• Radiation Oncology Journal
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• v.19 no.1
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• pp.27-33
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• 2001

Purpose : To evaluate interim results in terms of failure, cosmetic results and survival after breast conserving operation and radiation therapy in early breast cancer. Material and Methods : From January 1992 through December 1997, seventy two patients with early stage 0, I and II breast cancer were treated with conservative surgery plus radiotherapy at Keimyung University Dongsan Medical Center. Age distribution was 25 to 77 years old with median age of 43. According to TNM stage, five patients had stage 0, thirty three were stage I, twenty five were IIa, and nine were IIb. Most patients underwent excision of all gross tumor and ipsilateral axillary dissection. Breast was irradiated through medial and lateral tangential fields of 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks. We delivered a boost irradiation dose of 10 to 16 Gy in 1 to 2 weeks to excision site. Adjuvant chemotherapy was administered in forty one patients with CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens of 6 cycles concurrently or before radiation. Cosmetic results were assessed by questionnaire to patients grading of excellent, good, fair, poor. Follow-up periods were 22 to 91 months with median 40 months. Results : Five year disease free survival rate (5YDFS) was $95.8\%$. According to stage, 5YDFS was $100\%,\;96.9\%,\;96\%\;and\;88.9\%$ in stage 0, I, IIa and IIb, respectively. Two patients had distant metastasis and one had local and distant failure. One patient with distant failure had bone and liver metastasis at 14 months after treatment and the other had lung and both supraclavicular metastasis at 21 months after treatment. Patient with local and distant failure had local recurrence on other quadrant in same breast and then salvaged with total mastectomy and chemotherapy but she died due to brain metastasis at 55 months. Complications were radiation pneumonitis in five patients (four patients of asymptomatic, one patients of symptomatic) and hand or arm edema(4 patients). Fifty nine patients answered our cosmetic result questionnaire and cosmetic results were good to excellent in fifty one patients $(86\%)$. Conclusion : We considered that conservative surgery and radiation for the treatment of early stage invasive breast cancer was safe and had excellent survival and cosmetic results. We need to assess about prognostic factors with longer follow up and with large number of patients.

• Radiation Oncology Journal
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• v.27 no.3
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• pp.153-162
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• 2009

Purpose: To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. Materials and Methods: One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10~16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13~179 months, with a median of 92.5 months. Results: The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy ($\leq$6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). Conclusion: Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.

• Pediatric Infection and Vaccine
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• v.12 no.1
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• pp.52-60
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• 2005

Purpose : The aim of this study is to know seasonal distribution of group A streptococci obtained from one center using emm genotyping and T serotyping in Masan from 2003 through 2004. Methods : Among children who visited the Changwon Fatima Hospital at Masan, Korea from June 2003 through February 2004, 100 patients who had clinical findings of acute pharyngitis, scarlet fever, and cellulitis were confirmed as GAS by culture, and were enrolled in our study. All obtained GAS were sent to the WHO Collaborative Center for Reference and Research on Streptococci, University of Minnesota, Minneapolis for T serotyping and emm genotyping. We classified these results again according to seasonal and disease's entities. Results : 19 different T serotypes was typed. T4(27.5%), T1(17.6%), T6(13.7%), and T12(13.7%) serotypes were relatively common in summer, while T4(28.3%), T12(15.2%), and T12/B3264(8.7%) were common in winter. T4 and T12 were persistent all year around. Distribution of T serotypes in 89 patients with pharyngotonsillitis were T4(26.7%), T12(14.0%), T1(12.8%), and T6(11.6%) in order of frequency. 15 different emm genotypes was typed. The number of emm 1, emm 6, emm 9, and emm 44 genotypes decreased or disappeared in winter, and the number of emm 3, emm 12, and emm 89 genotypes increased or reappeared in winter. Conclusion : Because T serotyping and emm genotyping are useful tools for evaluating epidemiology and pathogenesis of group A streptococci, we should monitor these strains every year, and should serotype and genotype GAS obtained from the invasive streptococcal infections.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.280-287
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• 2007

Purpose : Urinary lithiasis is uncommon in children, however, it may lead to chronic renal insufficiency and even end stage renal disease. The etiology of stone formation in children is largely unknown; although the most common causes are known to be associated with congenital anomalies of the genito-urinary(G-U) tract, urinary tract infections(UTI), and metabolic diseases. Methods : A total of 73 children(male:female=42:31, mean age $6.6{\pm}5.3$ years) presented with urinary lithiasis between Sep. 1998 and Jul. 2007 at Seoul National University Children's Hospital. The medical records were reviewed retrospectively. Results : The most common presenting symptoms were gross hematuria(28/73, 38%) and flank or abdominal pain(23/73, 32%). The stones were located in the upper urinary tract in 48 patients(66%), in the bladder in 18(24%), and in both the bladder and upper urinary tract in 2 (3%). Congenital anomalies of the G-U tract with/without UTI were detected in 30 children (41%), hypercalciuria with/without hypercalcemia in 15(20%), and other metabolic diseases in 8(11%). In 17 patients(23%), no underlying cause of stone formation was detected. The majority of stones were infected stones(24/36, 67%), which were followed by calcium stones(8/36, 22%), uric acid stones(3/36, 8%). and cystine stones(1/36, 3%). Thirty-four patients(46%) underwent surgical procedures and/or extracorporeal shockwave lithotripsy for stone removal, and 13(18%) passed stones spontaneously with/without medical management. Stones recurred in 6 patients(8%): 4 with neurogenic bladder augmented by ileocystoplasty, 1 with cystinuria, and 1 with unknown etiology. Conclusion : The common causes of urinary lithiasis in children were congenital anomalies of the G-U tract with/without UTI and metabolic disorders including hypercalciuria/hypercalcemia. For the management of stones, minimally invasive procedures should be chosen on the basis of accompanying symptoms and the composition, locations and etiology of stones.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.229-238
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• 2007

Purpose : Since the first febrile UTI(urinary tract infection) in infants is commonly associated with vesicoureteral reflux(VUR), imaging studies such as renal ultrasonography, dimercaptosuccinic acid(DMSA) scan, and voiding cystourethrography(VCUG) are recommended. How-ever, because of the invasiveness of VCUG, it is difficult to perform in all young infants with febrile UTI. The purpose of this study is to compare the clinical and laboratory characteristics, radiologic findings between the young infant group(1 to 6month, n=121) and the old infant group(7 to 24months, n=91), and to determine the clinical and radiologic risk factors that predict the presence of VUR before the VCUG in patients with their first febrile UTI under 2 years of age. Methods : We reviewed the medical records of 211 first febrile UTI patients under 2 years of age retrospectively, and compared clinical, laboratory, and radiologic findings between the two age groups. Results : The young infant group had a male preponderance and a higher incidence of Escherichia coli in their urine culture. The incidence of acute renal parenchymal defects on DMSA scans were significantly increased in the young infant group. The incidence of VUR was 29% in patients who had a VCUG, but there were no differences in the incidence of VUR between the two age groups. Abnormal findings on DMSA scan significantly correlated with higher incidence of VUR in the young infant group. Incidence of abnormal findings DMSA scan significantly increased with high grade VUR(garde III-V ). Conclusion : In treating first febrile UTI patients under 2 years, physicians have to consider such characteristics as age less than 6 months, male preponderance, E.coli in the urine culture, and increased incidence of abnormal findings on DMSA scans which correlated well with the presence of VUR. The results of the DMSA scan might help us to predict the presence of VUR before the VCUG in first febrile UTI and help us to reduce performing invasive radio-logic studies especially in the young infant group. (J Korean Soc Pediatr Nephrol 2007;11:229-238)

• Childhood Kidney Diseases
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• v.12 no.1
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• pp.62-69
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• 2008

Purpose: The most concerning issue in children with urinary tract infection(UTI) is the probability of underlying genitourinary anomalies and vesicoureteral reflux (VUR), which is frequently associated with renal scarring and eventually end-stage renal disease. Therefore, voiding cystourethrography(VCUG) is usually recommended at the earliest convenient time for children with UTI. However, VCUG is an invasive procedure that requires catheterization and exposure to X-ray. In this study, we aimed to determine the predictability of clinical, laboratory and imaging parameters for VUR in children with UTI. Methods: Data of children with bacteriologically proven UTI who underwent VCUG were evaluated retrospectively for clinical(age, gender, fever), laboratory(leukocytosis, ESR, CRP, pyuria, blood urea nitrogen, serum creatinine) and imaging(renal ultrasound and DMSA renal scan) findings. First, children with UTI were divided into two groups according to the presence of VUR as non-VUR group and with VUR group, and clinical, laboratory variables were compared between these groups. Second, patients who had VUR were reclassified as low-grade VUR(grade I-II) group and high-grade(grade III-V) VUR group according to grading of VUR, and clinical, laboratory and imaging variables were compared between these groups. Results: Among 410 children with UTI, 137 had VUR and 78 high-grade VUR. Fever, leukocytosis, ESR, CRP, pyuria were associated with VUR. In addition, abnormal findings of ultrasonography and DMSA renal scan were closely related to VUR. However, these clinical and laboratory variable in patients with high grade VUR were not different significantly, compared to those with low-grade VUR group. Conclusion: Fever, leukocytosis, ESR, CRP seems to be potentially useful predictors of VUR in pediatric patients with UTI. In addition, renal ultrasonography and DMSA renal scan findings supported the presence of VUR. Further study of these findings could limit unnecessary VCUG in patients with UTI.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.64-71
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• 2004

Background: Video-assisted sympathicotomy is a safe and effective method for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side-effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the relationship between temperature change measured by DITI (digital infrared thermographic imaging) and clinical results according to the level and extent of sympathicotomy in essential hyperhidrosis. we tried to obtain a more precisely and objectively, the distribution and degree of compensatory sweating by DITI and also for ascertaining the clinical usefulness. Material and Method: From January 2000 to June 2002, the thoracoscopic sympathicotomy was performed in 28 patients suffering from essential hyperhidrosis in Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into four groups, Group I: patients having undergone T2 sympathicotomy, Group II: patients having undergone T3 sympathicotomy, Group III: patients having undergone T3,4 sympathicotomy, and Group IV: patients having undergone T2,3,4 sympathicotomy. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory and plantar sweating, and temperature changes of entire body measured by DITI Result: There was no difference in age and follow-up period among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However, the rate of long-term satisfaction were 85.8%, 85.8%, 42.9%, and 28.6% in group I, II, III, and IV (p<0.05). More than embarrassing compensatory sweating was present in 14.2%, 14.2%, 57.1%, 71.4% in group I, II, III, and IV (p<0.05) In regard to plantar sweating, decrease in sweating was expressed in each of four groups, but was not significant between groups. An apparent increase of temperature measured by DITI indicated sufficient denervation and predicted long-lasting relief of essential hyperhidrosis and also decrease in temperature of trunk and lower extremity by DITI had correlated well with postoperative satisfaction, and also postoperative compensatory sweating. Conclusion: We suggested that the incidence and degree of compensatory sweating was closely related to the site and the extent of thoracic sympathicotomy. Resection of the lower interganglionic neural fiber of the second thoracic sympathetic ganglion on the third rib is the most practical and minimally invasive treatment than other surgical methods. We were also to anticipated the distribution and degree of compensatory sweating by DITI precisely and objectively and for ascertaining the clinical usefulness.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.684-690
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• 2004

Background: Primary thymic epithelial neoplasm is a type of mediastinal tumors that have various biologic and morphologic features. In this study, we reclassified 59 cases of thymic epithelial tumors by the new WHO classification. We inquired whether the new WHO classification has independent prognostic relevance by analyzing clinical characteristics of thymic epithelial tumors including Masaoka's clinical stage. Material and Method: From December 1986 to August 2003, 59. patients who underwent surgery in the Keimyung University Dongsan Medical Center with definite diagnosis of thymic epithelial tumor were studied. We analyzed the histologic subtype (WHO classification). clinical stage (Masaoka's clinical stage) and patient's characteristics (sex, age, myasthenia gravis, tumor size, invasion. recurrence, metastasis) as prognostic factors. We analyzed the relationship between histologic subtype and clinical stage. Result: 32 patients were male and 27 were female. Mean age was 50.1$\pm$14.2. From WHO A to C, all thymic epithelial tumors were reclassified by the new WHO classification. Six patients (10.2%) had Type A, 7 (11.9%) had Type AB, 7 (11.9%) had Type B$_1$, 10 (16.9%) had Type B$_2$ and 7 (11.9%) had Type B$_3$, 22 (37.3%) had Type C. Two factors were shown by multivariate analysis to be associated with a favorable prognosis: completeness of resection (p=0.003) and non-invasiveness (p=0.001). The overall 5-year survival of the 59 patients was 53%, subtype A and AB were 92.3%, B$_1$ and B$_2$ were 70.2%, and B$_3$ and C were 26.1%. The association between histologic subtype and invasive behavior (stage) was statistically significant (p<0.001). Conclusion: The WHO classfication is not only a histologic classfication of the thymic epithelial tumors but also a significant prognostic factor that influence the survival of thymic epithelial tumors.

