No abstract available.
Acute Kidney Injury* ; Rhabdomyolysis*

Ameloblastoma is a rare epithelial tumor of the jaw, comprising approximately 1% of all tumors and cysts of odontogenic origin. The tumor has been the subject of much controversy and discussion. Ameloblastoma is slow growing, locally invasive, and has a high rate of local recurrence, but rarely metastasizes. The neoplasm has been considered radioresistant, so it has been treated with surgery primarily except some cases. Recently it is suggested that ameloblastoma is radiosensitive, so radiation therapy (RT) would be used in addition to or, in certain cases, in place of surgery. We report these two cases which were referred to the Department of Therapeutic Radiology for deciding the need of postoperative RT, because ameloblastoma is rare and has been known to be radioresistant. Postoperative RT was given to one of these two patients.
Ameloblastoma* ; Humans ; Jaw* ; Radiation Oncology ; Recurrence

PURPOSE: To evaluate the predictive value of the early response of 18F-flurodeoxyglucose positron emission tomography (FDG PET) during concurrent chemoradiotherapy (CCRT) for locally advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: FDG PET was performed before and during CCRT for 13 NSCLC patients. Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured and the changes were calculated. These early metabolic changes were compared with the standard tumor response by computed tomograms (CT) one month after CCRT. RESULTS: One month after the completion of CCRT, 9 patients had partial response (PR) of tumor and 4 patients had stable disease. The percent changes of SUVmax (%DeltaSUVmax) were larger in responder group than in non-responder group (55.7% +/- 15.6% vs. 23.1% +/- 19.0%, p = 0.01). The percent changes of SUVmean (%DeltaSUVmean) were also larger in responder group than in non-responder group (54.4% +/- 15.9% vs. 22.3% +/- 23.0%, p = 0.01). The percent changes of MTV (%DeltaMTV) or TLG (%DeltaTLG) had no correlation with the tumor response after treatment. All the 7 patients (100%) with %DeltaSUVmax > or = 50% had PR, but only 2 out of 6 patients (33%) with %DeltaSUVmax < 50% had PR after CCRT (p = 0.009). Likewise, all the 6 patients (100%) with %DeltaSUVmean > or = 50% had PR, but only 3 out of 7 patients (43%) with %DeltaSUVmean < 50% had PR after CCRT (p = 0.026). CONCLUSION: The degree of metabolic changes measured by PET-CT during CCRT was predictive for NSCLC tumor response after CCRT.
Carcinoma, Non-Small-Cell Lung* ; Chemoradiotherapy* ; Glycolysis ; Humans ; Lung Neoplasms ; Positron-Emission Tomography ; Tumor Burden

PURPOSE: Endobronchial tuberculosis and bronchogenic cancer are common causes of atelectasis or obstructive pneumonitis in Korea. Differntiation between endobronchial tuberculosis and bronchogenic carcinoma is important for the treatment and prognosis but it is sometimes difficult to differentiate these two lesions with radiologic examinations. The purpose of this study was to find the differential points between endobronchial tuberculosis and bronchogenic carcinoma associated with atelectasis or obstructive pneumonitis. MATERIALS AND METHODS: Forty patients in whom atelectasis or obstructive pneumonitis was detected on chest radiographs comprised the study. A definite mass opacity was not observed on chest radiographs in all patients. In these patients, the causes of obstruction were endobronchial tuberculosis (n=20) and bronchogenic cancer (n=20) which were microbiologically or pathologically confirmed. RESULTS: Double obstructive lesions were more frequently found in endobronchial tuberculosis (8/20) than in bronchogenic cancer (1/20). Multiple calcifications along the bronchial wall and severe distortion of bronchi were observed only in endobronchial tuberculosis (4/20) and associated low density mass at obstruction site was only observed in bronchogenic cancer (6/20). Bronchial dilatation (11/20) and parenchymal calcifications (14/20) distal to obstruction site, air containing bronchogram at post obstructive bronchus (14/20) were more frequently found in endobronchial tuberculosis. Contour bulging at obstruction site (14/20), and only mucus bronchogram at post obstructive bronchus (14/20) were more frequently found in bronchogenic carcinoma. CONCLUSION: In patients with atelectasis or obstructive pneumonitis, endobronchial tuberculosis is characterized by double obstructive lesion, multiple calcifications at the bronchial wall, and severe distortion of the bronchi. Endobronchial carcinoma is characterized by a low density mass at the obstructive site.
Bronchi ; Carcinoma, Bronchogenic* ; Dilatation ; Humans ; Korea ; Mucus ; Pneumonia* ; Prognosis ; Pulmonary Atelectasis* ; Radiography, Thoracic ; Tuberculosis*

