BOP is made of N-Vinyl pyrrolidone-Methylmethacrylate monomer, polyamide fibres, and calcium glusconate. BOP is biocompatible, biodegradable, and osteoconductive matrix, easy to use and quite safe. Authors have operated 14 patients who has bilateral hernaiated nucleus pulposus, multiple herniated nucleus pulposus, or herniated nucleus pulposus accompanied with spinal stenosis, spondylolysis or spondylolisthesis in lumbosacral portion from September, 1989 till August, 1990. The results were satisfactory. We analysed this patients and report the method of ligamentoplasty with the discussions about spinal fusion and spinal instability.
Calcium ; Humans ; Nylons ; Spinal Fusion ; Spinal Stenosis ; Spine* ; Spondylolisthesis ; Spondylolysis

PURPOSE: This study was designed to demonstrate the potential therapeutic advantage of 3-dimensional (3-D) treatment planning over the conventional 2-dimensional (2-D) approach in patients with carcinoma of the nasopharynx. MATERIAL AND METHODS: The two techniques were compared both qualitatively and quantitatively for the boost portion of the treatment (19.8 Gy of a total 70.2 Gy treatment schedule) in patient with T4. The comparisons between 2-D and 3-D plans were made using dose statistics, dose-volume histogram, tumor control probabilities, and normal tissue complication probabilities. RESULTS: The 3-D treatment planning improved the dose homogeneity in the planning target volume. In addition, it caused the mean dose of the planning target volume to increase by 15.2% over 2-D planning. The mean dose to normal structures such as the temporal lobe, brain stem, parotid gland, and temporomandibular joint was reduced with the 3-D plan. The probability of tumor control was increased by 6% with 3-D treatment planning compared to the 2-D planning, while the probability of normal tissue complication was reduced. CONCLUSION: This study demonstrated the potential advantage of increasing the tumor control by using 3-D planning, but prospective studies are required to define the true clinical benefit.
Brain Stem ; Humans ; Nasopharynx* ; Parotid Gland ; Temporal Lobe ; Temporomandibular Joint

PURPOSE: To find the more effective treatment methods that improving thesurvival of patients with glioblastoma multiforme(GBM), we analyze the prognostic factors and the outcome of therapy in patients with GBM. METHODS AND MATERIALS: One hundred twenty-one patients with a diagnosis of GBM treated at Severance Hospital between 1973 and 1993 were analyzed for survival with respect to patients characteristics, that is, duration of symptom, age, and Karnofsky performance status, as well as treatment related variables such as extent of surgery and radiotherapy. RESULTS: The median survival time(MST) and 2-year overall survival rate (OSR) of the patients with GBM were 13 months and 20.8%, respectively. Duration of symptom, age, Karnofsky performance status(KPS), radiotherapy, and extent of surgical resection were associated with improved survival in a univariate analysis. Patients whose duration of symptom was longer than 3 months, had the 2-year OSR of 47.2%(p=0.0082), who were younger than age 50, 32.9%(p=0.0003). In patients with a KPS of 80 or higher, the 2 year OSR was 36.9%(p=0.0422). Patients undergoing radiotherapy had the 2-year OSR of 22.9%(p=0.030), and surgical resection of 23.3%(p<0.000). A cox regression model confirmed a significant correlation of duration of symptom, age, radiotherapy,and extent of surgical resection with survival, excluding KPS(p=0.8823). The 2-year OSR were 22.3% and 19.4%, combined with chemotherapy or without, respectively(p=0.06028). The duration of symptom of 3 months or shorter. 50 years of age or older, and undergoing stereotactic biopsy only were considered as risk factors. then patients without any risk factors had the MST of 29 months and 2-year OSR of 53.9% compared to 4 months and 0% for patients who had all 3 risk factors. Most of all treatment failure occurred in the primary tumor site(86.4%) CONCLUSION: The duration of symptom, age, radiotherapy, and extent of surgical resection were a prognostically significant independent variables. To get a better survival, it seems to be reasonable that the study design which improves the local control rates is warranted.
Biopsy ; Diagnosis ; Drug Therapy ; Glioblastoma* ; Humans ; Karnofsky Performance Status ; Radiotherapy ; Risk Factors ; Survival Rate ; Treatment Failure

