• Tuberculosis and Respiratory Diseases
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• v.60 no.6
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• pp.645-652
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• 2006

Objective: Patients with lung cancer have a relative high risk of developing secondary primary lung cancers. This study examined the additional value of autofluorescence bronchoscopy (AFB) for diagnosing synchronous lung cancers and premalignant lesions. Methods: Patients diagnosed with lung cancer from January 2005 to December 2005 were enrolled in this study. The patients underwent a lung cancer evaluation, which included white light bronchoscopy (WLB), followed by AFB. In addition to the primary lesions, any abnormal or suspicious lesions detected during WLB and AFB were biopsied. Results: Seventy-six patients had non-small cell lung cancer (NSCLC) and 23 had small cell lung cancer (SCLC). In addition to the primary lesions, 84 endobronchial biopsies were performed in 46 patients. Five definite synchronous cancerous lesions were detected in three patients with initial unresectable NSCLC and in one with SCLC. The secondary malignant lesions found in two patients were considered metastatic because of the presence of mediastinal nodes or systemic involvement. One patient with an unresectable NSCLC, two with a resectable NSCLC, and one with SCLC had severe dysplasia. The detection rate for cancerous lesions by the clinician was 6.0% (6/99) including AFB compared with 3.0% (3/99) with WLB alone. The prevalence of definite synchronized cancer was 4.0% (4/99) after using AFB compared with 2.0% (2/99) before, and the staging-up effect was 1.0% (1/99) after AFB. Since the majority of patients were diagnosed with advanced disease, the subjects with newly detected cancerous lesions did not have their treatment plans altered, except for one patient with a stage-up IV NSCLC who did not undergo radiotherapy. Conclusions: Additional AFB is effective in detecting early secondary cancerous lesions and is a more precise tool in the staging workup of patients with primary lung cancer than with WLB alone.

• Radiation Oncology Journal
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• v.24 no.1
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• pp.11-20
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• 2006

Puroose: In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could improve survival rate and lower acute toxicity compared to conventional RT. Materials and Methods: From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status ${\leq}3$ and locally advanced pancreas cancer without distant metastasis, evaluated by CT or PET/CT, were included. We administered stereotactic RT consisting of either 33 Gy, 36 Gy or 39 Gy in 3 fractions to 6, 4 and 9 patients, respectively, in an effort to increase the radiation dose step by step, and analyzed the survival rate and gastrointestinal toxicities by the acute radiation morbidity criteria of Radiation Therapeutic Oncology Group (RTOG). Prognostic factors of age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9, planning target volume (PTV), and adjacent organ and vessel invasion on CT scan were evaluated by Log Rank test. Results: The median survival time was 11 months with 1-year survival rate of 36.8%. During follow-up period (range $3{\sim}20$ months, median 10 months), no significant gastrointestinal acute toxicity (RTOG grade 3) was observed. In univariate analysis, age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9 level, and adjacent organ and vessel invasion did not show any significant changes of survival rate, however, patients with PTV (80 cc showed more favorable survival rate than those with PTV>80 cc (p-value<0.05). In multivariate analysis, age younger than 65 years and PTV>80 cc showed better survival rate. Conclusion: In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience and, finally, quality of life would be increased. Consequently, this could be regarded as an effective novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.

• Journal of Yeungnam Medical Science
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• v.15 no.2
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• pp.275-285
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• 1998

Sarcoma of the uterus is very rare malignant tumor originating from uterine muscle or connective tissue. We have experienced 20 cases of uterine sarcoma from January 1991 to June 1998. The results were as follows: 1. The pathologic types were 13 cases(65.0%) of leiomyosarcoma, 5 cases(25.0%) of malignant mixed Mullerian tumor, 1 case of rhabdomyosarcoma, and 1 case of angiosarcoma. 2. The average age and parity was 50.2 and 3.7. The chief complaints were irregular vaginal bleeding(35.0%), lower abdominal pain(25.0%), and abdominal mass(25.0%). 3. Nine cases(45.0%) were FIGO stage I, 1 case(5.0%) was stage II, 6 cases(30.0%) were stage III, and 4 cases(20.0%) were stage IV. 4. The survival was from 1.5 months to over 130 months(median 16.5 months), and there was no correlation between survival and FIGO stage or pathologic type. The correlation between survival and number of mitotic figure was incalcurable. 5. CA 125 levels were serially measured as a tumor marker in monitoring patients and the positive rate was 40%. Further study was needed to make a conclusion for usefulness of CA 125 as a tumor marker.

