PURPOSE: This study was undertaken to evaluate the treatment outcome and side effects of accelerated radiotherapy (RT) using concomitant boost for stage III non-small cell lung cancer (NSCLC). METHODS: Between April 1991 and December 1994, 102 patients with stage III NSCLC who had the favorable prognostic factors by CALGB criteria, were treated with concomitant boost radiotherapy. Patients were treated with standard large fields to 54 Gy in 6 weeks. The boost treatment was administered concomitantly during the last 2 weeks with a dose of 13 Gy in 10 fractions. The interfraction interval was at least 6 hours. The total tumor dose was 66-70 Gy, given over 6 weeks. RESULTS: With 30 months median follow-up period for survivors, median survival was 15 months with 2 and 3-year overall survival rates of 34% and 19%, respectively. Thirty patients (29%) who had achieved complete remission after RT showed significantly better 2-year survival rates than those without complete remission (58% vs 22%, p 0.001). Local failure and distant metastases as the first or only failure occurred in 40 (44%) and 13 (14%), respectively, and ultimate local and distant failure rates were 45% and 29%, respectively. Although Grade IV esophageal complication of T-E fistula was observed in one patient, most patients with pulmonary complication showed mild, transient radiation pneumonitis. CONCLUSION: This result suggests that the treatrnent of stage III NSCLC with concomitant boost RT may improve survival rates without enhanced radiation induced toxicity compared with conventional RT. Further investigation of dose escalation by conformal radiotherapy of combining chemotherapy and accelerated RT is warranted.
Carcinoma, Non-Small-Cell Lung ; Drug Therapy ; Fistula ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Radiation Pneumonitis ; Radiotherapy* ; Radiotherapy, Conformal ; Small Cell Lung Carcinoma* ; Survival Rate ; Survivors ; Treatment Outcome

PURPOSE: Because of the complexity and un-expectation of the courses and clinical features for the complex anal fistula, the management of it presents a difficult surgical challenge. Various techniques have been used, such as seton placement, advancement flap closure, muscle filling procedure, and fibrin glue injection. The classic lay-open and seton placement may distort the anal anatomy and result in poor functional outcomes, such as incontinence. Also, advancement flap techniques are associated with relatively high recurrence rates. This study assesses the results of surgery for a complex anal fistula, as performed in Hangun Hospital, Busan. Operative procedures were comprised of two or more separate procedures, including 1) a total fistulectomy, 2) muscle reconstruction, sometimes muscle transposition, 3) direct closure of the primary opening without making a mucosal advancement flap, and 4) a drainage procedure and/or other minor procedure. METHODS: Surgical procedures were performed on 22 patients (18 males) with a complex anal fistula between July 2004 and December 2004. The clinical and the manometric results were analyzed with respect to postoperative recurrence, delayed wound healing, and postoperative fecal incontinence. RESULTS: Nineteen of the 22 patients were completely healed without any sequelae. Treatment failure was encountered in one patient two months postoperatively, when an additional fistulotomy was performed to achieve a cure. There were two patients displaying delayed healing, who were successfully treated by curettage. No patient complained of postoperative fecal incontinence in either the clinical examination on the manometric study (mean resting pressure, 75.5+/-3.5 mmHg; maximal squeeze pressure, 175.7+/-10.3 mmHg). CONCLUSIONS: This short- term study suggests that a direct closure of the internal opening after a total fistulectomy can be an alternative surgical option for the treatment of a complex anal fistula.
Curettage ; Drainage ; Fecal Incontinence ; Fibrin Tissue Adhesive ; Humans ; Muscles ; Rectal Fistula ; Recurrence ; Surgical Procedures, Operative ; Treatment Failure ; Wound Healing

The decision of surgical treatment for pancreatic cystic lesions may mainly depend on the malignant potential of each lesion. Surgical excision is the most optimal treatment for the mucinous cystic neoplasm due to its high malignant potential. On the other hand, intraductal papillary mucinous neoplasm (IPMN) is divided into main duct type and branch-duct type. Main duct IPMN has high risk of malignant transformation. Therefore, surgical resection has been recommended for all main duct IPMN. Branch duct IPMN has relatively low malignant potential, and usually shows slow progression. A branch duct IPMN that is asymptomatic, less than 3 cm in size and without mural nodules may be followed-up without resection. Serous cystic neoplasm is usually benign in nature. Surgical treatment for serous cystic neoplasm should be considered when definitive diagnosis being uncertain, larger than 4 cm in size, or presence of symptoms. Solid pseudopapillary neoplasm also has low malignant potential which needs surgical excision. Surgical treatment for pancreatic pseudocyst is considered in limited cases with complication, such as infection or bleeding, and which is not controlled with non-surgical treatment. Management strategy for pancreatic cystic lesions should be individualized, and the decision to resect or follow-up a lesion should be based on factors such as the presence or absence of symptoms, patient age, cyst size, grading of malignant potential, location of the lesion, and the surgical risk of the patient.
Follow-Up Studies ; Hand ; Hemorrhage ; Humans ; Mucins ; Pancreas ; Pancreatic Cyst ; Pancreatic Pseudocyst

