This study, involving thirty-two patients with carcinoma of uterine cervix treated by high dose rate intracavitary irradiation using a remotely controlled afterloading system, compares the doss at point A and B with the Curie-minutes prescription. A linear least-square regression analysis was used to compare the two sets of date. Correlation coefficients between doses at points A and B arid the Ci-min prescription are 0.92(p<0.001) and 0.90 (p<0.001), respectively, and linear relationship is observed between these two system. The limitation and significance of the comparison of the two approaches to intracavitary dosimetry is discussed.
Cervix Uteri ; Dioctyl Sulfosuccinic Acid ; Female ; Humans ; Prescriptions ; Uterine Cervical Neoplasms*

PURPOSE: Henoch-Schonlein purpura(HSP) is usually a self-limited disease with a good eventual outcome. The prognosis of HSP is mainly determined by the renal involvement. In this study, We evaluated children with biopsy-proven Henoch-Schonlein purpura nephritis about the clinical outcome correlated with renal manifestation and morphologic findings. METHODS: The clinical features, initial laboratory and pathologic findings, and clinical outcome were evaluated in 60 children with biopsy-proven Henoch-Schonlein purpura nephritis at Yonsei University Severance Hospital during the period from Jan. 1990 to Dec. 2002. RESULTS: The ratio of male to female patients was 1.2:1. The interval between the onset of Henoch-Schonlein purpura and renal manifestation was less than 3 months in 81% of the patients. Initial renal manifestation was microscopic hematuria in 100% of patients, isolated hematuria in 15%, acute nephritic syndrome in 7%, nephrotic syndrome in 22% of patients. Renal manifestation correlated with clinical outcome. Grade II and III were the most common in histologic grades of ISKDC. Renal pathologic finding correlated with clinical outcome. CONCLUSION: Renal manifestation and pathologic findings correlated with the clinical outcome. It is necessary to evaluate the correlation between pathologic findings and treatment.
Child ; Female ; Hematuria ; Humans ; Male ; Nephritis* ; Nephrotic Syndrome ; Pathology ; Prognosis ; Purpura, Schoenlein-Henoch*

PURPOSE: We wanted to evaluate the efficacy and toxicity of modified FOLFOX-6 chemotherapy for treating recurrent or inoperable gastric cancer patients. MATERIALS AND METHODS: From April 2006 to August 2007, 35 patients with recurrent gastric cancer after curative resection and 43 patients with inoperable gastric cancer underwent chemotherapy, and the results were retrospectively investigated. RESULTS: 78 patients were assessable for response and toxicity, and they underwent an average of 7.1 cycles of chemotherapy. The response was evaluated according to the RECIST criteria. 11 partial responses (14.1%), 35 cases of stable disease (44.9%), and 32 cases of progressive disease (41%) were observed. The median time to progression was 6 months, and the average overall survival was 13 months. CTCAE grade 1 or 2 anemia (52.6%) was the most prevalent toxicity. Other common toxicities included thrombocytopenia (17.9%) and peripheral neuropathy (30.8%). There were 13 changes in the chemotherapy regimen to S1-cisplatin due to disease progression, but only an average of 1.76 cycles of S1-cisplatin were delivered due to severe toxicities and poor compliance. CONCLUSION: Acceptable efficacy and toxicity were seen as 59% of the patients showed non-progression, and no grade 3 or 4 toxicities were observed. In conclusion, the modified FOLFOX-6 chemotherapy is considered to be the proper 1st-line choice as a palliative treatment for recurrent or inoperable gastric cancer patients.
Anemia ; Disease Progression ; Humans ; Organoplatinum Compounds ; Palliative Care ; Peripheral Nervous System Diseases ; Retrospective Studies ; Stomach Neoplasms ; Thrombocytopenia

PURPOSE: This study was performed to determine the optimal tile size for the fractal dimension of the mandibular trabecular bone using a tile counting method. MATERIALS AND METHODS: Digital intraoral radiographic images were obtained at the mandibular angle, molar, premolar, and incisor regions of 29 human dry mandibles. After preprocessing, the parameters representing morphometric characteristics of the trabecular bone were calculated. The fractal dimensions of the processed images were analyzed in various tile sizes by the tile counting method. RESULTS: The optimal range of tile size was 0.132 mm to 0.396 mm for the fractal dimension using the tile counting method. The sizes were closely related to the morphometric parameters. CONCLUSION: The fractal dimension of mandibular trabecular bone, as calculated with the tile counting method, can be best characterized with a range of tile sizes from 0.132 to 0.396 mm.
Bicuspid ; Fractals ; Humans ; Incisor ; Mandible ; Molar ; Trabecular Meshwork