Malignant fibrous histiocytoma(MFH) of the maxilla is a rare malignant bone tumor. Seven percents of all MFH occur in the head and neck. Approximately 12% of these tumors occur in the maxilla. Local recurrence or distant metastasis was reported in 55% of cases of maxillary MFH. The mean survival time of 30 months was reported from a review of 14 MFHs in he masxilla, mandible and oral soft tissues. MFH of the maxilla is best treated surgically but radical neck dissection dose not appear to be indicated unless there is clinical evidence of lymph node metastases. Although the use of radiation therapy for head and neck MFH has not been studied for a series of cases, individual cases of regression or histological change have been reported. Other authors have reported numbers of cases who received radiation therapy without benefit. Response to combination chemotherapy has been reported in 33% of 23 patients with recurrent or metastatic MFH. We report here a case of MFH occurring in the maxilla with a review of literature about the clinical behavior and treatment of these lesions.
Drug Therapy, Combination ; Head ; Histiocytoma, Malignant Fibrous* ; Humans ; Lymph Nodes ; Mandible ; Maxilla* ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Recurrence ; Survival Rate

Purpose: The aim of this study is to evaluate the clinical utility of late 6-month dimercapto-succinic acid (DMSA) renal scan in predicting vesicoureteral reflux (VUR) and long-lasting renal scars in children with first acute pyelonephritis (APN). Methods: A retrospective case study of children admitted with APN from January 2010 to July 2017 was performed. The study included patients with voiding cystourethrography (VCUG) and acute and late 6-month DMSA scan. We analyzed the clinical, laboratory and imaging findings of patients with and without late cortical defects at 6 months and those with or without VUR. Results: Among 145 children with APN, 50 (34.5%) had cortical defects on the late DMSA renal scan and 60 (41.4%) showed VUR. Thirteen of 38 (34.2%) children undergoing 18-month DMSA renal scan showed a long-lasting renal scars. Compared with children without late cortical defects, patients with late 6-month cortical defects had a higher incidence of VUR and long-lasting renal scars, and relapse of UTI (all P<0.05). In a multivariable analysis, both high-grade VUR and relapse of UTI were independently correlated with the presence of late 6-month cortical defects (P<0.05). Late cortical defects and relapse of UTI were also associated with the presence of VUR (P<0.05). Only the late 6-mo cortical defects was an independent predictor of long-lasting renal scars in children with APN (P<0.05). Conclusion An abnormal late 6-month DMSA renal scan may be useful in identifying VUR and long-lasting renal scars in children diagnosed with APN.

BACKGROUND: Allogeneic blood transfusion has risks from transfusion-transmitted pathogens. Blood management programs are widely used for cardiovascular or orthopedic surgery, but there have been few studies that have focused on blood conservation during brain tumor resection surgery. The purpose of this study was to evaluate the benefits of blood management for brain tumor surgery. METHODS: A total of 26 patients undergoing brain tumor resection surgery were included in the study. Thirteen patients with meningiomas, 10 patients with malignant gliomas and 3 patients with other tumors were included. The surgical blood loss was estimated by preoperative imaging studies, and the tumors that could be operated with minimal bleeding were excluded. Preoperative autologous donation (PAD) was done when the expected amount of surgical bleeding surpassed 300 mL. Preoperative embolization was performed in the patients with meningiomas whenever it was technically feasible. Six percent hydroxyethyl starch 130/0.4 (Voluven) was administered during anesthesia for expanding the blood volume and we performed meticulous surgical techniques for minimizing the blood loss. RESULTS: The amount of bleeding was less than 300 mL in 69.2% of the patients. Preoperative autologous blood was donated by 10 patents and 20% of the PAD units were discarded. Five patients with meningimas received preoperative embolization. None of the patients, except for one patient who had massive bleeding of 7,000 mL, were transfused allogeneic blood. Eighty one percent of the patients received Voluven without complications. CONCLUSION: Multiple strategies that include preoperative embolization, proper surgical techniques for minimizing blood loss, PAD and hydroxyehtyl starch could effectively decrease the amount of allogenic blood transfused during brain tumor resection surgery.
Anesthesia ; Blood Loss, Surgical ; Blood Transfusion ; Blood Transfusion, Autologous ; Blood Volume ; Brain ; Brain Neoplasms ; Glioma ; Hemorrhage ; Hetastarch ; Humans ; Meningioma ; Orthopedics ; Starch

