Purpose: To assess patient radiation doses during diagnostic and therapeutic neurointerventional procedures from multiple centers and propose dose reference level (RL). Materials and Methods: Consecutive neurointerventional procedures, performed in 22 hospitals from December 2020 to June 2021, were retrospectively studied. We collected data from a sample of 429 diagnostic and 731 therapeutic procedures. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time (FT), and total number of image frames (NI) were obtained. RL were calculated as the 3rd quartiles of the distribution. Results: Analysis of 1160 procedures from 22 hospitals confirmed the large variability in patient dose for similar procedures. RLs in terms of DAP, CAK, FT, and NI were 101.6 Gy·cm2, 711.3 mGy, 13.3 minutes, and 637 frames for cerebral angiography, 199.9 Gy·cm2, 3,458.7 mGy, 57.3 minutes, and 1,000 frames for aneurysm coiling, 225.1 Gy·cm2, 1,590 mGy, 44.7 minutes, and 800 frames for stroke thrombolysis, 412.3 Gy·cm2, 4,447.8 mGy, 99.3 minutes, and 1,621.3 frames for arteriovenous malformation (AVM) embolization, respectively. For all procedures, the results were comparable to most of those already published. Statistical analysis showed male and presence of procedural complications were significant factors in aneurysmal coiling. Male, number of passages, and procedural combined technique were significant factors in stroke thrombolysis. In AVM embolization, a significantly higher radiation dose was found in the definitive endovascular cure group. Conclusion Various RLs introduced in this study promote the optimization of patient doses in diagnostic and therapeutic interventional neuroradiology procedures. Proposed 3rd quartile DAP (Gy·cm2) values were 101.6 for diagnostic cerebral angiography, 199.9 for aneurysm coiling, 225.1 for stroke thrombolysis, and 412.3 for AVM embolization. Continual evolution of practices and technologies requires regular updates of RLs.

PURPOSE: To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms across multi-centers and propose a diagnostic reference level (DRL). MATERIALS AND METHODS: We studied a sample of 490 diagnostic and 371 therapeutic procedures for intracranial aneurysms, which were performed at 23 hospitals in Korea in 2015. Parameters including dose-area product (DAP), cumulative air kerma (CAK), fluoroscopic time and total angiographic image frames were obtained and analyzed. RESULTS: Total mean DAP, CAK, fluoroscopy time, and total angiographic image frames were 106.2 ± 66.4 Gy-cm2, 697.1 ± 473.7 mGy, 9.7 ± 6.5 minutes, 241.5 ± 116.6 frames for diagnostic procedures, 218.8 ± 164.3 Gy-cm², 3365.7 ± 2205.8 mGy, 51.5 ± 31.1 minutes, 443.5 ± 270.7 frames for therapeutic procedures, respectively. For diagnostic procedure, the third quartiles for DRLs were 144.2 Gy-cm² for DAP, 921.1 mGy for CAK, 12.2 minutes for fluoroscopy times and 286.5 for number of image frames, respectively. For therapeutic procedures, the third quartiles for DRLs were 271.0 Gy-cm² for DAP, 4471.3 mGy for CAK, 64.7 minutes for fluoroscopy times and 567.3 for number of image frames, respectively. On average, rotational angiography was used 1.5 ± 0.7 times/session (range, 0-4; n=490) for diagnostic procedures and 1.6 ± 1.2 times/session (range, 0-4; n=368) for therapeutic procedures, respectively. CONCLUSION: Radiation dose as measured by DAP, fluoroscopy time and image frames were lower in our patients compared to another study regarding cerebral angiography, and DAP was lower with fewer angiographic image frames for therapeutic procedures. Proposed DRLs can be used for quality assurance and patient safety in diagnostic and therapeutic procedures.
Angiography ; Cerebral Angiography ; Fluoroscopy ; Humans ; Intracranial Aneurysm* ; Korea ; Patient Safety ; Radiation Exposure*

