Concurrent treatment with ursolic acid and low-intensity treadmill exercise improves muscle atrophy and related outcomes in rats

The objective of this study was to analyze the concurrent treatment effects of ursolic acid (UA) and low-intensity treadmill exercise and to confirm the effectiveness of UA as an exercise mimetic to safely improve muscle atrophy-related diseases using Sprague-Dawley (SD) rats with skeletal muscle atrophy. Significant muscle atrophy was induced in male SD rats through hind limb immobilization using casting for 10 days. The muscle atrophy-induced SD rats were group into four: SED, sedentary; UA, daily intraperitoneal UA injection, 5 mg/kg; EX, low-intensity (10–12 m/min, 0° grade) treadmill exercise; and UEX, daily intraperitoneal UA injection, 5 mg/kg, and low-intensity (10–12 m/min, 0° grade) treadmill exercise. After 8 weeks of treatment, endurance capacity was analyzed using a treadmill, and tissues were extracted for analysis of visceral fat mass, body weight, muscle mass, expression of muscle atrophy- and hypertrophy-related genes, and endurance capacity. Although the effects of body weight gain control, muscle mass increase, and endurance capacity improvement were inadequate in the UA group, significant results were confirmed in the UEX group. The UEX group had significantly reduced body weight and visceral fat, significantly improved mass of tibialis anterior and gastrocnemius muscles, and significantly decreased atrophy-related gene expression of MuRF1 and atrogin-1, but did not have significant change in hypertrophy-related gene expression of Akt and mTOR. The endurance capacity was significantly improved in the EX and UEX groups. These data suggest that concurrent treatment with low-intensity exercise and UA is effective for atrophy-related physical dysfunctions.

Evaluation of cytolytic activity and phenotypic changes of circulating blood immune cells in patients with colorectal cancer by a simple preparation of peripheral blood mononuclear cells / 대한외과학회지

PURPOSE: This study aimed to assess the cytolytic activity and the phenotype of circulating blood immune cells in cancer patients by using a simple preparation of peripheral blood mononuclear cells (PBMCs). METHODS: Peripheral blood was obtained from 94 diagnosed colorectal cancer (CRC) patients and 112 healthy donors. PBMCs were cocultured with K562 cells for 2 hours and lactate dehydrogenase released from the dead K562 cells was measured by using a spectrophotometer. Meanwhile, PBMCs were stained with fluorescence conjugated monoclonal antibodies (mAbs) and analyzed by flow cytometry. RESULTS: The cytolytic activity of PBMCs were significantly different between CRC patient and healthy groups (8.82% +/- 3.84% vs. 17.51% +/- 8.57%; P < 0.001). However, no significant difference in the cytolytic activity was observed after surgery in the CRC patient group (before surgery, 8.82% +/- 3.84% vs. after surgery, 9.95% +/- 4.94%; P = 0.326). In addition, the percentage of peripheral blood natural killer cells was significantly higher in the preoperative patient group than in the healthy group (19.97% +/- 11.51% vs. 15.60% +/- 5.77%, P = 0.041). In contrast, the percentage of peripheral blood lymphocytes was lower in the preoperative patient group than in the healthy group (28.41% +/- 8.31% vs. 36.4% +/- 8.6%, P < 0.001). CONCLUSION: These results demonstrate that circulating blood immune cells of CRC patients are functionally impaired and undergo an immunophenotypic perturbation, and show that a simple preparation of PBMCs can be useful to evaluate cellular immunity in cancer.

