The cavernous sinus contains significant structures such as the internal carotid artery and cranial nerves III to VI. Cavernous sinus lesions may cause ophthalmoplegia, proptosis, and diplopia. We report a 56-year-old woman who presented with throbbing headache and associated right-sided ocular pain. While awaiting imaging studies, she suddenly developed opthalmoplegia and ptosis of the right eye. She had ipsilateral palsy of the third and fourth cranial nerves, while the sixth nerve remained intact. Magnetic resonance imaging revealed a pituitary gland mass extending into the right cavernous sinus with associated sphenoid sinusitis. The patient underwent endoscopic sinus surgery and subsequent pituitary tumor removal by transsphenoidal approach. During preoperative evaluation, a mass was found protruding in her left bronchus. The pituitary tumor pathologic examination revealed metastatic adenocarcinoma of the lung. In this patient, the initial symptoms of lung cancer were headache and cavernous sinus syndrome, which had metastasized to the pituitary gland.
Adenocarcinoma ; Bronchi ; Carotid Artery, Internal ; Cavernous Sinus* ; Cranial Nerves ; Diplopia ; Exophthalmos ; Female ; Headache ; Humans ; Lung ; Lung Neoplasms* ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Ophthalmoplegia ; Paralysis ; Pituitary Gland ; Pituitary Neoplasms ; Sphenoid Sinus ; Sphenoid Sinusitis ; Trochlear Nerve

BACKGROUND AND OBJECTIVES: Olfactory neuroblastoma is a rare tumor arising from the olfactory neuroepithelium, for which surgery is the mainstay of treatment; but there are no generally accepted treatment approaches, according to tumor stage. In this study, we present our experiences with this tumor and the results of treatment to consider the clinical analysis and treatment modality. SUBJECTS AND METHOD: All of the patients, who had been treated for olfactory neuroblastoma at Severance hospital during the past ten years, were analyzed retrospectively and each of their diagnosis of olfactory neuroblastoma was histologically confirmed. RESULTS: Eleven patients aged 8 to 70 years were assessed, and 5 year disease-free survival rate were 60%. Sixty-four percent of those patients had received surgical treatment. Craniofacial resection was used mainly as an initial surgical treatment and followed by postoperative radiotherapy in 57% of the patients. If only cervical lymph node metastasis had developed at the initial diagnosis, elective neck treatment including bilateral neck dissection was performed. Chemotherapy was used either as postoperative adjuvant therapy, initial therapy with radiotherapy or salvage therapy, but not as an initial single treatment modality. Forty-five percent of the patients had recurrence and metastasis developed after the initial treatment. In the patients with cervical lymph node metastasis (n=1) and nodal recurrence (n=2), neck dissection was effective in nodal control. CONCLUSION: Complete surgical resection and postoperative radiotherapy were the main treatment modalities of olfactory neuroblastoma. Especially, postoperative radiotherapy is an essential treatment to both early- and advanced-stage olfactory neuroblastoma. Craniofacial resection is a main surgical modality, but in early stage, limited external intervention including endoscopic mass excision can be considered. If the patient has cervical lymph node metastasis or nodal recurrence, radical neck dissection should be performed. Chemotherapy seems to be considered as an adjuvant therapy, not single treatment modality.
Diagnosis ; Disease-Free Survival ; Drug Therapy ; Esthesioneuroblastoma, Olfactory* ; Humans ; Lymph Nodes ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Salvage Therapy ; Treatment Outcome*

PURPOSE: The incidence of hip fracture associated with disability, pain and death increases in old age. The decreased bone mineral density, particularly due to osteoporosis, has been described as one of factors associated with the proximal femur fracture. Therefore, this study, measured the bone mineral density (BMD) of elderly patients with hip fractures to better understand the relationship between osteoporosis and proximal femur fractures. MATERIALS AND METHODS: The bone densities of the femoral neck and trochanteric region were measured by dual energy x-ray absorptiometry (DEXA) in 60 patients with femur neck fractures and 82 patients with intertrochanteric fractures. Individuals (158 subjects) who had their BMD checked in a Health promotion center without a proximal femoral fracture were selected as a control group. The patients were divided into subgroups according to gender and type of fracture. RESULTS: The BMD of the hip in the patients with proximal femur fractures was significantly lower than that of the control subjects. The intertrochanteric fracture group had a lower T-score than the femur neck fracture group. However the differences were not significant. No significant differences were found between the displaced and undisplaced femur neck fracture groups and between the stable and unstable intertrochanteric fracture groups. CONCLUSION: The BMD in elderly patients with proximal femur fracture was significantly lower than that of the control group. There was a poorer association between a decreased BMD and femur neck fractures in elderly males. There were no association between the BMD and location of the fracture or fracture type.
Absorptiometry, Photon ; Aged ; Bone Density ; Femoral Fractures ; Femoral Neck Fractures ; Femur ; Femur Neck ; Health Promotion ; Hip ; Hip Fractures ; Humans ; Incidence ; Male ; Osteoporosis

