor volume adequately by drawing the isodose curve as correctly as possible. Also we estimate the maximum point dose of bladder(MBD) and rectum(MRD) and calculate the inclusion area where the absorbed dose rate is higher than that of point A in the bladder(HBV) and rectum(HRV), respectively. RESULTS: Of forty-five cases, the isodose curve of point A seems to cover tumor volume optimally in only 24(53%). The optimal tumor coverage seems to be associated not with the stage of the disease but with the tumor volume. There is no statistically significant association between SBD/SRD and MBD/MRD, respectively. SRD has statistically marginally significant association with HRV, while TV has statistically significant association with HBV and HRV. CONCLUSION: Our current treatment calculation methods seem to have the defect in the aspects of the nonoptimal coverage of the bulky tumor and the inappropriate estimation of bladder dose. We therefore need to modify the applicator geometry to optimize the dose distribution at the position of lower tandem source. Also it appears that the position of the bladder in relation to the applicators needs to be defined individually to define "hot spots".
Brachytherapy* ; Cervix Uteri* ; Female ; Humans ; Magnetic Resonance Imaging* ; Prescriptions ; Radiotherapy ; Tumor Burden ; Urinary Bladder ; Uterine Cervical Neoplasms

Epidural tuberculoma without bony involvement was first reported by Rao et al. in 1971; however, extraosseous spinal epidural tuberculoma and tuberculous infection of the cauda equina have never been reported. We experienced a case of epidural tuberculoma without bony involvement, which was diagnosed by decompression and biopsy, and treated with combined antituberculous chemotherapy. It resembled herniated nucleus pulposus at the L4-5 level, based on its clinical features, a physical examination, myelography and computed tomography. In the course of antituberculous medication, tuberculosis of the cauda equina occurred, which caused paraparesis. Herein, this case is reported in terms of its treatment and clinical course, with a review of the literature.
Biopsy ; Cauda Equina* ; Decompression ; Drug Therapy ; Epidural Space ; Myelography ; Paraparesis ; Physical Examination ; Spine* ; Tuberculoma* ; Tuberculosis