Diagnosis and Treatment of Anorectal Lesions in Crohn's Disease

PURPOSE: Anorectal lesions in patients with Crohn's disease (CD) are difficult to manage because of frequent recurrences and complications. The aim of this study is to evaluate the relationship between anorectal lesions and CD and to analyze the methods of management and the results of anorectal lesions. METHODS: The records of 33 patients with CD who had anorectal lesions, who visited our institution from July 2001 to June 2007, were reviewed retrospectively. RESULTS: CDs involving the small and the large bowel in 24 patients, the small bowel in 4 patients, the large bowel in 4 patients, and only the anorectum in 1 patient. Twenty-two patients (75.9%) were diagnosed as CD with unusual anorectal findings: unhealed wound or delayed healing of wound after the initial anal operation, multiple ulcers or fissures, broad based or friable fistula tract, non-cryptoglandular type of fistula, multiple fistula tracts, and recurrent or concurrent fistula. The predominant type of anorectal lesion was a perianal fistula (28 patients, 84.8%). Twelve out of 45 anal specimens (26.7%) showed noncaseating epithelioid granulomas, characteristic findings of CD. Conservative treatment was performed in 7 patients (21.2%), anorectal operations in 26 patients (78.8%). Twelve of those 26 patients underwent multiple operations. Anorectal operations were performed as follows: incision and drainage (8), fistulotomy or fistulectomy (17), muscle-preserving surgery (7), seton drainage (12), and modified Hanley's procedure (1). All anorectal operations, except those for an abscess, were performed after induction of remission of the CD. Satisfactory results were achieved in 29 patients (87.9%). CONCLUSION: In patients with unusual anorectal lesions, a diagnostic work-up for CD should be performed. Anorectal lesions with CD may be properly managed using several different methods, depending on the anorectal conditions and the activity of the CD.

The role of p38 MAP kinase on RANKL regulation in mouse periodontal ligament fibroblasts / 대한치주과학회지

No abstract available.

Traumatic Hip Dislocation in Children: Case Report

From August 1998 to June 2005, we treated 5 children (7 cases) who suffered with traumatic dislocation of hip. The mean follow-up period was 4.1 years (range: 1~8 years). Acceptable reduction was achieved in all cases by first closed reduction. The complications were 2 redislocations in 2 patients, respectively. Closed reduction is an effective method for treating traumatic dislocation of the hip in children and long term follow-up should be performed for detecting late-onset complications such as avascular necrosis, growth disturbance and traumatic osteoarthritis.

Comparative Study of Bipolar Hemiarthroplasty and Second Generation Intramedullary Nailing on Treatment of Elderly Unstable Peritrochanteric Femoral Fractures

PURPOSE: To evaluate and compare the clinical and radiological outcome of bipolar hemiarthroplasty and second generation intramedullary nailing for elderly unstable peritrochanteric femoral fracutre. MATERIALS AND METHODS: From January 2000 to July 2004, 56 elderly unstable peritrochanteric fractures were treated with a bipolar hemiarthroplasty (34 cases) or a ITST intramedullary nailing (22 cases). The fractures were classified using the OTA/AO classification. The clinical results were evaluated by walking capability, hip joint pain, and thigh pain. The radiological results were evaluated on the basis of the radiographs at follow-up. RESULTS: In bipolar hemiarthroplasty group, The mean operation time was 134 minute, the mean blood loss was 648 ml. In intramedullary nailing group, The mean operation time was 103 minute, the mean blood loss was 386 ml. There were no different walking ability between prefracture and postoperative state in 22 cases (65%) of bipolar hemiarthroplasty group, 18 cases (80%) of intramedullary nailing group respectively. There were 5 cases (14%) hip joint pain in bipolar hemiarthroplasty group and 4 cases (18%) thigh pain in ITST intramedullary nailing group postoperatively. CONCLUSION: Comparing the operation time, blood loss, and walking ability, ITST intramedullary nailing group show superior clinical outcomes than bipolar hemiarthroplasty group. However, The effort for decreasing postoperative thigh pain might be required.