PURPOSE: We evaluated the clinical outcome of a tension free vaginal tape(TVT) procedure for the treatment of stress urinary incontinence in women. MATERIALS AND METHODS: One hundred-nine women(94 with genuine stress urinary incontine : and 15 with mixed urinary incontinence) underwent a TVT procedure under spinal, general anesthesia. Mean age was 48.6+/-9.3 years. The mean follow-up period was 13.5+/-2.0 months. Two women had experienced failed antiincontinence surgery and seven women had experienced pelvic surgery. RESULTS: The mean operation time was 35.6+/-1.6 minutes and mean hospital stay was 2.03+/-0.4 day. Mean duration of postoperative indwelling catheter was 10.4+/-2.5 hours. Sixteen patients(14.6%) had immediate postoperative voiding difficulties necessitating an extra procedure(soundation with Hegar dilator). Nine patients(8.3%) with de novo detrusor instability were improved by anticholinergics medication. Nine(66.7%) of 15 women with urge incontinence were significantly improved or cured after surgery. Success rate was 96.3% and 95.4% in postoperative 3 and 6 months, respectively. The patients satisfied with this procedure were 103(94.5%) in postoperative 3 months and 102(93.6.%) in postoperative 6 months. There were no significant changes in the postoperative outcome over time. CONCLUSIONS: We consider the TVT procedure is a safe and effective surgical procedure for the treatment of female stress urinary incontinence, though longer follow-up is necessary to determine long term effect.
Anesthesia, General ; Catheters, Indwelling ; Cholinergic Antagonists ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Urge

The metastasis of uterine leiomyosarcoma to the neck node has not been reported previously and the radiotherapy has been rarely used for the metastatic lesion of the other sites. We report a case of neck metastasis from a uterine leiomyosarcoma, which developed 10 months after surgery and postoperative pelvic radiotherapy. It also involved the parapharyngeal space, adjacent spine, and spinal canal. The metastatic neck mass was inoperable, and was treated by neck radiotherapy (6,000 cGy) and chemotherapy including taxol and carboplatin. The mass has regressed progressively to a nearly impalpable state. She has never developed spinal cord compression syndrome, and has maintained good swallowing for eight months since the neck radiotherapy and chemotherapy. Since the extensive metastatic neck mass showed good local response to high dose radiotherapy and chemotherapy, both treatments may be considered for an unresectable metastatic leiomyosarcoma.
Carboplatin ; Deglutition ; Drug Therapy* ; Leiomyosarcoma* ; Lymphatic Diseases* ; Neck ; Neoplasm Metastasis ; Paclitaxel ; Radiotherapy* ; Spinal Canal ; Spinal Cord Compression ; Spine

PURPOSE: Perforator flap-using ischial sore reconstruction is performed in a prone position. But after the surgery, recurrence frequently occurs in a sitting position. In this sense, we introduce modified flap insetting method which closely resembles patient's sitting position to lessen the flap tension surgically. MATERIALS AND METHODS: Authors tried to check a skin tension difference between prone position and sitting position in normal people group and to find out the importance of performing flap insetting in hip flexion position. Healthy volunteers were collected (n=20) and designed the same length of 4 divided sections around the ischium. Lengths of each section were measured when hip joint was flexed to 90 degree and when both hip and knee joints were flexed to 90 degree and the statistical evaluation was performed. Twenty cases with ischial sore underwent reconstructive surgery using perforator flap under hip flexion position and followed-up for any recurrences. RESULTS: There was a meaningful difference between the joint flexed skin length and that of the neutral position. Flap showed sufficient thickness over 12 months. CONCLUSION: It seems that recurrence could be reduced when the reconstructed flap could sufficiently cover in a sitting position regarding its significant length difference in normal people group.
Healthy Volunteers ; Hip Joint ; Hip* ; Ischium ; Joints ; Knee Joint ; Methods ; Perforator Flap* ; Pressure Ulcer ; Prone Position ; Recurrence ; Skin