Radiation therapy is an effective cancer treatment modality as a primary treatment in early cancer and as an adjuvant treatment in advanced cancer, especially in head and neck lesions, but it also causes irreversible chronic damages to overlying normal tissues that may lead to wound complications. As well, at the microscopic level, radiation injury causes both stasis and occlusion of small vessels. Therefore, surgical reconstruction of previously-irradiated lesions in the head and neck poses a great problem. Fifth-six patients with head and neck lesions underwent 57 microsurgical reconstructions between 1990-1998. Thirteen patients were irradiated before surgery. The previous radiation dose was 30-75.6 Gy. The free tissue transfer was successful in 52 of the 57 microsurgical reconstructions(91.2%). The success rate was 92.3%(12/13) in previously-irradiated patients and 90.9%(40/44) in nonirradiated patients. Postoperative complications, such as flap loss, fistula, and infection, developed in 4 irradiated patients and 8 nonirradiated patients. Overall complication rate was 30.8%(4/13) in previously-irradiated patients and 18.2%(8/44) in nonirradiated patients. Although the failure rate of previously-irradiated patients was higher than that of nonirradiated patients, there was no statistically significant difference between them. Thus, free tissue transfers in patients with previously-irradiated head and neck lesions are suitable for one-stage reconstruction.
Fistula ; Head* ; Humans ; Neck* ; Postoperative Complications ; Radiation Injuries ; Wounds and Injuries

The wound healing in adult mammals is a complex process that inevitably leaves scar. Various treatment modalities have been investigated to minimize the scar formation, and a few of them succeeded. Intra-lesional injection of steroids is one of the methods that have been widely accepted for the treatment of specific scars such as keloids or hypertrophic scars. On the other hand, there have been some attempts made to reduce the scar by enhancing the expression of matrix metalloproteinase(MMPs) because it results in degradation of collagens in scar tissues. Verapamil, a calcium channel blocker, was one of the few factors promoting the expression of MMPs such as collagenases by altering the shape of fibroblasts from a bipolar spindle type to a round one. No investigation, however, has been done to elucidate the effect of simultaneous intra- lesional injection of steroid and verapamil to wounds on early scar formation. To investigate the effect of scar reduction by injecting steroid and verapamil simultaneously, we examined morphologic finding of tissue and we measured width of scar followed by incision wounds treated with normal saline(Control group), steroid(Group A), verapamil(Group B) and both steroid and verapamil (Group C), respectively. The scar width significantly reduced in Group B and Group C 2 and 4 weeks after the incision and in Group A 8 weeks after incision, in comparison with control group. At that time the scar width in Group C significant reduced compared to those of other groups. Furthermore the collagen fibers were less, thicker and more regularly arranged in the scar tissue in group C 8 weeks after incision than those in the other groups and their structure was most close to the normal one of the dermis. The contour of fibroblasts in Group B and Group C looked rounder than that in Group A and control group. In conclusion, simultaneous intra-lesional injection of steroid and verapamil decreases collagen deposition into the wound and subsequently minimize scar width.
Adult ; Animals ; Calcium Channels ; Cicatrix* ; Cicatrix, Hypertrophic ; Collagen ; Collagenases ; Dermis ; Fibroblasts ; Hand ; Humans ; Keloid ; Mammals ; Matrix Metalloproteinases ; Rats* ; Steroids ; Verapamil* ; Wound Healing ; Wounds and Injuries*

OBJECTIVE: Detection of focal non-hemorrhagic lesion (NHL) has become more efficient in diffuse axonal injury (DAI) patients using an MRI. The aims of this study are to find out the radiological distribution, progress of NHL and its clinical significance. METHODS: Between September 2005 and October 2011, 32 individuals with NHLs on brain MRI were enrolled. NHLs were classified by brain location into 4 major districts and 13 detailed locations including cortical and subcortical, corpus callosum, deep nuclei and adjacent area, and brainstem. The severity of NHL was scored from grades 1 to 4, according to the number of districts involved. Fourteen patients with NHL were available for MRI follow-up and an investigation of the changes was conducted. RESULTS: Thirty-two patients had 59 NHLs. The most common district of NHL was cortical and subcortical area; 15 patients had 20 NHSs. However the most common specific location was the splenium of the corpus callosum; 14 patients had 14 lesions. The more lesions patients had, the lower the GCS, however, this was not a statistically meaningful difference. On follow-up MRI in 14 patients, out of 24 lesions, 13 NHLs resolved, 5 showed cystic change, and 6 showed atrophic changes. CONCLUSION: NHLs were located most commonly in the splenium and occur frequently in the thalamus and the mesial temporal lobe. Because most NHS occur concomitantly with hemorrhagic lesions, it was difficult to determine their effects on prognosis. Since most NHLs resolve completely, they are probably less significant to prognosis than hemorrhagic lesions.
Brain ; Brain Injuries ; Brain Stem ; Corpus Callosum ; Diffuse Axonal Injury ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Temporal Lobe ; Thalamus

