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Long-term Results of Gamma Knife Radiosurgery for Craniopharyngioma (두개인두종의 감마나이프 치료 후 장기 추적 결과)

  • Kim, Yun Sok;Lee, Do Heui;Ra, Dong Suk;Chun, Young Il;Ahn, Jae Sung;Jeon, Sang Ryong;Kim, Jeong Hoon;Roh, Sung Woo;Ra, Young Shin;Kim, Chang Jin;Kwon, Yang;Rhim, Seung Chul;Lee, Jung Kyo;Kwun, Byung Duk
    • Journal of Korean Neurosurgical Society
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    • v.30 no.sup2
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    • pp.289-293
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    • 2001
  • Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

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Prediction of response by FDG PET early during concurrent chemoradiotherapy for locally advanced non-small cell lung cancer

  • Kim, Suzy;Oh, So Won;Kim, Jin Soo;Kim, Ki Hwan;Kim, Yu Kyeong
    • Radiation Oncology Journal
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    • v.32 no.4
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    • pp.231-237
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    • 2014
  • Purpose: To evaluate the predictive value of the early response of $^{18}F$-flurodeoxyglucose positron emission tomography (FDG PET) during concurrent chemoradiotherapy (CCRT) for locally advanced non-small cell lung cancer (NSCLC). Materials and Methods: FDG PET was performed before and during CCRT for 13 NSCLC patients. Maximum standardized uptake value ($SUV_{max}$), mean standardized uptake value ($SUV_{mean}$), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured and the changes were calculated. These early metabolic changes were compared with the standard tumor response by computed tomograms (CT) one month after CCRT. Results: One month after the completion of CCRT, 9 patients had partial response (PR) of tumor and 4 patients had stable disease. The percent changes of $SUV_{max}$ ($%{\Delta}SUV_{max}$) were larger in responder group than in non-responder group ($55.7%{\pm}15.6%$ vs. $23.1%{\pm}19.0%$, p = 0.01). The percent changes of $SUV_{mean}$ ($%{\Delta}SUV_{mean}$) were also larger in responder group than in non-responder group ($54.4%{\pm}15.9%$ vs. $22.3%{\pm}23.0%$, p = 0.01). The percent changes of MTV ($%{\Delta}MTV$) or TLG ($%{\Delta}TLG$) had no correlation with the tumor response after treatment. All the 7 patients (100%) with $%{\Delta}SUV_{max}{\geq}50%$ had PR, but only 2 out of 6 patients (33%) with $%{\Delta}SUV_{max}$ < 50% had PR after CCRT (p = 0.009). Likewise, all the 6 patients (100%) with $%{\Delta}SUV_{mean}{\geq}50%$ had PR, but only 3 out of 7 patients (43%) with $%{\Delta}SUV_{mean}$ < 50% had PR after CCRT (p = 0.026). Conclusion: The degree of metabolic changes measured by PET-CT during CCRT was predictive for NSCLC tumor response after CCRT.

Clinical Experiences of Gamete Intrafallopian Transfer (GIFT) Procedure (Gamete Intrafallopian Transfer(GIFT)방법의 임상체험에 관한 고찰)

  • Song, J.S.;Park, Y.S.;Kye, Y.S.;Kim, E.I.;Hur, K.O.;Han, C.W.;Mok, Y.J.
    • Clinical and Experimental Reproductive Medicine
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    • v.17 no.2
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    • pp.145-151
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    • 1990
  • This study was carried out to elevating the pregnancy rate in infertile patient by Gamete intrafallopian transfer (GIFT). The GIFT program was performed from July 1988 to June 1990. Of the 131 cycles, the mean age of patient was 31.6 years and the mean duration of infertility was 5.3 years. 41 patients became pregnant, for a pregnancy rate of 31.3%. 5 preclinical abortions and 6 clinincal abortion was occured. 2 ectopic pregnanices and 1 combined pregnancy were occured. 7 twin pregnancies and 1 triplet were occured (multiple pregnancy rate;22.2%). 11 pregnancies were term delivered, 17 are ongoing pregnancies. GIFT may be considered as an alternative to in vitro fertilazation in infertility cases in which at least one fallopian tube is patent.