PURPOSE: The purpose of this study was to determine the clinical usefulness of remnant preservation in anterior cruciate ligament (ACL) reconstruction using Achilles tendon graft. MATERIALS AND METHODS: Between April 2004 and June 2007, 26 patients who were followed up for at least 12 months after ACL reconstruction with Achilles tendon were included in this study. They were divided into two groups according to whether the remnant was preserved. The post-reconstruction state was evaluated using pivot-shift test, Telos anterior stress test, International Knee Documentation Committee (IKDC) scale, Lysolm score and single limb standing test. RESULTS: No statistically significant differences in mechanical stability and mean values of IKDC scale and Lysholm test between the two groups were present. In single limb standing test, the remnant-preserving group showed 1.1+/-0.8 cm and the remnant sacrificing group showed 1.8+/-1.2 cm (p=0.04). However, there were no significant differences between the injured knee and the intact knee in the group which the remnant was preserved. CONCLUSION: ACL reconstruction using allo Achilles graft showed satisfactory results in terms of stability and function. Preserving the tibial remnant seems to be helpful to restore knee joint proprioception.
Achilles Tendon ; Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Exercise Test ; Extremities ; Humans ; Knee ; Knee Joint ; Proprioception ; Transplantation, Homologous ; Transplants

PURPOSE: To evaluate diagnostic sensitivity of nuclear imaging in the detection of residual thyroid tissue and metastatic lesion, we have compared neck scintigrams with Tc-99m pertechnetate (Tc-99m scan) and high dose I-131 iodide (I-131 scan) in patients with differentiated thyroid cancer. SUBJECTS AND METHODS: One hundred thirty-five thyroidectomized patients for differentiated thyroid cancer were enrolled in this study. Twenty-three had a previous history of radioiodine therapy. Planar and pin-hole images of anterior neck with Tc-99m were acquired at 20 minutes after injection, followed by I-131 scan three days after high-dose radioiodine therapy within 7 days interval. Patients were asked to discontinue thyroid hormone replacement more than 4 weeks. RESULTS: All subjects were in hypothyroid state. Seventy out of 135 patients (51.9%) showed concordant findings between Tc-99m and I-131 scans. I-131 scan showed higher number of uptake foci in all of 65 patients showing discordant finding. Tc-99m scan showed no thyroid bed uptake in 34 patients, whereas 23 of them (67.6%) showed bed uptake in I-131 scan. Tc-99m scan did not show any uptake in thyroid bed in 11 of 112 patients without previous history of radioiodine therapy, but 9 of them showed bed uptake in I-131 scan. Tc-99m scan showed no bed uptake in all of the 23 patients with previous history of radioiodine therapy, in contrast 14 of them (60.9%) showed bed uptake in I-131 scan. CONCLUSION: These results suggest that Tc-99m scan has poor detectability for residual thyroid tissue or metastatic lesion in thyroidectomized differentiated thyroid cancer patients, compared to high dose I-131 therapy scan. Tc-99m scan could not detect any remnant tissue or metastatic lesion in patients with previous history of radioiodine treatment, especially.
Humans ; Neck ; Neoplasm Metastasis ; Sodium Pertechnetate Tc 99m* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy*