Effect of chitosan on bone matrix expression and mineralization in primary rat calvarial cell / 대한치주과학회지

Periodontal therapy has dealt primarily with attempts at arresting progression of disease, however, more recent techniques have focused on regenerating the periodontal ligament having the capacity to regenerate the periodontium. The effect of chitosan, a carbohydrate biopolymer extracted from chitin, on periodontal ligament regeneration is of particular interest. The purpose of this study was to evaluate the effect of chitosan on the expression of extracellular matrix proteins in primary rat calvarial cells in vitro. In the control group, cells was cultured with BGJb media. In the experimental groups, cells were cultured with chitosan in concentration of 0.01, 0.1, 1.0 and 2.0 mg/ml. Then each group was characterized by examining alkaline phosphatase activity at 3 and 7 days, and the ability to produce mineralized nodules of rat calvarial cells at 14 and 21 days. Synthesis of type I collagen (COL-I), osteocalcin (OCN), bone sialoprotein (BSP) was evaluated by RT-PCR at 14 days. The results were as follows: 1. Alkaline phosphatase activity was significantly higher in the concentration of chitosan 0.01mg/ml, 0.1mg/ml and 1.0mg/ml compared to control (p<0.05). 2. The percentage of mineralized bone nodule was more in the concentration of chitosan 0.1mg/ml and 1.0 mg/ml than the control. 3. At 14 day culture, the expression of OCN was increased by chitosan in concentration of 1.0 mg/ml and 2.0 mg/ml. These results suggested that chitosan in concentration of 0.1 and 1.0 mg/ml stimulate the extracellular matrix of primary rat calvarial cells and may facilitate the formation of bone.

Effect of Critical Pathway of Lumbar Posterolateral Fusion in Spinal Stenosis / 대한정형외과학회잡지

PURPOSE: This study was conducted to identify the effects of the critical pathway (CP) on the quality of medical care, and to determine means of reducing costs for lumbar posterolateral fusion in patient with lumbar spinal stenosis. MATERIALS AND METHODS: The subjects were 25 control patients with lumbar posterolateral fusion, and 25 experimental patients with application of CP. We compared the patients' functional status using the Oswestry disability index, patients'satisfaction by quality patient care scale, the length of hospitalization and the medical charges between the two groups. RESULTS: Differences between the Oswestry disability index of the experimental and control groups were not significant. No differences were found between two groups regarding general care, but the experimental group was more satisfied with specific care related to spinal fusion. The mean length of stay of the experimental group was shorter than that of the control group, and the charge of medication and treatment of the experimental group was lower than that of the control group. CONCLUSION: Critical pathway improves the quality of care and reduces medical charges.

Role of the Nuclear Transcription Factor NF-kappa B Caused by Acute Hypoxia in the Heart

PURPOSE: Nuclear factor-kappa B(NF-kappa B) is now recognized as playing a potential role in programmed cell death and the adaptive response to various stress. Cellular hypoxia is a primary manifestation of many cardiovascular diseases. It seems that vascular endothelial growth factor (VEGF) and insulin like growth factor-I(IGF-I) have a function as a protective molecule in the heart against several stress including hypoxia. In this study, the role of NF-kappa B to the cellular response and regulation of protective molecules against the acute hypoxia in the heart was studied. METHODS: To cause acute hypoxic stress to the heart, Sprague Dawley rats were exposed to hypoxic chamer(N2 92% and O2 8%). After the hypoxic exposure, nuclear proteins, total proteins and mRNA were isolated from heart. Translocation of the transcription factors NF-kappa B, NF-ATc, AP-1 and NKX-2.5 were evaluated by electrophoretic mobility shift assay(EMSA). The expression of IGF-I and VEGF were studied before and after the hypoxic stress by competitive-PCR, Northern hybridization and Western hybridization. To confirm the role of the NF-kappa B in the heart, the rats also were pretreated with diethyl-dithiocarbamic acid(DDTC) into peritoneal cavity to block NF-kappa B translocation into nucleus. RESULTS: The expression of NF-kappa B, AP-1 and NF-ATc were increased by the hypoxic stress. Increased expression of the VEGF and IGF-I were also observed by the hypoxic stress. However, the blocking of the NF-kappa B translocation reduced those expressions of VEGF and IGF-I. CONCLUSION: These results suggest that NF-kappa B has a protective role against the acute hypoxia through several gene expression, especially VEGF and IGF-I in heart muscle.