OBJECTIVE: The aim was to establish an optimal cut-off score of the Children's Depression Inventory (CDI) for detecting depression and rating severity in Korean adolescents. METHODS: A total of 468 students aged 12-16 years from 8 middle schools in Busan, Korea participated in this study. The Korean version of the CDI and Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version were used to evaluate depressive symptoms. Receiver-operating characteristics (ROC) analyses were conducted to evaluate case-finding performance and set the cut-off scores. RESULTS: ROC analyses demonstrated that the overall discrimination power of the CDI is good enough to evaluate adolescent depression. The CDI sum score of 20 was identified as the optimal screening cut-off score, where sensitivity was 0.83 and specificity was 0.89. This cut-off score could apply regardless of subjects' gender. The cut-off scores were examined in order of the depression severity: 15 for mild, 20 for moderate, and 25 for severe depression with high sensitivity and specificity. CONCLUSION: The CDI cut-off scores of our study can be recommended for screening depressed youth and rating the severity of depressive symptoms. The high negative predictive value suggested that the cut-off score of 20 would result in a small number of missed cases. Further studies are needed to ascertain these CDI cut-off scores for different age groups.
Adolescent* ; Appointments and Schedules ; Busan ; Depression* ; Discrimination (Psychology) ; Humans ; Korea ; Mass Screening* ; Mood Disorders ; ROC Curve ; Schizophrenia ; Sensitivity and Specificity

BACKGROUND: It is important that patients with human immunodeficiency virus (HIV) remain under medical care to improve their health and to reduce the potential for HIV transmission. We explored factors associated with missed visits for HIV medical care according to age group. METHODS: Data were derived from a city-wide, cross-sectional survey of 812 HIV-infected adults in Seoul. Multiple logistic analyses were used to explore predictors of missed visits. RESULTS: Of the 775 subjects, 99.3% were treated with antiretroviral therapy (ART) and 12.5% had missed a scheduled appointment for HIV medical care during the past 12 months. Compared with the group aged ≥ 50 years, the 20–34-years and 35–49-years groups were strongly associated with missed visits (adjusted odds ratio [aOR], 5.0 and 2.2, respectively). When divided by age group, lower education level (aOR, 3.0) in subjects aged 20–34 years, low income (aOR, 3.5), National Medical Aid beneficiary (aOR, 0.3), and treatment interruption due to side effects of ART (aOR, 3.4) in subjects aged 35–49 years, and National Medical Aid beneficiary (aOR, 7.1) in subjects aged ≥ 50 years were associated with missed visits. CONCLUSION: In conclusion, younger age was a strong predictor of missed visits for HIV medical care. However, the risk factors differed according to age group, and the strongest predictor in each age group was related to socioeconomic status.
Acquired Immunodeficiency Syndrome ; Adult* ; Cross-Sectional Studies ; Education ; HIV ; Humans* ; Korea* ; Odds Ratio ; Risk Factors ; Seoul* ; Social Class

BACKGROUND: In July 2017, there was an outbreak of Campylobacter jejuni infection in three auxiliary police squads in Seoul, Korea. An epidemiological investigation was conducted to identify the cause and source of the illness. MATERIALS AND METHODS: A retrospective cohort study of all members of the three auxiliary police squads was conducted. Self-administered questionnaires were distributed to all members of the three squads and the food handlers. Rectal swabs were collected from symptomatic police and food handlers. RESULTS: The overall attack rate was 20.4%, and the epidemic curve indicated a point source type outbreak. Of the 257 auxiliary policemen who consumed the incriminated lunch, 55 met the case definition. Of 36 rectal swabs, 10 were positive for C. jejuni and had the same pulsed-field gel electrophoresis pattern. The major symptoms were loose stool (100%) and abdominal pain (59.3%); the median incubation period was 69 hours. In the univariate epidemiological analysis, watermelon (relative risk [RR], 5.75; 95% confidence interval [CI], 2.14–15.43), half-cut chicken soup (RR, 3.96; 95% CI, 1.49–10.54), steamed rice with millet (RR, 2.73; 95% CI, 1.29–5.77), and radish kimchi (RR, 2.57; 95% CI, 1.45–4.55) were positively associated with the illness. Inspection of the food service facility found that the drainpipe under the meat cleaning sink did not work. CONCLUSION This outbreak could have been caused by cross-contamination with C. jejuni from raw chicken via environmental sources.

