A Case of Pseudoaneurysm of the Superior Thyroid Artery after Core Needle Biopsy

A pseudoaneurysm is a collection of blood that locates between the two outer layers of an artery, the muscularis propria and the adventitia. It is resulted from disruption of a portion of the arterial wall. A pseudoaneurysm can be caused by trauma, blood vessel intervention, intravenous drug use, vasculitis, infectious aneurysm, and postoperative anastomotic leakage. The pseudoaneurysm of superior thyroid artery after core needle biopsy is rare. We report a case of pseudoaneurysm caused by thyroid core needle biopsy and treated by surgical treatment.

Comparison of Operative Mortality and Complications between Bronchoplastic Lobectomy and Pneumonectomy in Lung Cancer Patients

Bronchoplastic lobectomy is a lung-saving procedure indicated for central tumors, for which the alternative is pneumonectomy. We compared operative mortality and complications between bronchoplastic lobectomy and pneumonectomy in lung cancer patients. From March 1993 through December 2005, 1,461 patients were surgically resected for non-small cell lung cancer, including 73 who underwent bronchoplastic lobectomy and 258 who underwent pneumonectomy. Bronchoplastic lobectomy was performed on any lesion that could be completely resected by this technique, whereas pneumonectomy was only performed on lesions that could not be removed by bronchoplastic lobectomy. Operative deaths occurred in 1 of 73 (1.4%) bronchoplastic lobectomy and 26 of 258 (10.1%) pneumonectomy patients (p=0.014). Major complications occurred in 16 of 73 (21.9%) bronchoplastic lobectomy and 58 of 258 (22.5%) pneumonectomy patients (p=1.0). Bronchoplastic lobectomy has a lower risk of operative mortality than pneumonectomy. Although the complication rates were similar, bronchoplastic lobectomy was associated with improved postoperative cardiopulmonary status and a low prevalence of fatal complications after bronchial anastomosis. These findings indicate that bronchoplastic lobectomy is a valuable alternative to pneumonectomy for anatomically appropriate patients, regardless of underlying cardiopulmonary function.

Analysis of Surgical Results for the Patients with Pulmonary Metastasis from Colorectal Carcinoma / 대한흉부외과학회지

BACKGROUND: The lung is the most common site of metastatic colorectal cancer comprising 10% of all curative resection of colorectal cancer. The reported 5 year survival rate varies among institutions. The purpose of the present study was to present the retrospective analysis of colorectal metastatic lung cancer surgery at our institution. MATERIAL AND METHOD: A total of 61 patients undergoing surgery for metastatic colorectal lung cancer between July 1996 and December 2003 were included in the present study. The stage of the primary colorectal cancer, site of pulmonary metastasis, method of lung resection, the number and size of the metastatic nodules, the recurrence rate, and survival were assessed. RESULT: The 3 and 5 year survival rates were 66% and 41%, respectively. No significant risk factors were identified among the studied variables by either univariate or multivariate analysis. The mean disease free survival rate was 17 months. The most common recurrent site was lung, and among these patients, 3 underwent a second operation and two are still alive. CONCLUSION: The results of the above data suggest that pulmonary resection of metastatic lung cancer in select patients after curative resection of colon cancer may be a good therapeutic option with the potential for excellent results.

Prognostic Relevance of WHO Classification and Masaoka Stage in Thymoma / 대한흉부외과학회지

