Ulcerated Perianal Infantile Hemangioma Treated with Propranolol / 대한피부과학회지

Infantile hemangioma is a self-resolving benign tumor that commonly requires no intervention. Despite its distinctive, self-limiting course, infantile hemangiomas may result in ulcerations that cause pain, potential scarring, bleeding, and infection. Active treatment is usually required to manage these lesions. The discovery of propranolol in the treatment of infantile hemangioma was described in 2008 by Leaute-Labreze, et al. Since then, its effectiveness and safety have been confirmed by several cases, and replacing systemic corticosteroids as a first-line therapy. Herein, we report the successful treatment of children with ulcerated perianal infantile hemangioma with propranolol.

Clinical Study of Neonatal Pelvicectasia

OBJECTIVE: This study was conducted to investigate the different cause of pelvicectasia and its clinical outcome. The most important management of pelvicectasia consist of the early diagnosis and evaluation of the pathologic abnormalities of congenital pelvicectasia. This will help to offer the guideline on management of neonatal pelvicectasia. METHODS: We examined one hundred and seventy-one live neonates who were hospitalized and diagnosed with pelvicectasia at Soonchunhyang University Cheonan Hospital from January 2008 to December 2008. A retrospective study was carried out in these patients for last three years. Renal ultrasonography was repeated at 1 month after birth and then 3 months interval. Diuretic renal scan with (99m)Tc-labeled diethylenetriamine pentaacetic acid augmented with furosemide and voiding cystourethrogram was done after 4 to 6 weeks of first renal ultrasonography. Patients were followed-up for 1 to 30 months (average, 7.2 months). RESULTS: Pelvicectasia was postnatally detected in 171 cases (33.7%) among 507 neonates. Males were twice than females. Additional imaging studies revealed that normal kidney structure was the most common postnatal diagnosis (97.1%), followed by ureteropelvic obstruction, vesicoureteral reflux, multicystic kidney, ureteric duplication. Spontaneous regression of pelvicectasia was revealed in 165 renal units (67.6%). CONCLUSION: There are many cause of spontaneous regression in mild to moderate pelvicectasia. Urinary tract infection occurs in many neonates with pelvicectasia. Mild to moderate neonatal pelvicectasia without vesicoureteral reflux is clinically much less significant. Accordingly, close observation with serial renal ultrasonography may be sufficient.

Efficacy and safety of deferiprone (Ferriprox), an oral iron-chelating agent, in pediatric patients / 대한혈액학회지

BACKGROUND: Iron overload is a predictable and life-threatening complication in patients dependent on the regular transfusion of RBCs. The aims of this study were to investigate the efficacy and safety of deferiprone in a variety of pediatric hematologic and/or oncologic patients with a high iron overload. METHODS: Seventeen patients (age: 1.1-20.4 years; median: 10.6 years) from 7 hospitals who were treated with deferiprone from 2006 to 2009 were enrolled in this study. Medical records of enrolled patients were reviewed retrospectively. RESULTS: Serum ferritin levels were 4,677.8+/-1,130.9 microgram/L at baseline compared to 3,363.9+/-1,149.7 microgram/L at the end of deferiprone treatment (P=0.033). Only 1 patient developed neutropenia as a complication. CONCLUSION: Deferiprone treatment is relatively safe for pediatric patients suffering from various hematologic and oncologic diseases that require RBC transfusions as part of treatment. However, the potential development of critical complications such as agranulocytosis and/or neutropenia remains a concern.

A Case of Mediastinal Cavernous Hemangioma

We report a case of cavernous hemangioma of the anterior mediastinum that was incidentally detected by chest radiography taken at a routine health check-up. A mass lesion was seen in the anterior mediastinum on computed tomography and magnetic resonance imaging. Direct surgical removal was performed for diagnosis and treatment through right thoracotomy. Histopathology confirmed the mass as a cavernous haemangioma. Post-operative course was uneventful.

