Purpose: The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer. Materials and Methods: We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms. Results: Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios. Conclusion Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting.

Purpose: The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer. Materials and Methods: We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms. Results: Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios. Conclusion Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting.

BACKGROUND/AIMS: We investigated whether sodium picosulfate with magnesium citrate (SPMC) plus bisacodyl compares favorably with conventional polyethylene glycol (PEG) with respect to bowel cleansing adequacy, compliance, and safety. METHODS: We performed a multicenter, prospective, single-blinded study in outpatients undergoing daytime colonoscopies. Patients were randomized into a split preparation SPMC/bisacodyl group and a conventional split PEG group. We compared preparation adequacy using the Boston bowel preparation scale (BBPS), ease of use using a modified Likert scale (LS), compliance/satisfaction level using a visual analogue scale (VAS), and safety by monitoring adverse events during the colonoscopy between the two groups. RESULTS: A total of 365 patients were evaluated by intention to treat (ITT) analysis, and 319 were evaluated by per protocol (PP) population analysis (153 for SPMC/bisacodyl, 166 for PEG). The mean total BBPS score was not different between the two groups in both the ITT and PP analyses (p>0.05). The mean VAS score for satisfaction and LS score for the ease of use were higher in the SPMC/bisacodyl group (p<0.001). The adverse event rate was lower in the SPMC/bisacodyl group than in the PEG group (p<0.05). CONCLUSIONS: The SPMC/bisacodyl treatment was comparable to conventional PEG with respect to bowel preparation adequacy and superior with respect to compliance, satisfaction, and safety.
Adult ; Aged ; Cathartics/*administration & dosage ; Citrates/*administration & dosage ; Citric Acid/*administration & dosage ; Colon/*drug effects/surgery ; *Colonoscopy ; Drug Combinations ; Drug Therapy, Combination/methods ; Female ; Humans ; Intention to Treat Analysis ; Laxatives/*administration & dosage ; Male ; Middle Aged ; Organometallic Compounds/*administration & dosage ; Patient Compliance ; Patient Satisfaction ; Picolines/*administration & dosage ; Polyethylene Glycols/*administration & dosage ; Preoperative Care/methods/psychology ; Single-Blind Method ; Young Adult

A differential diagnosis between neurosarcoidosis and neurosyphilis is particularly problematic in patients with a positive serologic result for syphilis. We report here a patient with a solitary cavernous sinus sarcoidosis who had a history of syphilis and showed rapidly progressing cavernous sinus syndrome. A transsphenoidal biopsy was performed and a histopathologic examination revealed a non-caseating granuloma with an asteroid body. His facial pain disappeared after steroid therapy. He received oral prednisolone for one year. A follow-up magnetic resonance imaging of the brain revealed resolution of the mass over the cavernous sinus. Particularly in patients with a history of syphilis, neurosyphilis should be included in a differential diagnosis of neurosarcoidosis.
Biopsy ; Brain ; Cavernous Sinus* ; Diagnosis, Differential ; Facial Pain ; Follow-Up Studies ; Granuloma ; Humans ; Magnetic Resonance Imaging ; Neurosyphilis* ; Prednisolone ; Sarcoidosis ; Syphilis

A 76-year-old woman with compression fracture of L1 underwent percutaneous balloon kyphoplasty using polymethyl methacrylate. Three years after kyphoplasty of L1, the patient was readmitted with severe low back pain. Magnetic resonance imaging revealed progressive collapse of L1 vertebra and new compression fracture at T12. There were no signs of infection. As conservative treatment failed, combined surgery consisting of anterior corpectomy of T12 and L1, interposition of a titanium mesh cage filled with autologous rib graft, and anterior instrumentation of T11-L2 was performed. Histologic examination showed granulomatous inflammation surrounding the cement. Polymerase chain reaction and culture of the specimen confirmed the diagnosis of tuberculosis. The anti-tuberculous medications were administered for 10 months, and the patient recovered without any sequelae. Tuberculous spondylitis should be included in the differential diagnosis of spondylitis after cement augmentation. If conservative antibiotic therapy fails, resection of the infected bone-cement complex is indicated.
Aged ; Cementoplasty ; Diagnosis, Differential ; Female ; Fractures, Compression ; Humans ; Inflammation ; Kyphoplasty ; Low Back Pain ; Magnetic Resonance Imaging ; Polymerase Chain Reaction ; Polymethyl Methacrylate ; Ribs ; Spine ; Spondylitis ; Titanium ; Transplants ; Tuberculosis ; Tuberculosis, Spinal ; Vertebroplasty