BACKGROUND: Although thymomas are relatively common mediastinal tumors, to date not only has a universal system of pathologic classification not been established but neither has a clearly defined predictable relationship between treatment and prognosis been made. Recently, a new guideline for classification was reported by WHO, and efforts, based on this work, have been made to better define the relationship between treatment and prognostic outcome. In the present study a comparative analysis between the WHO classification and Masaoka stage system with the clinical disease pattern was conducted. MATERIAL AND METHOD: A total of 98 patients undergoing complete resection for mediastinal thymoma between Juanuary 1993 and June 2003 were included in the present study. The male female ratio was 48:50 and the mean age at operation was 49.6+/-13.9 years. A retrospective analytic comparison studying the relationship between the WHO classification and the Masaoka stage system with the clinical disease pattern of thymoma was conducted. Pathologic slide specimens were carefully examined, details of postoperative treatment were documented, and a relationship with the prognostic outcome and recurrence was studied. RESULT: There were 7 patients in type A according to the WHO system of classification, 14 in AB, 28 in B1, 23 in B2, 18 in B3, and 9 in type C. The study of the relationship between the Masaoka stage and WHO classification system showed 4 patients to be in WHO system type A, 7 in type AB, 22 in B1, 17 in B2, and 3 in type B3 among 53 (54%) patients shown to be in Masaoka stage I. Among 28 (28.5%) patients in Masaoka stage II system, there were 2 patients in type A, 7 in AB, 4 in B1, 2 in B2, 8 in B3, and 5 in type C. Among 15 (15.3%) in Masaoka stage III, there were 1 patient in type B1, 3 in B2, 7 in B3, and 4 in type C. Finally, among 2 (2%) patients found to be in Masaoka stage IV there was 1 patient in type B1, and 1 in type B2. The mean follow up duration was 28+/-6.8 months. There were 3 deaths in the entire series of which 2 were in type B2 (Masaoka stages III and IV), and 1 was in type C (Masaoka stage II). Of the patients that experienced relapse, 6 patients remain alive of which 2 were in type B2 (Masaoka III), 2 in type B3 (Masaoka I and III) and 2 in type C (Masaoka stage II). The 5 year survival rate by the Kaplan-Meier method was 90% for those in type B2 WHO classification system, 87.5% for type C. The 5 year freedom from recurrence rate was 80.7% for those in WHO type B2, 81.6% for those in type B3, and 50% for those in type C. By the Log-Rank method, a statistically significant correlation between survival and recurrence was found with the WHO system of classification (p<0.05). An analysis of the relationship between the WHO classification and Masaoka stage system using the Spearman correction method, showed a slope=0.401 (p=0.023), showing a close correlation. CONCLUSION: As type C of the WHO classification system is associated with a high postoperative mortality and recurrence rate, aggressive treatment postoperatively and meticulous follow up are warranted. The WHO classification and Masaoka stage system were found to have a close relationship with each other and either the WHO classification method or the Masaoka stage system may be used as a predict prognostic outcome of Thymoma.

The National Survey of Breast Cancer Treatment Pattern in Korea (1998): The Use of Breast-Conserving Treatment / 대한방사선종양학회지

PURPOSE: In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. MATERIALS AND METHODS: Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. RESULTS: Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast- conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I, and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. CONCLUSION: Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.

Propriety and Efficacy of Postoperative Adjuvant Concurrent Chemoradiotherapy for High Risk Group Early Stage Cervical Ccancer Patients Following Radical Hysterectomy and Pelvic Lymph Node Dissection / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to evaluate the efficacy of postoperative concurrent chemoradiotherapy (CCRT) and to investigate the recurrence and survival rates after adjuvant CCRT in high risk early cervical cancer (stage IA2, IB, IIA) patients who were treated by radical hysterectomy and pelvic lymphadenectomy. METHODS: From July 1994 to June 2003, we reviewed the chart of 146 patients who underwent radical abdominal hysterectomy and pelvic lymphadenectomy at Ajou University Hospital for early cervical cancer (stage IA2, IB, IIA). CCRT was performed in 30 patients with high risk factors such as positive pelvic lymph node, positive parametrial involvement, or positive surgical margins. Chemotherapy consisted of cisplatin (70 mg/m2 on day 1) and 5-FU (1000 mg/m2 on day 2-5) for 4 cycles every 4 weeks beginning 2-3 weeks after operation. Pelvic radiotherapy were started with 2nd and 3rd cycle of chemotherapy concurrently. We compared the recurrence rate and survival rate with 114 patients who received no adjuvant therapy after operation. The mean follow up period was 49 months (24-94 months). RESULTS: Disease recurred in 9 of 144 patients treated with surgery (6.3%). There were recurrences in 3 patients after CCRT (10.0%), and in 6 patients in the control group (5.3%) respectively. The actuarial 5-year overall survival rates for patients with adjuvant CCRT, and with no adjuvant treatment were 100%vs. 96.8% (p>0.05). The recurrence and progression-free survival rates were 9.5% vs 6.3%, 90.5% vs. 93.7% (p>0.05). CONCLUSION: This study shows good local control and 5 years overall and progression free survival rates in the high-risk cervical cancer patients after CCRT which is similar results seen in control group. Our results indicate that adjuvant concurrent chemoradiotherapy seems to be effective in stage IA2-IIA cervical cancer patients with high risk.

Comparison of Concurrent Chemoradiotherapy Regimen Toxicities in the Treatment of Loco-Regionally Advanced Cervical Cancer / 대한산부인과학회잡지