• Journal of Digestive Cancer Research
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• v.1 no.2
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• pp.104-107
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• 2013

Gallbladder (GB) cancer is highly malignant neoplasm found in advanced stage and chemotherapy commonly plays a palliative role in GB cancer. We report a case of unresectable GB cancer treated with chemotherapy followed by extended cholecystectomy. Fifty-six-year-old male visited our hospital with weight loss and dyspnea on exertion. Computed tomography detected pulmonary embolism and diffuse GB wall thickening with para-aortic lymph node enlargement. The length of common channel was 23mm at magnetic resonance cholangiopancreatography which stands for anomalous union of the pancreaticobiliary duct. Anticoagulation was started for pulmonary embolism. GB wall mass was regarded as unresectable GB cancer with distant lymph node metastasis. Gemcitabine and cisplatin combination chemotherapy was carried out for 6 cycles. Primary tumor was stationary but multiple enlarged lymphnodes were almost completely disappeared. Extended cholecystectomy with hepaticojejunostomy was performed. Post-operative tumor stage was T3N1 (stage IIIB) and R0 resection was achieved. After operation he has no evidence of disease recurrence for 6 months.

• Cartoon and Animation Studies
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• s.5
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• pp.440-446
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• 2001

폭력의 발생 원인은 다양하고 그 표현 방식도 여러 가지 양상으로 나타나지만 인간의 기저에 갖고 있는 일반적 원인은 욕구불만이다. 욕구불만의 해소가 이루어지지 않은 상태에서의 인간은 항상 폭력성이 잠재되어있는 상태가 된다고 볼 수 있다. 윌리엄 맥두걸은 본능이 인간행동에 동기를 부여하는 가장 중요한 요인이며, 지각과 정서보다 동기의 힘을 강조했다. 사람은 본능이 동기를 부여해 준 것을 지각하고 적절한 대상이 지각되면 그 대상은 행동을 자극하는 감정변화를 일으킨다. 이러한 검정변화를 충동이라 할 수 있는데 지그문트 프로이드는 인간의 많은행동이 불합리한 본능적 충동에 바탕을 둔다고 보고 있다. 충동은 대개 생리적인 긴장, 결핍,또는 불균형상태에 뿌리는 두며 충족되어야 할 절박한기본 욕구로 유기체에 행동을 강요한다. 충동은 선천적이며, 기본적인 생리적 욕구와 직접적으로 관련된 충동과 학습을 통한 모방충동, 약물복용의 반복적으로 인한 양물중독이 있고, 성취, 활동, 친화, 호기심, 배설, 탐구, 조작, 모성애, 고통회피, 성애, 수면 등 인간의 생활에 반영되는 거의 모든 욕구를 포함한다. 따라서 욕구의 해소를 위해 무엇인가를 해야만 하는 인간은 욕구의 억압상태나 좌절상태에서 심한 분노와 폭력의 충동을 느끼게 된다. 현대 심층심리학은 어린이들이 말을 충분히 자유자재로 구사하기 전에 겪고 억누르게 된 무시무시한 분노의 환상을 가지고 있는데,. 공포예술의 무시무시한 영상들이 결부되어있다는 것이 밝혀졌다. 픽카드(P.M. Pickard)에 의하면 어린아이는 그들의 내적 현실을 외적 현실을 적응시키려는 힘겨운 투쟁 속에 근친상간적 갈등, 흡혈귀, 살인, 식인 등 끔찍한 환상을 겪는 것 간다고 한다. 청소년기는 사회적 부적응기로서 현실과 어릴 적 꿈꿔왔던 이상과의 괴리감에서 오는 당혹과 분노가 발생되는데, 이 시기에 많은 청소년들이 극단적인 선정적인 폭력성에 탐닉하게 되는 경향이 있다. 현실은 결코 아름답지 못하고, 행복하게 살 수 없다는 것에 대한 깨달음에서 기인한다. 욕구불만의 강도가 심해질수록 폭력성은 더욱 강하게 나타나는데 개인에게서 뿐만 아니라 가족, 동료, 사회 단체나 종교, 국가간에도 집단적으로도 발생하게 된다. 사회적으로 볼 때 폭력은 용인되는 것이 아니므로 도덕적으로 절제를 하거나 상대방과 적절한 타협과 조정을 필요로 한다. 그러나 절제의 한계를 넘어선다고 생각되거나, 조정의 노력이 불가능하거나, 실패했을 때 폭력적인 행동으로 나타나게 된다. 리차즈(I.A Richards)는 분노와 공포는 일단 겉잡을 수 없는 경향이 있다고 하면서 오늘날 폭력에 대한 요구가 일상의 정서 생활에 있어, 억압을 통한, 빈곤함을 반영하고 있지 않은지 생각해봐야 할 것이라고 충고한다.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.518-521
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• 2010