Combined Modality Treatment in Nasopharyngeal Carcinoma / 대한방사선종양학회지

PURPOSE: We performed a retrospective analysis to compare short term results of induction chemotherapy-radiotherapy versus concurrent chemo-radiotherapy in patients with locally advanced nasopharyngeal carcinoma. MATERIALS AND METHODS: From Oct. 1989 to May 1998, 62 patients with locally advanced nasopharyngeal carcinoma were treated with induction chemotherapy followed by radiotherapy (induction group) or concurrent chemo-radiotherapy (concurrent group). Induction chemotherapy was done for 50 patients, and concurrent chemotherapy for 12 patients. Age, sex, performance status, and pathologic types were evenly distributed between two groups. Stage distribution showed 32% with IIB, 30% with III, and 38% with IV in induction group, and 50%, 33.3%, and 16.7% in concurrent group, respectively. Chemotherapy regimen was CF (cisplatin and 5-FU) in both groups, and drug delivery method also same. Cisplatin 100 mg/m2 was intravenously infused on day 1, and 5-FU 1,000 mg/m2 on day 2~6. This was repeated at 3 weeks interval. At the end of radiotherapy, total cycles of chemotherapy were 1~3 (median 2) in both groups. Conventionally fractionated radiotherapy with daily fraction size 1.8~2.0 Gy and 5 fractions/week was done. Total dose was 69.4~86 Gy(median 73.4 Gy) for induction group, and 69.4~75.4 Gy (median 70.8 Gy) for concurrent group. Follow-up time was 9~116 months (median 40.5 months) for induction group, 14~29 months (median 21 months) for concurrent group, respectively. RESULTS: Overall 2 year survival rate (2YSR) for all patients was 78.7%. According to treatment modality, 2YSR were 77% for induction group, 87% for concurrent group (p>0.05). 2 year disease-free survival rate were 56% and 81% (p>0.05), respectively. Complete response to treatment were 75.5% for induction group and 91.7% for concurrent group, but there was no statistical difference. The incidence of grade 3~4 hematologic toxicity during radiotherapy was not differ between two groups, but grade 2 leukopenia was more frequent in concurrent group (18% vs 66.7%). Grade 3~4 mucositis was more frequent in concurrent group (4.0% vs 33.3%). Overall incidence of grade 3~4 acute toxicity during radiotherapy was more frequent in concurrent group (6.0% vs 41.7%, p=0.005). CONCLUSION: Concurrent chemo-radiotherapy showed a trend of improvement in short-term survival and in treatment response when compared with induction chemotherapy-radiotherapy in locally advanced nasopharyngeal carcinoma. More controlled randomized trial are needed.

Hypereosinophilic Syndrome Accompanied by Digital Necrosis

Hypereosinophilic syndrome (HES) is a heterogeneous group of disorders with the common feature of prolonged eosinophilia of unknown cause and associated dysfunctions of organ systems, including the hematologic, cardiovascular, cutaneous, neurologic and respiratory systems, as well as the spleen, liver, eye, and gastrointestinal tract. Bone marrow is involved in almost all subjects, and the most severe complications involve the heart and the central nervous systems. We report a case of HES observed in a 37-year-old man with digital necrosis and persistent eosinophilia lasting for more than 6 months. This patient also showed signs of peripheral neuropathy, cutaneous manifestations, and eosinophilic hyperplasia on the bone marrow biopsy.

Comparative Analysis of Transurethral Resection of the Prostate and Side Firing Laser Prostatectomy(VLAP) / 대한비뇨기과학회지