Cerebrovascular disease and coronary heart disease are the first and the fourth common causes of death among adults in Korea. Reported risk factors of one of these diseases may prevent other diseases. Therefore, we tried to compare and discriminate the risk factors of these diseases. We recruited four case groups and four control groups among the inpatients who were admitted to Wonju Christian Hospital from March, 1994 to November, 1995. Four control groups were matched with each of four case groups by age and sex. The number of patients in each of four case and control groups were 106 and 168 for acute myocardial infarction(AMI), 84 and 133 for subarachnoid hemorrhage(SAH), 102 and 148 for intracerebral hemorrhage(ICH), and 91 and 182 for ischemic stroke(IS) respectively. Factors whose levels were significantly higher in AMI and IS than in responding control group(RCG) were education, economic status, and triglyceride. Factors whose levels were significantly lower in hemorrhagic stroke than in RCG were age of menarch, and prothrombin time. The factor whose level was higher in AMI than in RCG was uric acid. The factor whose level was higher in AMI, ICH, and SAH than in RCG was blood sugar. Factors whose levels were significantly higher in all the case groups than in RCG were earlobe crease, Quetelet index, white blood cell count, hemoglobin, hematocrit, and total cholesterol. The list of risk factors were somewhat different among the four diseases, though none of the risk factors to the one disease except prothrombin time acted as a preventive factor to the other diseases. The percent of grouped cases correctly classified was higher in the discrimination of ischemic diseases(AMI and IS) from hemorrhagic diseases(SAH and ICH) than in the discrimination of cerebrovascular disease from AMI. The factors concerned in the discrimination of ischemic diseases from hemorrhagic diseases were prothrombin time, earlobe crease, gender, age uric aci, education, albumin, hemoglobin, the history of taking steroid, total cholesterol, and hematocrit according to the selection order through forward selection.
Adult ; Blood Glucose ; Body Mass Index ; Case-Control Studies* ; Cause of Death ; Cholesterol ; Coronary Disease* ; Discrimination (Psychology) ; Education ; Gangwon-do ; Hematocrit ; Humans ; Inpatients ; Korea ; Leukocyte Count ; Prothrombin Time ; Risk Factors* ; Stroke ; Triglycerides ; Uric Acid

PURPOSE: Although using the high energy photon beam with conventional parallel-opposed beams radio-therapy for nasopharyngeal carcinoma, radiation-induced xerostomia is a troublesome problem for patient. We conducted this study to explore a new parotid gland sparing technique in 3-D conformal radiotherap (3-D CRT) in an effort to prevent the radiation-induced xerostomia. MATERIALS AND METHODS: We performed three different planning for four clinically node-negative naso-phar yngeal cancer patients with different location of tumor(intracranial extension, nasal cavity extension, oropharyngeal extension, parapharyngeal extension), and intercompared the plans. Total prescription dos <. Was 70.2 Gy to the isocenter, For plan-A, 2-D parallel opposing fields, a conventional radiotherapy technique, were employed. For plan-B, 2-D parallel opposing fields were used up until 54 Gy an < 3 afterwards 3-D non-coplanar beams were used. For plan-C, the new technique, 54 Gy was delivered b r 3-D conformal 3-port beams (AP and both lateral ports with wedge compensator; shielding both superficial lobes of parotid glands at the AP beam using BEV) from the beginning of the treatment and early spinal cord block (at 36 Gy) was performed. And bilateral posterio r necks were treated with electron after 36 Gy. After 54 Gy, non-coplanar beams were used for cone-down plan. We intercompared dose statistic; Dmax, Dmin, Dmean, D95, D05, V95, V05, Volume receiving 46 Gy) and dose volume histograms (DVH) of tumor and normal tissues and NTCP values of parotid glands for the above three plans. RESULTS: For all patients, the new technique (plan-C) was comparable or superior to the other plans in target volume isodose distribution and dose statistics and it has more homogenous target volume, coverage. The new technique was most superior to the other plans in parotid glands sparing (volume receiving 46 Gy: 100, 9 B, 69% for each plan-A, B and C). And it showed the lowest NTCP value of parotid glands in all patients (range of NTCP; 96-100%, 79-99%, 51-72% for each plan-A, B and C). CONCLUSION: We conclude that the new technique employing 3-D conformal radiotherapy at the beginning of radiotherapy and cone down using non-coplanar beams with early spinal cord block is highly recommended to spare parotid glands for node-negative nasopharygeal cancer patients.
Humans ; Nasal Cavity ; Neck ; Parotid Gland* ; Prescriptions ; Radiotherapy* ; Radiotherapy, Conformal* ; Spinal Cord ; Xerostomia