The Effect of Hydroxyethyl Starch and Crystalloid Solutions on Blood Loss and Transfusion Requirement in Patients with Recent Antiplatelet Therapy Undergoing Off-pump Coronary Bypass Surgery / 대한마취과학회지

BACKGROUND: Hydroxyethylstarch (HES) solutions are commonly used for intravascular volume expansion with varying effect on coagulation depending on molecular weight and mode of hydroxyl substitution.Clopidogrel and aspirin have been shown to reduce cardiovascular complications in patients with coronaryartery occlusive disease which renders patients to higher risk of bleeding complications who require surgery.The purpose of this study was to evaluate the effect of HES 200/0.5, 130/0.4 and crystalloid on blood loss and transfusion requirement in patients with recent antiplatelet therapy undergoing off-pump coronary bypass surgery (OPCAB) in a prospective, randomized trial. METHODS: Sixty patients scheduled for OPCAB, who received clopidogrel and aspirin within 5 days of surgery were randomly allocated into 3 groups:HES 200/0.5 (n = 20), HES 150/0.4 (n = 20), and Crystalloid (n = 20).Routine coagulation profile were measured before and 2 days after the surgery.Amount of perioperative blood loss, transfusion requirement and fluids input and output were recorded until 2 days postoperatively. RESULTS: The 3 groups were similar with regard to patients and operative characteristics.There were no significant differences in the amount of perioperative blood loss and transfusion requirement among the 3 groups. CONCLUSIONS: Both HES solutions were safe to use in terms of blood loss and transfusion requirement in patients undergoing OPCAB who received antiplatelet agents within 5 days of surgery.

Airway Management for General Anesthesia in a Patient with Severe Trismus due to Temporomandibular Joint Ankylosis : A case report

An ankylosis of temporomandibular joint (TMJ) can cause severe trismus, thus it may bring on many difficulties in airway management such as orotracheal intubation or laryngeal mask airway insertion. Such difficulties may cause serious complications related to airway management because the trismus due to ankylosis of TMJ can not be improved by administration of muscle relaxants or deep anesthesia in most cases. We report a case of nasotracheal intubation guided by a fiberoptic bronchoscope in a male patient with severe trismus due to TMJ ankylosis, who was scheduled for undergoing ophthalmic surgery.

Short Term Outcomes and Prognostic Factors Based on Radiofrequency Thermocoagulation on Lumbar Medial Branches / 대한통증학회지

BACKGROUND: Lumbar zygapophysial joints are a common source of chronic lower back pain and radiofrequency thermocoagulation (RF) of the medial branches (MB) has been shown to be effective at providing substantial pain relief for chronic low back pain.Therefore, we carried out this study to determine the short term outcomes and prognostic factors of RF on the MB of patients with lumbar facet syndrome. METHODS: We performed RF in fourteen patients who showed greater than 80% pain relief up to three times after a diagnostic MB block was conducted using 0.3 ml of 0.5% bupivacaine.Using 10 cm curved electrodes with 10-mm active tip, a 60 second, 80 degrees C lesion was made after electrical stimulation at 50 Hz for sensory and 2 Hz for motor nerve testing.The degree of pain relief was then assessed after 2 weeks, and again after 3 months using a visual analog scale (VAS) and a four point Likert scale.The outcome was regarded as 'success' if at least a 50% reduction in the VAS was observed.Possible prognostic factors between the two groups were also evaluated. RESULTS: The success rate was 71.4% (10/14) after three months of follow-up. However, there were transient complications, such as neuritis like syndrome, in 4 patients. In addition, short symptom duration and low minimal voltage (< 0.4 V) for sensory stimulation were shown to be the relevant prognostic factors for a successful outcome. CONCLUSIONS: RF may be an alternative to repeated MB block or intraarticular injection for palliation of lumbar facet syndrome. For better outcomes, early diagnosis and strict patient selection should be coupled with efforts to avoid anatomically incorrect RF.