Symptoms of deep cerebral vein thrombosis (DCVT) are variable and nonspecific. Radiologic findings are essential for the diagnoses. In the majority of cases of deep internal cerebral venous thrombosis, the thalamus is affected bilaterally, and venous hypertension by thrombosis causes parenchymal edema or venous infarction and may sometimes cause venous hemorrhage. Intravenous injections of mannitol can be administered or decompressive craniectomy can be performed for reduction of intracranial pressure. The objectives of antithrombotic treatment in DCVT include recanalization of the sinus or vein, and prevention of propagation of the thrombus. Herein, the authors report DCVT which was successfully treated by low molecular weight heparin.
Brain Edema ; Cerebral Infarction ; Cerebral Veins ; Decompressive Craniectomy ; Edema ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Hypertension ; Infarction ; Injections, Intravenous ; Intracranial Pressure ; Intracranial Thrombosis ; Mannitol ; Thalamus ; Thrombosis ; Veins ; Venous Thrombosis

PURPOSE: Suppression of the relatively high signal intensity of fat leads to more efficient use of thedynamic range for display of tissue contrast. In order to evaluate meniscal tears, we compared a fat-suppressedturbo spin-echo(FSTSE) sequence with turbo SE(TSE). MATERIALS AND METHODS: One hundred and seven knees in 103consecutive patients referred for MR study of the knee were imaged using both FSTSE and TSE sequence. The turbo SEsequence provided proton density-weighted and T2-weighted images (dual echo technique) with an effectiveecho-train length of five. For fat-suppression, a frequency-selective chemical presaturation pulse was applied.Forty-two knees (84 menisci) were studied arthroscopically and the findings were taken as the reference standard.FSTSE and TSE images were reviewed retrospectively by two radiologists. Next, for each patient, the quality ofFSTSE and TSE images was compared;the former were scored by each reviewer as either superior to, equal to, orinferior to TSE images. RESULTS: Among the 214 menisci evaluated, the results of FSTSE and TSE imaging were verysimilar (kappa index 0.87). Twenty four tears were found during arthroscopy in 84 menisci. FSTSE imaging was moresensitive than TSE (96% versus 83%), though specificity was equal(98%). Among the 107 cases, FSTSE images wererated by both observers as superior to TSE images for overall quality and visualization of the meniscus itself.CONCLUSION: For the evaluation of meniscal tears, FSTSE sequences were more sensitive than those obtained withTSE, and their image quality was superior. For the study of meniscus tears among a large population, FSTSE istherefore more useful than TSE.
Arthroscopy ; Humans ; Knee ; Magnetic Resonance Imaging* ; Protons ; Retrospective Studies ; Sensitivity and Specificity

The aim of the present study is to examine the brainstem sites where the electrical stimulation produces a suppression of dorsal horn neuron responses of neuropathic rats. An experimental neuropathy was induced by a unilateral ligation of L5-L6 spinal nerves of rats. Ten to 15 days after surgery, the spinal cord was exposed and single-unit recording was made on wide dynamic range (WDR) neurons in the dorsal horn. Neuronal responses to mechanical stimuli applied to somatic receptive fields were examined to see if they were modulated by electrical stimulation of various brainstem sites. Electrical stimulation of periaqueductal gray (PAG), n. raphe magnus (RMg) or n. reticularis gigantocellularis (Gi) significantly suppressed responses of WDR neurons to both noxious and non-noxious stimuli. Electrical stimulation of other brainstem areas, such as locus coeruleus. (LC) and n. reticularis paragigantocellularis lateralis (LPGi), produced little or no suppression. Microinjection of morphine into PAG, RMg, or Gi also produced a suppression as similar pattern to the case of electrical stimulation, whereas morphine injection into LC or LPGi exerted no effects. The results suggest that PAG, NRM and Gi are the principle brainstem nuclei involved in the descending inhibitory systems responsible for the control of neuropathic pain. These systems are likely activated by endogenous opioids and exert their inhibitory effect by acting on WDR neurons in the spinal cord.
Analgesics, Opioid ; Animals ; Brain Stem* ; Electric Stimulation* ; Horns ; Ligation ; Locus Coeruleus ; Microinjections ; Models, Animal* ; Morphine ; Neuralgia* ; Neurons ; Periaqueductal Gray ; Posterior Horn Cells* ; Rats* ; Spinal Cord ; Spinal Nerves