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovial membrane and causing joint damage and bone destruction. The symptoms of cricoarytenoid joint (CJ) arthritis often include hoarseness, and a sense of pharyngeal fullness in the throat. Sometimes, in cases with bilateral CJ involvement, an urgent tracheostomy might be required for acute airway obstruction. In this report, we describe a 45-years-old man suffering from voice change and aspiration due to hampered adduction of the vocal fold that was caused by RA with bilateral CJ involvement. The medication treatment for RA was carried out and the patient retrieved her normal voice after one month.
Airway Obstruction ; Arthritis ; Arthritis, Rheumatoid ; Arytenoid Cartilage ; Hoarseness ; Humans ; Joints ; Pharynx ; Stress, Psychological ; Synovial Membrane ; Tracheostomy ; Vocal Cord Paralysis ; Vocal Cords ; Voice

Warthin's tumor (Papillary cystadenoma lymphomatosum) is a slowly growing benign tumor. It is usually found in the parotid gland but sometimes in extraparotid locations such as periparotid lymph nodes and jugular lymph nodes. We here report the case of a 65-year-old male patient with multiple neck masses. The computed tomographic scan showed multiple masses in the left parotid gland, at the left mid-neck and right upper neck. We enucleated the intraparotid mass and excised multiple neck mass. The histopathologic examination revealed Warthin's tumor, which is multifocal and is found in multisites.
Adenolymphoma ; Aged ; Cystadenoma ; Humans ; Lymph Nodes ; Male ; Neck ; Parotid Gland

PURPOSE: This research was conducted to assess the incidence, clinical characteristics, and treatment outcomes for desmoid tumors in patients with familial adenomatous polyposis (FAP). METHODS: At Medical Center, we recruited 47 patients who had been diagnosed as having intraabdominal or abdominal wall desmoid tumor between Aug. 1995 and Dec. 2005. We compared FAP-associated desmoid tumors with non-FAP-associated desmoid tumors according to clinical characteristics and treatment outcomes. RESULTS: Desmoid tumors developed 12/46 (26.1%) in FAP, 1/14 (7.1%) in attenuated FAP and 34 in non-FAP associated. Unlike non-FAP-associated desmoid tumors, the occurrence of FAP-associated desmoid tumors in tended to be higher in the earlier age groups (< or =40 yrs, 92.3% vs 67.6%, P=0.082) and no sexual predominancy was observed (male:female ratio of 1.2:1 vs a tumor ratio 1:3.9, P=0.033). Intraabdominal-type desmoid tumors associated for the majority of FAP-associated desmoid tumors (92.3% vs 38.2%, P=0.002), and 70% of the desmoid tumors occurred within 3 years after total proctocolectomy. In the treatment of FAP-associated intraabdominal desmoid tumors, surgery was performed in 7 cases (58.3%), and complete resections were done in only 3 cases (25%), with one recurrence. In non-FAP-associated desmoid tumors, complete resection was possible in 10 cases (76.9%), and there was no recurrence (P=0.036). The medical treatment for unresectable or incompletely resectable cases in cases of non-FAP-associated desmoid tumor was good, but for FAP-associated desmoid tumors, the effectiveness was not good, and further investigation was needed. CONCLUSIONS: Intraabdominal desmoid tumors in FAP patients occurred frequently in the early (< or =3 yrs) postoperative period, and the treatment, outcome including surgery and medication, outcome was not good in patients with FAP-associated desmoid tumors.
Abdominal Wall ; Adenomatous Polyposis Coli ; Fibromatosis, Aggressive ; Humans ; Incidence ; Postoperative Period ; Recurrence