PURPOSE: Side firing laser prostatectomy(VLAP) is now considered as alternative promise of transurethral resection of the prostate(TURP). This study was designed to compare VLAP to conventional TURP in the efficacy and safety. MATERIALS AND METHODS: There was no significant differences in preoperative clinical characteristics between the TURP group and VLAP group. To evaluate the effectiveness and safety of VLAP, we compared the results of transurethral resection of prostate(TURP, n=115) to laser prostatectomy(VLAP, n=45) in international prostate symptom score(IPSS), maximal flow rate(Qmax), post-voiding residual urine at preoperative, after 1 month, 6 months and 12 months postoperatively. For the VLAP procedure, Nd: YAG was used. Patient was treated with 600micrometer internal reflector fiber covered by crystal glass cadding(SideTrackTM). RESULTS: There was no statistically significant difference in the results between TURP group and VLAP group. TURP group; IPSS of preoperative, after 1 month, 6 months, 12 months was 23.8, 9.0, 9.1, 9.0 and Qmax was 7.8ml/s, 17.0ml/s, 17.1ml/s, 17.6ml/s and residual urine was 159.3ml, 52.7ml, 40.0ml, 34.6ml. VLAP group; IPSS of preoperative, after 1 month, 6 months, 12 months was 22.8, 9.7, 9.8, 9.3 and Qmax was 8.1ml/s, 16.0ml/s, 16.7ml/s, 17.1ml/s and residual urine was 135.7ml, 46.8ml, 34.5ml, 28.1ml. Postoperative period of catheter indwelling and hospitalization was shorter in VLAP group than TURP group(3.7+/-2.0 days vs 5.3+/-1.9 days, 4.5+/-1.6 days vs 6.8+/-3.5 days). CONCLUSIONS: VLAP has no siginificant complications such as postoperative bleeding, TURP syndrome. VLAP would be recommended as following: 1) prostate weight is smaller, 2) physical status is poor, 3) anticoagulant treatment, 4) when patient wants more safe treatment. We had a good results by means of VLAP. The good results come from the use of internal reflecting type laser fiber. These results suggest that VLAP is considered the most promising alternative to TURP.

Induction Chemotherapy and Radiotherapy in Locally Advanced Non-Small Cell Lung Cancer (NSCLC) / 대한방사선종양학회지

PURPOSE: We performed this study to evaluate the prognostic factors and the effect of induction chemotherapy in locally advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: A retrospective analysis was done for 130 patients with locally advanced NSCLC treated with curative radiotherapy alone or induction chemo-radiotherapy from January 1986 to October 1996. Eighty-five patients were treated with radiotherapy alone, forty-five with induction chemotherapy and radiotherapy. Age, sex, performance status, histopathologic type, and stage were evenly distributed in both groups. The patients were treated with 6 MV or 10 MV X-ray. Conventional fractionation with daily fraction size 1.8~2.0 Gy was done. Of the patients, 129 patients received total dose above 59.6 Gy (56~66 Gy, median 60 Gy). Induction chemotherapy regimen were CAP (Cyclophosphamide, Adriamycin, Cisplatin) in 6 patients, MVP (Mitomycin, Vinblastine, Cisplatin) in 9 patients, MIC (Mitomycin, Ifosfamide Cisplatin) in 13 patients, and EP (Etoposide, Cisplatin) in 17 patients. Chemotherapy was done in 2~5 cycles (median 2). RESULTS: Overall 1-, 2-, and 3-year survival rate (YSR) for all patients were 41.5%, 13.7%, and 7%, respectively (median survival time 11 months). According to treatment modality, median survival time, overall 1-, 2-, and 3-YSR were 9 months, 32.9%, 10.5%, 6% for radiotherapy alone group, and 14 months, 57.8%, 20%, 7.6% for induction chemotherapy group, respectively (p=0.0005). Complete response (CR) to overall treatments was 25% (21/84) in radiotherapy alone and 40.5% (17/42) in induction chemotherapy group (p=0.09). The prognostic factors affecting overall survival were hemoglobin level (p=0.04), NSE (neuron-specific enolase) level (p=0.004), and response to overall treatment(p= 0.004). According to treatment modalities, NSE (neuron-specific enolase) (p=0.006) and response to overall treatment (p=0.003) were associated with overall survival in radiotherapy alone group, and response to overall treatment (p=0.007) in induction chemotherapy group. The failure pattern analysis revealed no significant difference between treatment modalities. But, in patients with CR to overall treatment, distant metastasis were found in 11/19 patients with radiotherapy alone, and 3/13 patients with induction chemotherapy and radiotherapy (p=0.07). Locoregional failure patterns were not different between two groups (10/19 vs 6/13). CONCLUSION: Induction chemotherapy and radiotherapy achieved increased 2YSR compared to radio therapy alone. At least in CR patients, there was decreased tendency in distant metastasis with induction chemotherapy. But, locoregional failures and long-term survival were not improved. Thus, there is need of more effort to increasing local control and further decreasing distant metastasis.

