PURPOSE: To evaluate the effect of common three photon energies (6-MV, 10-MV, and 15-MV) on intensity-modulated radiation therapy (IMRT) plans to treat prostate cancer patients. MATERIALS AND METHODS: Twenty patients with prostate cancer treated locally to 81.0 Gy were retrospectively studied. 6-MV, 10-MV, and 15-MV IMRT plans for each patient were generated using suitable planning objectives, dose constraints, and 8-field setting. The plans were analyzed in terms of dose-volume histogram for the target coverage, dose conformity, organs at risk (OAR) sparing, and normal tissue integral dose. RESULTS: Regardless of the energies chosen at the plans, the target coverage, conformity, and homogeneity of the plans were similar. However, there was a significant dose increase in rectal wall and femoral heads for 6-MV compared to those for 10-MV and 15-MV. The V20 Gy of rectal wall with 6-MV, 10-MV, and 15-MV were 95.6%, 88.4%, and 89.4% while the mean dose to femoral heads were 31.7, 25.9, and 26.3 Gy, respectively. Integral doses to the normal tissues in higher energy (10-MV and 15-MV) plans were reduced by about 7%. Overall, integral doses in mid and low dose regions in 6-MV plans were increased by up to 13%. CONCLUSION: In this study, 10-MV prostate IMRT plans showed better OAR sparing and less integral doses than the 6-MV. The biological and clinical significance of this finding remains to be determined afterward, considering neutron dose contribution.
Head ; Humans ; Neutrons ; Organs at Risk ; Prostate ; Prostatic Neoplasms ; Retrospective Studies

The funding acknowledgment in this article was omitted as published.

Melanocytic nevus may be histologically associated with clefts or slits of nests, resembling lymphatic or vascular spaces. This unique histologic feature is known as an artifact of injection or tissue processing. The pseudovascular space may resemble the lymphatic invasion of malignant melanoma. Therefore it is important that dermatologists are aware of this histologic variant of melanoctic nevus in order to prevent misdiagnosis. We report three cases of melanocytic nevi with pseudovascular spaces in a 48-year-old, 43-year-old and 44-year-old women. Histologic examination of one case identified a compound melanocytic nevus and two cases identified intradermal nevi. Nevus cell nests were clustered in the dermis or dermoepidermal junction. Vessel-like spaces also were seen in the nevus cell nest. Immunohistochemically, the cells lining the pseudovascular space were positive for S-100 protein, and negative for factor VIII-related antigen and CD31 stain. We concluded that these spaces were lined by nevomelanocytes and were not truly vascular. We herein report on three melanocytic nevi with pseudovascular spaces.
Adult ; Artifacts ; Dermis ; Diagnostic Errors ; Female ; Humans ; Melanoma ; Middle Aged ; Nevus ; Nevus, Intradermal ; Nevus, Pigmented* ; S100 Proteins ; von Willebrand Factor

Chemotherapy-induced acral erythema (CIAE) is a toxic reaction to a number of different chemotherapeutic agents, and causes symmetrical, well-demarcated, painful erythema on the palms and soles which is self-limiting. CIAE with bullous reaction in relation to methotrexate has been reported, but it is more commonly associated with cytosine arabinoside. The differential diagnosis of this condition from more serious conditions such as graft-vs-host disease or toxic epidermal necrolysis is essential. In this paper, we report the case of a 65-year-old man who developed bullous acral erythema after the administration of high-dose methotrexate for the treatment of Non-Hodgkin's lymphoma.
Aged ; Cytarabine ; Diagnosis, Differential ; Erythema* ; Graft vs Host Disease ; Hand-Foot Syndrome ; Humans ; Lymphoma, Non-Hodgkin ; Methotrexate ; Stevens-Johnson Syndrome

