PURPOSE: Radiotherapy of the neck is known to cause carotid artery stenosis. We compared the carotid artery dose received between volumetric modulated arc therapy (VMAT) and conventional fixed-field intensity-modulated radiotherapy (IMRT) plans in patients with early glottic cancer. MATERIALS AND METHODS: Twenty-one early glottic cancer patients who previously underwent definitive radiotherapy were selected for this study. For each patient, double arc VMAT, 8-field IMRT, 3-dimensional conformal radiotherapy (3DCRT), and lateral parallel-opposed photon field radiotherapy (LPRT) plans were created. The 3DCRT plan was generated using lateral parallel-opposed photon fields plus an anterior photon field. VMAT and IMRT treatment plan optimization was performed under standardized conditions to obtain adequate target volume coverage and spare the carotid artery. Dose-volume specifications for the VMAT, IMRT, 3DCRT, and LPRT plans were calculated with radiotherapy planning system. Monitor units (MUs) and delivery time were measured to evaluate treatment efficiency. RESULTS: Target volume coverage and homogeneity results were comparable between VMAT and IMRT; however, VMAT was superior to IMRT for carotid artery dose sparing. The mean dose to the carotid arteries in double arc VMAT was reduced by 6.8% compared to fixed-field IMRT (p < 0.001). The MUs for VMAT and IMRT were not significantly different (p = 0.089). VMAT allowed an approximately two-fold reduction in treatment delivery time in comparison to IMRT (3 to 5 minutes vs. 5 to 10 minutes). CONCLUSION: VMAT resulted in a lower carotid artery dose compared to conventional fixed-field IMRT, and maintained good target coverage in patients with early glottic cancer.
Animals ; Carotid Arteries ; Carotid Stenosis ; Glottis ; Humans ; Mice ; Neck ; Radiotherapy ; Radiotherapy, Conformal ; Radiotherapy, Intensity-Modulated*

Occipital nerve blockade is a widely used procedure in the treatment of primary and secondary headache disorders. The procedure is generally well tolerated, although local side effects such as cutaneous atrophy, hyperpigmentation, and alopecia can occur. The present study describes a case of alopecia following occipital nerve blockade with triamcinolone. This complication can be avoided by precautions such as local injection and the use of alternative steroid preparations.
Alopecia ; Atrophy ; Headache Disorders, Secondary ; Hyperpigmentation ; Nerve Block ; Triamcinolone

Occipital nerve blockade is a widely used procedure in the treatment of primary and secondary headache disorders. The procedure is generally well tolerated, although local side effects such as cutaneous atrophy, hyperpigmentation, and alopecia can occur. The present study describes a case of alopecia following occipital nerve blockade with triamcinolone. This complication can be avoided by precautions such as local injection and the use of alternative steroid preparations.
Alopecia ; Atrophy ; Headache Disorders, Secondary ; Hyperpigmentation ; Nerve Block ; Triamcinolone

BACKGROUNE/AIMS: Esophageal variceal ligation (EVL) is the most preferable method for controling variceal bleeding. However, EVL is associated with complications such as hemorrhage, chest pain, dysphagia, and odynophagia due to post-EVL ulcers in the esophageal mucosa. The aim of this study was to assess the effect of proton pump inhibitor (PPI), pantoprazole on the healing of post-EVL ulcers. METHODS: Forty seven patients were randomly allocated into PPI group and control group. Patients in PPI group received 40 mg of pantoprazole intravenously for 3 days after EVL, then 40 mg of oral pantoprazole for 11 days consecutively. Control patients received intravenous and oral placebo. Endoscopic examinations were performed twice at 7+/-2 days and 14+/-2 days after EVL respectively. Clinical outcomes include the size of ulcers, symptoms reported by patients; chest pain, dysphagia, and odynophagia. RESULTS: Forty seven patients completed the 7 days protocol (PPI/control; 25/22), and twenty six patients completed the 14 days protocol (PPI/control; 16/10). Post-EVL ulcers in PPI group were significantly smaller than those in control group (7 days; 98.7 mm2/119.4 mm2, 14 days; 32.3 mm2/43.8 mm2, p<0.01). No difference was observed between two the groups with respect to summations of symptom scores (p>0.05). Nineteen patients (PPI/control; 9/10) did not complete the 14 days protocol due to patients' refusal and adverse outcomes, such as hepatic failure and sepsis with bleeding from post-EVL ulcer occurred in two patients of control group. CONCLUSIONS: PPI treatment following EVL may be effective in healing post-EVL ulcer.
2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage/*therapeutic use ; Anti-Ulcer Agents/administration & dosage/*therapeutic use ; Esophageal and Gastric Varices/complications/*surgery ; Esophagoscopy ; Female ; Gastrointestinal Hemorrhage/prevention & control ; Humans ; Ligation ; Male ; Middle Aged ; Proton Pump Inhibitors/administration & dosage/*therapeutic use ; Regression Analysis ; Sickness Impact Profile ; Ulcer/*drug therapy/etiology