A case of alkaptonuria: the first case in Korea / 소아과

Alkaptonuria is a rare metabolic disease in which homogentisic acid cannot be metabolized due to a lack of the enzyme homogentisic acid oxidase. The disease often manifests itself in childhood by darkening of the urine upon standing. The disease leads to such serious consequences as ochronosis of cartilage and connective tissues with arthritis. It is expected that treatment with ascorbic acid and a dietary restriction of protein may decrease the late and serious consequences by diminishing the serum concentration of the metabolite benzoquinone acetic acid. A thirteen month-old girl was recently diagnosed with alkaptonuria by urine organic acid analysis. She excreted pinkish urine on a diaper and as time went by the urine color changed to a light brown. In laboratory findings, urine examination and culture results were normal. But urine organic acid analysis detected abnormal findings a prominent and massive elevation of homogentisic acid. The other physical findings were normal. This is the first case diagnosed in Korea.

A Case of Incomplete Congenital Duodenal Diaphragm Presented as Hematemesis / 대한소아소화기영양학회지

We have experienced a case of incomplete congenital duodenal diaphragm with a foreign body (a button), which was found by endoscopy in a 13 month-old girl. She had symptoms of hematemesis, vomiting and bloody stool for a day probably due to foreign body impaction.

Epidemiology and Clinical Outcomes in Children with Malignant Lymphoma in Korea: Retrospective Study / 대한소아혈액종양학회지

PURPOSE: Malignant lymphoma is the primary malignant tumor derived from lymphoid organs. It is composed of Hodgkin's disease and non-Hodgkin lymphoma. Recently, survival rate is on the rise due to improved combination chemotherapy, radiotherapy and high dose chemotherapy followed by hematopoietic stem cell transplantation. In South Korea, no epidemiologic studies concerning malignant lymphoma in the pediatric age group has been performed. Therefore, the Korean Society of Pediatric Hematology-Oncology retrospectively analyzed the incidence, pathologic subtypes, treatment strategies, and survival rates of pediatric malignant lymphomas in South Korea. METHOD: Questionnaires were made and sent to a group of training hospitals, with a return of 580 questionnaires from 24 hospitals. Among them, 517 reports were suitable for analysis. RESULTS: Among the 517 cases, Hodgkin's disease accounted for 58 cases and non-Hodgkin's lymphoma for 459 cases. Male to female ratio for malignant lymphoma was 2.7. Mean age at diagnosis was 8.3 years. Among the pathologic subtypes, mixed cellularity was the most frequent subtype for Hodgkin's disease. Most (70.7%) cases of non-Hodgkins lymphoma belonged to high grade NHL. Burkitt lymphoma accounted for 102 cases, and lymphoblastic lymphoma was found in 58 cases. Peripheral lymphadenopathy was the most common presenting sign upon diagnosis. B symptoms were significantly more frequent in Hodgkin's disease patients than in non-Hodgkin lymphoma patients. The Complete response rate was 62.1% for non-Hodgkin's lymphoma, and 82.8% for Hodgkin's disease. Overall 5 year survival rate was 60.0% in non-hodgkin's lymphoma, and 84.8% in Hodgkin's disease. CONCLUSION: The annual incidence of malignant lymphoma in Korea is 4.7 per million. In cases of chemotherapy-sensitive, refractory or relapsed malinant lymphoma, high dose chemotherapy followed by hematopoietic stem cell transplantation is vital for improved survival. For more systematic analysis of epidemiology on malignant lymphomas, better surveillance mechanisms on the occurrence of malignant lymphomas are crucial, and establishment of standardized treatment protocol for malignant lymphoma is required.

Epidemiology and Clinical Outcomes of Childhood Wilms Tumor in Korea / 대한소아혈액종양학회지

PURPOSE: Wilms tumor is the most common malignant renal tumor in children. We investigated the epidemiology, clinical features and treatment outcome of the children with Wilms tumor in Korea during the recent 10 years. METHODS: Two hundred forty six patients were enrolled between January 1991 and December 2000 from 26 major hospitals in Korea. The data regarding the clinical features including sex, age, pathologic type, prognostic factor and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed, The differences between groups were analyzed by log-rank test. RESULTS: There were 130 males and 116 females. The incidence between the age of 1~4 years was the highest with 66.2%. The annual incidence rate per 1, 000, 000 population varied from 1.9 to 2.1. The 10 years overall survival rate according to sex, clinical stage, pathologic type and relapse were as follows: 88.6% in male, 90.9% in female, 100% in stage I, 94.7% in stage II, 92.1% in stage III, 63.4% in stage IV, 85.7% in stage V, 95.3% in favorable histology, 64.1% in unfavorable histology, 94.8% in non-relapse, and 40.9% in relapse. The relapse rate was 12%. The 10 years overall survival rate of 246 patients were 89.1%. CONCLUSION: Our results could provide the most recent and important clinical information on Wilms tumor of children in Korea.

A Case of Multiple Septic Arthritis by Streptococcus pneumoniae in Kawasaki Disease / 소아과

In Kawasaki disease, arthritis may occur, generally affecting the hands, knees, ankles, or hips. Operations have not usually been needed. We report a case of Kawasaki Disease with multiple septic arthritis which was caused by S. pneumoniae and which needed athrotomy with drainage for both hips, both knees, and both ankle joints. A two year, ten-month-old girl was admitted to our pediatric department. She had a high fever for four days, erythema of the oral and pharyngeal mucosa with a "strawberry" tongue and dry, cracked lips and scarlatiniform rash around the neck and in the groin area, perianal desquamation and a nonsuppurative left cervical lymphadenopathy. At first, we diagnosed her condition as typical Kawasaki disease, and treated her with intravenous immunoglobulin(IVIG) and aspirin. On the sixth admission day, arthralgia developed in both hip joints. She refused to bear weight on the both lower limbs and resisted all passive motion of the hip. An ultrasonogram of the both hip joints revealed an effusion, and four milliliters of grossly purulent material was aspirated from them. Gram staining of this material showed many leukocytes and Gram-positive diplococci. The finding was consistent with septic arthritis. An open arthrotomy of the hip was done and antibiotics prescribed. On the 7th admission day, the findings of multiple athritis were found including ultrasonogram, in both hips, both knees, both ankles, both shoulders, and both elbow joints as well as both wrist joints. The purulent material culture from the left hip and right knee joints' fluid revealed S. pneumoniae. On the 9th and 11th admission day, arthrostomy was performed on the both hips, both knees, and both ankle joints.

The Effects of Radiation Using Ho-166 on Endothelial Function in a Porcine Coronary Model

BACKGROUND AND OBJECTIVES: It has been reported that intracoronary radiation therapy (ICRT) using a Ho-166 coated balloon inhibits restenosis of porcine coronary arteries. However, the consequences of ICRT on coronary artery endothelial function are unknown. The aim of this study is to investigate the effects of ICRT using a Ho-166 balloon on coronary artery endothelial function and vasomotor reactivity. MATERIALS AND METHODS: Female pigs (25-35 kg) were orally premedicated daily with aspirin (100 mg) and ticlopidine (250 mg) for the duration of the study. Under sterile conditions with local anesthesia of the skin provided by 2% lidocaine, an arteriotomy of the left carotid artery was performed, an 8 Fr sheath was inserted, and intraarterial heparin sodium (10,000 IU) was injected. Under fluoroscopic guidance, the coronary artery main branch was selected through an 8 Fr guiding catheter for coronary artery overdilation injury (balloon to artery ratio, 1.3:1) and ICRT. A Ho-166 coated balloon prepared to deliver 20 Gy at a depth of 2 mm from the balloon surface was used for ICRT. The coronary artery main branch in each pig was randomly assigned to either balloon injury (Group I) or balloon injury plus ICRT (Group II). Coronary artery segments were taken from the animals at 0 week (n=8), 4 weeks (n=6) and 8 weeks (n=8) after the intervention. Data in each group denote the relative ratio compared to non-injured coronary artery and are expressed as mean +/- standard error of mean. RESULTS: The degree of KCl-induced contractile response (g) was not different between the two groups at 0 and 4 weeks, but was significantly decreased in group II compared to group I at 8 weeks (I:1.04+/-0.06, II:0.79+/-0.07, p=0.014). In rings precontracted with prostaglandin F 2alpha (PGF 2alpha), the degree of NO-dependent relaxation (%) induced with substance P was significantly decreased in group II compared to group I at 0 week (I:0.93+/-0.33, II:0.47+/-0.31, p=0.03), but the difference between the two groups was not significant at 4 and 8 weeks. In rings precontracted with PGF 2alpha and LAME in the presence of indomethacin, the degree of EDHF-induced relaxation (%) using substance P was not different between the two groups at 0, 4 and 8 weeks; nor was the degree of sodium nitroprusside-induced endothelium independent relaxation (%) in depolarized conditions with PGF 2alpha. CONCLUSION: Endothelial function of the porcine coronary artery is only transiently impaired after ICRT using a Ho-166 coated balloon. Therefore this therapy can be used as an effective method to prevent restenosis after percutaneous coronary intervention.

The Effects of Beta-Radiation Using a Holmium-166 Coated Balloon on Neointimal Hyperplasia in a Porcine Coronary Stent Restenosis Model

BACKGROUND AND OBJECTIVES: Brachytherapy is a promising method in the prevention and treatment of coronary stent restenosis. We sought to observe the therapeutic effects of a radioactive balloon loaded with Holmium-166 (166Ho) in a porcine coronary stent restenosis model. Materials and Methods: A radioisotope of (166Ho) was coated on the balloon surface using a polyurethane coating (20 Gy in 0.5 mm depth). Stent overdilation injuries were performed in two coronary arteries in 8 pigs. Four weeks after the stent overdilation injury, radiation therapies were performed using a control balloon dilation in one coronary artery (Group I:n = 8) and a 166Ho-coated balloon in the other coronary artery in each pig (Group II:n = 8). Follow-up coronary angiogram and histopathologic assessment were performed at 4 weeks after the therepy was administered. RESULTS: Laboratory findings did not differ significantly between the pre-treatment baseline and the measurements taken after radiation. On quantitative coronary angiogram, the coronary artery diameters were not significantly different between the two groups before stenting or at 4 and 8 weeks after stenting. On histopathologic analysis, injury score, internal elastic lamina area and lumen area did not differ significantly between the two groups. The neointimal area was 1.78 +/- 0.11 mm2 in group I and 1.36 +/- 0.12 mm2 in group II (p=0.017), and the histopathologic area of stenosis was 35.1 +/- 1.6% in Group I, 27.6 +/- 1.9% in Group II (p=0.005). CONCLUSION: A treatment of beta-radiation in a stented porcine coronary artery using radioactive Ho-166 coated balloon inhibits stent restenosis without any side effects.

The Effects of (66)Ho-Loaded Radioactive Stent in a Porcine Model

BACKGROUND AND OBJECTIVES: Vascular brachytherpy known to be an effective method in the prevention of restenosis following percutaneous coronary intervention (PCI). In this study we observed the effects of a radioisotope-loaded stent in a porcine model. MATERIALS AND METHODS: Holmium-166 ((166)Ho) was loaded onto the stent surface using impregnated polyurethane, and placed the stents into 7 porcine coronary arteries. Four weeks after stent overdilation injury, histopathological examination was performed. RESULTS: The absorbed dose of (166)Ho to the coronary artery, from the 158.5+/-140.9 microCi (166)Ho stent, was about 141 Gy at a depth of 0.5 mm, which was calculated by Monte Carlo EGS 4 Code. The mean external, and internal elastic lamina areas, the luminal and neointimal areas and the histopathological area stenosis in the 7 porcine coronary arteries were 7.6+/-2.8 mm2, 4.7+/-1.6 mm2, 2.4+/-1.4 mm2, 2.3+/-1.6 mm2 and 49.4+/-24.9%, respectively. The histopathological findings revealed remarkable inflammatory reactions and thrombosis in two of the porcine coronary arteries. CONCLUSION: (166)Ho radioactive loaded stents, using impregnated polyurethane, may inhibit neointimal hyperplasia, but the problems of stent thrombosis and inflammation should be solved.

Experimental and Clinical Studies on the Intraarterial Injection of Holmium-166 Chitosan Complex in the Treatment of Hepatocellular Carcinoma

PURPOSE: The purposes of this study were to evaluate the biodistribution and effect of Ho-166 radionuclide by intra-arterial injection of the Ho-166 chitosan complex in dogs and to assess the clinical efficacy and side effects of this complex in the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: In an experimental study, 20 mCi of Ho-166 chitosan complex was injected into the left hepatic artery of six adult dogs. The distribution of radioactivity in each organ was calculated using a gamma camera scan at regular intervals. A beta ray radioactivity count (cpm) of blood and urine was performed periodically, and hematologic and hepatic function were regularly assessed. At 4, 8 and 12 weeks after intra-arterial injection, bone marrow and liver were pathologically evaluated. Twenty-five patients with a single, nodular HCC mass 3 -9 cm in diameter were treated by intra-arterial injection of Ho-166 chitosan complex, and immediately after the procedure a gamma camera scan was obtained. A beta ray radioactivity count(cpm) of blood was performed periodically, hematologic and hepatic function were regularly evaluated, and CT scans and angiograms were obtained 3 months after the procedure. On the basis of the CT and angiographic findings, the treatment effects were classified as complete (CR), partial (PR) or non-response(NR). RESULTS: In the animal study, blood radioactivity peaked immediately after injection and then declined rapidly. Urinary excretion was 0.17%. The proportion of radioactivity in each organ per whole body was 25% in the left lobe of the liver, 7% in the right lobe, 3% in the lung, 1.4 -3% in the bladder, and 2% in bone. WBC and platelet counts declined maximally at 3 -4 weeks and recovered at 12 weeks. The cellularity of bone marrow was 25% at 4 weeks and 55% at 12 weeks, findings which correlated well with the observed hematologic changes. In the clinical study of 25 HCC patients, CR was achieved in 17 (68%) cases, PR in 5 (20%) and NR in 3 (12%). At gamma camera imaging immediately after treatment, tumor radioactivity was localized in 76% of cases. In six cases (24%) WBC and platelet counts decreased 50% or more compared with their pretreatment level. In 67 -75% of cases, SGOT and SGPT were, within 1 -3 days, 2 -3 times higher than their pre-treatment level, and recovered at post 4 weeks. CONCLUSION: Ho-166 chitosan complex administrated intra-arterially localized the target organ with minimal side effects, and we therefore suggest that it may be used in the treatment of nodular and hypervascular HCC. Further study of its dosimetry and possible hematologic side reactions is needed, however.

Clinical and Molecular-Biologic Study of Extended Spectrum beta-lactamase Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit

PURPOSE: Extended spectrum beta-lactamase (ESBLs) producing Klebsiella pneumoniae has recently been increasingly responsible for infections. Considering the characteristics of the neonatal intensive care unit (NICU), the increase in such colonies is to be an important factor in the treatment and outcome of neonatal patients. Therefore, we performed this study in order to investigate the incidence of this colony and the clinical characteristics that are helpful in diagnosing these infections. METHODS: We performed a double disk synergy test and randomly amplified polymorphic DNA (RAPD) analysis of which 12 was resistant or intermediate to cefotaxime, and 4 colonies isolated from rectal swab taken in 14 patients between July and August, 1997. Also, we compared the annual isolation rate of K. pneumoniae, from those admitted to the Soonchunhyang University Chunan Hospital NICU from July, 1997 to June, 2000. We retrospectively studied the medical records and the clinical characteristics of those 79 cases from whom 110 colonies were isolated. RESULTS: From July to August, 1997, there was a K. pneumoniae outbreak in the NICU. Fifteen out of a total of sixteen isolates were positive in the double disk synergy test and turned out to be ESBL producing K. pneumoniae. Also the RAPD analysis of thirteen isolates which were from the NICU proved eleven isolates to have similar band pattern on RAPD typing. In those who were admitted to our NICU from July, 1997 to June, 2000, 110 colonies of K. pneumoniae resistant or intermediate to cefotaxime were isolated from 79 patients. Though patient group infected by the ESBLs producing K. pneumoniae had significantly no difference in gestational age or birth weight, they had a longer hospitalization period compared to the control group. CONCLUSION: It is possible that ESBLs producing K. pneumoniae be responsible for outbreaks in the NICU. The emerging of these can affect the morbidity in neonates and also can put great limits in the choice of antibiotics.