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Genetic Diversity and Population Structure of Korean Mint Agastache rugosa (Fisch & Meyer) Kuntze (Lamiaceae) Using ISSR Markers

  • Kang, Man Jung;Sundan, Suresh;Lee, Gi An;Ko, Ho Cheol;Chung, Jong Wook;Huh, Yun Chan;Gwag, Jae Gyun;Oh, Se Jong;Kim, Yeon Gyu;Cho, Gyu Taek
    • Korean Journal of Plant Resources
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    • v.26 no.3
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    • pp.362-369
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    • 2013
  • Agastache rugosa, a member of the mint family (Labiatae), is a perennial herb widely distributed in East Asian countries. It is used in traditional medicine for the treatment of cholera, vomiting, and miasma. This study assessed the genetic diversity and population structures on 65 accessions of Korean mint A. rugosa germplasm based on inter simple sequence repeat (ISSR) markers. The selected nine ISSR primers produced reproducible polymorphic banding patterns. In total, 126 bands were scored; 119 (94.4%) were polymorphic. The number of bands generated per primer varied from 7 to 18. A minimum of seven bands was generated by primer 874, while a maximum of 18 bands was generated by the primer 844. Six primers (815, 826, 835, 844, 868, and 874) generated 100% polymorphic bands. This was supported by other parameters such as total gene diversity ($H_T$) values, which ranged from 0.112 to 0.330 with a mean of 0.218. The effective number of alleles ($N_E$) ranged from 1.174 to 1.486 with a mean value of 1.351. Nei's genetic diversity (H) mean value was 0.218, and Shannon's information index (I) mean value was 0.343. The high values for total gene diversity, effective number of alleles, Nei's genetic diversity, and Shannon's information index indicated substantial variations within the population. Cluster analysis showed characteristic grouping, which is not in accordance with their geographical affiliation. The implications of the results of this study in developing a strategy for the conservation and breeding of A. rugosa and other medicinal plant germplasm are discussed.

Effects of Uwhangchungsim-won(Niuhuangqingxin-yuan) on Systemic Blood Pressure, Pulse Rate, Cerebral Blood Flow, and Cerebrovascular Reactivity in Humans (우황청심원(牛黃淸心元)이 정상인의 혈압(血壓), 맥박수(脈搏數), 뇌혈류(腦血流) 및 뇌혈관반응도(腦血管反應度)에 미치는 영향(影響))

  • Yun, Sang-Pil;Lee, Sang-Ho;Kim, Eun-Ju;Na, Byong-Jo;Jung, Dong-Won;Shin, Won-Jun;Moon, Sang-Kwan;Bae, Hyung-Sup;Kim, Lee-Dong
    • The Journal of Internal Korean Medicine
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    • v.25 no.3
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    • pp.440-450
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    • 2004
  • Objectives: Uwhangchungsim-won(UC) has been used in the treatment of a wide variety of conditions including stroke, hypertension, arterosclerosis, autonomic imbalance, and mental instability, in Korean traditional hospitals. The aim of this study was to evaluate the effect of DC on cerebral hemodynamics and to determine the appropriate dosage. Methods: We studied changes in hyperventilation-induced cerebrovascular reactivity and mean blood flow velocity of the middle cerebral arteries(MCAs) were studied by means of transcranial Doppler ultrasound. Changes in mean blood pressure, pulse rate and expiratory CO2(PECO2) were observed using Cardiocap TM/5. Six healthy young volunteers who were administrated with full doses of DC for group A, and half doses for group B. Six other healthy subjects comprised the control group. The evaluation was performed during basal condition, and repeated at 20, 40, 60, 120, and 180 minutes after administration. Results: Increases of cerebrovascular reactivity and mean blood flow velocity in the middle cerebral artery in group A were significantly different compared with group B and the control group (p<0.1). Mean blood pressure, pulse rate and expiratory CO2 did not change during the observation and were not different among these three groups. We observed that in cerebrovascular reactivity induced hyperventilation, group A was most effective at 40 minutes after administration, and its effectiveness lasted for 120 minutes. Conclusions: This study provides evidence for UC, in full doses, as an agent for dilation of the cerebral arteriols to increase hyperventilation-induced cerebrovascular reactivity as a consequence of faster recovery of blood flow velocity.