A one-day-old baby was transferred for cyanosis and heart murmur. Echocardiographic evaluation revealed that he had severe neonatal Ebstein's anomaly (Carpentier type C), pulmonary atresia, and pulmonary circulation via patent ductus arteriosus. Because the wall of the atrialized right ventricle was very thin, showed decreased contractility, and the small right ventricle showed pulmonary atresia, we decided that a two-ventricular repair was impossible. When the patient was one-month-old, he underwent right atrium reduction-plasty, a right ventricular exclusion procedure (including atrialized right ventricle resection and functional right ventricle plication), and right modified Blalock-Taussig shunt. He was discharged without specific problems. He received a bidirectional cavopulmonary shunt successfully at 4 months later.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.2
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• pp.310-315
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• 2001

The soft tissue tumors that occur commonly in newborn infants include palatal and gingival cyst of the newborn, congenital epulis, hemangioma, teratoma, pyogenic granuloma, and irritation fibroma. Such soft tissue tumors in the alveolar ridge of newborns are usually treated by surgical excision. If untreated, they can cause airway obstruction and breathing difficulty due to aspiration. They also cause discomfort during oral feeding. If nasal feeding is tried, since vomitting is impossible, there is a risk of aspiration pneumonia. In this case, a newborn infant visited our hospital with soft tissue tumor as chief complaint, and the infant was treated by surgical excision. It appeared to be similar to pyogenic granuloma and irritation fibroma upon histologic exam. However, it was different from those diseases since multinucleated giant cells were observed and it was congenital. The pathologic process of this neoplasm is not clear. This case is reported, since it is difficult to classify it as a specific disease.

• Tuberculosis and Respiratory Diseases
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• v.57 no.6
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• pp.557-566
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• 2004

Background : To find out effectiveness of multimodality treatments based on induction chemotherapy(CTx) in patients with clinical stage IIIA NSCLC Methods : From 1997 to 2002, 74 patients with clinical stage IIIA NSCLC underwent induction CTx at the hospital of Chungnam National University. Induction CTx included above two cycles of cisplatin-based regimens(ectoposide, gemcitabine, vinorelbine, or taxol) followed by tumor evaluation. In 30 complete resection group, additional 4500-5000cGy radiotherapy(RTx) was delivered in 15 patients with pathologic nodal metastasis. 29 out of 44 patients who were unresectable disease, refusal of operation, and incomplete resection were followed by 60-70Gy RTx in local treatment. Additional 1-3 cycle CTx were done in case of induction CTx responders in both local treatment groups. Results : Induction CTx response rate were 44.6%(complete remission 1.4% & partial response 43.2%) and there was no difference of response rate by regimens(p=0.506). After induction chemotherapy, only 33 out of resectable 55 ones(including initial resectable 37 patients) were performed by surgical treatment because of 13 refusal of surgery by themselves and 9 poor predicted reserve lung function. There were 30(40.5%) patients with complete resection, 2(2.6%) persons with incomplete resection, and 1(1.3%) person with open & closure. Response rate in 27 ones with chest RTx out of non-operation group was 4.8% CR and 11.9% PR. In complete resection group, relapse free interval was 13.6 months and 2 year recur rate was 52%. In non-complete resection(incomplete resection or non-operation) group, disease progression free interval was 11.2 months and 2 year disease progression rate was 66.7%. Median survival time of induction CTx 74 patients with IIIA NSCLC was 25.1months. When compared complete resection group with non-complete resection group, the median survival time was 31.7 and 23.4months(p=0.024) and the 2-year overall survival rate was 80% and 41%. In the complete resection group, adjuvant postoperative RTx subgroup significantly improved the 2-year local control rate(0% vs. 40%, p= 0.007) but did not significantly improve overall survival(32.2months vs. 34.9months, p=0.48). Conculusion : Induction CTx is a possible method in the multimodality treatments, especially followed by complete resection, but overall survival by any local treatment(surgical resection or RTx) was low. Additional studies should be needed to analysis data for appropriate patient selection, new chemotherapy regimens and the time when should RTx be initiated.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.195-203
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• 2008

