Evaluation of Difference between Skin Motion and Tumor Motion for Respiration Gated Radiotherapy / 의학물리

Accounting for tumor motion in treatment planning and delivery is one of the most recent and significant challenges facing radiotherapy. The purpose of this study was to investigate the correlation and clarified the relationship between the motion of an external marker using the Real?Time Position Management (RPM) System and an internal organ motion signal obtained fluoroscope. We enrolled 10 patients with locally advanced lung cancer and liver cancer, retrospectively. The external marker was a plastic box, which is part of the RPM used to track the patient's respiration. We investigated the quantitatively correlation between the motions of an external marker with RPM and internal motion with fluoroscope. The internal fiducial motion is predominant in the caraniocaudal direction, with a range of 1.3~3.5 cm with fluoroscopic unit. The external fiducial motion is predominant in the caraniocaudal direction, with a range of 0.43~2.19 cm with RPM gating. The two measurements ratio is from 1.31 to 5.56. When the regularization guided standard deviation is from 0.08 to 0.87, mean 0.204 cm, except only for patients #3 separated by a mean 0.13 cm, maximum of 0.23 cm. This result is a good correlation between internal tumor motion imaged by fluoroscopic unit and external marker motion with RPM during expiration within 0.23 cm. We have demonstrated that gating may be best performed but special attention should be paid to gating for patients whose fiducials do not move in synchrony, because targeting on the correct phase difference alone would not guarantee that the entire tumor volume is within the treatment field.

Evaluation of clinical methods in the diagnosis of temporomandibular joint disorders: a comparison study with magnetic resonance imaging

PURPOSE: The diagnostic relevancies and characteristics and of clinical methods in the diagnosis of internal derangement (ID) were tested by comparing the results of them with those of magnetic resonance imaging (MRI). METHODS: 75 patients (150 temporomandibular joints; TMJs), who were suspected to have ID by clinical diagnoses, were included. Clinical diagnoses including mouth opening pathway and TMJ sound were conducted and MRI takings were done. Accuracies, sensitivities, specificities, positive predictive values, and negative predictive values of clinical diagnosis, mouth opening pathway, and TMJ sound were calculated by comparing with diagnoses with MRIs. RESULTS: Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis were 59.3%, 83%, 49%, 81%, and 51%. They were 59%, 82%, 25%, 73%, and 35% for mouth opening pathways. Although deviation was somewhat accurate for representing disc displacement with reduction (ADDWR), other discrepancies on opening pathways were not clinically relevant. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clicking sounds were 85%, 49%, 78%, 85%, and 37%. TMJs with crepitus were only three. But all TMJs with crepitus were diagnosed to have disc displacement without reduction (ADDWOR). CONCLUSION: When compared with diagnoses with MRIs, clinical diagnoses for ID were not so accurate. But they were suitable for screening tests for ID. Opening pathways and TMJ sounds were not so relevant in the diagnoses of IDs and so it was concluded that considerations for other factors must be included in the diagnoses of IDs.

Literature review & case report : the conservative treatment of unicystic ameloblastoma

An Ameloblastoma is one of the most common odontogenic tumors. The treatment of ameloblastoma has been controversial because of this disease entity as a slow-growing, locally invasive tumor with high rate of recurrence. Recurrence rate of ameloblastoma are reported 15% to 25% after radical treatment and 75% to 90% after conservative treatment. On the other hand, Robinson and Gardner reported that the recurrence rate after conservative treatment of unicystic ameloblastoma was lower than those of multicystic or solid lesion. In this report, what we want to show is to review the articles to find out pros and cons of conservative treatment of ameloblastoma. In addition we would like to discuss which requies conservative treatment or radical treatment are more acceptable through our case report.

The cDNA microarray study for the effect of FGF-5 administration on fibroblast

Histomorphometric study on the influence of steroid topical irrigation and implant surface on bone healing in the irradiated rabbit tibia