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Adverse Effect of Human Hydrosalpingeal Fluid on the Development of Mouse Embryo (II) (인체의 난관수종액이 생쥐의 배아발달에 미치는 영향: II. 포배기내의 세포 수에 미치는 영향)

  • Koong, Mi-Kyoung;Jun, Jin-Hyun;Song, Sang-Jin;Song, Ji-Hong;Hong, Soo-Jeong;Yoon, Keun-Jae;Song, Il-Pyo;Kim, Jeong-Wook;Kang, Inn-Soo
    • Clinical and Experimental Reproductive Medicine
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    • v.26 no.2
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    • pp.213-217
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    • 1999
  • In our previous study, we observed that hydrosalpingeal fluid (HSF) adversely effect mouswe embryo development and hatching. The aim of this study was to evaluate the effect of HSF as assessed by the blastocyst development rate (BDR) and by cell counting in vitro. HSF was collected from ninie patients undergoing salpingoneostomy to correct hydrosalpinx. Two-cell embryos were obtained from superovulated ICR mice. T6 medium and $T6{\pm}0.4%$ bovine serum albumin were used as control media. T6 medium containing 10% or 50% HSF and 100% HSF from each patient were used as test media. Nine to 15 embryos were cultured in micro drops prepared from each of these media. To assess the total cell number within each blastocyst, the blastocysts were fixed and stained with Hoechst 33342 to facilitate cell counting. The mean BDR in two control media were 88.89% and 85.40%. The mean BDR in media containing 10%, 50%, 100% HSF were 85.87%, 89.58% and $75.57%^*$, respectively ($^*$: p<0.05). The overall mean cell count $({\pm}SEM)$ in control media were $87.6{\pm}9.65\;and\;90.12{\pm}11.38$. The BDR was affected adversely only by 100% HSF and not in media containing 10% or 50% HSF. Mean cell counts were decreased significantly only in blastocysts cultured 100% HSF ($63.8{\pm}13.66$; p<0.01) but not in blastocysts cultured in 10% or 50% HSF ($91.3{\pm}12.44\;and\;82.9{\pm}18.27$, respectively). Thus, it is concluded that HSF has no embyotoxic effect but has a mildly negatively effect on embryonic growth and development.

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Statistical Analysis of Quality Control Data of Blood Components (혈액성분제제 품질관리 자료의 통계학적인 비교)

  • Kim, Chongahm;Seo, Dong Hee;Kwon, So Yong;Oh, Yuong Chul;Lim, Chae Seung;Jang, Choong Hoon;Kim, Soonduck
    • Korean Journal of Clinical Laboratory Science
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    • v.36 no.1
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    • pp.19-26
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    • 2004
  • According to increase of domestic blood components use, the quality control of blood components is necessary to support good products. The purpose of this study is used to provide the producing index of the good product as compared with the accuracy and validity for the distribution of the quality control data. The value of mean, standard deviation, 95% confidence interval and degree of normal distribution of data were calculated by univariate procedure, the value of monthly mean of each blood centers per items were compared by Analysis of Variance(ANOVA) test for the degree of distribution. When there was difference among the mean values, the Duncan's multiple range test was done to confirm the difference. Finally, methods for accessing accuracy and validity of the quality data was done by the Contingency table test. The quality data of five blood centers was showed to the normal distribution and it was in a acceptable range. For each blood centers, the monthly means of Hematocrit(Hct), Platelet(PLT) and pH were not significantly different except Hct of C center, PLT of B, D center and pH of A center. The quality data per items was graded according to quality to six level. As a result of the comparative analysis, the monthly means of Hct of C and E center was significantly different higher than that of D, B and A center. The monthly means of PLT of A center and pH of C center was significantly different higher than that of the others. In the accuracy and validity of the quality control data, C center for Hct, A center for PLT and C center for pH were better than the other. The C blood center was most satisfiable and stable in the quality control for blood component. If the quality control method used in C blood center is adopted in other blood centers, the prepared level of the blood component of the center will be improved partly.

