PURPOSE: To investigate the patterns of care for patients with nasopharyngeal carcinoma (NPC) in South Korea. MATERIALS AND METHODS: A multi-institutional retrospective study was performed (Korean Radiation Oncology Group [KROG] 11-06) on a total of 1,445 patients from 15 institutions. RESULTS: Of the 1,445 patients, more than half were stages III (39.9%) and IV (35.8%). In addition to patterns of care, we also investigated trends over time with the periods 1988-1993, 1994-2002, and 2003-2011. The frequencies of magnetic resonance imaging and positron emission tomography-computed tomography were markedly increased in the third period compared to previous 2 periods. Concurrent chemoradiation (CCRT) was performed on 894 patients (61.9%), neoadjuvant chemotherapy on 468 patients (32.4%), and adjuvant chemotherapy on 366 patients (25.3%). Of stage II-IV patients, CCRT performed on 78.8% in 2003-2011 compared to 15.0% in 1988-1993. For patients treated with CCRT, cisplatin was the most commonly used agent in 81.3% of patients. Over the periods of time, commonly used radiotherapy (RT) techniques were changed from 2-dimensional RT (1988-1993, 92.5%) to 3-dimensional RT (2003-2011, 35.5%) or intensity-modulated RT (IMRT; 2003-2011, 56.5%). Median RT doses given to primary tumors, high-risk lymphatics, and low-risk lymphatics were 70.0 Gy, 58.1 Gy, and 48.0 Gy, respectively. Adoption of IMRT increased the dose per fraction and escalated total radiation dose. CONCLUSION: Assessment of the patterns of care for NPC patients in South Korea demonstrated that management for NPC including diagnostic imaging, treatment regimen, RT techniques and dose schedule, advanced in accordance with the international guidelines.
Appointments and Schedules ; Chemotherapy, Adjuvant ; Cisplatin ; Diagnostic Imaging ; Drug Therapy ; Electrons ; Humans ; Korea* ; Magnetic Resonance Imaging ; Nasopharyngeal Neoplasms ; Radiation Oncology ; Radiotherapy ; Retrospective Studies

PURPOSE: The purpose of this study was to investigate the predictable value of pretreatment 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) in radiotherapy (RT) for patients with hepatocellular carcinoma (HCC) or portal vein tumor thrombosis (PVTT). MATERIALS AND METHODS: We conducted a retrospective analysis of 36 stage I-IV HCC patients treated with RT. 18F-FDG PET-CT was performed before RT. Treatment target was determined HCC or PVTT lesions by treatment aim. They were irradiated at a median prescription dose of 50 Gy. The response was evaluated within 3 months after completion of RT using the Response Evaluation Criteria in Solid Tumors (RECIST). Response rate, overall survival (OS), and the pattern of failure (POF) were analyzed. RESULTS: The response rate was 61.1%. The statistically significant prognostic factor affecting response in RT field was maximal standardized uptake value (maxSUV) only. The high SUV group (maxSUV > or = 5.1) showed the better radiologic response than the low SUV group (maxSUV < 5.1). The median OS were 996.0 days in definitive group and 144.0 days in palliative group. Factors affecting OS were the %reduction of alpha-fetoprotein (AFP) level in the definitive group and Child-Pugh class in the palliative group. To predict the POF, maxSUV based on the cutoff value of 5.1 was the only significant factor in distant metastasis group. CONCLUSION: The results of this study suggest that the maxSUV of 18F-FDG PET-CT may be a prognostic factor for treatment outcome and the POF after RT. A %reduction of AFP level and Child-Pugh class could be used to predict OS in HCC.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Electrons ; Fluorodeoxyglucose F18* ; Humans ; Neoplasm Metastasis ; Portal Vein ; Positron-Emission Tomography ; Prescriptions ; Radiotherapy* ; Retrospective Studies ; Thrombosis ; Treatment Outcome