PURPOSE: 99mTc-sestamibi (MIBI) and 99mTc-tetrofosmin have been used as substrates for P-glycoprotein (Pgp) and multidrug resistance associated protein (MRP), which are closely associated with multidrug resistance of the tumors. To understand different handling of radiotracers in cancer cell lines expressing Pgp and MRP, we compared cellular uptakes of 99mTc-MIBI and 99mTc-tetrofosmin. The effects of cyclosporin A (CsA), well-known multidrug resistant reversing agent, on the uptake of both tracers were also compared. MATERIALS AND METHODS: HCT15/CL02 human colorectal cancer cells for Pgp expressing cells, and human non-small cell lung cancer A549 cells for MRP expressing cells, were used for in vitro and in vivo studies. RT-PCR, western blot analysis and immunohistochemistry were used for detection of Pgp and MRP. MDR-reversal effect with CsA was evaluated at different drug concentrations after incubation with MIBI or tetrofosmin. Radioactivities of supernatant and pellet were measured with gamma well counter. Tumoral uptake of the tracers were measured from tumor bearing nude mice treated with or without CsA. RESULTS: RT-PCR, western blot analysis of the cells and immunochemical staining revealed selective expression of Pgp and MRP for HCT15/CL02 and A549 cells, respectively. There were no significant difference in cellular uptakes of both tracers in HCT15/CL02 cells, but MIBI uptake was slightly higher than that of tetrofosmin in A549 cells. Co-incubation with CsA resulted in a increase in cellular uptakes of MIBI and tetrofosmin. Uptake of MIBI or tetrofosmin in HCT15/CL02 cells was increased by 10- and 2.4-fold, and by 7.5 and 6.3-fold in A549 cells, respectively. Percentage increase of MIBI was higher than that of tetrofosmin with CsA for both cells (p< 0.05). In vivo biodistribution study showed that MIBI (114% at 10 min, 257% at 60 min, 396% at 240 min) and tetrofosmin uptake (110% at 10 min, 205% at 60 min, 410% at 240 min) were progressively increased by the time, up to 240 min with CsA. But increases in tumoral uptake were not significantly different between MIBI and tetrofosmin for both tumors. CONCLUSION: MIBI seems to be a better tracer than tetrofosmin for evaluating MDR reversal effect of the modulators in vitro, but these differences were not evident in vivo tumoral uptake. Both MIBI and tetrofosmin seem to be suitable tracers for imaging Pgp- and MRP-mediated drug resistance in tumors.
Animals ; Blotting, Western ; Carcinoma, Non-Small-Cell Lung ; Cell Line ; Colorectal Neoplasms ; Cyclosporine ; Drug Resistance ; Drug Resistance, Multiple* ; Humans ; Immunohistochemistry ; Mice ; Mice, Nude ; Multidrug Resistance-Associated Proteins* ; P-Glycoprotein* ; Radioactivity ; Technetium Tc 99m Sestamibi

PURPOSE: To evaluate the use of monoclonal antibody (MoAb) as a carrier of the receptor-binding ligand, the receptor mediated uptake into liver and subsequent metabolism of (111) In-labeled galactosylated MoAb-chelator conjugates were investigated and compared with those of (111) In labeled MoAb. MATERIALS AND METHODS: T101 MoAb, IgG2 against human lymphocytic leukemic cell, conjugated with cyclic DTPA dianhydride (DTPA) or 2-p-isothiocyanatobenzyl-6-methyl-DTPA (1B4M) was galactosylated with 2-imino-2-methoxyethyl-1-thio-beta-D-galactose and then radiolabeled with (111) In. Biodistribution and metabolism study was performed with two (111) In-conjugates in mice and rats. RESULTS: (111) In-labeled T101 and its galactosylated conjugates were taken to the liver by the time, mostly within 10 min. However DTPA conjugate was retained longer in the liver than the 1B4M conjugate (55% vs 20% of injected dose at 44 hr). During this time, the radiometabolite of DTPA conjugate was excreted similarly into urine (24%) and feces (17%). The radiometabolite of 1B4M was excreted primarily into feces (68%) rather than urine (8%). Size exclusion HPLC analysis of the bile and supernatant of liver homogenate showed two peaks, the first (35%) with the retention time (Rt) identical to IgG and the second (65%) with Rt similar to free 111In at 3 hr post-injection for the 1B4M conjugate, indicating that the metabolite is rapidly excreted through the biliary system. In contrast to DTPA conjugate, the small (111) In-DTPA-like metabolite was the major radioindium component (90%) in the liver homogenate as early as 3 hour post-injection, but the cumulative radioindium activity in feces was only 17% at 44 hour, indicating that the metabolite from DTPA conjugate does not clear readily through the biliary tract. CONCLUSION: The galactosylation of the MoAb conjugates resulted in higher hepatocyte uptake and enhanced metabolism, compared to those without galactosylation. Metabolism of the MoAb-conjugates is different between compounds radiolabled with different chelators due to different characteristics of radiometabolites generated in the liver.
Animals ; Bile ; Biliary Tract ; Chelating Agents ; Chromatography, High Pressure Liquid ; Feces ; Hepatocytes ; Humans ; Immunoglobulin G ; Liver ; Metabolism* ; Mice ; Pentetic Acid ; Rats