PURPOSE: The purpose of this study was to identify the role adaptation process experienced by executive directors of nursing department of general hospitals. METHODS: Data were collected from 9 executive nursing directors though in-depth interviews about their experiences. The main question was "How do you describe your experience of the process of role adaptation as an executive nursing director?" Qualitative data from field and transcribed notes were analyzed using Strauss & Corbin's grounded theory methodology. RESULTS: The core category of experience of the process of role adaptation as an executive nursing director was identified as "entering the center with pushing and pulling". The participants used five interactional strategies; 'maintaining modest attitudes', 'inquiring about trends of popular feeling', 'making each person a faithful follower', 'collecting & displaying power', 'leading with initiative'. The consequences of role adaptation in executive nursing directors were 'coexisting with others', 'immersing in one's new role with dedication', and 'having capacity for high tolerance'. The types of role adaptations of executive directors in nursing department were friendly type, propulsive type, accommodating type. CONCLUSION: The results of this study produced useful information for executive nursing directors on designing a self-managerial program to enhance role adaptation based on interactional strategies.
Adaptation, Psychological ; Female ; Humans ; Interviews as Topic ; Leadership ; Middle Aged ; Nurse Administrators/*psychology ; Professional Competence

Generalized plane xanthoma is a group of plane xanthomas that appear as yellow to yellowish-brown flat patches or slightly-elevated plaques with a wide-spread distribution. This disease is not common and may occur in hyperlipidemic or nomolipidemic states. Generalized plane xanthoma with normolipidemia is often associated with multiple myeloma, other reticulo-endothelial malignancies and monoclonal gammopathy with unknown siginificance (MGUS). We report a case of generalized plane xanthoma associated with monoclonal gammopathy of unknown siginificance in a 40 year-old man.
Adult ; Humans ; Multiple Myeloma ; Paraproteinemias* ; Xanthomatosis*

PURPOSE: To analyze the clinical and radiological results of whole lumbosacral fusion, and to identify whether an extension of the fusion level is required. MATERIALS AND METHODS: A retrospective review was carried out on 40 patients who had undergone whole lumbosacral fusion. The adjacent segment changes were evaluated by the radiological findings including intervertebral space narrowing, traction spur, endplate sclerosis and vacuum phenomenon. The clinical results were evaluated using a visual analogue scale (VAS) and Oswestry disability index (ODI). RESULTS: The mean age was 63.8 years and the mean follow-up period was 41.7 months. At the last follow-up, adjacent segment changes were observed in 12 cases of intervertebral space narrowing, 15 cases of traction spur, 20 cases of endplate sclerosis and 8 cases of vacuum phenomenon. In the clinical results, the VAS was improved to 4.0 points from 7.6 points, and the ODI improved to 43.9% from 86.0%. There were no revision cases due to adjacent segment problems. CONCLUSION: Whole lumbosacral fusion in spinal stenosis with degenerative lumbar scoliosis was concomitant with some adjacent segment problems, but presented favorable outcomes. For the prevention of junctional problem, caution should be taken when extending the fusion level to the proximal level in whole lumbosacral fusion.
Follow-Up Studies ; Humans ; Retrospective Studies ; Sclerosis ; Scoliosis ; Spinal Stenosis ; Traction ; Vacuum

Purpose: We present a dehazing algorithm using dark channel prior (DCP) and bright channel prior (BCP) to enhance the quality of retinal images obtained through conventional fundus photography. Methods: A retrospective analysis was conducted on retinal images from patients who visited Gangnam Sacred Heart Hospital between January 2000 and September 2022. These images were captured using a digital fundus camera (KOWA Nonmyd 8S Fundus Camera, KOWA Company, Nagoya, Japan) without pupil dilation. We used two mathematical algorithms: DCP only and DCP and BCP combined. The original, DCP-processed, and DCP & BCP-processed images were compared. Fisher's exact test was used to identify significant quality improvements. Results: The DCP and the newly proposed DCP plus BCP algorithm effectively eliminated haze and enhanced the contrast of cataract images. Notably, DCP demonstrated limited improvements in fundus photographs from patients with small pupils, whereas the proposed DCP plus BCP method effectively revealed previously obscured retinal details and vessels. However, these methods exhibited limited performance in severe cataracts compared to the clear images obtained after surgery. The quality enhancement with the proposed method was significant in photographs of patients with cataracts (p = 0.032) and small pupils (p < 0.01). Conclusions Our algorithm produced clearer images of blood vessels and optic disc structures, while significantly reducing artifacts in fundus images from patients with small pupils or cataracts. The proposed algorithm can provide visually enhanced images, potentially aiding physicians in the diagnosis of retinal diseases in patients with cataracts.