BACKGROUND: Prolonged extracorporeal circulation entails tremendous threats of red cell lysis, severe bleeding problems due to platelet injury and activation, and endothelial damages by sequestered leukocytes. In consideration of these problems, a new centrifugal pump was developed and tested clinically to evaluate its effectiveness. METHODS: We compared the effects of a centrifugal pump with those of a roller pump on hematological responses during cardiopulmonary bypass (CPB) in 20 coronary artery bypass surgery patients. The patients were divided into two groups of 10 each. The studied parameters included WBC counts, platelet counts, plasma Hb and D-dimer. Blood samples were taken after sternotomy, at 60 min, 120 min and 180 min after CPB start, and at 2 hr after CPB stop. RESULTS: No differences between the groups were found in bypass time, aortic cross clamp time, extracorporeal circulation flow and hematocrit. The centrifugal pump group demonstrated less platelet depletion (p<0.05), hemolysis (plasma Hb, p<0.05) and fibrinolysis (D-dimer, p<0.05). These differences were CPB time dependent and became statistically significant after 120 min bypass. CONCLUSION: We conclude that roller pump still can be safely used for standard cardiac procedures with bypass time less than 120 minutes and the centrifugal pump has significant potential to be safely applied to CPB for long ypass time in order to avoid postperfusion syndrome.
Blood Platelets ; Cardiopulmonary Bypass* ; Coronary Artery Bypass ; Extracorporeal Circulation ; Fibrinolysis ; Hematocrit ; Hemolysis ; Hemorrhage ; Humans ; Leukocytes ; Plasma ; Platelet Count ; Sternotomy

PURPOSE: To evaluate the pathologic effects of preoperative radiotherapy on the resectable distal rectal cancer, we analyzed the results of postoperative pathologic findings for the patients with preoperative radiotherapy and surgery. MATERIALS AND METHODS: From July 1995 to April 1996, we treated sixteen patients of resectable rectal cancer with preoperative radiation therapy and curative surgery. At diagnosis, Thomas Jefferson (TJ) system was used for the clinical stage of the patients. We treated the patients with conventional radiation therapy of 4500-5000cGy before surgery. The surgery was carried out 4 weeks after completion of radiation therapy. Modified Astler Coller (MAC) system was used for the postoperative pathologic stage. We analyzed the pathologic stages and findings according to preoperative clinical stage and compared with those of the control group in similar clinical stages. RESULTS: All patients were treated with sphincter preservation surgery after preoperative radiation therapy. Pathologic complete response (CR) was shown in 1 case (6.3%). We compared the results between preoperative radiation therapy group (Preop.RT group) and surgery only group (control group). In TJ stage II, among nine patients of Preop.RT group, 8 patients (88.9%) were in MAC stage B except 1 CR patient, but among 17 patients of control group, 11 patients (64.7%) were in MAC stage B and 6 patients (35.3%) in MAC stage C. In TJ stage III, among 7 patients of Preop.RT group, 4 patients (57.1%) were in MAC stage B and 3 patients (42.9%) in MAC stage C. Among 14 patients of control group, 4 patients (28.6%) were in MAC stage B and 10 patients (71.4%) in MAC stage C. Above results showed that postoperative pathologic stage was decreased in Preop.RT group with statistical significance (p=0.049). The postoperative pathologic findings (blood vessel invasion, lymphatic vessel invasion, perineural invasion) were decreased in the Preop.RT group compared with those of control group. But statistical significance was found only in lymphatic vessel invasion (p=0.019). CONCLUSION: The postoperative pathologic stages and adverse prognostic pathologic findings were decreased in preoperative radiation therapy group. The lymphatic vessel invasion and MAC stage C findings were abruptly decreased in preoperative radiation therapy group. The preoperative radiation therapy was found to be effective in resectable rectal cancer. The patients group in our study was very small and long term follow up was not done. Therefore, further study about this issues is needed .
Diagnosis ; Follow-Up Studies ; Humans ; Lymphatic Vessels ; Radiotherapy ; Rectal Neoplasms*

Although many reseraches have been persued to detect the molecular tumor marker to define the cancer, ideal tumor marker which speak for the characteristics of malignancy and has high sensitivity and specificity is not known. One of the characteristics of the malignant cells is indefinite proliferative potential, in other word, immortality. The expression of telomerase and stabilization of telomeres are concomitant with the attainment of immortality in tumor cells; thus the measurement of telomerase activity in clinically obtained tumor samples may provide important information which would be useful as a diagnostic marker to detect immortal cancer cells. Telomerase activity was analyzed in 12 non-small cell lung cancer cell lines and 41 primary non-small cell lung cancers with the use of a PCR-based assay. All the cell lines and the majority of tumors displayed telomerase activity, but telomerase was not detectable in most of the corresponding pathologically-normal tissues. Telomere length was not correlated with telomerase activity. The present study indicate that measurement of telomerase activity may be useful as a molecular tumor marker in non-small cell lung cancer.
Carcinoma, Non-Small-Cell Lung* ; Cell Line ; Lung Neoplasms ; Sensitivity and Specificity ; Telomerase* ; Telomere