Purpose: To investigate the treatment outcome and failure patterns after definitive chemoradiation therapy in locally advanced, unresectable esophageal cancer. Materials and Methods: From February 1994 to December 2002, 168 patients with locally advanced unresectable or medically inoperable esophageal cancer were treated by definitive chemoradiation therapy. External beam radiation therapy (EBRT) ($42{\sim}46\;Gy$) was delivered to the region encompassing the primary tumor and involved lymph nodes, while the supraclavicular fossa and celiac area were included in the treatment area as a function of disease location. The administered cone-down radiation dose to the gross tumor went up to $54{\sim}66\;Gy$, while the fraction size of the EBRT was 1.8-2.0 Gy/fraction qd or 1.2 Gy/fraction bid. An optional high dose rate (HDR) intraluminal brachytherapy (BT) boost was also administered (Ir-192, $9{\sim}12\;Gy/3{\sim}4\;fx$). Two cycles of concurrent FP chemotherapy (5-FU $1,000\;mg/m^2$/day, days $2{\sim}6$, $30{\sim}34$, cisplatin $60\;mg/m^2$/day, days 1, 29) were delivered during radiotherapy with the addition of two more cycles. Results: One hundred sixty patients were analyzable for this review [median follow-up time: 10 months (range $1{\sim}149$ months)). The number of patients within AJCC stages I, II, III, and IV was 5 (3.1%), 38 (23.8%), 68 (42.5%), and 49 (30.6%), respectively. A HDR intraluminal BT was performed in 26 patients. The 160 patients had a median EBRT radiation dose of 59.4 Gy (range $44.4{\sim}66$) and a total radiation dose, including BT, of 60 Gy (range $44.4{\sim}72$), while 144 patients received a dose higher than 40 Gy. Despite the treatment, the disease recurrence rate was 101/160 (63.1%). Of these, the patterns of recurrence were local in 20 patients (12.5%), persistent disease and local progression in 61 (38.1%), distant metastasis in 15 (9.4%), and concomitant local and distant failure in 5 (3.1%). The overall survival rate was 31.8% at 2 years and 14.2% at 5 years (median 11.1 months). Disease-free survival was 29.0% at 2 years and 22.7% at 5 years (median 10.4 months). The response to treatment and N-stage were significant factors affecting overall survival. In addition, total radiation dose (${\geq}50\;Gy$ vs. < 50 Gy), BT and fractionation scheme (qd. vs. bid.) were not significant factors for overall survival and disease-free survival. Conclusion: Survival outcome after definitive chemoradiation therapy in unresectable esophageal cancer was comparable to those of other series. The main failure pattern was local recurrence. Survival rate did not improve with increased radiation dose over 50 Gy or the use of brachytherapy or hyperfractionation.

• Radiation Oncology Journal
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• v.9 no.1
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• pp.87-91
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• 1991

Total 28 patients with resectable, locally advanced gastric cancer were entered in our prospective randomized study from June 15, 1988 to Sep. 15, 1990 in Yeungnam University Hospital. This study consisted of curative resection, IORT, external irradiation and combination of chemotherapy. Twenty-four of 28 patients were treated with single dose of 1500 cGy with 9 MeV election intraoperatively. External irradiation of $4300\sim4500$ cGy with 180 cGy per fraction, 5 days per week was started within 4th weeks of postoperative days. Various chemotherapy with or without external irradiation were added for reducing hematogenous and/or peritoneal dissemination and determination of complication of each arm. Duration of follow up was $4\sim31$ months. No serious complication related with radiation were reported compare to resection and chemotherapy only group. Although our follow up period is too short to draw any conclusion, IORT appears to improve local control, hopely further survival. Continuous follow up should be needed for evaluation of real therapeutic gain such as complication vs. improved survival.