• The Korean Journal of Nuclear Medicine
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• v.32 no.3
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• pp.238-249
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• 1998

Purpose: To localize and compare the neural basis of verbal and visual human working memory, we performed functional activation study using $H_2^{15}O$ PET. Materials and Methods: Repeated $H_2^{15}O$ PET scans with one control and three different activation tasks were performed on six right-handed normal volunteers. Each activation task was composed of 13 match-ing trials. On each trial, four targets, a fixation dot and a probe were presented sequentially and subject's task was to press a response button to indicate whether or not the probe was one of the previous targets. Short meaningful Korean words, simple drawings and monochromic pictures of human faces were used as matching objects for verbal or visual memory. All the images were spatially normalized and the differences between control and activation states were statistically analyzed using SPM96. Results: Statistical analysis of verbal memory activation with short words showed activation in the left Broca's area, promoter cortex, cerebellum and right cingulate gyrus. In verbal memory with simple drawings, activation was shown in the larger regions including where activated with short words and left superior temporal cortex, basal ganglia, thalamus, prefrontal cortex, anterior portion of right superior temporal gyrus and right infero-lateral frontal cortex. On the other hand, the visual memory task activated predominantly right-sided structures, especially inferior frontal cortex, supplementary motor cortex and superior parietal cortex. Conclusion: The results are consistent with the hypothesis of the laterality and dissociation of the verbal and visual working memory from the invasive electrophysiological studies and emphasize the pivotal role of frontal cortex and cingulate gyrus in working memory system.

• The Korean Journal of Nuclear Medicine
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• v.26 no.2
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• pp.299-306
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• 1992

Gastic emptying scan in diabetic patients is widely used to assess the degree of motility disturbance and the symtoms such as nausea, vomiting, bloating, abdominal pain and early gastric fullness which we can't find anatomic lesion by fiberoscopic or barium study In order to determine the relationship among diabetic gastropathy, neropathy, retinopathy and disease duration, gastric emptying scan using $^{99m}Tc-tin$ colloid labeled scramble egg in hamburger was performed in 10 healty male controls and 50 diabetic patients which were subdivided to no neuropathy, peripheral neuropathy and autonomic neuropathy groups according to the degree of diabetic neuropathy and no retinopathy, background retinopathy and proliferative retinopathy groups according to the degree of diabetic retinopathy. After medication of cisapride for 2 weeks, we observed the presence of improvement of gastric motility in diabetics. The results were as following: 1) In controls, gastric emptying time (GET1/2) was $75{\pm}13.6$ min and 2 hour gastric retension rate (GRR2) was $32{\pm}11.1%$. 2) In diabetics, GET/2 was prolonged more than 2 hours and GRR2 was $58{\pm}23.1%$. According to degree of neuropathy, GET1/2 was prolonged more than 2 hours in all three groups and GRR2 was $54{\pm}24.1%$ in no neuropathy group, $57{\pm}24.3%$ in peripheral neuropathy group and $69{\pm}24.6%$ in autonomic neuropathy group. According to degree of retinopathy, GET1/2 was $110{\pm}23.4$ min in no retinopathy group and prolonged more than 2 hours in other two groups and GRR2 was $45{\pm}21.6%$ in no retinopathy group, $71{\pm}19.7%$ in background retinopathy group and $73{\pm}21.5%$ in proliferative retinopathy group. 3) After cisapride medication for 2 weeks, GET1/2 and GRR2 were improved as $90{\pm}14.6$ min and $40{\pm}13.8%$ (initial GET1/2 and GRR2 were above 2 hours and $61{\pm}15.4%$). We can conclude from above findings that gastropathy in diabetic neuropathy suggesting main underlying factor in motility disorder The degree of retinopathy and disease duration were correlated with severity of gastropathy in diabetics. From the results of gastric emptying scan, we can conclude that cisapride was useful drug for improving diabetic gastropathy and gastric emptying scan was valuable for assessing severity of diabetic gastropathy as non-invasive method.