The purpose of this study was to evaluate and compare the influence of Steroid topical irrigation and implant surface on bone healing in the irradiated rabbit tibia. Implant to bone contact surface ratio and the pattern of bone healing around hydroxyapatite(HA) coated implant and pure titanium (Ti) implant which were inserted into the irradiated rabbit tibia were compared. 16 Korean house mature male rabbits were used as experimental animal. Each rabbit received 15 Gy of irradiation. 4 weeks after the irradiation, two holes were prepared in the irradiated tibia of each rabbits, where two surface type of implants were inserted :1) HA coated type and 2) pure Ti type. Right before placing implants, one group of rabbit received steroid irrigation and the other group did saline. After the irrigation, two implants of HA coated type and pure Ti type were inserted into the tibia of each rabbits. Each rabbit were sacrificed at 2nd, 4th, and 8th week after the implantation and the specimens were observed by the light microscope. The pattern of bone healing and histomorphometric analysis of the implant-bone interface were done. The results were as follows. 1. All implants inserted into the irradiated tibia of rabbit did not show any sign of clinical mobility and the bone around implants inserted into the irradiated tibia of rabbit did not show any resorption. 2. The bone to implant contact surface ratio around HA coated implants that received steroid irrigation got more bone to implant contact surface ratio than that of the saline irrigation. This result showed statistically significant(p<0.05). There was no statistically significant difference in 8th week group. 3. Though there was no statistically significant difference HA coated implants had more bone to implant contact surface ratio than pure Ti implant in 2nd and 4th groups, and there was no difference in 8th week group. 4. All implants inserted into the irradiated tibia of rabbit had exhibited successful osseointegraion.

Considerations for Orthodontic Treatment in Elderly Patients

BACKGROUND: The growth of elderly population increased the need for oral health care. Elderly patients with poor teeth alignment needs more attention with orthodontic treatment METHODS: Elderly patients visiting department of orthodontics, Kangdong Sacred Heart Hospital between 2000-2004 were treated with fixed appliances in one or both dental arches. Treatment plans were different from than that of younger patients and included uncommon and strategic removals of teeth and prosthesis. RESULTS: There was decrease in orthodontic treatment forces with increasing age, and the observation made from this study was favorable in the patients' as well as in the orthodontist's, point of view. It was possible to move the remaining teeth considerably, and the retention was made with various fixed appliances. CONCLUSIONS: Orthodontic treatment is not limited by patient age. However, it is wise not to extend treatment goals too far beyond the patients' objective needs

Psoas abscess: Analysis of 24 cases / 대한내과학회지

BACKGROUND: Psoas abscess is a rare condition with vague clinical presentations, therefore misdiagnosis or delayed diagnosis is often made. We have reviewed the characteristics of the clinical presentation, microbiology, and treatment of 24 patients with psoas abscess. METHODS: The records of all patients treated with psoas abscess at Ajou University Hospital between March, 1996 and May, 2001 were retrospectively reviewed. RESULTS: A total of 24 cases of psoas abscess were reviewed: among these 17 cases were due to secondary cases and seven cases were diagnosed as primary psoas abscess. The right side was affected in 11 cases, the left side in nine, and both sides in four. Methicillin-susceptible Staphylococcus aureus was the most frequent (7/24 cases) pathogen, which were detected in cultures from five of seven patients with primary abscesses, whereas Mycobacterium tuberculosis (6/17 cases) and mixed enteric flora were detected in secondary abscesses. Three of the patients with primary psoas abscess expired from septic shock. The mortality rate was 12.5%. CONCLUSION: A psoas abscess should be considered when any patient presents with nonspecific abdominal pain, back pain and fever. This condition may be diagnosed promptly with computed tomography. Treatment involves use of appropriate antibiotics, as well as drainage of the abscess. Antibiotic coverage must include S. aureus and enteric bacteria. However, in endemic areas (such as Korea), tuberculous infection should be also considered.

Reconstruction using mandibular horizontal distraction osteogenesis and implant prosthesis in mandibular deficiency: a case report

Distraction osteogenesis is a biologic process in which new bone is formed between bone fragments being separated by a tractional force. This technique has the advantage of initiating new bone growth without bone transplantation and promoting the growth of soft tissue. Mandibular distraction osteogenesis has shown to be effective to treat congenital or acquired mandibular hypoplasias. On the basis of positive results with implant-supported prostheses, the use of implants in the distracted site can significantly help stabilize the prosthesis. We obtained good result in the patient with mandibular deficiency due to trauma, who have been reconstructed with distraction osteogenesis and implant. We report our experiences with literature view.

THE THREE DIMENSIONAL STRESS ANALYSIS ON VARIOUS DIRECTIONS OF THE MANDIBULAR CONDYLE MOVEMENT BY USING FINITE ELEMENT METHOD

The condyle head of mandible was usually influenced by the stressful forces generated from a voluntary movement of bone fragment after the sagittal ramus osteotomy which would be mainly performed for the mandibular deformity patient. In this study we measured the stress values exerted on condyle and evaluated which area of condyle had a more stress concentration while condyle head moved in X, Y and Z axis by using a 3 dimensional finite element model. The result were as follows: 1. On bodily movement, the value of maximum force was 40.98Kg/cm2 at the (-X) direction and the stress area was the center of superiposterior nonaticular area of the condyle. 2. On ratational movement, the value of maximum force was 173.1Kg/cm2 at the (+Y) direction and the stress area was the anterior area of condyle neck. 3. From the general point of view there were more stress on rotational movement than on bodily movement. 4. The stress concentration area was the condyle head on bodily movement and the condyle neck on ratational movement. 5. From the result of this study. We found out that this results were a correspondence with clinical predictions in which a condyle head got the most stress concentration only when a condyle head in the posterior rotational position during orthognathic surgery. 6. The results of this study show that we should consider not to place the condyle head in the posterior position and posterior rotational position during orthognathic surgery.