Epithelioid hemangioendothelioma(EH) is a rare vascular tumor of low-grade malignancy. It was previously described as intravascular bronchioloalveolar tumor (IVBAT). But electron microscopic study and immunohistochemical staining results have proved endothelial origin. Patients are usually asymptomatic and the tumors are found incidentally on routine chest X-rays. Most patients show a slowly progressive clinical course, even though some patients occasionally die as results of respiratory failure or extrathoracic complications. Confirmative diagnosis is made through thoracoscopic or open-lung biopsy. There is still no effective therapeutic modality for pulmonary EH. We have experienced a 55-year-old woman whose simple chest x-ray film revealed bilateral multiple small nodules. The nodules were histopathologically and immunohistochemically diagnosed as primary epithelioid hemangioendothelioma of the lung. The possibility of metastatic disease was excluded thorough clinical, laboratory and radiological studies. Comparison of radiographic chest film taken 3 years ago showed no significant progression of the pulmonary nodular lesions. Conservative management was instituted and careful 4 months follow-up showed no significant changes.
Biopsy ; Diagnosis ; Female ; Follow-Up Studies ; Hemangioendothelioma, Epithelioid* ; Humans ; Lung ; Middle Aged ; Respiratory Insufficiency ; Thorax ; X-Ray Film

PURPOSE: Recurrent bile duct stones, following biliary surgery, cause many difficult problems and reoperation on the biliary tract has limitation due to high mortality and morbidity. In recent years, various non-operative modalities for the management of recurrent stone have been developed and reoperation on biliary. This study was designed to determine the factors contributing to the success rate, and to investigate the optimal treatment method, of reccurrent biliary stones. METHODS: Thirty-nine patients, treated by percutaneous transhepatic stone removal (PTBD group), and 42 treated by a common bile duct exploration (operation group), at Chung- Ang University Hospital, between January 1999 and August 2002, were retrospectively analyzed. RESULTS: Complete removal (Success) was achieved in 82.1 and 86.1% of the cases of the PTBD and operation groups, respectively. There were no significant differences observed relating to the sex, age, duration of hospital stay, cost, success rate. However, the complication rate was significantly decreased in the PTBD group (8 cases (20.5%) vs. 22 cases (51.2%) P=0.0057). CONCLUSION: Form the comparison of the operation and PTBD groups, similar success rates were observed. Percutaneous transhepatic stone removal is also an effective method for the management of recurrent bile duct stones. After studying more cases, re-evaluation must be performed concerning the potential advantages of percutaneous transhepatic stone removal.
Bile Ducts ; Biliary Tract ; Common Bile Duct ; Humans ; Length of Stay ; Mortality ; Reoperation ; Retrospective Studies

"Hemobilia" upper gastrointestinal bleeding that originates from within the biliary tract, is a rare complication of the laparoscopic cholecystectomy. Only a few cases have been reported in the literature. It is more common in accidential or iatrogenic injury of the liver and bile ducts, even occurring spontaneously in cholelithiasis, several inflamatory processes, and vascular and neoplastic changes. The laparoscopic cholecystectomy is a recently developed and advanced surgical procedure that has rapidly gained acceptance. Its complications remain to be clinically analyzed. The authors experienced a case of massive hemobilia after a laparoscopic cholecystectomy. A 54-years-old man with hemobila resulting from right hepatic artery pseudoaneurysm communicating with the intra-hepatic bile duct was treated with angiographic tanscatheter embolization on the of 24th postoperative day. We report this case with a brief review of the literature.
Aneurysm, False ; Bile Ducts ; Biliary Tract ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Hemobilia* ; Hemorrhage ; Hepatic Artery ; Liver