OBJECTIVE: Concurrent chemoradiotherapy is the idea where the chemotherapeutic agent acts as a radiosensitizer thus producing a synergistic effect between radiotherapy and chemotherapy. We evaluated the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) in loco-regionally advanced cervical cancer patients. METHODS: The medical records were retrospectively reviewed for 24 patients who underwent CCRT (cisplatin 70 mg/m2 on day 1, 29; 5-FU: 1000 mg/m2 on day 2-5 and 30-33 X 4 cycles), 26 patients who underwent weekly CCRT (cisplatin: 40 mg/m2 X 6 weeks) and 62 patients who had underwent radiation therapy alone for loco-regionally advanced cervical cancer at Ajou University Hospital. Toxicity was assessed according to the Gynecologic Oncology Group toxicity criteria. Statistical analysis was performed with chi- squre test. RESULTS: 2 year overall survival rate of patients only treated with RT was 75.0% (39/52). When this was compaired to CCRT, 83.3% (20/24) with monthly CCRT and 88.5% (23/26) with weekly CCRT of 2 year overall survival rates were attained. Recurrence rates were measured 2 years after each therapy done, they were 30.8% (16/52) with RT, 25.0% (6/24) with weekly CCRT, and 23.1% (6/26) monthly CCRT. During CCRT, grade 3 and 4 acute complication rates of nausea/vomiting (20.8% vs. 3.8%) and leukocytopenia (29.1% vs. 15.4%) was significantly higher in monthly group compared to weekly group (p<0.05). Weekly group had more patients who completed planned therapy compaired to monthly group (70.9% vs. 84.6%). CONCLUSION: CCRT improved overall survival rates and disease-free survival rate, but in some cases increased acute toxicity, and it is suggested that CCRT may be advantageous compared to radiation therapy for loco-regionally advanced cervical cancer. Weekly CCRT does not seem to afford distinct advantages in terms of acute toxicities over monthly CCRT, except for possible better patient compliance. Due to small size sample and short duration of follow up, further study of a large group of patients and the long survival rate is necessary.

Effect of Oral Nutritional Support During Radiation Therapy in Patients with Thoracic and Gead/Neck Cancer / 대한암학회지

PURPOSE: This study was designed to evaluate the role of oral nutritional support and nutritional counseling by dietician during radiation therapy. MATERIALS AND METHODS: This study included total 58 patients with head/neck, lung, or esophageal cancers who received radiation therapy with radical purpose between February and December, 1996. They were randomized either into nutrient supplement group (Group I) or control group (Group II). In Group I, the dietician advised patients to take high density nutrient supplement (NuCare, 250 kcal/can, Miwon co., LTD) based on dieticians initial evaluation for oral intake from initiation to completion of radiation therapy. In Group II, patients received nutritional support other than high density nutrient supplement only when patients lose weight more than 2 Kg during radiation treatment. All patients were evaluated for nutritional status and diet pattern and received nutritional counseling before radiation therapy and then weekly during treatment. RESULTS: Total 45 patients (22 patients in group I, 23 patients in group II) were available. In group I, all patients received average 3 cans (2~4 cans) a day. The calory from nutrient supplement was 43.9% of their daily energy intake (25.9~68.7%). About 72.7% of patients in Group I could keep up with their oral intake over 80% of daily requirement energy comparing to only 12.3% for patients in Group II(p0.05). CONCLUSION: There was less significant weight loss in patients who started oral nutritional supplement based on the daily requirement energy early in radiation therapy. We think it is better to recommend nutritional supplement before weight loss started because radiation induced side effects such as esophagitis and oral mucositis prohibited patients to continue to take nutrient supplement.

The Effect of External Beam Radiation on Neointimal Formation in the Rat Carotid Injury Model

BACKGROUND: Restenosis after successful percutaneous transluminal coronary angioplasty remains a major obstacle to the long-term success of the procedure. Uncontrolled proliferation and extracelluar matrix synthesis in response to mechanical injury are important contributors to this proces. External beam radiation or gamma radiation affects self-renewing tissues by arresting cell division, and therefore limits proliferation by reducing the number of clonal progenitors. The purpose of this study was to determine whether external beam radiation (EBR) could reduce the extent of neointimal formation after balloon injury in the rat carotid injury model and, if it could, to define the minimum effective dose. METHODS: 32 Sprague-Dawley rats (mean weight : 370+/-78g) underwent carotid injury by using 2F Fogarty balloon and EBR with doses ranging from 5 to 20 Gy. Rats were sacrificed after 2 weeks. The arteries were perfusin-fixed in paraformaldehyde. The dose was specified to a depth of 15mm. Histomorphometry was performed to compare external elastic lamina (EEL) area (mm2), lumen area (mm2)and neointimal area (mm2 of the injured segments. RESULTS: EEL area showed no significant difference in each different radiation group. Low dose EBR (5 Gy and 10Gy) had no significant impact on neointimal hyperplasia in rat carotid injury model. However, in high dose group (15Gy and 20Gy) neointimal area was significantly reduced (p<0.01) indicating high dose EBR markedly prevented neointimal hyperplasia. CONCLUSION: Radiation therapy may be an effective adjunctive method for reducing the restenosis rate after successful angioplasty in the rat carotid injury model.