Thyrotoxicosis factitia, a syndrome that results from a surreptitious ingestion of excess thyroid hormone, has generally been diagnosed in young or middle-aged women who have psychopathological disturbances. An 18-year-old female was admitted to the hospital 24 hours after taking an overdose of more than 50 tablets of synthyroid (levothyroxine, 5mg). She had taken 6 to 9 tablets of synthyroid daily for 6 months for the purpose of weight reduction even though she was not overweight. Because of her stuporous mental state and an acute respiratory failure, she was intubated and treated in the intensive care unit. After careful history taking and after her plasma thyroid hormone levels were determined, we diagnosed a thyroid storm that was caused by a thyrotoxicosis factitia. The laboratory results were, T3 430.0 ng/dL, free T4 70.0 ng/dL, TSH 0.05 IU/mL. Her symptoms improved after treatment by steroids and propranolol. She was discharged 8days after admission. Cases of thyrotoxicosis factitia have been reported very infrequently and, there has been no reports of a thyroid storm due to thyrotoxicosis factitia in Korea. We now report a case of a thyroid storm that resulted from thyrotoxicosis factitia that was caused by the ingestion of a massive dose of thyroid hormone that was takan daily for 6 months. We also present a brief review of the relevant literature.
Adolescent ; Eating ; Female ; Humans ; Intensive Care Units ; Korea ; Overweight ; Plasma ; Propranolol ; Respiratory Insufficiency ; Steroids ; Stupor ; Tablets ; Thyroid Crisis* ; Thyroid Gland* ; Thyrotoxicosis* ; Weight Loss

BACKGROUND: The spectrum of clinical presentations of extrapulmonary tuberculosis (EPT) is so diverse that it may mimic other systemic diseases and often leads physicians to misdiagnosis. Since its diagnosis is largely depended on physician's suspicion of the disease, it would be worthwhile to scrutinize the clinical characteristics of EPT. We retrospectively evaluated clinical manifestations of 312 patients who were diagnosed as EPT in a tertiary referral hospital. METHODS: The medical records of 312 patients, diagnosed as having EPT at Youngdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively. RESULTS: Total 312 patients, 149 (47.8%) men and 163 (52.2%) women with age ranged from 13 years to 87 years, were included in this study. The most common site of the involvement was pleura (35.6%). Patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain on infected site (48.1%). Leukocytosis, anemia, and elevated ESR and CRP were found in 12.8%, 50.3%, 79.3%, and 63.1% of the patients, respectively. Twenty-four percent of patients had underlying medical illnesses such as old age over 60 years, diabetes mellitus or liver cirrhosis. In 67.3% of patients, tuberculosis was suspected at initial visit. However, tuberculosis was microbiologically proven in only 23.7% of patients. Histopathological diagnosis of EPT was made in 48.7% of patients. The time interval from symptom onset to diagnosis varied, and mean duration was 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs. CONCLUSION: Although EPT had a wide spectrum of clinical manifestations and its diagnostic methods were lack, high index of suspicion could be obtained from chest radiograph, localized or systemic symptoms, and several laboratory parameters reviewed in this descriptive study. In case of doubt, early treatment instead of awaiting microbiological result may be necessary to avoid the devastating complications.
Anemia ; Diabetes Mellitus ; Diagnosis* ; Diagnostic Errors ; Female ; Humans ; Leukocytosis ; Liver Cirrhosis ; Male ; Medical Records ; Pleura ; Radiography, Thoracic ; Retrospective Studies ; Tertiary Care Centers ; Tuberculosis

Adrenal gland is a common site of metastatic tumors such as breast cancer, lung cancer, and colon cancer. When adrenal mass is found incidentally, adenoma is the most common among single adrenal masses. But in the case of bilateral adrenal masses, infection, bilateral metastases and hemorrhage are common. Secondary involvement of the adrenal gland is found in 25% of autopsy cases of non-Hodgkin's lymphoma. However, adrenal insufficiency is rare because it becomes apparent only when approximately 90% of adrenal cortex is destructed. We exprienced two cases of malignant lymphoma which involved the adrenal glands bilaterally. One case in which adrenal insufficiency was suspicious, was accompanied by hypovolemic shock and sepsis at the initial presentation. He died of sepsis combined with DIC even though hydrocortisone, intravenous saline infusion, and antibiotics therapy were started immediately. The other one was found incidentally, in which adrenal infiltraion was confirmed by CT scan. Hormonal level was normal and adrenal masses disappeared after chemotherapy.
Adenoma ; Adrenal Cortex ; Adrenal Glands* ; Adrenal Insufficiency ; Anti-Bacterial Agents ; Autopsy ; Breast Neoplasms ; Colonic Neoplasms ; Dacarbazine ; Drug Therapy ; Hemorrhage ; Hydrocortisone ; Lung Neoplasms ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Neoplasm Metastasis ; Sepsis ; Shock ; Tomography, X-Ray Computed