Cardiopulmonary bypass in children is associated with capillary leak, which results in an increase in total body water after open heart surgery. The purpose of these studies was to assess the cardiopulmonary effects of modified ultrafiltration after pediatric open heart surgery. Study A: Twenty-six consecutive children aged 0.1~10 years(median 7 months) underwent cardiac operation incorporating modified ultrafiltration. After completion of cardiopulmonary bypass, modified ultrafiltration was commenced at the flow rate of 100~150l/min for 3~14 min. After modified ultrafiltration, elevation of hematocrit(28.3%+/-3.6% vs. 33.8%+/-4.0%, p<0.001), increased systolic blood pressure(66.7+/-11.2mmHg vs. 76.2+/-11.8mmHg, p<0.02), and decreased central venous pressure(7.8+/-3.7mmHg vs. 6.9+/-2.9mmHg, p<0.001) were observed. Study B: Twenty-six children who underwent cardiac operation with the diagnosis of VSD under 2 years were assigned to control(n=14) or modified ultrafiltration(n=12). Peak inspiratory pressure checked immediately after operation was significantly lower in modified ultrafiltration group than in control group(20.0+/-2.4 cmH2O vs. 22.4+/-2.3cmH2O, p< 0.03). Modified ultrafiltration after cardiopulmonary bypass in children improves early hemo- dynamics and pulmonary mechanics, and represents an excellent option for perioperative management of accumulation of fluid in the tissues. We will continually employ the modified ultrafiltration technique in pediatric cardiac operations.
Body Water ; Capillaries ; Cardiopulmonary Bypass ; Child ; Diagnosis ; Filtration ; Heart* ; Hemodynamics ; Humans ; Mechanics ; Thoracic Surgery* ; Ultrafiltration*

Of all the potentially lethal complications of the head injury, extradural hemorrhage is the most readily diagnosed and remediable, yet the mortality rate remains distressingly high. The authors report on 58 consecutive patients with extradural hematoma. The mortality was 31%. The classical clinical course with a lucidal interval was seen in three patients only. The classical neurological signs of an extradural hematoma, contralateral hemiparesis, and ipsilateral third nerve palsy were seen in 9 patients(15.5%). The main factors associated with increased mortality were concomitant brain injury, rapid development of the hematoma and unconsciousness at the time of operation. In almost half of the fatal cases, there was a delay in the diagnosis and operation. Consequently better results are possible with better organization of the supervision and treatment of brain injured patients.
Brain ; Brain Injuries ; Craniocerebral Trauma ; Diagnosis ; Hematoma* ; Hemorrhage ; Humans ; Mortality* ; Oculomotor Nerve Diseases ; Organization and Administration ; Paresis ; Unconsciousness

The authors describe a new technique for the reduction and wiring of atlanto-axial dislocation. More strong supporting effect has been achieved by double wiring of the posterior arch of the cervical vertebrae. Various techniques for the fixation of the atlanto-axial dislocation have been discussed.olved.
Cervical Vertebrae ; Dislocations* ; Female ; Odontoid Process*

With the establishment of the anterior cervical approach as the procedure of choice for cervical fracture-dislocation, attention has now turned to refinements of Cloward technique. The purpose of application of the Cloward technique is to achieve early stabilization of the fracture-dislocation, to shorten the recumbency period, and to promote rehabilitation. Recently the authors have experienced with the Cloward technique in the treatment of cervical fracture-dislocation. Our results indicated that anterior interbody fusion has been a satisfactory method for stabilizing one or more segment of the cervical fracture-dislocation. The prevention of dowel fracture or extrusion following fusion has been a important factor in the success. Another advantage obtained is to use the operating microscope for decompression of nerve roots. The chronic locked facets have not been reduced by the application of Cloward technique, but have been managed to achieve stabilization with Smith-Robinson technique. The lateral cervical pucture technique(C1-C2) for pantopaque myelography has been shown to be a valuable adjunct of acute injuries of the cervical spinal cord. A new technique for wiring and fusion of atlanto-axial dislocation has been performed with satisfactory results.
Decompression ; Dislocations* ; Iophendylate ; Myelography ; Rehabilitation ; Spinal Cord

The authors report a case of malignant brain-stem glioma with typical clinical signs in which successful surgical decompression and biopsy were obtained under the surgical microscope, and factors favoring surgical removal of such lesion are discussed.
Biopsy* ; Decompression* ; Decompression, Surgical ; Glioma*