Government healthcare expenditure is rising in Korea, and the costs incurred by patients in Korea exceed those incurred by patients in other Organization for Economic Co-operation and Development countries. Despite the increasing health expenditure, patient demand for services is increasing as well, so it is now becoming recognized that cancer care needs to be balanced. The most important measure in cancer care optimization is to provide high-quality care while keeping costs sustainable. The Korean Cancer Association considers the current situation of cancer therapy in Korea the foremost issue, which has led to the implementation of the nationwide ‘Right Decisions in Cancer Care’ initiative. This initiative is based on the concepts of medical professionalism in that it should be led by physicians working in the field of oncology, that education should be offered to patients and clinicians, and that it should influence healthcare policy. In this article, we introduce the nationwide ‘Right Decision in Cancer Care’ initiative and highlight the five initial items on its agenda. The agenda is open to expansion and update as the medical environment evolves and additional clinical evidence becomes available.

PURPOSE: This retrospective study was conducted to assess outcome and to determine the prognostic factors in patients with a desmoid tumor treated with postoperative radiotherapy. MATERIALS AND METHODS: Twenty-seven patients with a desmoid tumor who were treated with postoperative radiotherapy between June 1984 and October 2005 were analyzed. There were 13 male and 14 female patients. The age of the patients ranged from 3 to 79 years (median age, 28 years). Tumors were located in an extra-abdominal area (21 cases), and in the abdominal walls (6 cases). The tumor size ranged from 2.5 to 25 cm (median size, 7.5 cm) in the largest linear dimension. Thirteen cases received radiotherapy after initial surgery, and 14 recurrent cases received radiotherapy after additional surgery. The total radiation dose given was 45~66 Gy (median dose, 59.4 Gy), and the fraction size was 1.8~2.0 Gy. RESULTS: The median follow-up period was 61 months (range, 12~203 months). Two patients developed local progression and six patients experienced local recurrence. The 5-year disease-free survival rate and the 5-year progression-free survival rate were 61% and 70%, respectively. Wide local excision was associated with better disease free survival with statistical significance (p=0.028). Radiotherapy after initial surgery (p=0.046) and a higher radiation dose of more than 60 Gy (p=0.049) were associated with better progression free survival with statistical significance. At the time of the last follow-up, the number of additional surgeries was higher in patients that received radiotherapy after reoperation (p<0.001). CONCLUSION: Radiotherapy after the initial operation improved local control and decreased the number of subsequent operations. Thus, postoperative radiotherapy after an initial operation is recommended in patients with a high risk of recurrence for a desmoid tumor.
Disease-Free Survival ; Female ; Fibromatosis, Aggressive* ; Follow-Up Studies ; Humans ; Male ; Radiotherapy ; Radiotherapy, Adjuvant* ; Recurrence ; Reoperation ; Retrospective Studies

We investigated the surgical outcome of radical maxillectomy in advanced maxillary sinus cancers invading through the posterior wall and into the infratemporal fossa. Twenty-eight patients with maxillary sinus squamous cell carcinoma, who visited the Otorhinolaryngology Department at Severance Hospital from March, 1993 to February, 2001 and underwent the surgery, were analyzed retrospectively by reviewing clinical medical records and radiologic test results. The mean follow- up period was 78.8 months. (26 -162 months) Local recurrence, sites of local recurrence, and the 2-year disease-free survival rate were analyzed. Of the total 28 cases, 9 cases were T3, and 19cases were T4. Total maxillectomy was performed in 12 cases (42.9%) and radical maxillectomy in 16 cases (57.1%). Regardless of staging, radical maxillectomy was performed only when cancers invaded through the posterior wall and into the infratemporal fossa. When cancers only maginally or did not invade the posterior wall, total maxillectomy was performed. The 2-year disease-free survival rate was 75% for both total and radical maxillectomy, and the local recurrence rates were 8.3% and 18.7% respectively. All recurrence occurred at the posterior resection margin of the maxillectomy. We strongly recommend the use of radical maxillectomy in the cases of advanced maxillary sinus cancers invading the infratemporal fossa. Radical maxillectomy can provide sufficient safety margins and lower the local recurrence rate.
Adult ; Aged ; Carcinoma, Squamous Cell/mortality/pathology/*surgery ; Disease-Free Survival ; Female ; Humans ; Male ; Maxilla/blood supply/*surgery ; Maxillary Artery/surgery ; Maxillary Neoplasms/mortality/pathology/*surgery ; Maxillary Sinus/*surgery ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome