Esthetics ; Humans ; Mandibular Condyle ; Mandibular Reconstruction ; Mouth ; Temporomandibular Joint ; Transplants

PURPOSE: The degree of radiation-induced lung fibrosis (RILF) can be measured quantitatively by fibrosis volume (VF) on chest computed tomography (CT) scan. The purpose of this study was to investigate the interobserver and intraobserver variability in CT-based measurement of VF. MATERIALS AND METHODS: We selected 10 non-small cell lung cancer patients developed with RILF after postoperative radiation therapy (PORT) and delineated VF on the follow-up chest CT scanned at more than 6 months after radiotherapy. Three radiation oncologists independently delineated VF to investigate the interobserver variability. Three times of delineation of VF was performed by two radiation oncologists for the analysis of intraobserver variability. We analysed the concordance index (CI) and inter/intraclass correlation coefficient (ICC). RESULTS: The median CI was 0.61 (range, 0.44 to 0.68) for interobserver variability and the median CIs for intraobserver variability were 0.69 (range, 0.65 to 0.79) and 0.61(range, 0.55 to 0.65) by two observers. The ICC for interobserver variability was 0.974 (p < 0.001) and ICCs for intraobserver variability were 0.996 (p < 0.001) and 0.991 (p < 0.001), respectively. CONCLUSION: CT-based measurement of VF with patients who received PORT was a highly consistent and reproducible quantitative method between and within observers.
Carcinoma, Non-Small-Cell Lung ; Evaluation Studies as Topic* ; Fibrosis* ; Follow-Up Studies ; Humans ; Lung* ; Observer Variation* ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed

PURPOSE: Lower urinary tract dysfunction is the most common complication after radical pelvic surgery. The aims of this study were to assess the effect of radical hysterectomy (RH) on the storage function of the lower urinary tract and to evaluate the impact of radiation therapy (RT) on postoperative urodynamic parameters. METHODS: This was a retrospective review of preoperative and postoperative urodynamic variables, which were prospectively collected. All women from 2006 to 2008, who underwent RH for uterine cervical cancer with a stage of 1A to 2B with or without adjuvant RT were enrolled. All patients were divided into two groups: group 1, without RT, and group 2, with adjuvant RT. Urodynamic studies were performed before, 10 days after, and 6 months after RH. RESULTS: A total of 42 patients with a mean (+/-standard error) age of 51.9 (+/-12.3) years were analyzed. There were no significant differences in age, body mass index or clinical stage between the two groups. On the 10th postoperative day, all parameters were decreased except postvoid residual volume. In comparison with group 2 (n=14), group 1 (n=28) showed a significant increase in bladder compliance. At 6 months postoperatively, bladder compliance in group 1 had increased four times or more compared with that on postoperative 10 days. However, it had increased only 2.5 times in group 2 at the same time point (P<0.001). CONCLUSIONS: The results of our study suggest that adjuvant RT after RH might result in a deterioration of bladder compliance. It is highly suggested that practitioners pay attention to low bladder compliance, especially in patients who have adjuvant RT after RH.
Body Mass Index ; Compliance ; Female ; Humans ; Hysterectomy ; Prospective Studies ; Residual Volume ; Retrospective Studies ; Urinary Bladder ; Urinary Tract ; Urodynamics ; Uterine Cervical Neoplasms

PURPOSE: Axillary node involvement is the single most important prognostic variable in patients with breast cancer. If axillary lymph node status of breast cancer patients could be accurately predicted from basic clinical information and from characteristics of their primary tumors, many patients could be spared axillary lymph node dissection. With the availability of numerous histologic prognosticators and new immunochemical prognostic indicators, it is reasonable to reconsider the necessity of axillary node dissection for lesions more advanced than duct carcinoma in situ. MATERIALS AND METHODS: Six hundred fifty-six patients with Tl invasive breast cancer were evaluated. All the patients underwent axillary dissection, and the pathologic status of the nodes was known. The parameters of the primary tumor in this study were age, size, family history, tumor palpability, nuclear and histological grade, hormone receptor status, lymphatic vessel invasion (LVI), and various tumor markers (bc1-2, cathepsinD, c-erbB2, E-cadherin, p53). RESULTS: Approximately 31% of the 656 patients with Tl breast carcinoma had axillary node metastasis. Four factors were identified as significant predictors of node metastasis: age 35 or less (p=0.01), lymphatic vessel invasion (p < 0.01), tumor palpability (p=0.02), and tumor size (p<0.01). However, independent predictors of lymph node metastasis in the multivariate logistic regression analyses were tumor size (p=0.04) and LVI (p=0.03). CONCLUSION: Characteristics of the primary tumor can help assess the risk for axillary lymph node metastases in Tl breast cancer. Selected patients who have 1cm or less without lymphatic vessel invasion are considered to be at minimal risk of axillary node metastasis and might be spared routine axillary dissection.
Breast Neoplasms* ; Breast* ; Cadherins ; Carcinoma in Situ ; Humans ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Vessels ; Neoplasm Metastasis* ; Prognosis ; Biomarkers, Tumor

PURPOSE: Primary aldosteronism due to an adrenal cortical adenoma is a surgically curable disease. However, hypertension is known to persist postoperatively in many patients. The aim of this study was to determine the factors influencing the long-term outcome of blood pressure after an adrenalectomy for a primary aldosteronism and to evaluate the changing pattern of renin and aldosterone. METHODS: Forty-two cases of primary aldosteronism, which were operated on and followed up at the Department of Surgery, Seoul National University Hospital from January 1986 to June 2001 were included in this study. The subjects were classified into a normotensive group and a hypertensive group and the two groups were compared according to the clinical, biochemical and pathological parameters. RESULTS: After surgery, the aldosterone concentration was decreased and the plasma renin activity was increased. During a mean follow-up period of 28 months, 31 patients (73.8%) had a normal blood pressure without an antihypertensive treatment. The significant risk factors for persistent hypertension were a family history of hypertension, a long duration of preoperative hypertension, a poor response of preoperative spironolactone. The hypertensive group had a higher level of postoperative plasma renin activity and an aldosterone concentration in the long-term follow-up period after surgery. CONCLUSION: A family history of hypertension, the duration of hypertension and the response to spironolactone were factors influencing persistent hypertension after surgery for a primary aldosteronism. A high level of plasma renin activity and aldosterone during the follow-up period is related to the persistent hypertension. Therefore, early detection and surgery for a primary aldosteronism would reduce the preoperative cardiovascular changes and improve the postoperative outcome.
Adrenalectomy ; Adrenocortical Adenoma ; Aldosterone ; Blood Pressure ; Follow-Up Studies ; Humans ; Hyperaldosteronism* ; Hypertension ; Plasma ; Renin ; Risk Factors ; Seoul ; Spironolactone

PURPOSE: To determine the clinical feature, surgical management of primary and recurrent disease, predictive factors for outcome, and impact of multimodality therapy in retroperitoneal sarcoma. MATERIALS AND METHODS: 60 patients were confirmed pathologically as soft-tissue sarcoma of the retroperitoneum by operation or needle biopsy in Seoul National University Hospital from 1983 to 1995. A retrospective analysis was performed. RESULTS: The abdominal mass was common presenting symptom. Histologically liposarcomas(25%) and leiomyosarcomas(23.3%) were most common, and MFHs(11.7%) and malignant schwannomas(11.7%) followed. The overall 5 year survival rate was 54.6%. Complete resection was possible in 51.7% of patients and strongly predicts outcome (<0.0001). These patients had a median survival of 130 months compared to 20 months for those undergoing partial resection and 9 months for those with unresectable tumors. 11(35%) of completely resected patients have had local recurrence. These patients underwent reoperation when feasible. Complete resection of recurrent disease was performed in 10 patients(90%), with a 42 months median survival time after reoperation. Resection of adjacent organ was performed in 19 patients. 14 of these were completely resected, and showed 100% of 5 year survival rate. Tumor grade was not a significant predictor of outcome. Gender, histologic type, encapsulation, stage, resectability, combined resection were significant prognostic factors by univariate analysis. But resectability was only independent prognostic factor on mutivariate analysis. Radiation therapy and chemotherapy could not be shown to have significant impact on survival. CONCLUSION: Complete resection is the most important prognostic factor of retroperitoneal sarcoma. Extensive and aggressive surgery must be considered including resection of adjacent organs. Multiple resection seems to improve survival in recunent cases.
Biopsy, Needle ; Drug Therapy ; Humans ; Recurrence ; Reoperation ; Retrospective Studies ; Sarcoma* ; Seoul ; Survival Rate

Substernal extension of a goiter into the thoracic inlet endows a generally benign neck mass with morbid potential. The reported incidence varies between 1% and 15% of all thyroidectomies performed. Whether all patients with a substernal goiter should undergo an operation or whether the operation should be performed selectively remains controversial. From May 1989 to March 1996, 10 patients underwent thyroidectomies for substernal goiters, and those cases of resected substernal goiters have been reviewed to access the symptoms and signs that brought patients to surgery: the size and the position of goiter, the preoperative work-up, the risk associated with the operation, and the histopathologic state of the goiter. There were 3 male and 7 female patients, and their ages ranged from 40 to 68 years. The chief complaints were cervical mass (4), dyspnea (2), facial edema (1) and chest pain (1). No symtomatic cases (2) were also found. The average mass size was 8.4 cm (5-14 cm) and the average weight was 109 gm (41-350 gm). Although chest film was the most used, computed tomography was by far the most useful study. Thyroid scans often failed to show the substernal goiter. Fine-needle aspiration was not helpful because of inaccessibility. In the majority of the patients (7 cases), the substernal goiters were removed by a cervical incision. Three cases of goiters located deep to the carina level required a combined cervical and sternotomy approach or thoracotomy. In the cervical incision group, the complications were transient hypocalcemia (1) and unilateral recurrent laryngeal nerve injury (1). In the combined cervical and sternotomy approach or thoracotomy, unilateral recurrent laryngeal nerve injury (1) and bilateral recurrent laryngeal nerve injury (1) and mediastinitis (1) were the complications. An occult papillary carcinoma, which was not identified preoperatively, was found in one case. Removal was almost always accomplished via cervical incision and with low morbidity and no deaths. Also, the substernal goiters revealed unusual symptoms and signs, such as dyspnea, facial edema and chest pain, compared to usual thyoid goiters and were relatively bigger in size. In conclusion, most substernal goiter above the carinal level could be removed by cervical incision with a low rate of complication. The threat of compression, the substantial chance of malignancy, and the safety of resection mean that the presence of a substernal goiter is an indication for surgery.
Bays ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Chest Pain ; Dyspnea ; Edema ; Female ; Goiter ; Goiter, Substernal* ; Humans ; Hypocalcemia ; Incidence ; Male ; Mediastinitis ; Neck ; Recurrent Laryngeal Nerve Injuries ; Sternotomy ; Thoracotomy ; Thorax ; Thyroid Gland ; Thyroidectomy