PURPOSE: This study was performed to assess postoperative complications and recurrence rates and to elucidate the risk factors in Crohn's disease (CD). METHODS: A retrospective review was undertaken for patients who had undergone bowel surgery at Asan Medical Center between October 1991 and June 2006. Symptomatic recurrence was defined as the presence of symptoms related to CD that was subsequently verified by radiologic or endoscopic finding. Surgical recurrence was defined as the need for repeated surgery for enteric CD. RESULTS: There were 160 patients with a mean follow up of 34 months (108 men and 52 women; mean age: 29.7+/-10.9). The most common indication for surgery was a complication of CD, such as intra-abdominal abscess (31.9%), intestinal obstruction (21.9%), and internal fistula (19.4%). Another frequent indication was medical intractability (23.8%). The types of surgical procedures were ileocolic resection (50.0%), small bowel resection (25.0%), total/subtotal colectomy (17.5%), and others. The cumulative symptomatic recurrences were 15.9% and 36.4% at 2 and 5 years, and the cumulative surgical recurrence was 13.6% at 5 years. The cumulative surgical recurrence was higher for stricturing-type CD than for penetrating-type CD (P=0.049). No other significant risk factor for recurrence was found in our study. Twenty patients (12.5%) had postoperative complications, such as intra-abdominal abscess, anastomosis leakage, obstruction, and wound infection. CONCLUSIONS: The postoperative complication and recurrence rates were acceptable. For stricturing-type Crohn's disease surgical recurrence is higher than penetrating type, but long-term follow up is needed to verify the risk factors for recurrence.
Abdominal Abscess ; Colectomy ; Crohn Disease ; Fistula ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Risk Factors ; Wound Infection

PURPOSE: An individualized surveillance protocol based on stratified prognostic factors is needed for the early detection of recurrent disease. The aim of this study was to determine both the clinicopathological characteristics for early-recurring colorectal cancer and the impact on survival. METHODS: From January 1996 to September 2000, 1,504 patients with curatively resected colorectal cancer were recruited. The primary goal of this study was to evaluate the time interval until first loco-regional or distant recurrence, and the secondary goal was the last survival status. Early recurrence was defined as recurrence within the first 12 months postoperatively. Clinicopathologic data and preoperative CT records were reviewed. The follow-up period was over 48 months. RESULTS: The 5-year recurrence rate was 25.4%, and 39.5% of these were detected within the first 12 months postoperatively. In the multivariate analysis, the independent prognostic factors for early recurrence were cell differentiation (PD/MUC/SRC), lymphovascular invasion, and absence of adjuvant chemotherapy in stage III and curatively resected colorectal cancer in stage IV. Inaccurate interpretation by a low-quality CT scan resulted in a stage III cancer being understaged preoperatively. The 5-year overall survival rate according to the recurrent time interval was significantly different (early recurrence: 7.4% vs. late recurrence: 23.6%, P<0.05). The resection rate was similar in both groups (early recurrence: 22.7% vs. late recurrence: 27.6%, P=0.392). CONCLUSIONS: Colorectal cancer that recurred within 12 months showed more aggressive biologic behaviors and poor survival. Understaging caused by incomplete preoperative evaluation for disease extension may cause treatment failure.
Cell Differentiation ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Recurrence ; Survival Rate ; Treatment Failure

PURPOSE: Surgical resection is still considered as the gold standard in patients with hepatic metastases from colorectal cancer. The impact of the number of hepatic metastases is a controversial issue. We aimed to evaluate the outcomes and the prognostic factors after hepatic resection in multiple hepatic metastases from colorectal cancer. METHODS: Between June 1989 and October 2005, 42 patients underwent hepatic resections for three or more hepatic metastases from colorectal cancer. Disease-free survival analyses were performed on patients grouped as a function of the following factors: age, sex, preoperative serum CEA level, primary tumor site, nodal status, intrahepatic distribution, diameter of the liver lesion, their number, and the resection margin. RESULTS: Of the 42 patients, 29 (69.0%) developed recurrence (16 in the liver alone, 5 in the liver and another distant site, 8 in a distant site alone) during a median follow-up of 24 months. The overall 1-, 2-, and 5-year survival rates were 89.1%, 58.6%, and 31.8%, respectively. The 1-year and 2-year disease-free survival rates were 38.1 and 29.4%, respectively. There was no postoperative mortality and the morbidity rate was 11.9%. The disease-free survival rate was independently associated with the resection margin of the metastatic tumor (P=0.017). The 1-year disease- free survival rates in patients with more than a 5-mm resection margin and with less than a 5-mm resection margin were 72.7%, and 25.8%, respectively. CONCLUSIONS: If technically feasible, an aggressive hepatic resection should be performed for the treatment of multiple hepatic metastases from colorectal cancer. The surgical resection margin may govern the outcomes in patients with surgically curable hepatic metastases from colorectal cancer.
Colorectal Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Liver ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Survival Rate