BACKGROUND: For the antibody screening test, the classical LISS tube indirect antiglobulin test has been replaced by the microtube column agglutination system in Korea. This system was first created in 1990 by Lapierre and it is distributed through DiaMed (DiaMed Ag, Cresssier, Morat, Switzerland) around the world. Similar systems, such as Ortho BioVue, have been developed and competed after that. We evaluated a newly developed microtube column agglutination system, DG Gel (Diagnostic Grifols, Barcelona, Spain), and we compare it with the other established systems. METHODS: In a comparative study, a total of 126 samples, including 76 antibody screening positive samples and 50 negative samples, were tested in parallel by the LISS/Coombs card (DiaMed Ag, Cresssier, Morat, Switzerland) and the DG Gel microtube column agglutination system. The positive samples that were proved by the LISS/Coombs card and the DG Gel system were identified by the ID-Dia panel (DiaMed Ag, Cresssier, Morat, Switzerland) and Identisera Diana (Diagnostic Grifols, Barcelona, Spain). Discrepant samples were rechecked with I, II and III cells that were supplied by the panel of the Korea Red Cross Blood Center. RESULTS: Among the 126 samples, the DG Gel antibody screening system showed 98.7% (75/76) sensitivity and 100% (50/50) specificity. We obtained concordant results in 75 samples (98.7%) and discrepant results in one sample (1.32%) between the DG Gel and DiaMed-ID for antibody identification. CONCLUSION: Both the microtube column agglutination systems work well and showed high estimated sensitivity and specificity with high concordance. Therefore, the DG gel microtube column agglutination system can be used with good results.
Agglutination* ; Coombs Test ; Korea ; Mass Screening* ; Red Cross ; Sensitivity and Specificity

PURPOSE: The purpose of this study was to develop a stent-based image guided surgery system and to apply it to oral and maxillofacial surgeries for anatomically complex sites. MATERIALS AND METHODS: We devised a patient-specific stent for patient-to-image registration and navigation. Threedimensional positions of the reference probe and the tool probe were tracked by an optical camera system and the relative position of the handpiece drill tip to the reference probe was monitored continuously on the monitor of a PC. Using 8 landmarks for measuring accuracy, the spatial discrepancy between CT image coordinate and physical coordinate was calculated for testing the normality. RESULTS: The accuracy over 8 anatomical landmarks showed an overall mean of 0.56+/-0.16 mm. The developed system was applied to a surgery for a vertical alveolar bone augmentation in right mandibular posterior area and possible interior alveolar nerve injury case of an impacted third molar. The developed system provided continuous monitoring of invisible anatomical structures during operation and 3D information for operation sites. The clinical challenge showed sufficient accuracy and availability of anatomically complex operation sites. CONCLUSION: The developed system showed sufficient accuracy and availability in oral and maxillofacial surgeries for anatomically complex sites.
Mandrillus ; Molar, Third ; Organothiophosphorus Compounds ; Stents ; Surgery, Computer-Assisted ; Surgery, Oral ; Track and Field

PURPOSE: To evaluate the survival rate, local failure rate and patterns of failure, and analyze the prognostic factors affecting local relapse of ductal carcinoma in situ treated with breast conserving surgery and radiotherapy Materials and Methods: From June 1995 to December 2001, 96 patients with ductal carcinoma in situ treated with breast conserving surgery and radiotherapy were retrospectively analyzed. The operations were either local or wide excision in all patients, with an axillary lymph node dissection performed in some patients. Radiation dose to the whole breast was 50.4 Gy, over 5 weeks, with 1.8 Gy daily fractions, with additional doses (10~14 Gy) administered to the primary tumor bed in some patients with close (< or =2 mm) or positive resection margin. The median follow-up period was 43 months (range 12~102 months). RESULTS: The 5-year local relapse free survival and overall survival rates were 91 and 100% respectively. Local relapse occurred in 6 patients (6.3%). Of the 6 recurrences, one was invasive ductal cell carcinoma. With the exception of one, all patients recurred 2 years after surgery. There was no regional recurrence or distant metastasis. Five patients with local recurrence were salvaged with total mastectomy, and are alive with no evidence of disease. One patient with recurrent invasive ductal cell carcinoma will receive salvage treatment. On analysis of the prognostic factors affecting local relapse, none of the factors among the age, status of resection margin, comedo type and nuclear grade affected local relapse. Operation extent also did not affect local control (p=0.30). In the patients with close resection margin, boost irradiation to the primary tumor bed did not affect local control (p=1.0). CONCLUSIONS: The survival rate and local control of the patients with ductal carcinoma in situ treated with breast conserving surgery and radiotherapy were excellent. Close resection margin and boost irradiation to the primary tumor bed did not affect local relapse, but further follow-up with much more patients is needed.
Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Mastectomy, Segmental* ; Mastectomy, Simple ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome*