• Radiation Oncology Journal
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• v.21 no.1
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• pp.27-34
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• 2003

Purpose : To evaluate the efficacy of radiotherapy, and the factors affecting survival in patients of extrahepatic bile duct cancer, by analyzing the results of postoperative radiotherapy Materials and Methods : Between October 1991 and July 2001, 21 patients with extrahepatic bile duct cancer, who received radiotherapy after a radical resection, were retrospectively reviewed. The patients' ages ranged from 39 to 75 years, with a median of 61 years, and a male to female ratio of 16 to 5. The numbers of patients with proximal and distal bile duct cancer were 14 and 7, respectively. From the postoperative pathological examination, 19 of the patients were found to have microscopic residues, and 7 to be lymph node positive. Patients with AJCC stages I, II and III were 10, 10 and 1, respectively. The total radiation dose administered was 4,500$\~$6,300 cGy, with a median dose of 5,040 cGy. The follow up period was 20$\~$81 months, with a median of 57.5 months. Results : The overall and disease free survival rates at 3 and 5 years were 41.0 and 29.3$\%$, and 41.6 and 29.7$\%$, respectively. The influences of age, sex, tumor location, differentiation, microscopic residue, neural invasion, 7 and N stage, the stage itself, the dose of radiation and chemotherapy, on survival were evaluated. The T stage and the stage itself were found to be significant from a univariate analysis (p<0.05), but the degree of significance was limited by the small number of patients. A recurrence occurred in 12 patients (57.1$\%$), 5 in locoregional sites, 4 in distant sites and 3 in a combination of locoregional and distant sites, and the sites of distant metastasis were the liver, 6, and the bone, 1 Grade 2 or 3 acute leucopenias occurred in 2 patients and grade 2 chronic peptic ulcers occurred in 4, who were all recovered by conservative management. Conclusion : Postoperative radiotherapy is feasigbls in extrah데atic bile duct cancer, with tolerable toxicity, but prospective studies, with a large patient enrollment, are needed for the evaluation of the effects of postoperative radiotherapy and the related prognostic factors.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.653-658
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• 2002

The cause and clinical course of the postoperative ARDS is, as of yet, not very well understood. The current study is a review of our experience on patients with ARDS after thoracotomy. Material and Method: Between Jan. 1996 to Aug. 2001, a retrospective analysis was conducted on 32 post-thoracotomy ARDS patients among 4018 patients receiving thoracotomy inclusive of thoracoscopic surgery. Result: The incidence of ARDS after pneumonectomy cases was 5.3%(13/245), 1.3% after lobectomy(9/ 710), and 4.4% after esophageal surgery(10/226). Of the 32 ARDS patients, 31 had malignant disease. The remaining 1 patient had aspergillosis. In the majority, the cause of ARDS was unknown. The average onset was on the 7.4th postoperative day. In 10 cases, the initial lesion was in the right lower lung field(31.2%), in the left lower lung field in 9(28.1%), and in both lower lung fields in 12(37.5%) cases. In all, the initial lesion was in the lower lung fields in 96.9% of the cases(31/32). There was a significant relationship between the development of ARDS and intraoperative I/O balance. The overall mortality rate was 65.6%(21/32). In the earlier period of the study(1996-Jun, 1998) the mortality rate was 100%, but in the latter period(July, 1998-Aug, 2001) it was significantly reduced to 47.6%: Conclusion: The current data showed a higher incidence of postoperative ARDS in patients with malignant disease and in those receiving extensive lymph node dissection with either lobectomy or pneumonectomy, and also in patients receiving esophageal surgery. In addition, introperative fluid overload was also associated with an increased incidence of ARDS. Treatment outcome could be improved with prone positioning and NO gas inhalation.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.364-372
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• 2001

Background : To observe the immediate and long-term results of bronchial artery embolization(BAE) for hemoptysis and the factors influencing the recurrences. Methods : This study involved 75 patients with massive, or moderate and recurrent hemoptysis, who underwent bronchial artery embolization(BAE) from 1994 to 1999. The underlying diseases included pulmonary tuberculosis in 35, bronchiectasis in 22, aspergilloma in 12, lung cancer in 3, and 3 with other diseases. Results : After BAE, bleeding was controlled immediately in 61 patients(82.7%). One patient died of another medical problem, 3 patients were referred to surgery and 5 patients could not be followed-up. In the remaining 66 patients who were followed for more than one-year after BAE, 37(56.1%) patients had another hemorrhage (26 hemoptysis, 11 minor hemosputa). Among the recurred 37 subjects, 19(51.4%) experienced hemorrhage within 1 month after BAE, 31(83.8%) within 1 year, and 36(94.1%) within 3 years. The underlying lung diseases, the amount of bleeding and the extent of the involved lungs were factors affecting the outcome, especially blood loss >500cc was an important factor affecting the recurrence rate. BAE for two cases with lung malignancy was ineffective. Long-term control of bleeding (3-year cumulative non-recurrence) was achieved in 30 subjects(45.5%). Conclusion : Bronchial artery embolization(BAE) is effective as an initial treatment for moderate to massive hemoptysis. Because most of the recurrences occurred within 3 years, it is important to follow-up such patients for at least 3 years after BAE and the most significant factor affecting the prognosis was amount of blood loss.

• Clinical and Experimental Pediatrics
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• v.52 no.1
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• pp.93-98
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• 2009

Purpose : The purpose of this study was to evaluate the clinical characteristics and outcomes of patients with neuroblastoma aged less than 1 year. Methods : From January 1997 to December 2007, 41 patients aged less than 1 year were diagnosed with neuroblastoma. Patients were divided into 3 risk groups according to the stage of the disease and N-myc amplification. Low-risk patients underwent surgery with (stage 2) or without (stage 1) short-term chemotherapy. Intermediate-risk patients underwent chemotherapy and surgery with or without local radiation therapy. High-risk patients underwent chemotherapy, surgery, radiation therapy, and high-dose chemotherapy/autologous stem cell rescue (HDCT/ASCR). Results : While tumor relapse occurred in only 1 patient, 7 patients died of treatment-related toxicities. Causes of treatment- related death included infection during conventional chemotherapy in 5 patients and acute myocarditis during HDCT/ASCR in 2 patients. The overall 5-year survival (${\pm}$ standard error) and 5-year event-free survival (EFS) rates after diagnosis for all 41 patients were $82.8{\pm}5.9%$ and $80.0{\pm}$6.3%$, respectively, with a median follow-up of 58 (9-137) months. The 5-year EFS rates for low-risk, intermediate-risk, and high-risk patients were 100%, $68.4{\pm}10.8%$, and $66.7{\pm}19.3%$, respectively. Conclusion : Increased efforts to reduce infection-associated toxicity deaths during conventional chemotherapy are needed to further improve the survival of patients with neuroblastoma aged less than 1 year.

• The Korean Society of Law and Medicine
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• v.20 no.1
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• pp.133-162
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• 2019

Due to the nature of medical malpractice lawsuits, it is difficult for medical consumers, who are weak in getting information when it comes to health care problem, to secure all information inside the hospital. Even if you are confident about the hospital infection, it is true that people have difficult to obtain medical testimony by expert. It is seen as no easy task to testify to the malpractice of colleagues who work in the same field not only in our country but also abroad, when a doctor gives negative testimony to another doctor in a medical malpractice lawsuit. Although few health care providers will be motivated to take medical care from the outset, testimony or statements from a medical practitioner can have a significant impact on the outcome of a lawsuit, as it is impossible for the patient to control or be aware of the whole process of medical conduct, especially in the event of a hospital infection and the victim. If the hospital can prove the causality of damages caused by negligence of the employees or supervision of the hospital itself in a medical suit caused by the infection, the level of protection of the victim could be raised further. We sought to find a solution to these problems by looking at the provisions of other laws related to hospital infection. In particular, as the comparative legal review regarding hospital infection, Germany's legislative precedent sets a medical contract as a typical civil law contract, so it is thought that looking at German civil law regulations also has implications for Korean law. We also tried to improve the French Special Act 'rights of patients' and we can look at the consequent changes in court cases. Finally, the content of the U.S. case's and the theory of 'the doctrine of res ipsa loquitur' in relation to it show that doctors and hospitals have been forced to shift the burden of proof through this theory. This paper tried to find out the implications of mitigating the burden of proof by reviewing various issues that might be related to medical litigation of hospital infection from a comparative point of view.

• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.92-98
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• 2011

Purpose: We describe a all-arthroscopic technique for decompression of spinoglenoid ganglion cyst and present our clinical results for this procedure. Materials and Methods: From March 2006 to June 2009, eight patients (7 males, 1 female; mean age 40.6 years; range: 21~61) were included who underwent arthroscopic decompression of spinoglenoid ganglion cyst. The most common symptoms were vague shoulder pain and external rotation weakness, which lasted 6.4 months (range: 3~8) on average. Five of eight patients were noted abnormalities on electromyographic (EMG) examination to have suprascapular nerve neuropathy and magnetic resonance imaging (MRI) showed spinoglenoid ganglion cysts in all eight patients and the cyst size was 2.6 cm (range: 1.8~3.6). Labral pathology was identified intraoperatively in all patients and the cysts were decompressed by the posterosuperior capsulotomy under arthroscopic control and labral repair with suture anchors was performed in six patients. Results: The average clinical outcome scores including Constant and Murley, Simple shoulder test (SST) all improved significantly at the time of the final follow-up and there were no complications resulting from the procedures. All patients including the patients with abnormal EMG study recovered strength on isokinetic strength testing. Follow-up MRI scans were performed on all patients at a mean of 5.2 months postoperatively (range: 3~12) revealed complete resolution of the cysts and no evidence of recurrences were seen at an average of 18 months (range: 12~26) of follow-up. Conclusion: Arthroscopic decompression of spinoglenoid ganglion cyst effectively restores patient function and all patients in this study showed improvement in their postoperative MRI findings. Arthroscopic decompression is also useful in the appropriate treatment for labral pathology and may contribute to decreased risk of cyst recurrence.

• Radiation Oncology Journal
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• v.28 no.3
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• pp.133-140
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• 2010

Purpose: We retrospectively investigated the effect of irradiation using helical tomotherapy in recurrent pelvic tumors that underwent prior irradiation. Materials and Methods: Fourteen patients with recurrent pelvic tumors consisting of rectal cancer (57.1%), cervical cancer (35.7%) and cancer with an unknown origin (7.1%) were treated with tomotherapy. At the time of irradiation, median tumor size was 3.5 cm and 7 patients complained of pain originating from a recurrent tumor. The median radiation dose delivered to the gross tumor volume, clinical target volume, and planning target volume was 50 Gy, 47.8 Gy and 45 Gy, respectively and delivered at 5 fractions per week over the course of 4 to 5 weeks. Treatment response and duration of local disease control were evaluated using the Response Evaluation Criteria in Solid Tumors (ver. 1.0) and the Kaplan-Meyer method. Treatment-related toxicities were assessed through Common Terminology Criteria for Adverse Events (ver. 3.0). Results: The median follow-up time was 17.3 months, while the response rate was 64.3%. Symptomatic improvement appeared in 6 patients (85.7%). The median duration time of local disease control was 25.8 months. The rates of local failure, distant failure, and synchronous local and distant failure were 57.1%, 21.4%, and 7.1%, respectively. Acute toxicities were limited in grade I or II toxicities, except for one patient. No treatment related death or late toxicity was observed. Conclusion: Helical tomotherapy could be suggested as a feasible palliative option in recurrent pelvic tumors with prior radiotherapy. However, to increase treatment effect and overcome the limitation of this outcome, a large clinical study should be performed.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.356-364
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• 2002

Background: This study was undertaken to investigate the outcome of composite graft aortic root replacement using coronary button reimplantation technique for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and September 2001, 54 patients having aortic root replacement with a composite valve graft using direct coronary button reimplantation were reviewed retrospectively. Left ventricular dysfunction was present in 14 patients(25.9%), aortic regurgitation in 48(89%), and Marfan's syndrome in 17(31.5%). The indications for operation were annuloaortic ectasia in 29 patients(53.7%), aortic dissection in 11(20.4%), aneurysms of the ascending aorta involving aortic root in 12(22.2%), and aortitis in 2(3.7%). Six patients(11.1%) had previous cardiac or ascending aortic operations. Concomitant procedures were arch replacement in 21 patients(38.9%), coronary artery bypass graft in 7(13%), mitral valve repair or replacement in 4(7.4%), and others in 6. The mean time of circulatory arrest, total bypass, and aortic crossclamp were 18 $\pm$ 9 minutes, 177 $\pm$ 42 minutes, and 127 $\pm$ 31 minutes, respectively. Result: There was 1 early death(1.9%). Mean follow-up was 24.6$\pm$ 19.5 months. There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage. The Kaplan-Meier survival rate was 98.0 $\pm$ 2.0% and 93.1 $\pm$ 5.1% at 1 and 6 years, respectively. Two patients required reoperation owing to a false aneurysm at the root anastomosis site and a malfunction of prosthetic aortic valve(3.8%). Staged operation for dissection of the remaining thoracoabdominal aorta was performed in 1 patient. The freedom rate from reoperation was 97.8 $\pm$ 2.0% and 65.3 $\pm$ 26.7% at 1 and 6 years, respectively.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.341-350
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• 2007

Background: We present here the early and midterm surgical results for infective endocarditis and we especially focus on the effect of aggressive reconstruction or root implantation after wide debridement. Material and Method: Between January 1995 and Jun 2006, we enrolled 79 adult infective endocarditis patients who underwent surgical treatment. There were 63 and 16 native and prosthetic valve endocarditis cases, respectively. They included 27 cases of culture negative endocarditis. With performing valve replacement or repair, 28 of the patient underwent a more aggressive surgical option, for example, aortic root replacement or reconstruction, or heart base reconstruction etc. Result: There were statistical relationships between the in-hospital mortality and staphylococcal infection, urgent-based operation and operation during the active phase of endocarditis. Wide debridement and aggressive reconstruction were not related to either the post operative mortality or the early morbidity. Culture negative endocarditis was not related to the postoperative mortality and morbidity. Conclusion: Physicians must pay attention to patients' medical treatment during the preoperative period of the infective endocarditis. If surgery is considered for treating infective endocarditis, it should be performed before the downhill course of the disease so that the surgical outcome is improved. Wide debridement and more aggressive reconstruction are also warranted.

• Tuberculosis and Respiratory Diseases
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• v.52 no.5
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• pp.475-484
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• 2002

Background : Unresectable non-small cell lung cancer has a poor response to chemotherapy and has an unfortunate prognosis. More effective and less toxic cytotoxic agents are needed to improve the outcome of these patients. The efficacy and safety of vinorelbine monotherapy in these advanced lung cancer patients was evaluanted. Materials and Methods : Sixteen patients with non-small cell lung cancer in stage III or IV, who received vinorelbine alone as an initial anticancer chemotherapy from June 1996 to December 2000 were enrolled in this study. Vinorelbine was given intravenously at a dose 30mg/$m^2$ every week. Results : A mong the sixteen patients, six had a partial response(38%) and the median survival was 16 weeks. The median response duration was 27 weeks (95% CI 6-47), and the time to progression was 16 weeks(95% CI 6-26). Among a total of 112 cycles, neutropenia(WHO grade 3 or 4) and anemia(grade 3) occurred in 9% and 3%, respectively. Only 1 patient required hospitalization for neutropenic fever. Non-hematologic toxicity was minor and was easily controlled. Conclusion : Vinorelbine monotherapy was well tolerated, and moderately effective in patients with advanced non-small cell lung cancer.