PURPOSE: Resection of the bowel or solid organs may be required for pelvic tumor surgery. The present study was performed to assess combined surgical procedures and determine the role of the general surgeon in gynecologic oncology surgery METHODS: We performed a retrospective study of 135 patients with gynecologic malignancy who underwent a combined operation with a general surgeon between January 2000 and December 2005 at Asan Medical Center. The purpose of the combined operation was categorized into 3 groups: a tumor debulking operation, a resolution of intraoperative complications by a gynecologic surgeon, or an intraoperative diagnostic change. RESULTS: The incidence of combined operations for debulking, resolution of intraoperative complications, and intraoperative diagnostic changes were 103 cases (76.3%), 22 cases (16.3%), and 10 cases (7.4%), respectively. Ovarian cancer was the most common gynecologic malignancy (74.1%) and the rate of a combined operation with a general surgeon in ovarian cancer was 18.5% during the time period. Colorectal resection was the most common procedure by a colorectal surgeon (61.5%). Twenty four patients (17.8%) experienced postoperative complications, including ileus, wound infection, pancreas leakage, and stomal necrosis, with no significant differences according to the purpose of combined operation, pathologic diagnosis, or bowel preparation. The rate of a preoperative consultation to a general surgeon by gynecologic surgeons in cases with colorectal or solid organ invasion preoperatively was 53.2%. CONCLUSION: A general surgeon is an important consultant in a debulking operation of gynecologic malignancies, especially ovarian cancer, or treatment of complications. Thorough preoperative evaluation, bowel preparation, and preoperative consultation to a general surgeon is important in gynecologic oncology surgery.
Consultants ; Humans ; Ileus ; Incidence ; Intraoperative Complications ; Necrosis ; Ovarian Neoplasms ; Pancreas ; Postoperative Complications ; Retrospective Studies ; Wound Infection

PURPOSE: Colorectal cancer is regarded as preventable with routine checkups. The purpose of this study was to evaluate the usefulness of each test performed during routine checkups and to assess the clinicopathological characteristics of colorectal cancer detected at the Health Promotion Center (HPC). RESULTS: We recruited 120 colorectal cancer patients identified on routine checkup at the HPC. The control group was composed of 3,829 colorectal cancer patients who underwent surgery during the same period. Clinicopathological variables were compared using the chi-square test. RESULTS: The male-to-female ratio was 79:41; the mean age was 57.9 (30~78) years. The incidence of right colon cancer was 16.7%, and that of left colon cancer was 83.7%. Sigmoidoscopy (55.5%), colonoscopy (28.3%), and fecal occult blood tests (FOBT, 10.8%) were used for detecting colorectal cancer. The overall positive rates of FOBT and serum carcinoembryonic antigen (CEA) were 28.3% and 20.8%, respectively, but were higher in advanced colon cancer (49.0% and 31.4%) and right colon cancer (60% and 25%). Early colorectal cancer was more frequent in the study group (54.9%) than in the control group (16.9%, P<0.001). Right colon cancer was significantly associated with advanced colon cancer (80%), and left colon cancer was associated with early colon cancer (62.3%, P=0.001). CONCLUSIONS: Endoscopy, including sigmoidoscopy and colonoscopy, played a crucial role in detecting early colorectal cancer at the HPC. Including endoscopy in basic routine checkup programs should help to increase early detection of colorectal cancer.
Carcinoembryonic Antigen ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms* ; Endoscopy ; Health Promotion* ; Humans ; Incidence ; Occult Blood ; Sigmoidoscopy