Hypothyroidism Following Surgery and Radiation Therapy for Head and Neck Cancer / 대한치료방사선과학회지

PURPOSE: Radiation therapy in combination with surgery has an important role in the therapy of the head and neck cancer. We conducted a prospective study for patients with head and neck cancer treated with surgery and radiation to evaluate the effect of therapies on the thyroid gland, and to identify the factors that might influence the development of hypothyroidism. MATERIALS AND METHODS: From September 1986 through December 1994, 71 patients with head and cancer treated with surgery and radiation were included in this prospective study. Patients' age ranged from 32 to 73 years with a median age of 58 years. There were 12 women and 59 men. The primary tumor sites were larynx in 34 patients, hypopharynx in 13 patients, oral cavity in 12 patients, unknown primary of the neck in 6 patients, salivary gland in 3 patients, maxillary sinus in 2 patients, and oropharynx in 1 patient. Total laryngectomy with neck dissection was carried out in 45 patients and neck dissection alone in 26 patients. All patients were serially monitored for thyroid function (T3, T4, free T4, TSH, antithyroglobulin antibody and antimicrosomal antibody) before and after radiation therapy. Radiation dose to the thyroid gland ranged from 40.6Gy to 60Gy with a median dose of 50Gy. The follow-up duration was 3 to 80 months. RESULTS: The overall incidence of hypothyroidism was 56.3% (40/71); 7 out of 71 patients (9.9%) developed clinical hypothyroidism and 33 patients (46.4%) developed subclinical hypothyroidism. No thyroid nodules, thyroid cancers, or hyperthyroidism was detected. Hypothyroidism developed earlier in patients who underwent total laryngectomy with neck dissection than in patients with neck dissection alone (P<0.05). The risk factor that significantly influenced the incidence of hypothyroidism was a combination of surgery (total laryngectomy with neck dissection) and radiation therapy (P= 0.0000). Four of 26 patients (15.4%) with neck dissection alone developed hypothyroidism while 36 of 45 patients (80%) with laryngectomy and neck dissection developed hypothyroidism. CONCLUSION: The hypothyroidism following surgery and radiation therapy was a relatively common complication. The factor that significantly influenced the incidence of hypothyroidism was combination of surgery and radiation therapy. Evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests is recommended for an early detection of hypothyroidism and thyroid hormone replacement therapy is recommended whenever hypothyroidism develops.

A Ureteroduodenal Fistula Associated with Adenocarcinoma of the Renal Pelvis / 대한비뇨기과학회지

Spontaneous fistula formation between the ureter and duodenum is extremely rare. The underlying cause of fistula between upper urinary tract and GI system is tuberculosis, chronic inflammation, carcinoma and GI diseases. Renal pelvis adenocarcinoma is also rare. We report a case of ureteroduodenal fistula associated with adenocarcinoma of the renal pelvis in 65-year old female with a brief review of literature.

