PURPOSE: To find out the role of postoperative adjuvant radiotherapy in the treatment of rectal cancer by comparing survival, pelvic control, complication rate, and any prognostic factor between surgery alone and postoperative radiotherapy group. MATERIALS AND METHODS: From Feb. 1982 to Dec. 1996 total 212 patients were treated by radical surgery with or without postoperative radiotherapy due to rectal carcinoma of modified Astler-Coller stage B2-C3. Of them, 18 patients had incomplete radiotherapy and so the remaining 194 patients were the database analyzed in this study. One hundred four patients received postoperative radiotherapy and the other 90 patients had surgery only. Radiotherapy was performed in the range of 39.6-55.8 Gy (mean: 49.9 Gy) to the whole pelvis and if necessary, tumor bed was boosted by 5.4-10 Gy. Both survival and pelvic control rates were calculated by Kaplan-Meier method and their statistical significance was tested by Log-rank test. Multivariate analysis was performed by Cox proportional hazards model. RESULTS: 5-year actuarial survival rate (5YSR) and 5-year disease-free survival rate (5YDFSR) of entire patients were 53% and 49%, respectively. 5YSRs of surgery alone group and adjuvant radiotherapy group were 63% vs 45%, respectively ( p=0.03). This difference is thought to reflect uneven distribution of stages between two treatment groups ( p<0.05 by x2-test) with more advanced disease patients in adjuvant radiotherapy group. 5YSRs of surgery alone vs adjuvant radiotherapy group in MAC B2+3, C1, C2+3 were 68% vs 55% ( p=0.09), 100% vs 100%, 40% vs 33% ( p=0.71), respectively. 5YDFSRs of surgery alone vs adjuvant radiotherapy group in above three stages were 65% vs 49% ( p=0.14), 100% vs 100%, 33% vs 31% ( p=0.46), respectively. 5-year pelvic control rate (5YPCR) of entire patients was 72.5%. 5YPCRs of surgery alone and adjuvant radiotherapy group were 71% vs 74%, respectively (p=0.41). 5YPCRs of surgery alone vs adjuvant radiotherapy group in B2+3, C1, C2+3 were 79% vs 75% ( p= 0.88), 100% vs 100%, 44% vs 68% ( p=0.01), respectively. Multivariate analysis showed that only stage was significant factor affecting overall and disease-free survival in entire patients and also in both treatment groups. In view of pelvic control, stage and operation type were significant in entire patients and only stage in surgery alone group but in adjuvant radiotherapy group, operation type instead of stage was the only significant factor in multivariate analysis as a negative prognostic factor in abdominoperineal resection cases. CONCLUSION: Our retrospective study showed that postoperative adjuvant radiotherapy could improve the pelvic control in MAC C2+3 group. To improve both pelvic control and survival in all patients with MAC B2 or more, other treatment modality such as concurrent continuous infusion of 5-FU, which is the most standard agent, along with radiotherapy should be considered.
Disease-Free Survival ; Fluorouracil ; Humans ; Multivariate Analysis ; Pelvis ; Proportional Hazards Models ; Radiotherapy ; Radiotherapy, Adjuvant* ; Rectal Neoplasms* ; Retrospective Studies ; Survival Rate

No abstract available.

