Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.
Aged ; Critical Illness* ; Delayed Diagnosis ; Headache ; Humans ; Intensive Care Units ; Male ; Neurologic Manifestations ; Posterior Leukoencephalopathy Syndrome* ; Postoperative Period ; Seizures

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

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

No abstract available.
Bradycardia ; Insufflation ; Laparoscopy

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

Malignant lymphoma of uterus and ovary is a very rare disease. Under the impression of ovarian malignancy, subtotal abdominal hysterectomy with bilateral salpingo-ophorectomy was done due to severe pelvic adhesion. Histopathologic and immunohistochemical study demonstrated the tumor to be diffuse large B-cell lymphoma of the ovary with involvement of the uterus. So, we have experienced a case of malignant lymphoma of the uterus and ovary in Department of Obstetrics and Gynecology and Pathology, College of Medicine Korea University and discribed our case with a brief review of literature.
B-Lymphocytes* ; Female ; Gynecology ; Hysterectomy ; Korea ; Lymphoma ; Lymphoma, B-Cell* ; Obstetrics ; Ovary* ; Pathology ; Rare Diseases ; Uterus*

To evaluate the efficacy of hyperfractionated re-irradiation using a three-dimensional conformal radiotherapy (3-D CRT) technique in patients with locally recurrent carcinoma of the nasopharynx. Four patients with locally recurrent nasopharyngeal cancer were retreated with a hyperfractionated schedule using a 3-D CRT technique. Re-irradiation was delivered in 1.1-1.2 Gy fractions twice per day (BID), with interfraction intervals of more than 6 hours. The total dose ranged from 59.4 to 69.2 Gy. A 3-D CRT technique with 5- or 6-field coplanar and/or non-coplanar beams were employed during the entire treatment procedure. All four patients achieved complete remission of locally recurrent lesions, with marked improvement of subjective symptoms, immediately after re-irradiation. All are alive and well without evidence of disease after limited follow-up periods, which range from 7 to 20 months. So far, there have been no radiation-induced neurologic complications. Four patients with locally recurrent carcinoma of the nasopharynx were successfully treated by hyperfractionated re-irradiation using a 3-D CRT technique. A relatively high re-irradiation dose of more than 60 Gy may be safely delivered with no serious acute or late radiation-induced complications in patients with local recurrences and who were initially treated with doses greater than 70 Gy.
Aged ; Dose Fractionation* ; Human ; Male ; Middle Age ; Nasopharyngeal Neoplasms/radiotherapy* ; Neoplasm Recurrence, Local/radiotherapy* ; Radiotherapy Dosage ; Radiotherapy, Conformal*

PURPOSE: To assess the efficacy of high dose rate - intracavitary radiotherapy (HDR-ICR) in the radiotherapy of FIGO stage IB squamous cell carcinoma of uterine cervix and to determine the optimum dose combination xheme of external radiotherapy and ICR to achieve acceptable local control without severe complication. METHODS AND MATERIALS: One hundred and sixty two patients with FIGO stage Ib squamous cell carcinoma of uterine cervix who received definitive radiotherapy between May 1979 and December 1990 were retrospectively analyzed. All the patients received external radiotherapy combined with HDR-ICR. External dose of 40-46 Gy in 4.5-5 weeks was given to whole pelvis(median 45 Gy) and ICR dose of 30-39 Gy in 10-13 times was given to the point A. Midline shielding was done after 20-45 Gy of external radiotherapy(median 40 Gy). Summation of external dose plus ICR dose to the point A range were 64.20-95.00 Gy, and mean was 83.94 Gy. We analyzed the local control rate, survival rate, and late complication rate. RESULTS: Initial complete response rate was 99.4% for all patients. Overall 5-year survival rate was 91.1% and 5-year disease free survival rate was 90.9%. Local failure rate was 4.9% and distant failure rate was 4.3% Tumor size was the only significant prognostic factor. When tumor size greater than 3cm, 5-year survival rate was 92.6% and less than 3cm, that was 79.6%, Late complication rate was 23.5% with 18.5% of rectal complication and 4.9% of bladder complication. Mean rectal dose summation of external midline dose plus ICR rectal point dose was lower in the patients without rectal complication(74.88 Gy) than those with rectal complication (78.87 Gy). Complication rate was inceased with low rate of improvement of survival rate when summation of external midline dose plus point A or point R dose by ICR was greater than 70-75 Gy. CONCLUSION: The definitive radiation therapy using high dose rate ICR in FIGO stage IB uterine cervical cancer is effective treatment modality with good local control and survival rate without severe complication.
Carcinoma, Squamous Cell ; Cervix Uteri ; Disease-Free Survival ; Female ; Humans ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Urinary Bladder ; Uterine Cervical Neoplasms*

No abstract available.
Cor Triatriatum ; Echocardiography ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets

PURPOSE: Although It has been known that the tolerance of the liver to external beam irradiation depends on the irradiated volume and dose, few data exist which quantify this dependence. However, recently, with the development of three dimensional (3-D) treatment planning, have the tools to quantify the relationships between dose, volume, and normal tissue complications become available. The objective of this study is to investigate the relationships between normal tissue complication probability (NTCP) and the risk of radiation hepatitis for patients who received variant dose partial liver irradiation. MATERIALS AND METHOD: From March 1992 to December 1994, 10 patients with hepatoma and 10 patients with bile duct cancer were included in this study. Eighteen patients had normal hepatic function, but 2 patients (prothrombin time 73%, 68%) had mild liver cirrhosis before irradiation. Radiation therapy was delivered with 10MV linear accelerator, 180~200 cGy fraction per day. The total dose ranged from 3,960 cGy to 6,000 cGy (median dose 5,040 cGy). The normal tissue complication probability was calculated by using Lyman's model. Radiation hepatitis was defined as the development of anicteric elevation of alkaline phosphatase of at least two fold and non-malignant ascites in the absence of documented progressive. RESULTS: The calculated NTCP ranged from 0.001 to 0.840 (median 0.05). Three of the 20 patients developed radiation hepatitis. The NTCP of the patients with radiation hepatitis were 0.390, 0.528, 0.844 (median : 0.58+/-0.23), but that of the patients without radiation hepatitis ranged from 0.001 to 0.308 (median : 0.09+/-0.09). When the NTCP was calculated by using the volume factor of 0.32, a radiation hepatitis was observed only in patients with the NTCP value more than 0.39. By contrast, clinical results of evolving radiation hepatitis were not well correlated with NTCP value calculated when the volume factor of 0.69 was applied. On the basis of these observations, the volume factor of 0.32 was more correlated to predict a radiation hepatitis. CONCLUSION: The risk of radiation hepatitis was increased above the cut-off value. Therefore the NTCP seems to be used for predicting the radiation hepatitis.
Alkaline Phosphatase ; Ascites ; Bile Duct Neoplasms ; Carcinoma, Hepatocellular ; Hepatitis* ; Humans ; Liver ; Liver Cirrhosis ; Particle Accelerators