RECONSTRUCTION WITH METAL PLATE AND ILIAC BONE GRAFT ON AMELOBLASTOMA

This is to report a case of immediate reconstruction after hemimandibulectomy by using of bicorticocancellous block bone harvested from the iliac crest in the case of an ameloblastomaon the mandible. Because the lesion involved condylar area, it was reconstructed with titanium artificial condyle attached to A/O metal plate. Three weeks after the operation, infection developed with suppuration and was well treated with adequate antibiotic therapy and drainage. The patient has been followed up over a four-year period and taken an orthopantomogram every three or six month for the examination of mandibular movement, the potentiality of recurrence and the remodeling of the grafted bone. At present, the patient is satisfied with her appearence and has a normal occlusion with proper masticatory function, and there is no sign of recurrence.

A Case of Primary Adenocarcinoma of the Fallopian Tube / 대한부인종양콜포스코피학회잡지

Primary adenocarcinoma of the fallopian tube is an extremely rare malignancy of the female genital tract. We had experienced a case of primary adenocarcinoma of the left fallopian tube which diagnosed ineidentally on the basis of the biopsy findings, and reported the case with a brief review of the concerned literatures.

Klinefelter's Syndrome: 14 Cases / 대한비뇨기과학회지

Fourteen cases of Klinefelter's syndromes were clinically investigated in a year of 1976 in Dept. of Urology, Seoul National University Hospital. Cases are summarized as follows: 1. An average age of patients is 24 ranging from 19 to 35. 2. Three cases out of the 14 were married and came for sterility tests. 3. Gynecomastias were positive in 7 cases. Most of the cases showed female type of pubic hairs. 4. An average height was 170cm, an average span, 172.6cm. and an average length of leg (symphysis to floor), 96.4cm. 5. Semen analysis revealed azoospermias in all patients. 6. Histological findings of testis were thickened basement membrane, peritubular fibrosis, and markedly proliferated Leydig cells in most of the patients. 7. Chromatin was positive in all patients, and chromosome was 47(XXY) in all patients. 8. These patients were treated with testosterone and psychotherapy.

Clinical Observation on the Penis Carcinoma / 대한비뇨기과학회지

Clinical observation was made on the 16 patients of penile carcinoma admitted to the Department of Urology, Seoul National University Hospital during the period from September, 1967 to August, 1976 and the following results were obtained. 1. The incidence of penile carcinoma was 0.5% of total inpatients of urologic department and 3.5% of male genitourinary tumors. 2. Age distribution was between 29 and 78, snowing highest incidence at 50-59 years. 3. Clinical findings were; mass 77%, discharge 28%, ulcer 25%, bleeding 13%, and inguinal lymphadenopathy 50%. 4. The average duration of the symptoms on admission to hospital was 10 months with the highest incidence in 1 to 6 months. 5. The locations of the tumors were; preputial cavity 87%, confined to glans 6%, penile shaft involved 6%. 6. Treatments were made with partial amputation in 50%, partial amputation with inguinal lymphadenectomy in 37%, and biopsy in 13%.

Clinical Observation of Long-term Follow-up of Bladder Tumors / 대한비뇨기과학회지

A clinical observation was made on bladder tumors which were followed up more than 3 years during the period of 21 years and 9 months from January. 1955 to September, 1976. The result obtained were as follows: 1. Thirty three cases of total 428 bladder tumors were followed up more than 3 years giving rate of 7.7%. 2. The sex ratio was 3.1 : 1 with 25 male and 8 female. 3. All of the cases were beyond the second decade. 4. Twenty two cases were admitted to our clinic within 6 months with painless gross hematuria most commonly. 5. Twenty five cases revealed normal upper urinary tract and 11 cases revealed bladder filling defects on IVP 6. Twelve cases involved the lateral walls and 7 cases on trigone. 7. All were the papillary growths and transitional cell type, and 25 cases were Grade I-II. 8. Fourteen cases were recurred within 6 months after first treatment. 9. In the treatment, T. U. R. were performed in 22 cases, total cystectomy with urinary diversion in 9 cases.