Preliminary Report of the 1998~1999 Patterns of Care Study of Radiation Therapy for Esophageal Cancer in Korea / 대한방사선종양학회지

PURPOSE: For the first time, a nationwide survey in the Republic of Korea was conducted to determine the basic parameters for the treatment of esophageal cancer and to offer a solid cooperative system for the Korean Pattern of Care Study database. MATERIALS AND METHODS: During 1998~1999, biopsy-confirmed 246 esophageal cancer patients that received radiotherapy were enrolled from 23 different institutions in South Korea. Random sampling was based on power allocation method. Patient parameters and specific information regarding tumor characteristics and treatment methods were collected and registered through the web based PCS system. The data was analyzed by the use of the Chi-squared test. RESULTS: The median age of the collected patients was 62 years. The male to female ratio was about 91 to 9 with an absolute male predominance. The performance status ranged from ECOG 0 to 1 in 82.5% of the patients. Diagnostic procedures included an esophagogram (228 patients, 92.7%), endoscopy (226 patients, 91.9%), and a chest CT scan (238 patients, 96.7%). Squamous cell carcinoma was diagnosed in 96.3% of the patients; mid-thoracic esophageal cancer was most prevalent (110 patients, 44.7%) and 135 patients presented with clinical stage III disease. Fifty seven patients received radiotherapy alone and 37 patients received surgery with adjuvant postoperative radiotherapy. Half of the patients (123 patients) received chemotherapy together with RT and 70 patients (56.9%) received it as concurrent chemoradiotherapy. The most frequently used chemotherapeutic agent was a combination of cisplatin and 5-FU. Most patients received radiotherapy either with 6 MV (116 patients, 47.2%) or with 10 MV photons (87 patients, 35.4%). Radiotherapy was delivered through a conventional AP-PA field for 206 patients (83.7%) without using a CT plan and the median delivered dose was 3,600 cGy. The median total dose of postoperative radiotherapy was 5,040 cGy while for the non-operative patients the median total dose was 5,970 cGy. Thirty-four patients received intraluminal brachytherapy with high dose rate Iridium-192. Brachytherapy was delivered with a median dose of 300 cGy in each fraction and was typically delivered 3~4 times. The most frequently encountered complication during the radiotherapy treatment was esophagitis in 155 patients (63.0%). CONCLUSION: For the evaluation and treatment of esophageal cancer patients at radiation facilities in Korea, this study will provide guidelines and benchmark data for the solid cooperative systems of the Korean PCS. Although some differences were noted between institutions, there was no major difference in the treatment modalities and RT techniques.

Effects of Zinc and Hypothermic Process during the Light and Dark Adaptation of Vertebrate Retina

PURPOSE: The purpose of this study was to clarify the effects of zinc treatment and hypothermia on visual adaptation and visual sensitivity in bullfrogs (Rana catesbeiana), which are poikilothermal animals capable of adjusting quickly to environmental temperature changes. METHODS: The effects of both zinc treatment and hypothermia on visual sensitivity were studied by using electroretinogram (ERG) recording and absorption spectra scanning before and after zinc and TSQ (N-[6-methoxy-8-quinolyl]-p-toluene sulfonamide) treatment, with or without temperature changes. RESULTS: In spite of malnutrition due to hibernation, the optimal zinc concentration effect was obtained at 10-4 M (10-2 M 200 microliter ZnCl2 in 20 microliter Ringer's solution) according to ERG recording. After zinc treatment and hypothermia induction, increments of all ERG components and thresholds were taken by ERG recording. These results showed that both zinc treatment and hypothermia may increase visual sensitivity during visual adaptation. In spectral scans, the absorbance increment due to zinc treatment and hypothermia was shown over the whole spectral range (400~750 nm), and it was especially prominent at alpha-peak (about 500 nm). In addition, there was a decrease in absorption differences between dark adaptation and light adaptation after zinc treatment. Furthermore, according to the visual sensitivity decrement using TSQ as a zinc specific chelator, this visual sensitivity increase was shown to be caused by zinc. CONCLUSIONS: As the results suggest, both zinc treatment and hypothermic effects may improve visual sensitivity by promoting rhodopsin regeneration and inhibiting rhodopsin bleaching induced by light illumination. Zinc may activate the enzyme activity of retinol dehydrogenase and phosphodiesterase, while hypothermic effects may improve precursor transport, which is required for rhodopsin regeneration, by tightening membrane adhesion between retinas and retinal pigment epithelia. In addition, we believe that zinc treatment and hypothermic effects may work synergistically to accelerate visual sensitivity during visual adaptation.