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Allometric equations, stem density and biomass expansion factors for Cryptomeria japonica in Mount Halla, Jeju Island, Korea

  • Jung, Sung Cheol;Lumbres, Roscinto Ian C.;Won, Hyun Kyu;Seo, Yeon Ok
    • Journal of Ecology and Environment
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    • v.37 no.4
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    • pp.177-184
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    • 2014
  • This study was conducted to develop allometric equations and to determine the stem density and biomass expansion factor (BEF) for the estimation of the aboveground and belowground biomass of Cryptomeria japonica in Jeju Island, Korea. A total of 18 trees were harvested from the 40-year-old C. japonica stands in Hannam experimental forest, Jeju Island. The mean biomass of the C. japonica was $50.4Mg\;ha^{-1}$ in stem wood, $23.1Mg\;ha^{-1}$ in root, $9.6Mg\;ha^{-1}$ in branch, $4.6Mg\;ha^{-1}$ in needle and $4.3Mg\;ha^{-1}$ in stem bark. The diameter at breast height (DBH) was selected as independent variable for the development of allometric equations. To evaluate the performance of these equations, coefficient of determination ($R^2$) and root mean square error (RMSE) were used and results of the evaluation showed that $R^2$ ranged from 71% (root biomass equation) to 96% (aboveground biomass equation) and the RMSE ranged from 0.10 (aboveground biomass equation) to 0.33 (root biomass equation). The mean stem density of C. japonica was $0.37g\;cm^{-3}$ and the mean aboveground BEF was $1.28g\;g^{-1}$. Furthermore, the ratio of the root biomass to aboveground biomass was 0.32.

Blossom smart expander technology for tissue expander-based breast reconstruction facilitates shorter duration to full expansion: A pilot study

  • Choi, Youna K.;Rochlin, Danielle H.;Nguyen, Dung H.
    • Archives of Plastic Surgery
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    • v.47 no.5
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    • pp.419-427
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    • 2020
  • Background This study evaluated the Blossom system, an innovative self-filling, rate-controlled, pressure-responsive saline tissue expander (TE) system. We investigated the feasibility of utilizing this technology to facilitate implant-based and combined flap with implant-based breast reconstruction in comparison to conventional tissue expansion. Methods In this prospective, single-center, single-surgeon pilot study, participants underwent either implant-based breast reconstruction or a combination of autologous flap and implantbased breast reconstruction. Outcome measures included time to full expansion, complications, total expansion volume, and pain scores. Results Fourteen patients (TEs; n=22), were included in this study. The mean time to full expansion was 13.4 days (standard error of the mean [SEM], 1.3 days) in the combination group and 11.7 days (SEM, 1.4 days) in the implant group (P=0.78). The overall major complication rate was 4.5% (n=1). No statistically significant differences were found in the complication rate between the combination group and the implant group. The maximum patient-reported pain scores during the expansion process were low, but were significantly higher in the combination group (mean, 2.00±0.09) than in the implant group (mean, 0.29±0.25; P=0.005). Conclusions The reported average duration for conventional subcutaneous TE expansion is 79.4 days, but this pilot study using the Blossom system achieved an average expansion duration of less than 14 days in both groups. The Blossom system may accommodate single-stage breast reconstruction. The overall complication rate of this study was 4.5%, which is promising compared to the reported complication rates of two-stage breast reconstruction with TEs (20%-45%).

Primary Total Elbow Replacement for Treatment of Complex Distal Humerus Fracture: Outcomes of Short-term Follow-up

  • Kim, Du-Han;Kim, Beom-Soo;Baek, Chung-Sin;Cho, Chul-Hyun
    • Clinics in Shoulder and Elbow
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    • v.23 no.1
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    • pp.20-26
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    • 2020
  • Background: High complication rate after open reduction and internal fixation can lead to use of primary total elbow replacement (TER) in treatment of complex distal humerus fractures in elderly patients. The purpose of this study was to investigate the short-term outcomes and complications after primary TER in patients with complex distal humerus fracture. Methods: Nine patients with acute complex distal humerus fracture were treated by primary TER using the semiconstrained Coonrad-Morrey prosthesis. The mean age of patients was 72.7 years (range, 63-85 years). Clinical and radiographic outcomes were evaluated over a mean follow-up of 29.0 months (range, 12-65 months) using visual analog scale (VAS) score for pain; Mayo elbow performance score (MEPS); Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score; and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, mean VAS, MEPS, and Quick-DASH scores were 1.2, 80.5, and 20, respectively. The mean range of motion was 127.7° of flexion, 13.8° of extension, 73.3° of pronation, and 74.4° of supination. There was no evidence of bushing wear or high-grade implant loosening on serial plain radiographs. Three complications (33.3%) comprising two periprosthetic fractures and one ulnar neuropathy were observed. Conclusions: Primary TER for treatment of complex distal humerus fractures in elderly patients yielded satisfactory short-term outcomes. However, surgeons should consider the high complication rate after primary TER.