PURPOSE: To evaluate the radial displacement of clinical target volume in the patients with node negative head and neck (H&N) cancer and to quantify the relative positional changes compared to that of normal healthy volunteers. MATERIALS AND METHODS: Three node-negative H&N cancer patients and five healthy volunteers were enrolled in this study. For setup accuracy, neck thermoplastic masks and laser alignment were used in each of the acquired computed tomography (CT) images. Both groups had total three sequential CT images in every two weeks. The lymph node (LN) level of the neck was delineated based on the Radiation Therapy Oncology Group (RTOG) consensus guideline by one physician. We use the second cervical vertebra body as a reference point to match each CT image set. Each of the sequential CT images and delineated neck LN levels were fused with the primary image, then maximal radial displacement was measured at 1.5 cm intervals from skull base (SB) to caudal margin of LN level V, and the volume differences at each node level were quantified. RESULTS: The mean radial displacements were 2.26 (+/-1.03) mm in the control group and 3.05 (+/-1.97) in the H&N cancer patients. There was a statistically significant difference between the groups in terms of the mean radial displacement (p = 0.03). In addition, the mean radial displacement increased with the distance from SB. As for the mean volume differences, there was no statistical significance between the two groups. CONCLUSION: This study suggests that a more generous radial margin should be applied to the lower part of the neck LN for better clinical target coverage and dose delivery.
Consensus ; Displacement (Psychology) ; Head ; Head and Neck Neoplasms ; Humans ; Lymph Nodes ; Masks ; Neck ; Skull Base ; Spine

No abstract available.
Craniocerebral Trauma* ; Head* ; Prognosis*

BACKGROUND: Although myocardial contrast 2D echocardiography is a good method to diagnose and evaluate myocardial ischemia and reperfusion, it has required intracoronary or intra aortic root injection of contrast agent and furthemore, the degree of myocardial contrast produced is small. Second harmonic imaging which is based on the non linear emission of harmonics by resonant microbubble in the ultrasound field improves the ultrasound contrast single to noise ratio. METHODS: We measure the videointensity of interventricular septum(IVS) and lateral wall(LW) of second harmonic imaging myocardial contrast 2D echocardiography before and after LV injection of Levovist(300mg/ml, 0.4ml/Kg) in both pre and post left anterior descending coronary artery(LAD) ligation in 7 open chest pigs. RESULTS: 1) The mean(+/-SD) pre LAD ligation videointensity is significantly greater with after contrast than before contrast(IVS : 111.1+/-33.9 vs 31.1+/-7.6 ; p=0.00046, LW : 120.5+/-21.5 vs 42.2+/-10.0 ; p=0.00006). The post LAD ligation videointensity is also significantly greater with after contrast than before contrast(IVS : 62.8+/-24.6 vs 35.6+/-15.1 ; p=0.00379, LW : 129.9+/-10.9 vs 48.7+/-21.1 ; p=0.00006). 2) The videointensity of IVS is significantly greater with after contrast than before contrast in both pre and post LAD ligation(62.8+/-24.6 vs 111.1+/-33.9 ; p=0.0031). The post LAD ligation videointensity of LW after contrast is not different from that of pre LAD ligation(129.9+/-10.9 vs 120.5+/-21.5 ; p=0.1037). 3) The post LAD ligation videointensity increase of IVS is lower than pre LAD ligantion videointensity increase(27.2+/-18.3 vs 79.9+/-35.0 ; p=0.0006). But the videointensity increase of LW is not different between pre and post LAD ligation(78.2+/-23.4 vs 81.2+/-24.5 ; p=0.3778). CONCLUSION: These findings indicate that the myocardial blood flow and its decrease due to LAD ligation can be evaluated accurately by second harmonic imaging myocardial contrast 2D echocardiography.
Coronary Vessels* ; Echocardiography* ; Ligation* ; Microbubbles ; Myocardial Ischemia ; Noise ; Reperfusion ; Swine ; Thorax ; Ultrasonography

Congenital vertical talus associating tarsal coalition, which is a very anomalous condition and causes severe rigid flat foot, is presented with literary reviews. This case was treated with soft tissue release and triple arthrodesis.
Arthrodesis ; Flatfoot ; Talus

Results of 170 total knee arthroplasties(TKAs) performed from 1986 to 1995, followed up for at least one year, were reviewed. Lateral retinacular release was performed in 76 knees(45%) and not performed in 94 knees(55%). We compared the results of TKAs combined with lateral retinacular release with those without lateral retinacular release. The clinical results of TKAs were evaluated by the Knee Scoring System of Hospital for Special Surgery(HSS). The average follow-up period was 34 months. The clinical results assessed by HSS score, pain score and range of motion improved postoperatively in both groups, but there was no significant difference between the two groups. There were 8(4.7%) with patellar subluxations in 170 TKAs, one(1.3%) in the group with lateral retinacular release and 7(7.5%) in the group without lateral retinacular release(t-test; p<0.05). Analysis of lateral tilt of patella on roentgenographs also showed a significant difference between the two groups. 7 knees(9.2%) with lateral tilt were observed in the group with lateral retinacular release and 22 knees(23.4%) with lateral tilt in the group without lateral retinacular release(t-test; p<0.05). There was no osteonecrosis or fracture of patella in either group. In summary, lateral retinacular release might improve the patellar tracking and lower the incidence of patellar subluxation and lateral tilt of patella. Lateral retinacular release alone did not seem to cause patellar osteonecrosis and subsequent patellar fracture which were detectable in plain roentgenographs. So, we suggest that lateral retinacular release can be performed without great risk of potential patellar complications in TKAs requiring lateral retinacular release for proper patellar tracking.
Arthroplasty* ; Follow-Up Studies ; Incidence ; Knee* ; Osteonecrosis ; Patella ; Range of Motion, Articular

The authors performed clear lens extraction on 22 eye to treat severe high myopia more than 12 diopters(D). The changes in spherical equivalent (S. E.), visual acuity improvement, and the complications were evaluated during 6 months postoperatively. A scleral pocket incision and continuous curvilinear capsulorhexis was made and lens extraction was performed via phacoemulsification and low power poserior chamber intraocular lens was implanted. The postoperative refractive error target were form -1.5D to-2.0D. More than 85% of eyes were within +/-1D of targeted refractive error. The posoperative uncorrected visual acuities were increased more than 20/200 in all eyes and 20% of eyes were increased more than 20/40 at postoperative two months. The postoperative corrected visual acuities were increased two or more limes in more than 80% of eyes. Intraoperatively, hyphema in one eye, wound leaking in two eyes and radial tear during contimuous curvilinear capsulorhexis in one eye were developed. Poltoperatively, retinal detachment in two eyes, subretinal neovascularization in one eye and posterior capsular opacification in three eyes were developed. In conclusion, the clear lens extraction was a effective method for correction of severe high myopia but longer follow-up of large number of cases is needed to fully assess the safety.
Capsulorhexis ; Citrus aurantiifolia ; Follow-Up Studies ; Hyphema ; Lenses, Intraocular ; Myopia* ; Phacoemulsification ; Refractive Errors ; Retinal Detachment ; Visual Acuity ; Wounds and Injuries

PURPOSE: To evaluate factors associated with the development of strabismus after cataract extraction and primary intraocular lens implantation. METHODS: Medical records of 80 patients who had undergone cataract extraction with primary intraocular lens implantation between 6 months and 21 years of age from March 1993 to March 2008 were reviewed. Nine patients (11 eyes) with strabismus before cataract surgery were excluded. Patients were divided into 2 groups; patients with congenital bilateral cataracts (43 patients, 86 eyes) or patients with unilateral cataracts (28 patients, 28 eyes). Data were collected on age at cataract surgery, pre and post-cataract extraction visual acuity, interocular visual acuity differences, nystagmus, operation method, and the existence of associated other ocular diseases to evaluate the association of the onset of strabismus and after cataract. RESULTS: Factors statistically significantly associated with the development of strabismus include presence of nystagmus in bilateral cataracts and postoperative visual acuity differences > 0.3 in unilateral cataracts. A post-cataract extraction mean visual acuity < or = 0.2 and preservation of posterior capsule were significant factors in both groups. CONCLUSIONS: Children with congenital cataracts should be monitored carefully after cataract surgery for the development of strabismus especially when they have poor postoperative visual acuity, nystagmus, large postoperative interocular visual acuity differences, or preservation of posterior capsule.
Cataract ; Cataract Extraction ; Child ; Humans ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Medical Records ; Strabismus ; Visual Acuity