Comparison of the clinical outcomes between intestinal Behcet's disease and simple ulcer / 대한내과학회지

BACKGROUND: This study was performed to compare the clinical outcomes of intestinal Behcet's disease with a simple ulcer. METHODS: We analyzed the medical records of 52 patients that were suspected as having intestinal Behcet's disease. Of these patients, 27 patients (Group 1) met both the criteria of the International Study Group for Behcet's Disease and the Behcet's Disease Research Committee of Japan. Thirteen patients (Group 2) met only the latter criteria and the other patients (Group 3) did not meet any criteria. The efficacy of medical treatment was assessed by the presence of gastrointestinal symptoms and follow-up colonoscopic findings. RESULTS: The mean age for patients with a diagnosis of an intestinal lesion was 38.6+/-12.2 years. The sex ratio was 1.08:1 (M:F) and the mean follow-up duration was 35.2+/-39.5 months. A single, smaller than 5 mm, round and shallow ulcer with an erythematous margin that was located at the leocecal area showed most typical colonoscopic features for intestinal Behcet's disease. No significant differences were found in the clinical manifestations and colonoscopic findings among the three groups of patients. Nineteen (44%) patients achieved complere remission from a sumptomatic point of view and 10 (39%) patients were proved to be complete remission according to follow up colonoscopy after medical treatment. Eleven patients (21.2%) underwent surgery. The overall cumulative rates of a first surgery and re-surgery were 40.5% and 71.9% at 10 years. No statistical relationship was found in the response of medical treatment and the cumulative rate of surgery among the groups. CONCLUSIONS: The clinical course and outcomes of an intestinal simple ulcer are not different from that for intestinal Behcet's disease.

A Case of Primary Hepatic Epithelioid Hemangioendothelioma Mimicking Metastatic Carcinoma / 대한소화기학회지

Epithelioid hemangioendothelioma is a rare vascular origin tumor which usually occurs in soft tissues, liver, and lung. It usually affects adult women and presents as multiple hepatic nodules with mainly peripheral distribution. It is difficult to diagnose and treat because of non-specific clinical manifestations and findings on the imaging study. Moreover, pathological misdiagnosis is common. We report a case of this rare tumor that was detected incidentally. Final diagnosis was based on histological evidence. A 52-years old man suffered from right upper quadrant abdominal pain for 3 months, and was initially misdiagnosed as a metastatic carcinoma. Physical examination revealed superior cervical lymphadenopathy with mild hepatomegaly. Finally, hepatic epithelioid hemangioendothelioma was diagnosed on the basis of positive immunohistochemical staining for factor VIII, CD34, and VEGF. Our case highlights the importance of a histological diagnosis to avoid misdiagnosis.

Spontaneous Transmesenteric Hernia in Adult

A 27-year-old female patient presented to the emergency room with abdominal pain and vomiting. The clinical findings including the computed tomography (CT) scan, suggested internal herniation. The patient had no history of previous abdominal operation or peritonitis. At the surgery, a part of the distal jejunum and proximal ileum 90 cm in length was herniated through a 4 cm-sized round mesenteric defect of the mesentery. Spontaneous transmesenteric hernia is a rare cause of internal herniation, but the possibility should be kept in mind even when the patient has no history of abdominal operation or peritonitis.

An Analysis Based on Hospital Stay in Ischemic Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Ischemic colitis is the most prevalent form of gastrointestinal ischemia, accounting for approximately 50 to 60% of all gastrointestinal ischemic episodes. There are many conditions that predispose an individual to ischemic colitis as well as a wide variety of clinical and endoscopic presentations. This study reviewed the risk factors associated with ischemic colitis, the site of colonic involvement and the effect of antibiotics on the hospital stay. METHODS: 34 inpatients with ischemic colitis during October 2001 and November 2004 were analyzed retrospectively. All patients had intestinal bleeding. RESULTS: The mean age of the patients was 56+/-14. Among the 34 cases, 15 cases had the risk factors associated with ischemic colitis. The presenting symptoms were mainly abdominal pain and diarrhea. The endoscopic findings revealed four cases with pancolitis. One case with chronic liver disease died from septic shock. The mean hospital stay was 12+/-5 days, which was reduced by early admission and colonoscopic diagnosis, bowel rest and fluid therapy. However, patient's age, clinical presentations, location of the involved colon, the presence of risk factors and the use of antibiotics did not influence the hospital stay. CONCLUSIONS: If ischemic colitis with intestinal bleeding is suspected, an early colonoscopic diagnosis and medical treatment such as bowel rest and fluid therapy can reduce the hospital stay.