PURPOSE: Nocodazole, a microtubule disrupting reagent, is known to arrest cells in the M phase, To gain insight on the regulatory mechanism of H2B histone gene expression by nocodazole in HL-60 cell, the binding pattern of nuclear proteins to cis element in the human H2B histone gene promoter has been investigated with DNase I footprinting and DNA mobility shift assay. MATERIALS AND METHODS: Northern blot hybridization was performed by the method of Virca et al. A Hinc II-Sac I fragment of pSPH28 was used as probe for Northern blot analysis of H2B histone mRNA. DNase I footprinting and DNA mobility shift assay were performed by the method of Lim et al. End labeled DNA oligomer (upper strand, 5'-CTTCACCTTATTTGCATAA GCGATTC-3') for octamer binding activity was mixed with nuclear extracts in a 20 ul reaction volume containing 60 mM KC1, 12 mM HEPES, pH 7.9, 5 mM MgCl2, 0.2 mM EDTA, 0.2 mM DTT, 12% glycerol, and 2 ug of poly [dI-dC]. RESULTS: The level of H2B histone mRNA rapidly was reduced at 24 hours in nocodazole-treated HL-60 cells and the mRNA was repressed in proportion to the concentration of nocodazole. Nocodazole-dependent repression of H2B histone gene was restored by replacement with nocodazole-free media. In DNase I footprinting analysis, one nuclear factor bound at 42 bp site (octamer motif) in the absence of nocodazole. In the presence of nocodazole, the binding of nuclear factor on octamer motif partially vanished. In DNA mobility shift assay, one DNA-protein complex (Octl) was formed when octamer motif was incubated with nuclear extract of HL-60 cell. After nocodazole treatment, Octl binding activity was reduced by time dependent manner. CONCLUSION: These results suggest that nocodazole-dependent repression of H2B histone gene is correlated with reduction of Octl binding activity in HL-60 cell.
Blotting, Northern ; Cell Division ; Deoxyribonuclease I ; DNA ; Edetic Acid ; Electrophoretic Mobility Shift Assay ; Gene Expression* ; Glycerol ; HEPES ; Histones* ; HL-60 Cells* ; Humans ; Hydrogen-Ion Concentration ; Magnesium Chloride ; Microtubules ; Nocodazole* ; Nuclear Proteins ; Repression, Psychology ; RNA, Messenger

In order to evaluate the radio-protective advantage of an enhanced dynamic wedge (EDW) over a physical wedge (PW), we measured peripheral doses scattered from both types of wedges using a 2D array of ion-chambers. A 2D array of ion-chambers was used for this purpose. In order to confirm the accuracy of the device, we first compared measured profiles of open fields with the profiles calculated by our commissioned treatment planning system. Then, we measured peripheral doses for the wedge angles of 15 degrees, 30 degrees, 45 degrees, and 60 degrees at source to surface distances (SSD) of 80 cm and 90 cm. The measured points were located at 0.5 cm depth from 1 cm to 5 cm outside of the field edge. In addition, the measurements were repeated by using thermoluminescence dosimeters (TLD). The peripheral doses of EDW were (1.4% to 11.9%) lower than those of PW (2.5% to 12.4%). At 15 MV energy, the average peripheral doses of both wedges were 2.9% higher than those at 6MV energy. At a small SSD (80 cm vs. 90 cm), peripheral dose differences were more recognizable. The average peripheral doses to the heel direction were 0.9% lower than those to the toe direction. The results from the TLD measurements confirmed these findings with similar tendency. Dynamic wedges can reduce unnecessary scattered doses to normal tissues outside of the field edge in many clinical situations. Such an advantage is more profound in the treatment of steeper wedge angles, and shorter SSD.
Heel ; Silver Sulfadiazine ; Toes