BACKGROUND: We report here the results of surveys for external quality assessment of blood bank tests performed in 2009. METHODS: Survey specimens were sent three times to 488, 491 and 490 participant institutes, and the response rates for the 1st, 2nd and 3rd trial were 97.7%, 98.0%, and 98.0%, respectively. Test items for the surveys were ABO grouping, Rh (D) typing, crossmatching, direct antiglobulin test, antibody screening and antibody identification test. RESULTS: The average accuracy rates of ABO grouping and Rh typing were 99.6-100% and 98.5-100%, respectively. In crossmatching test, the accuracy rates were 99.3-99.8% for the compatible samples, 92.7-100% for the incompatible samples, and 92.6-93.1% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.5-100% for negative samples and 98.1-98.8% for positive samples. The correctresults were reported by 98.0-100% of the surveyed institutions for antibody screening test and 82.9-100% for antibody identification test. Nineteen institutions gave repeatedly incorrect answers for crossmatching test. Eight institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year. CONCLUSIONS: The overall results of this survey were good, however, it is required that the institutions where the incorrect results were reported should perform corrective actions for quality improvement.
Academies and Institutes ; Blood Banks ; Coombs Test ; Korea ; Mass Screening ; Quality Improvement

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.
Administration, Oral ; Adult ; Aged ; Colonic Diseases/diagnosis ; Colonoscopy/*methods ; Humans ; Male ; Middle Aged ; Patient Compliance ; Phosphates/*administration & dosage ; Polyethylene Glycols/*administration & dosage ; Questionnaires ; Solutions ; Therapeutic Irrigation

Polymethl methacrylate (PMMA) screw reinforcement is frequently used in osteoporotic bone as well as in damaged pilot holes. However, PMMA use can be dangerous, since the amount of applied cement is uncontrolled. A 47-year-old male with traumatic cervical spondylolisthesis at C6-7 underwent anterior cervical plate fixation. During repeated drilling and tapping for false trajectory correction, a pilot hole was damaged. Although it was an unconventional method, PMMA augmentation was tried. However, PMMA was accidentally injected to the cervical spinal cord owing to lack of fluoroscopic guidance. The PMMA was surgically removed after corpectomy and durotomy. The patient had left side hemiparesis (Grade 2/5) immediately post operation. The patient improved spontaneously (Grade 4/5) except for 4th and 5th digit extension. Here, we report a rare complication of PMMA extrusion in the spinal cord during a damaged pilot hole injection, which has not previously been described.
Bone Cements/*adverse effects/therapeutic use ; Bone Screws ; Cervical Vertebrae/*surgery ; Humans ; Male ; Middle Aged ; Polymethyl Methacrylate/adverse effects/therapeutic use

We report here the results of surveys for external quality assessment of blood bank tests performed in 2008. Survey specimens were sent three times to 460, 470 and 473 participant institutes, and the response rates for the 1st, 2nd and 3rd trial were 97.6%, 97.7%, and 97.7%, respectively. Test items for the surveys were ABO grouping, Rh (D) typing, crossmatching, direct antiglobulin test, antibody screening and antibody identification test. The average accuracy rates of ABO grouping and Rh typing were 100% and 98.3-100%, respectively. In crossmatching test, the accuracy rates were 97.5-99.7% for the compatible samples, 92.4-99.2% for the incompatible samples, and 88.2-98.9% for the samples which could be detected as incompatible only by antiglobulin method. The accuracy rates of direct antiglobulin test were 98.4-99.7% for negative samples and 93.4-99.7% for positive samples. The correct results were reported by 99.6-100% of the surveyed institutions for antibody screening test and 98.2-100% for antibody identification test. Twenty-three institutions gave repeatedly incorrect answers for crossmatching test. Ten institutions out of them gave incorrect answers for all the test specimens sent out 3 times last year.
Academies and Institutes ; Blood Banks ; Coombs Test ; Korea ; Mass Screening

INTRODUCTION: Renal cell carcinoma (RCC) is a relative rare tumor, accounting for approximately 3% of adult malignancies. Renal cell carcinoma has a high metastatic potential and is renowned for its ability to spread to almost any organ of the body. Pancreas is a rare site for metastasis from other primary cancers. Moreover, pancreatic metastasis is difficult to differentiate and may be misdiagnosed as a primary pancreatic cancer. The aim of this study was to review our cases of renal cell carcinoma that had metastasized to the pancreas after radical nephrectomy. METHODS: We did a retrospective review of the records of 4 patients with pathologically confirmed RCC that had metastasized to the pancreas after radical nephrectomy. RESULTS: Our group of 4 patients consisted of 2 men and 2 women. Their average age was 58.7 years (+/- 10.51 years). The locations within the pancreas were the head, in 2 (50.0%) and the body/tail in 2 (50.0%) patients. The pancreatic metastases were treated by pancreaticoduodenectomy in 2 patients, and by distal pancreatectomy in 2 patients. Median survival duration was 109.0 (+/- 67.3 months) "Median" is associated with an interquartile range (25% to 75%). The number 67.3 appears to be a standard deviation which is associated with the "mean". CONCLUSIONS: RCC is an unpredictable tumor that may result in a late metastasis even from an early stage. Aggressive surgical management of pancreatic lesions offers a chance of long-term survival.
Accounting ; Adult ; Carcinoma, Renal Cell ; Female ; Head ; Humans ; Male ; Neoplasm Metastasis ; Nephrectomy ; Pancreas ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Retrospective Studies