The Effect of Radiation Therapy on Hemophilic Arthropathy / 대한방사선종양학회지

PURPOSE: Repetitive bleeding into the joint space is the cause of debilitative hemophilic arthropathy. To interrupt this process, we treated the hemophilic patients suffering from repetitive joint bleeding with radiation therapy. MATERIALS AND METHODS: From 1997 to 2001, a total of 41 joints from 37 hemophilic arthropathy patients were treated with radiation therapy at Kyung Hee University Hospital. The treated joints were 35 ankles, 3 knees and 3 elbows, respectively. The age of the patients ranged from 4 to 27 years (median age: 11 years). The radiation dose ranged from 900 cGy to 2360 cGy (median dose: 900cGy). The fraction size was 150 cGy, 180 cGy or 200 cGy. The number of bleeding in one year before and after radiotherapy was compared. RESULTS: There was a tendency of frequent bleeding for the patients younger than 11 (p=0.051) but there was also a tendency for more improvement in this group (p=0.057). The number of joint bleedings was related with joint pain (p=0.012) and joint swelling (p=0.033) but not with the Arbold-Hilgartner stage (p=0.739), cartilage destruction (p=0.718) and synovial hypertrophy (p=0.079). The number of bleeding was reduced in thirty-three cases, and eight cases showed no improvement after radiation therapy. The average number of bleeding in a month was 2.52 before radiotherapy, but this was reduced to 1.4 after radiotherapy (p=0.017). CONCLUSION: Radiation therapy was effective for the hemophilia patients with repetitive joint bleeding to decrease the bleeding frequency and to prevent hemophilic arthropathy.

A Case Report of Acute Pancreatitis in a CAPD Patient / 대한신장학회잡지

The diagnosis of acute pancreatitis occurred in CAPD patients is quite difficult due to its clinical similarity with acute peritonitis. Delayed diagnosis and treatment of acute pancreatitis in CAPD patients may result in fatal complication. We experienced a case of acute pancreatitis in a CAPD patient. A 62 years old female visited the hospital with acute abdominal pain and cloudy effluent for 3 days. She has been on CAPD for 3 years and had two episodes of peritonitis at 6 months and 1 year before the admission. The causative organism was Streptococcus viridans in each episode. The peritonitis symptoms and peritoneal leukocyte count incresed despite of using Vancomycin(R) and Netilmicin(R). Causative organism was not isolated from dialysis. Serum amylase concentrations increased from 105mg/dL at the admission to 1,052mg/dL on day 10 of admission. Abdominal ultrasonography and abdominal computerized tomogram revealed fat infiltration, focal necrosis and multiple cyst formation at pancreas area. Computerized tomogram guided aspiration cytology revealed acute inflammation and necrosis. Bacteria were not found in the aspirate. Clinical symptoms were improved after discontinuation of CAPD and intraperitoneal use of antibiotics. The patient restarted CAPD on the day 18 and remained without complications. We report this case with a brief review of literatures.

Clinical Considerations for Caudal Anesthesia in Childen / 대한마취과학회지

Caudal epidural anesthesia has become widely accepted as a means of providing postoperative pain relief and mtraoperative supplementation to general anesthesia for children. Caudal anesthesia was given to 63 infants and children under 15 years of age, who received lower abdominal surgery. After thiopental sodium 4-5 mg/kg IV and 1-2Vo1% halothane inhalation, caudal block was performed in the lateral position. Halothane was stopped immediately after caudal block and only 50% NO in oxygen was inhaled through the mask during operation. The patients were randomly divided into four groups: Group 1; 0.33% bupivacaine 0.7 ml/kg, Group 11; 0.33% bupivacaine 1.0 ml/kg, Group III; fentanyl 1 ug/kg combined with 0.33% bupivacaine 1.0 ml/kg, Group IV; 1.5% lidocaine 1.0 ml/kg. The time of onset, duration of analgesia, side effects during and after operation, intial voiding time, and use of analgesics in the ward were observed. The results were as follows: 1) Caudal block was successful at the 1st attempt in most cases. 2) During operation, supplementation of other inhalational anesthesies were need. 3) In all groups, surgical anesthesia could be obtained within 10 minutes. 4) Intraoperative adverse effects were not detected except for minimal movements on skin incision and spermatic cord traction in 12 cases and vomiting in 2 cases. 5) Postoperative analgetic effects were good in all groups, especially in fentanyl group. 6) In most cases, patients ean void within 6 hours without urinary catheterization. 7) Postoperative analgesics were not needed and patients parent's were highly satisfied with caudal anesthesia in all cases. From the above results, it was suggested that caudal anesthesia with 0.33% bupivacaine or 1.5% lidocaine without potent inhalational anesthetics was satisfactory for lawer abdominal surgery and l ug/kg of fentanyl had some benefits in postoperative analgesia in children.

Adrenaogenital Syndrome with Congenital Adrenal Hyperplasia

No abstract available.