Radiotherapy of Metastatic Neck Nodes from an Unknown Primary Site / 대한치료방사선과학회지

PURPOSE: This study was to evaluate survival, failure patterns, and prognostic factors of patients with metastatic neck nodes from an unknown primary site. MATERIALS AND METHODS: A retrospective analysis was done for 35 patients with metastatic neck nodes from an unknown primary site who were treated with radiation from January 1986 to September 1994. There were 26 male and 9 female patients. Patients' age ranged from 41 to 74 years (median 58 years). Stage distribution showed 1 patient with N1, 27 with N2, and 7 with N3. Amomg these patients, 7 with a supraclavicular lymph node alone were included. The histologic type was squamous cell carcinoma in 22 patients, undifferentiated carcinoma in 6, adenocarcinoma in 4. We could not classify a histologic type in 3 patients. Radiation therapy alone was done in 7 patients, induction chemotherapy and radiation therapy in 10, and postoperative radiation therapy in 18. Radiation therapy fields included both neck and pharyngeal axis, and total dose was 40-95.6Gy (median 60Gy) using 6MV X-ray. Chemotherapy consisted of 2 cycles of 5-fluorouracil and cisplatin. Surgical methods were a radical neck dissection in 17 patients and an excisional biopsy in 1 patient. Follow-up time ranged from 2 to 95 months, median 15 months. RESULTS: Overall and disease-free survival rate at 4 years were 33.4% and 33.9%, respectively. The factors associated with the overall survival rate were histologic type(adenocarcinoma vs. non-adenocarcinoma, p=0.0005), N stage(p=0.023), and the site of involved nodes(p=0.021). According to the treatment modality, 2-year survival rate was 14.3% in radiation therapy alone group, 35.8% in induction chemotherapy and radiation thrapy, and 37.5% in postoperative radiation therapy(Fig. 4, p=0.05), which might be due to the difference of N stage distribution. The failure patterns were analyzed in 25 patients with a complete response to the treatment. Local failure wasnoted in 7 patients, distant metastases in 6, local failure and distantmetastases in 1. Excluding the 7 patients with supraclavicular lymph node metastaes alone, 28%(7/25) of the patients had distant metastases. During the follow-up period, 11%(3/35) of the patients showed a delayed primary site, 1 in oral cavity, 1 in nasopharynx, and 1 in hypopharynx. CONCLUSION: N stage, the site of involved node, and histologic type were associated with survival rate. In patients with advanced N stage, curative rather than inductive chemotherapy is needed because combined surgery and radiation therapy achieved poor results and considerable patients developed distant metastases.

Radiotherapy Results of Midline Malignant Reticulosis (MMR) / 대한치료방사선과학회지

PURPOSE: This study was performed to evaluate survival, failure patterns, and prognositc factors of MMR patients after radiation therapy. We also discussed the need for chemotherapy. MATERIALS AND METHODS: A retrospective analysis was done for 23 patients with MMR who were treated with radiation therapy form June 1985 to November 1992. There were 19 male and 4 female patients. The patients' age ranged from 17 to 71 years(median 39 years). Systemic symptoms including fever, weight loss, or malaise were found in 30% of the patients. He nasal cavity was most frequently involved. No patients had nodal involvement at diagnosis. There were 2 patients with distant metastasis at presentation. Radiation therapy was delivered five times a week, 1.8 Gy daily, total 45~54 Gy(median 50.4 Gy) using 6 MV X-ray. No patients received chemotherapy as initial treatment. RESULTS: Overall 5-year and 10-yar survival rates were 52.4% and 44.1%, respectively. Seventy percent(12/17) of the patients achieved complete response to radiotherapy., and 29.4%(5/17) achieved partial response. The patients with complete response showed a better 5-year survival rate than those with partial response (66.9% vs. 20%, p-0.004). Symptom duration before diagnosis, the presence of systemic symptom, ad the number of primary sites had no influence on survival. The patterns of failure were as flows: local failure(1), failure in adjacent site(1), local and distant failure(1), distant metastasis(2), and conversion to malignant lymphoma(1). W could not find factors associated with the patterns of failure. CONCLUSION: The most important factor associated with survival was the response to radiotherapy. Seventeen percent of the patients had distant metastasis, and the salvage after distant metastasis was not successful. However, about 50% of the patients could achieve long-term survival with local radiation therapy alone. Therefore, chemotherapy of MMR should be done after a prospective randomized study for the factors associated with distant metastasis.