The gradual loss of telomeric DNA can contribute to replicative senescence and thus, having longer telomeric DNA is generally considered to provide a longer lifespan. Maintenance and stabilization of telomeric DNA is assisted by binding of multiple DNA-binding proteins, including those involved in double strand break (DSB) repair. We reasoned that declining DSB repair capacity and increased telomere shortening in aged individuals may be associated with decreased expression of DSB repair proteins capable of telomere binding. Our data presented here show that among the DSB repair proteins tested, only the expression of Ku70 and Mre11 showed statistically significant age-dependent changes in human lymphocytes. Furthermore, we found that expressions of Ku70 and Mre11 are statistically correlated, which indicate that the function of Ku70 and Mre11 may be related. All the other DSB repair proteins tested, Sir2, TRF1 and Ku80, did not show any significant differences upon aging. In line with these data, people who live in the regional community (longevity group), which was found to have statistically longer average life span than the rest area, shows higher level of Ku70 expression than those living in the neighboring control community. Taken together, our data show, for the first time, that Ku70 and Mre11 may represent new biomarkers for aging and further suggest that maintenance of higher expression of Ku70 and Mre11 may be responsible for keeping longer life span observed in the longevity group.
Telomere/genetics ; Middle Aged ; Longevity ; Humans ; DNA-Binding Proteins/*metabolism ; DNA Repair/*genetics ; DNA/genetics ; Cell Aging/*physiology ; CD4-Positive T-Lymphocytes/metabolism ; Antigens, Nuclear/*metabolism ; Aging/*physiology ; Aged, 80 and over ; Aged ; Adult

BACKGROUND: Basilar arterial dolichosis (BD) has chracteristics of tortuosity and elongation. BD can cause obstructive hydrocephalus, direct compression of brainstem and cranial nerves, and cerebral ischemia or infarction. It has been reported that brainstem infarction is usually located contralateral to the side of lateral displacement. This study was aimed to reveal the relation between the location of the infarction and the some characteristics of BD. METHODS: Among the 143 patients who had brainstem infarction from January, 2003 to July, 2004, 40 patients with BD were analyzed retrospectively. Characteristics of BD and infarct site were analysed with special respect via MRI and MRA. We surveyed the relation between the location of the infarction and the lateral displacement of BD. Subjects were divided into two groups by the degree of the lateral displacement of basilar artery (BA). We made a comparison between the two in clinical characteristics and risk factors. Height of the infarct site and the maximal point of lateral displacement from arbitrarily defined standard level (lower pons) were measured. We surveyed the lesional laterality associated with relative height of the infarct site. RESULTS: Infarct lesions located to the contralateral side of the laterally displaced BA were more prevalent (25 cases, 62.5%). There was significant correlation between the lesional laterality and the lateral displacement of the BA in group B (p=0.039) and between the lesion-height and the maximal dolichosis-height (r=0.639, p<0.001). CONCLUSIONS: Patients with BD are more likely to have brainstem infarction at the contralateral side of the laterally displaced BA.
Basilar Artery* ; Brain Ischemia ; Brain Stem Infarctions* ; Brain Stem* ; Cranial Nerves ; Humans ; Hydrocephalus ; Infarction ; Magnetic Resonance Imaging ; Retrospective Studies ; Risk Factors

BACKGROUND: Behavioral and psychological symptoms (BPS) following acute middle cerebral artery (MCA) infarcts are not uncommon, but these have been considered to be less important than physical disability. The purpose of this study is to evaluate the characteristics of BPS following acute MCA infarcts by using the Korean version of neuropsychiatric inventory (K-NPI). METHODS: Fifty-one patients with acute MCA infarcts were studied using the K-NPI scale. We investigated newly developed BPS after the onset of MCA infarcts by interviewing the primary caregiver of each patient. We then evaluated factors related to the BPS such as lesion laterality and various characteristics of the subjects. RESULTS: The most common BPS following acute MCA infarcts was depression. It was present in 69% of the patients, followed by anxiety (61%), agitation (39%), apathy (29%) and irritability (25%). Depression and anxiety were associated with left MCA lesion, whereas apathy was associated with right lesion. Patients with recurrent MCA infarcts more often had depression and anxiety than those without (p=0.03, p=0.04, respectively). Patients with MCA infarcts caused by cardioembolism more often had irritability and disinhibition than those with other subtypes (p=0.01, p=0.02, respectively). CONCLUSIONS: BPS is frequently observed following acute MCA infarcts. Therefore, early and adequate assessment of post stroke BPS and appropriate therapy may be important in patients with MCA infarcts.
Anxiety ; Apathy ; Caregivers ; Depression ; Dihydroergotamine ; Humans ; Middle Cerebral Artery* ; Stroke