PURPOSE: We performed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. METHODS AND MATERIALS: One hundred and six patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (9 4%) and ranged from 1 month to 92 months (median; 6 months). RESULTS: The median age was 62 years old and male to female ratio was 104:2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was performed in 83%. Mean tumor dose delivered with curative aim was 58.6 Gy (55-70.8 Gy) and median duration o f the radiation therapy was 53 days. The median survival of all patients was 6 months and 1-year and 2-year overall survival rte was 27% and 12%, respectively. Improvement of dysphagia was obtained in most patients except fo 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32% (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30% respectively, while those of the nonresponder was 4 months and 0% respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 rnonths and 16% while those of the patients who could not tolerate regular diet was 3 months and 0%, respectively (p=0.004). The survival difference between the patients with 5 cm or less turnor length and those with more than 5 cm tumor length was rnarginally statistically significant (p=0.06). However, the survival difference according to the periesophageal invasion or mediastinal lymphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9%). CONCLUSION: The survival outcome for advanced esophageal cancer patients treated by external be am radiotherapy alone was very poor, In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.
Brachytherapy ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Diet ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Female ; Follow-Up Studies ; Gastrostomy ; Humans ; Lymphatic Diseases ; Male ; Middle Aged ; Multivariate Analysis ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Thorax ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND: The end-tidal carbon dioxide (ETCO2) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. And it has been found to correlate with cardiac output during cardiopulmonary resuscitation (CPR) in animal model. The purpose of this study is to determine that the assessment of ETCO2 could provide a highly sensitive predictor of return of spontaneous circulation (ROSC) during CPR. METHODS: Prospective, observational study was performed from Oct 1996 to Mar 1997 at the Severance hospital. All patients were endotracheally intubated and connected immediately to mainstream capnography sensor. We measured ETCO2 with Escort II model 20100 monitor(Medical Data Electronics, Inc, USA). It works on the principle of nondispersed infrared absorption with radiometric single beam optics. RESULTS: This study included 70 patients (52 were men) with a mean age of 54+/-15 years. ROSC was obtained in 43 patients. The initial ETCO2 averaged 15.5 +/-8.2 mmHg in survivors and 6.5+/-5.3 mmHg in nonsurvivors (p<0.01), and during the first 20 minutes of CPR, the maximal ETCO2 averaged 29.7+/-10.3 mmHg in survivors and 10.2+/-8.9 mmHg in nonsurvivors (p<0.01). ETCO2 was not significantly different in relation to initial rhythm, survival time after ROSC and possible cause of arrest. There is no cutoff value of ETCO2 satisfying greater than 90% of both sensitivity and specificity in predict ROSC. When maximal ETCO2 was less than 12 mmHg, we observed sensivity of 100% in predicting ROSC. CONCLUSION: Our results demonstrate that ETCO2 measurement represents a valuable, noninvasive, and clinical tool for monitoring patients during CPR.
Absorption ; Capnography ; Carbon Dioxide* ; Carbon* ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Humans ; Models, Animal ; Observational Study ; Partial Pressure ; Prospective Studies ; Sensitivity and Specificity ; Survivors

The anterior cruciate ligament(ACL) is one of the most important structure for maintenance of the sta- bility of the knee joint. Chronic instability as a result of insufficiency can lead to functional disability, pain, meniscal tears, and degenerative change in articular cartilage. The incidence of injuries of this liga- ment is increasing tendency due to development of vehicle system, industrial system and sports activities. Different authors have recommended both operative and nonoperative treatment for anterior cruciate ligament injuries. Variable methods for functional recovery of anterior cruciate ligament were introduced and argued about ideal method. As arthroscopic techniques improve, surgeons are more inclined to rec- ommend surgical treatment. The methods of repair of acute rupture of the anterior cruciate ligament through the arthrotomy tech- nique have been used widely, but the arthroscopic repair is a relatively new technique. This arthroscopic technique is idealy applicable for rupture at femoral and tibial attachment site. A arthroscopic repair of anterior cruciate ligament was performed with use of the arthroscopy, in 15 consecutive, selected anterior cruciate ligaments that were ruptured at femoral or tibial attachment site, and within 2 weeks after injury. The 15 patients were followed for a minimum of one year(mean, eighteen months; maximum, thirty-eight months). The mean age of the 15 patients at the operation was thirty years(range, seventeen to forty-eight years). The results of arthroscopic repair of anterior cruciate ligament in 15 cases were satisfactory, and as fol- lows. l. All of the 15 cases, the laxity of repaired anterior cruciate ligaments were decreased. 2. The average Lysholm Knee Score Scale was increased from 16 points preoperatively to 89 points postoperatively. Five of the patients(33%) were rated as excellent, and ten patients(67%) were rated as good. 3. The range of motion of the repaired knee joints were from Oo to 135o that results were achieved at postoperative 6 months.
Anterior Cruciate Ligament* ; Arthroscopy ; Cartilage, Articular ; Humans ; Incidence ; Knee ; Knee Joint ; Range of Motion, Articular ; Rupture* ; Sports