1136 breast cancer patients admitted to and treated at the Department of Surgery, Seoul National University Hospital, between Jan. 1989 and Dec. 1995 were analysed retrospectively. We compared this group of patients with another group of 802 breast cancer patients between Jan. 1970 and Dec. 1988. The results are as follows. Neither the mean age (46.9 years), prevalent age group (5th decade) or common location of the tumor (outer upper quadrant) showed any difference between the two groups. The common presenting symptoms of patients, breast lump (89.0%) and bloody discharge (3.0%), also did not change significantly. However, the number of patients with microcalcification or abnormal mass density on mammography without specific symptoms and signs increased in this period. According to the AJCC staging system, more than half of thepatients were stage II (59.2%) followed by stage I (20.5%), stage III (13.2%), stage 0 (4.7%) and stage IV (2.3%). The proportion of patients with early breast cancer increased from 62.0% for the early-time group to 84.4% for the later-time group, while that of patients with advanced breast cancer decreased significantly from 38.0% to 15.5% (p<0.0001). Invasive ductal carcinoma,NOS (81.7%) and modified radical mastectomy (84.5%) was still the most common histologic type and type of operation performed respectively. Although the most common type of operation performed did not change significantly, a number of patients, 113 patients, underwent breast conservation surgeries during the later-time period. Quadrantectomy and axillary dissection was the most common type of breast conservation surgery. In summary, no obvious differences in age distribution, tumor location, or common histologic type were found between the two groups. However, the number of asymptomatic patients detected by mammography, the number of breast conservation surgery performed, and the proportion of early breast cancer were markedly increased remarkably in later-time group.
Age Distribution ; Breast Neoplasms* ; Breast* ; Humans ; Mammography ; Mastectomy, Modified Radical ; Retrospective Studies ; Seoul

A retrospective analysis was performed on 69 follow-up cases of ducal carcinoma in situ(DCIS) treated from Jan. 1981 to Dec. 1995 at Department of Surgery, Seoul National University Hospital. The results are as follows. The mean age was 45.4 years that ranged from 28 to 68. The proportion of DCIS to breast cancer was increased from 1.3% to 7.2% for 15 years. Clinical presentations of DCIS were mass, nipple discharge and suspicious mammographic findings. Patients presenting mass were decreased, while mammographically detected DCIS were increased. In 49.3% of cases, the tumor size was smaller than 2cm and in 21.3% of the cases, the tumor was not palpable. Treatment modality was changed to more conservative procedures. All of the patients survived well without local recurrence or distant metastasis for a mean follow-up of 36.3 months(range 7 to 146). Histopathologic review was also performed on 52 cases of which paraffin blocks were saved, by one pathologist and diagnosis was confirmed. Pure DCIS composed 16 cases(30.8%), and DCIS with microinvasion was 36 cases(69.2%). Clinical presentation of DCIS, such as age, nipple discharge, calcification on mammography and mass size were not related to the microinvasion, but mass palpability was related to microinvasion(p=0.018). There was no histopathologic features to predict progression to invasive carcinoma, regardless of comedo type, histologic grade and nuclear grade. The expression of cathepsin-D, nm23, p53 and c-erbB-2 protein, was also evaluated using immunohistochemical methods. The relationship between expression of immunohistochemical antibodies and prognostic variables such as tumor size, histologic grade, nuclear grade, and microinvasion was assessed. The overexpression of c-erbB-2 protein was associated with lower nuclear grade(p=0.033), and a strong correlation was seen between tumor size and cathepsin-D and p53 protein(p=0.035, p=0.016). In this study, we conclude that the fine classification and analysis of DCIS subtype, not only by histopathologic but also by immunohistochemical study can be helpful to predict biological behaviour of DCIS and decide the modality of treatment.
Antibodies ; Breast ; Breast Neoplasms ; Carcinoma in Situ* ; Carcinoma, Intraductal, Noninfiltrating ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Mammography ; Neoplasm Metastasis ; Nipples ; Paraffin ; Receptor, erbB-2 ; Recurrence ; Retrospective Studies ; Seoul

PURPOSE: Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. MATERIALS AND METHODS: From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). RESULTS: Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p < 0.001). Mean parotid dose of both glands > or =20 Gy were observed in 15 (28.3%) for CF and in 0 (0.0%) for MF. The whole brain percentage volumes receiving >98% of prescribed dose were 99.7% for CF and 99.5% for MF. CONCLUSION: Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.
Brain ; Humans ; Parotid Gland ; Xerostomia