PURPOSE: To define the clinical features and pattern of failure and to evaluate the results of radiation treatment in of adenosquamous cell carcinoma of the uterine cervix. MATERIALS AND METHODS: From Jun. 1981 to Dec. 1997, 43 patients with adenosquamous cell carcinoma of the uterine cervix were retrospectively analyzed external radiation treatment and HDR-ICR from Yonsei cancer center and Wonju cristian hospital. The median age was 51. Stage distribution according to FIGO were stage 1b in 10, 2a in 5, 2b in 18, 3b in 9, 4a in 1. Median follow-up period was 41 months. RESULTS: Overall survival rate and disease free survival rate were 57.2% and 60.2%. Complete response rate was 86.0%. Locoregional failure was observed in seven patients. CONCLUSION: Major pattern of failure was locoregional failure. Adenosquamous cell carcinoma was not more aggressive than other pathologic types.
Cervix Uteri* ; Disease-Free Survival ; Female ; Follow-Up Studies ; Gangwon-do ; Humans ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms

PURPOSE: Transcatheter arterial chemoembolization (TACE) has been actively performed for the treatment of unresectable or inoperable hepatocellular carcinoma. However, for the patients with treatment failure after TACE, few options are available for salvage. The purpose of this study was to investigate the efficacy of local radiotherapy as a salvage moda- lity for treatment failure after TACE. MATERIALS AND METHODS: From January 1993 to December 1997, 27 patients were included in this study. Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Childs class C, tumors occupying more than two thirds of the entire liver, and performance status on the ECOG scale of more than 3. Mean tumor size was 7.2+/- 2.9 cm. Liver cirrhosis was associated in 10 patients. Portal vein thrombosis was presented in 5 patients. Serum alpha-fetoprotein was positive in 8 patients. According to VICC staging, the number of patients in III and IVA were 17 and 10, respectively. Treatment failure to TACE was evaluated by CT scan and angiography. Radiotherapy was given to the field including tumor with generous margin using 10-MV X-ray. Mean tumor dose was 51.8+-7.9 Gy in daily 1.8 Gy fractions. Tumor response was based on CT scans 4~6 weeks following completion of treatment. RESULTS: An objective response was observed in 16 of 24 patients who were possible to be evaluated, giving a response rate of 66.7%. Survival rates after salvage radiotherapy at 1, 2, 3 years were 55.9%, 35.7%, and 21.4%, respectively. The median survival was 14 months. Six patients among responders are surviving at present. Acute toxicity included G1 elevation of AST/ALT in 4 patients, G2 thrombocytopenia in 2, G2 hyperbilirubinemia in 5, and G2 hypoalbuminemia in 3. During follow-up, 4 patients developed ascites. At 6 months after treatment, gastric ulcers and duodenal ulcer were developed in 2 and 1 patient, respectively. CONCLUSION: Local radiotherapy for treatment failure after TACE in hepatocellular carci- noma appears to be a feasible and effective salvage modality. It gives a 66.7% response rate with a median survival of 14 months. Acute toxicity was self-limiting and manageable. Gastric and duodenal ulcer were significant toxicities after treatment. Further studies are required to find optimal methods of radiotherapy to minimize toxicity.
alpha-Fetoproteins ; Angiography ; Ascites ; Carcinoma, Hepatocellular* ; Child ; Duodenal Ulcer ; Follow-Up Studies ; Humans ; Hyperbilirubinemia ; Hypoalbuminemia ; Liver ; Liver Cirrhosis ; Neoplasm Metastasis ; Noma ; Radiotherapy* ; Stomach Ulcer ; Survival Rate ; Thrombocytopenia ; Tomography, X-Ray Computed ; Treatment Failure ; Venous Thrombosis

PURPOSE: To evaluate the usefulness of electronic portal imaging device through objective compare of the images acquired using an EPID and a conventional port film. MATERIAL AND METHODS: From Apr. to Oct. 1997, a total of 150 sets of images from 20 patients who received radiation therapy in the pelvis area were evaluated in the Inha University Hospital and Severance Hospital. A dual image recording technique was devised to obtain both electronic portal images and port film images simultaneously with one treatment course. We did not perform double exposure. Five to ten images were acquired from each patient. All images were acquired from posteroanterior (PA) view except images from two patients. A dose rate of 100-300 MU/min and a 10- MV X-ray beam were used and 2-10 MUs were required to produce a verification image during treatment. Kodak diagnostic film with metal/film imaging cassette which was located on the top of the EPID detector was used for the port film. The source to detector distance was 140 cm. Eight anatomical landmarks (pelvic brim, sacrum, acetabulum, iliopectineal line, symphysis, ischium, obturator foramen, sacroiliac joint) were assessed. Four radiation oncologist joined to evaluate each image. The individual landmarks in the port film or in the EPID were rated - very clear (1), clear (2), visible (3), not clear (4), not visible (5). RESULTS: Using an video camera based EPID system, there was no difference of image quality between no enhanced EPID images and port film images. However, when we provided some change with window level for the portal image, the visibility of the sacrum and obturator foramen was improved in the portal images than in the port film images. All anatomical landmarks were more visible in the portal images than in the port film when we applied the CLAHE mode enhancement. The images acquired using an matrix ion chamber type EPID were also improved image quality after window level adjustment. CONCLUSION: The quality of image acquired using an electronic portal imaging device was comparable to that of the port film. When we used the enhance mode or window level adjustment, the image quality of the EPID was superior to that of the port film. EPID may replace the port film.
Acetabulum ; Animals ; Humans ; Ischium ; Mice ; Pelvis ; Sacrum