Effects of 166Holmium and 166Holmium-chitosan Complex(166Ho-CHICO) on Normal Brain of Rats

No abstract available.

Development of 166Ho-Stent for the Treatment of Esophageal Cancer / 대한핵의학회잡지

PURPOSE: Esophageal cancer patients have a difficulty in the intake of meals through the blocked esophageal lumen, which is caused by an ingrowth of cancer cells and largely influences on the prognosis. It is reported that esophageal cancer has a very low survival rate due to the lack of nourishment and immunity as the result of this. In this study a new radioactive stent, which prevents tumor ingrowth and restenosis by additional radiation treatment, has been developed. MATERIALS AND METHODS: Using HANARO research reactor, the radioactive stent assembly (166Ho-SA) was prepared by covering the metallic stent with a radioactive sleeve by means of a post-irradiation and pre-irradiation methods. RESULTS: Scanning electron microscopy and autoradiography exhibited that the distribution of 165/166Ho (NO3) compounds in polyurethane matrix was homogeneous. A geometrical model of the esophagus considering its structural properties, was developed for the computer simulation of energy deposition to the esophageal wall. The dose distributions of 166Ho-stent were calculated by means of the EGS4 code system. The sources are considered to be distributed uniformly on the surface in the form of a cylinder with a diameter of 20 mm and length of 40 mm. As an animal experiment, when radioactive stent developed in this study was inserted into the esophagus of a Mongrel dog, tissue destruction and widening of the esophageal lumen were observed. CONCLUSION: We have developed a new radioactive stent comprising of a radioactive tubular sleeve covering the metallic stent, which emits homogeneous radiation. If it is inserted into the blocked or narrowed lumen, it can lead to local destruction of the tumor due to irradiation effect with dilatation resulting from self-expansion of the metallic property. Accordingly, it is expected that restenosis esophageal lumen by the continuous ingrowth and infiltration of cancer after insertion of our radioactive stent will be decreased remarkably.

Intracavitary 166 Holmium - chitosan Complex Therapy in Patients with Malignant Peritoneal or Pleural Effusions / 대한암학회지

PURPOSE: Most malignant peritoneal or pleural effusions caused by advanced malignancy are unresponsive to systemic chemotherapy except for chemotherapy sensitive tumors, and they are equally ineffective to regional therapy or radiotherapy. Thus, for the purpose of palliating the symptoms related to malignant effusion and to reduce fluid reaccumulations, we evaluated the therapeutic feasibility and efficacy of intracavitary ' Ho-CHICO (chito- san complex) instillation for intractable malignant effusions. MATERIALS AND METHODS: Thirty one patients with cytologically or pathologically proven malignant effusions underwent intracavitary 166Ho-CHICO therapy from May 1996 to March 1998 at Ajou University Hospital. The subjective and objective responses were evaluated 4 weeks after the treatment, including the changes of symptoms, weight, abdominal girth, doses of diuretics, frequencies and amounts of repeat aspirations for fluid reaccumulations, and imaging studies of chest radiograph and ultrasounds. RESULTS: The response rates treated with Ho-CHICO were 50% in patients with peritoneal effusion and 46% in patients with pleural effusion (overall 49%). The response rates between 166Ho-CHICO doses of 50-80 mCi and 90-100 mCi were similar (50% vs 47%). Response rate of 70% was noted in patients with even distribution of radioisotope on the post-therapy scan, but, the response rate was lower in cases with focal (44%) and uneven (29%) distribution pattern. There was no difference in response by the effusion sites. All patients tolerated intracavitary 166Ho-CHICO instillation well, although the majority of patients experienced Grade I/II side effects such as pain, fever, weakness and dyspnea. But, no serious complications of Grade lII or IV degree were observed with 166Ho-CHICO therapy. CONCLUSION: Intracavitary 166Ho-CHICO instillation was clinically efficacious in controlling malignant effusions without a significant toxicity seen with conventional sclerotic therapy. The therapeutic modality appeared to offer similar benefits obtained with the conventional intracavitary therapy.