Influence of Total Laryngectomy on spinal Cord Dosein Advanced Laryngeal Cancers / 대한치료방사선과학회지

PURPOSE: This analysis was to evaluate the radiation dose around a tracheostoma and spinal cord in the case of advanced laryngeal cancers in which a total laryngectomy was done before radiotherapy. METHODS AND MATERIALS: The radiation dose around a tracheostoma and spinal cord was measured by thermoluminescence and film dosimety in the phantom. Radiotherapy treatment planning was done in 12 cases of advanced laryngeal cancer and compared with the measured dose in the phantom. RESULTS: Mean spinal cord doses in the phantom by thermoluminescence dosimetry were 86.4% (with a tracheostoma), 80.1% (without a tracheostoma). and the difference was 6.3%. Mean spinal cord doses in the phantom by film dosimetry were 84.7% (with a tracheostoma), 79.0% (without a tracheostoma), and the difference were 5.7%, Calculated spinal cord doses in the phantom were 84.0% (with a tracheostoma), 78.0% (without a tracheostoma), and the difference was 6.0%. Mean calculated spinal cord doses in 12 patients were 83.1% (with a tracheostoma), 76.9% (without a tracheostoma), and the difference was 6.2%. Measured dose of lateral and posterior wall of the tracheostoma by film was low (depth of maximum dose 12 mm). CONCLUSION: In the treatment planning of the advanced laryngeal cancers, the radiation dose of the tracheostoma and spinal cord should be evaluated and be followed by an appropriate management such as a bouls or a brachytherapy boost if the dose around the tracheostoma is low.

A Case of Adrenal Neuroblastoma / 대한비뇨기과학회지

Neuroblastoma originate in neural crest and is one of the most frequent tumor next to leukemia and brain tumor in child. The tumor is most highly malignant tumor due to early metastasis at diagnosis. It could be diagnosed by various diagnostic modalities such as roentgenologic examination, laboratory data and confirmed by pathologic diagnosis. Management of neuroblastoma is surgery, radiotherapy and chemotherapy. We experienced a case of adrenal neuroblastoma at age of 20-month male child and report with a brief review of literature

Comparison of the Result of Radiation Alone and Chemoradiation in Cervical Cancer / 대한치료방사선과학회지

PURPOSE: This analysis was to compare the result of radiation alone and chemoradiation in cervical cancer in terms of response, survival, failure, and complication. MATERIALS AND METHODS: A retrospective analysis of 135cervical cancer patients treated with definitive radiotherapy from November 1985 to December 1991 was performed. Fifty-six patients were treated with radiation alone and 79 patients were treated with cisplatin-based chemotherapy plus radiation. Follow-up period ranged from 5 to 105 months with a median 47 months. According to the FIGO classification, the patients were subdivided into 18(13.3%) stage IB, 7(5.2%) stage IIA, 97(71.9%) stage IIB, and 9(6.7%) stage IIIB. RESULTS: A complete response was noted in 51 patients (91.1% of the radiation alone group, and 68 patinets(86.1%) of the chemoradiation group. There was no statistical difference in complete response rate between the two groups. Overall survival rate at 5 years was 73.3%. According to stage, overall survival rates at 5 years were 88.9% in stage IB, 85.7% in stage IIA, 73.8% in stage IIB, and 37.5 in stage IIIB, respectively. According to treatment modality, overall survival rates at 5 years were 81.9% in the radiation alone group, 67.0% in the chemoradiation group (p=0.22). Disease-free survival rate at 5 years were 70.4% in the radiation alone group, 68.5% in the chemoradiation group(p=0.85). Locoregional control rates at 5 years were 76.1% in the radiation alone group, 73.8% in the chemoradiation group (p=0.70). Distant disease-free survival rates at 5 years were 83.9% in the radiation alone group, 90.3% in the chemoradiation group(p=0.59). Treatment-related bone marrow suppressions were noted in 3 (5.4%) patients of the radiation alone group, 14 patients (17.7%) of the chemoradiation group (p<0.05). Grade 2 vesical complications were noted in 14 patients of the radiation alone group and 10 patients of the chemoradiation group. Grade 2 rectal complications were noted in 2 patients of the radiation alone group, and 3 patients of the chemoradiation group. One case of rectal perforation was noted in the chemoradiation group, and grade 2 small bowel obstructions were noted in 2 patients of the radiation alone group. There were no statistical differences in the incidence of vesical, rectal, and small bowel complications between the two groups. CONCLUSION: No statistical differences was found between the radiation alone group and the chemoradiation group in terms of response, survival, and failure, but the incidence of bone marrow suppression was higher in the chemoradiation group.