PURPOSE: The purpose for this study is to compare the clinical differences of the two groups (ie. colonic obstruction and non-obstruction) in colonic surgery. METHODS: A retrospective clinical analysis was done in 149 patients with colorectal disease who had been surgically treated from January 1995 to December 1997 at our institution. RESULTS: 1) The peak age of incidence was in the 7th. and 8th. decades (53.3%)in the obstruction group and 6th. and 7th. decades (54.3%) in the non-obstruction group, the sex ratio of male to female was higher in the obstruction group (2.00:1) than in the non-obstruction group (1.04:1). 2) The most common cause of colonic obstruction was malignant disease in both groups (75.4% in the obstruction group and 78.3% in the non-obstruction group). 3) The most frequent symptom and sign of the two groups were abdominal pain (36.8% and 2.6% respectively). 4) The most common location was cecum (24.6%) followed by sigmoid colon (22.8%) and rectum (15.8%) in the obstruction group, and rectum (40.2%) followed by ascending colon (15.2%), cecum (13.0%), and transverse colon (13.1 %) in the non obstruction group. 5) The right hemicolectomy was the most common procedure in the obstruction group (29.8%) while abdominoperineal resection was most frequently performed in the non-obstruction group (23.9 %). The surgical resection rate was 77.4% and 100% in obstruction group and non-obstruction group, respectively. 6) In the case of colon cancer, the stage of cancer (according to Modified Astler-Coller classification) was much higher in the obstruction group. An average 6.5 metastatic lymph nodes were found from 18.5 dissected lymph nodes in the obstruction group whereas 2.7 out of 13.9 lymph nodes in the non-obstruction group. 7) The postoperative complication rate of obstruction group were 21.4% whereas that of non-obstruction group were 15.0% respectively. The postoperative mortality rate was 14% in the obstruction group and 3.3% in the non-obstruction group. The complication rate and postoperative mortality of the obstruction group was higher than those of the non-obstruction group, especially in the malignant disesae group. CONCLUSIONS: The results of our study indicate that the obstruction group has a different clinical course from the non- obstruction group and associated higher postoperative complication and mortality rate.
Abdominal Pain ; Cecum ; Colon* ; Colon, Ascending ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Humans ; Incidence ; Lymph Nodes ; Male ; Mortality ; Postoperative Complications ; Rectum ; Retrospective Studies ; Sex Ratio

To clarify the mechanisms of stone formation in gallbladder and in common bile duct, the bile composition, such as cholesterol, total bile acid, major bile acids, phospholipid, protein and calcium, from patients with gallbladder stones, common bile duct stones and control groups were analyzed for comparison. The control group consisted of patients who had neither biliary stone nor biliary tract disease. The results obtained are as follows; 1. In the mean concentrations of bile cholesterol and protein from each disease group, no statistically significant difference of these compositions was observed according to sorts of stone(p > 0.05). 2. In the cholesterol stone group the mean concentration of total bile acid of bile from gallbladder stone group was higher than that of common bile duct stone group (p < 0.05). In the pigment stone group, T/D ratio of bile from gallbladder stone group tended to be higher than that of CBD stone group. But these differences were not statistically significant (p = 0.09). 3. In the pigment stone groups, the mean concentration of bile phospholipid from gallbladder stone group was significantly higher than that of CBD stone group (p < 0.05). 4. The mean concentration of bile protein from gallbladder stone group was higher than that of CBD stone group in the pigment stone group (p < 0.05). 5. The mean concentration of bile calcium was significantly higher in gallbladder stone group than that in CBD stone group (p < 0.05). In conclusion, supersaturation of cholesterol in bile may not be sufficient to explain cholesterol gallstone formation. The increase in total bile acid especially LCA, DCA, CDCA may be involved in cholesterol gallbladder stone formation, whereas pigment gallbladder stone formation is thought to be related to decreased T/D ratio of bile which means high dihydroxycholanic acid of bile. Additionally, the results suggest that phospholipid, protein and calcium contribute to pigment gallbladder stone formation by playing great roles in forming matrix as nucleus in pigment stone, but further investigation may be needed to detect calcium ion critical for calcium crystal formation.
Bile Acids and Salts ; Bile* ; Biliary Tract Diseases ; Calcium ; Cholesterol ; Common Bile Duct* ; Gallbladder* ; Gallstones ; Humans