Ruptured dissecting aneurysm of the vertebral artery requires a rapid treatment because of the high rate of fatal early rebleeding. Stent-assisted coil embolization has been introduced as an effective procedure for both aneurysmal occlusion and parent artery preservation. We report a case of successful urgent treatment of ruptured dissecting aneurysm using a self-expandable, intracranial stent (Neuroform(R)) and a coated coil (HydroCoil(R)).
Aneurysm ; Aneurysm, Dissecting* ; Arteries ; Embolization, Therapeutic ; Humans ; Parents ; Stents* ; Vertebral Artery*

Pancreatic neuroendocrine tumors (pNETs) are rare neoplasms, which most commonly metastasize to the liver. However, intrathoracic metastases from pNETs are encountered infrequently. This report describes a case of nonfunctioning pNET with multiple cardiac metastases. A 56-year-old male presented with a palpable abdominal mass that showed progressive enlargement. Findings on computed tomography (CT) of the abdomen revealed two relatively well-marginated inhomogeneous low-attenuation masses, one in the head of the pancreas and the other in the tail. Multiple enhancing masses in the left pericardium with myocardial involvement were observed on chest CT and transthoracic echocardiography. Needle biopsies were performed on the mass in the tail of the pancreas and the left ventricular apical pericardium; histologic examination by hematoxylin and eosin morphology and immunohistochemical staining showed pNET in both. This is the first report of pNET with multiple cardiac metastases to previously undescribed metastatic sites.
Abdomen ; Biopsy, Needle ; Echocardiography ; Eosine Yellowish-(YS) ; Head ; Heart Neoplasms ; Hematoxylin ; Humans ; Liver ; Male ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors ; Pancreas ; Pericardium ; Thorax

An animal model of spinal cord trauma is essential for understanding the injury mechanisms, cord regeneration, and to aid the development of new therapeutic modalities. This study focused on the development of a graded experimental contusion model for spinal cord injury (SCI) using a pneumatic impact device made in Korea. A contusive injury was made to the dorsal aspect of the cord. Three trauma groups were defined according to the impact velocity (IV). A control group (n=6), received laminectomy only. Group 1 (n=10), 2 (n=10), and 3 (n=10) had IVs of 1.5 m/sec, 2.0 m/sec, and 3.5 m/sec respectively. Functional assessments were made up to the 14th day after injury. The cord was removed at the 14th post-injury day and prepared for histopathologic examination. Significant behavioral and histopathological abnormalities were found in control and each trauma group. All trauma groups showed severe functional impairment immediately after injury but following different rates of functional recovery (Fig. 5). As the impact velocity and impulse increased, the depth of contusive lesion revealed to be profound the results show that the rat model reproduces spinal cord lesions consistently, has a distinctive value in assessing the effects of impact energy.
Animals ; Behavior, Animal/physiology ; Humans ; Laminectomy ; Male ; *Models, Animal ; Motor Activity/physiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Recovery of Function ; Research Support, Non-U.S. Gov't ; *Spinal Cord Injuries/pathology/therapy

OBJECTIVE: Little is known regarding cervical cancer survivors' employment status, which represents social integration of cancer survivors as a pivotal domain of long-term quality of life. The goal of this study was to assess the correlates of unemployment and evaluate the impact on the comprehensive quality of life in cervical cancer survivors. METHODS: We enrolled 858 cervical cancer survivors from the gynecologic oncology departments of multi-centers in Korea. Factors associated with unemployment were identified using multivariate logistic regression analyses. We assessed different health-related quality of life domains with multivariate-adjusted least-square means between cervical cancer survivors who currently work and do not. RESULTS: After diagnosis and treatment, the percentage of unemployed survivors increased from 50.6% to 72.8%. Lower income (adjusted odds ratio [aOR], 1.97; 95% confidence interval [CI], 1.38 to 2.81), medical aid (aOR, 1.58; 95% CI, 1.05 to 2.38), two or more comorbidities (aOR, 1.80; 95% CI, 1.12 to 2.90), current alcohol drinkers (aOR, 2.33; 95% CI, 1.54 to 3.52), and employed at the time of diagnosis (aOR, 10.72; 95% CI, 7.10 to 16.16) were significantly associated with unemployment. Non-working groups showed significant differences with respect to physical functioning, role functioning, depression, and existential well-being. CONCLUSION: The proportion of unemployed cervical cancer survivors seems to increase, with low-income status and the presence of medical aid negatively being associated with employment, in addition to other comorbidities and previous working status. Effort should be made to secure the financial status of cervical cancer survivors.
Comorbidity ; Depression ; Employment ; Humans ; Korea ; Logistic Models ; Odds Ratio ; Quality of Life ; Survivors ; Unemployment ; Uterine Cervical Neoplasms