STATEMENT OF PROBLEM: Proper proximal contact is important for maintaining and stabilizing the dental arch. However, the proximal contact strength (PCS) is not a constant value and can be affected by a variety of factors. PURPOSE: This study examined the influences of postural changes on the posterior PCS. MATERIAL AND METHODS: Twelve adults with a normal occlusion and had not undergone prosthetic treatment or proximal restoration were participated in this study. A metal strip was inserted into the proximal surface and removed at a constant velocity. The contact strength was measured in every contact point between canine to second molar in both arches. The PCSs were obtained initially in the upright position, secondly in the supine position and finally in the upright position again. All measurements were repeated after a 2 hour period. Statistical analysis was carried out using the Friedman test (P < .05). RESULTS: Generally, a decrease in PCS occurred when the posture was changed from the initial upright to supine position, while it increased when the posture was changed from the supine to upright position. A significant change was observed in all areas except for between the canine-first premolar in the maxilla and between the first molarsecond molar in the mandible areas. CONCLUSION: The posterior PCS, which dentists generally believe to be a static feature of occlusion, is affected significantly by posture.
Adult ; Bicuspid ; Dental Arch ; Dentists ; Humans ; Mandible ; Maxilla ; Molar ; Posture ; Supine Position

We report a patient with pachydermoperiostosis accompanied by hypertrophic gastritis. A 26-year-old man showed deep folds and furrows of the face and scalp, and terminal spade-like expansion of fingers and toes. Physical examination revealed no abnormalities except a grotesque appearance. Results of routine laboratory tests were unremarkable. Mild periosteal reactoins of both femurs and humeri were noted on long bone series, and hypertrophic gastritis on fibroscopic examination drew our attention. The relationship between pachydermoperiostosis and hypertrophic gastritis is uncertain. However it is probable that hypertrophic gastritis may be the endodermal counterpart of the ectodermal manifestations of pachydermoperiostosis.
Adult ; Ectoderm ; Endoderm ; Femur ; Fingers ; Gastritis, Hypertrophic* ; Humans ; Osteoarthropathy, Primary Hypertrophic* ; Physical Examination ; Scalp ; Toes

PURPOSE: To evaluate the incidence and risk factors of glaucoma after pediatric cataract surgery. METHODS: We retrospectively reviewed 173 eyes which underwent pediatric cataract surgery from June 1998 to December 2009. The following parameters were ascertained: sex, laterality of cataract, age at diagnosis, age at surgery, cataract type, operation methods, optic capture, axial length (AXL), keratometry, follow-up period, and association of general abnormality. RESULTS: Out of the 173 eyes reviewed, 8.6% were diagnosed with glaucoma. The factors not significantly different in the glaucoma group compared to the non-glaucoma group were sex, laterality of cataract, age at diagnosis, AXL, and keratometry (p > 0.05). The incidence of glaucoma was significantly higher in the aphakic group compared to the pseudophakic group. Young age at surgery, no optic capture, pars plana lensectomy, sulcus IOL implantation, and nuclear type cataract were significantly associated with increased risk of postoperative glaucoma (p < 0.05). CONCLUSIONS: Patients with several predictors of postoperative glaucoma which may affect visual acuity may require extensive postoperative care after pediatric cataract surgery.
Cataract ; Eye ; Follow-Up Studies ; Glaucoma ; Humans ; Incidence ; Postoperative Care ; Retrospective Studies ; Risk Factors ; Visual Acuity