A woman who had a spontaneous subarachnoid hemorrhage (SAH) and temporal intracerebral hemorrhge (ICH) without any causative lesions on computed tomography (CT) and digital angiography at the day of the stroke. She was considered to have an angiographically negative SAH and scheduled for a repeated angiography. While she was waiting for the next study, she developed a second hemorrhage. CT angiography showed an aneurysmal shadow in the course of the posterior cerebral artery. After the operation, the aneurysm proved to be a pseudoaneurysm.
Aneurysm ; Aneurysm, False* ; Angiography ; Female ; Hemorrhage ; Humans ; Posterior Cerebral Artery ; Stroke ; Subarachnoid Hemorrhage

In infected uncemented hip arthroplasty, 4 cases which showed well-fixed femoral stem were managed by staged procedure. Thorough debridement, removal of acetabular socket and insertion of antibiotics impregnated cement spacer was done without removal of femoral stem. No recurrence of infection or loosening was developed after staged procedure and revisoin was performed after infection evidence disappeared. The interval between the two procedures was 4 months (3-6) on average. In Weber's criteria, all 4 cases were graded as having definitive cure of infection on both clinical and radiological criteria (Grade I) .
Acetabulum ; Anti-Bacterial Agents ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Debridement ; Hip ; Recurrence

Capillary hemangiomas are common soft tissue tumors on the skin or mucosa of the head and neck in the early childhood, but very rare in the neuraxis. A 47-year-old man presented with one month history of back pain on the lower thoracic area, radiating pain to both legs, and hypesthesia below T7 dermatome. Thoracic spine MRI showed 1x1.3x1.5 cm, well-defined intradural mass at T6-7 disc space level, which showed isointensity to spinal cord on T1, heterogeneous isointensity on T2-weighted images, and homogeneous strong enhancement. The patient underwent T6-7 total laminotomy, complete tumor removal and laminoplasty. Histologically, the mass showed a capsulated nodular lesion composed of capillary-sized vascular channels, which were tightly packed into nodules separated by fibrous septa. These features were consistent with capillary hemangioma.
Back Pain ; Capillaries ; Head ; Hemangioma, Capillary ; Humans ; Hypesthesia ; Laminectomy ; Leg ; Middle Aged ; Mucous Membrane ; Neck ; Skin ; Spinal Cord ; Spine

OBJECTIVE: Cerebral vasospasm is a common and potentially devastating complication of aneurysmal subarachnoid hemorrhage (aSAH). Inflammatory processes seem to play a major role in the pathogenesis of vasospasm. C-reactive protein (CRP) constitutes a highly sensitive inflammatory marker. Elevation of serum CRP levels has been demonstrated in patients with aSAH. The purpose of the current study was to evaluate the possible relationship between CRP levels in the serum and transcranial Doppler (TCD) and the development of vasospasm in patients with aSAH. METHODS: A total of 61 adult patients in whom aSAH was diagnosed were included in the study from November 2008 to May 2011. The patients' demographics, Hunt and Hess grade, Fisher grade, CT scans, digital subtraction angiography studies, and daily neurological examinations were recorded. Serial serum CRP measurements were obtained on days 1, 3, 5, 7, 9, 11 and 13 and TCD was measured on days 3, 5, 7, 9, 11 and 13. All patients underwent either surgical or endovascular treatment within 24 hours of their hemorrhagic attacks. RESULTS: Serum CRP levels peaked on the 3rd postoperative day. There were significant differences between the vasospasm group and the non-vasospasm group on the 1st, 3rd and 5th day. There were significant differences between the vasospasm group and the non-vasospasm group on the 3rd day in the mean middle cerebral artery velocities on TCD. CONCLUSION: Patients with high levels of CRP on the 1st postoperative day and high velocity of mean TCD on the 3rd postoperative day may require closer observation to monitor for the development of vasospasm.
Adult ; Aneurysm* ; Angiography, Digital Subtraction ; C-Reactive Protein* ; Demography ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neurologic Examination ; Organothiophosphorus Compounds ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial*

A 62-year-old woman, who presented with dipolipia, was found to have a giant aneurysm of the right internal carotid artery. Gradual ligation of the right internal carotid artery was followed by nausea and vomiting 10 days after the complete ligation. Follow up MRI showed intraluminal thrombus formation of the aneurysm and right temporo-occipital infarction.
Aneurysm ; Carotid Artery, Internal* ; Cerebral Arteries* ; Cerebral Infarction ; Female ; Follow-Up Studies ; Humans ; Infarction* ; Ligation* ; Magnetic Resonance Imaging ; Middle Aged ; Nausea ; Thrombosis ; Vomiting