Keloids are fibrous overgrowth resulting from abnormal wound healing processes at the site of cutaneous injury. It extends beyond the confines of the original wound, begins later after injury, and does not regress with time contrary to hypertrophic scar. The gold standard has not been established in the treatment of keloids, yet. Excision of keloid alone showed a high rate of recurrence (45-100%). Recently, we have experienced two keloidal masses in the auricle (one on helix, the other on lobule), which were treated with surgery and adjuvant steroid injection. We developed an anteriorly-based skin flap from the skin covering of the keloidal mass and used it for several reasons. We also used triamcinolone injection after the surgery. In this paper, we are presenting the result of these cases with a review of literature.
Cicatrix, Hypertrophic ; Keloid* ; Recurrence ; Skin ; Triamcinolone ; Wound Healing ; Wounds and Injuries

Mumps virus infections usually involve the parotid glands. It usually spreads from a human reservoir by airborne droplet of infected saliva. Therefore, early proper diagnosis and isolation of patients can help to inhibit dissemination of the disease. Diagnosis of mumps virus infection is mainly dependent on clinical inspection, palpation of the parotid and laboratory tests, because most mumps virus infections involve the parotid gland. Isolated submandibular gland involvement in mumps is rare and presents diagnostic challenge. We report unusual consecutive cases of mumps virus infections in two patients who were brothers, for whom bilateral submandibular glands were found to be involved paring parotid glands. These cases instruct us not to exclude mumps virus infection even in isolated uni/bilateral submandibular gland swelling.
Diagnosis ; Humans ; Mumps virus ; Mumps* ; Palpation ; Parotid Gland ; Saliva ; Siblings ; Submandibular Gland*

Anomalous origin of left coronary artery from pulmonary artery(ALCAPA) is a rare fatal congenital anormaly that needs early surgical intervention. Many reports say that the choice of operative procedure is reimplantation of the left coronary artery into the ascending aorta. We experienced the surgical management of a case of the ALCAPA. The patient was 44 days old and 3.45 kg weighed female baby who had a symptom of congestive heart failure. She underwent implantation of coronary artery on the aorta with cardiopulmonary bypass and recovered without any complications.
Aorta ; Bland White Garland Syndrome ; Cardiopulmonary Bypass ; Coronary Vessels* ; Female ; Heart Failure ; Humans ; Pulmonary Artery* ; Replantation ; Surgical Procedures, Operative

BACKGROUND: The treatment of post-inflammatory hyperpigmentation (PIH) remains challenging. Tranexamic acid, a well-known anti-fibrinolytic drug, has recently demonstrated a curative effect towards melasma and ultraviolet-induced PIH in Asian countries. However, the precise mechanism of its inhibitory effect on melanogenesis is not fully understood. OBJECTIVE: In order to clarify the inhibitory effect of tranexamic acid on PIH, we investigated its effects on mouse melanocytes (i.e., melan-a cells) and human melanocytes. METHODS: Melan-a cells and human melanocytes were cultured with fractional CO2 laser-treated keratinocyte-conditioned media. Melanin content and tyrosinase activity were evaluated in cells treated with or without tranexamic acid. Protein levels of tyrosinase, tyrosinase-related protein (TRP)-1, and TRP-2 were evaluated in melan-a cells. Signaling pathway molecules involved in melanogenesis in melanoma cells were also investigated. RESULTS: Tranexamic acid-treated melanocytes exhibited reduced melanin content and tyrosinase activity. Tranexamic acid also decreased tyrosinase, TRP-1, and TRP-2 protein levels. This inhibitory effect on melanogenesis was considered to be involved in extracellular signal-regulated kinase signaling pathways and subsequently microphthalmia-associated transcription factor degradation. CONCLUSION: Tranexamic acid may be an attractive candidate for the treatment of PIH.
Animals ; Asian Continental Ancestry Group ; Humans ; Hyperpigmentation ; MART-1 Antigen ; Melanins ; Melanocytes ; Melanoma ; Melanosis ; Mice ; Microphthalmia-Associated Transcription Factor ; Monophenol Monooxygenase ; Phosphotransferases ; Tranexamic Acid*