IMRT는 정밀한 입체조형 방사선량 분포를 얻을 수 있어서 종양의 모양에 맞추어 방사선량을 집중함으로써 종양에 들어가는 총방사선량을 증가시킬 수 있다. 그에 따라 적절한 증례에서는 국소제어율과 완치율 향상을 기대할 수 있다. 또한 여러 가지 표적에 대한 차별화된 방사선량을 분포시킬 수 있어서 종양부위를 포함 하면서도 동시에 종양 주위의 중요한 정상 장기를 보호 할 수 있으므로 국소 부작용을 감소시켜 환자의 삶의 질을 향상시킬 수 있다. IMRT는 일반적인 방사선치료보다 더 많은 방향에서 치료하고, MLC를 조절하여 세기를 조절한다. 치료할 부위는 MLC를 열고 보호해야 할 부위는 MLC를 닫고, 점진적으로 치료하기 때문에 선형가속기에서 사용되는 모니터단위(monitor unit, MU)는 일반적인 방사선치료보다 3-10배 많게 되므로 치료시간이 길게 된다. 그러므로 환자가 치료시간 동안 자세고정이 잘 되어야 IMRT를 시행할 수 있다. 또한 정상조직의 선량분포는 고선량을 받는 용적은 감소하고, 저선량을 받는 용적은 증가하게 된다. IMRT를 합리적으로 이용하게 되는 중요한 이유는 방사선치료에 의한 부작용의 감소이다. IMRT의 이용은 두경부암과 전체 유방을 치료해야 하는 유방암에서 근거수준1의 임상적 증거가 있어서 논쟁의 여지가 없으며, 전립선암 등 다른 부위의 종양들에서도 여러 수준의 임상적인 증거들이 있다. 생존율의 향상, 종양제 어율의 증가, 그 외 치료 유효성의 지표들에 대한 결과는 전반적으로 아직 확실한 결론이 나오지 않아서 앞으로 더욱 임상 연구가 필요하다.

The aim of this study was to evaluate clinical outcomes of laparoscopic surgery for colorectal cancer within a learning period. A total of 86 consecutive patients who underwent laparoscopic resection for colorectal cancer between January 2010 and December 2011 were investigated retrospectively. The patients were sorted into the early and late group; 43 patients were included in each group. Patient’s clinicopathologic features, perioperative outcomes, morbidity, and mortality were evaluated. The two groups showed similar operative results in terms of operation time, conversion rate to open surgery (16% vs 7%, p=0.313), and the rate of postoperative complication (34.9% vs 37.2%, p=0.313). The most serious complication, anastomotic leak, developed in five and four patients in the early and late group, respectively. Hemoglobin change, which means blood loss indirectly was lower in late phase and was statistically significant (2.3g/dL vs. 1.7g/dL, p=0.007). No difference in TNM stage and number of retrieved lymph nodes (19.2±11.9 vs 18.7±12.7, p=0.847) was observed between the two groups. Laparoscopic surgery for colorectal cancer can be performed safely and effectively even during a learning period, if the operation is performed carefully.

Pulmonary tuberculosis is an important public health problem. Early diagnosis and treatment is necessary for successful patient outcomes. However, diagnosis of pulmonary tuberculosis is difficult in cases with an unusual presentation and often requires a lung biopsy. The tuberculosis polymerase chain reaction results in tissue sample have potential for early diagnosis and treatment initiation for pulmonary tuberculosis. The relatively low sensitivity limit the use of this test in the detection of the pulmonary tuberculosis.

In this study, we identified 26 cases scheduled for lower extremity computed tomography (CT) angiography who had implanted metal devices. These CT exams were performed for evaluation of patients' symptoms related with gait disturbance. CT scans were performed on 128-MDCT using our standard parameters. The row image data were reconstructed using two different methods, standard filtered backprojection (FBP) algorithm and the metal artifact reduction for orthopedic implants (O-MAR) algorithm. Images were evaluated with 3-point scales. The difference of image scores for FBP (1.5±0.81) and OMAR (1.92±0.79) was significant (p<0.05). O-MAR reconstruction significantly improved quality of CT angiography for patients with metal implants.

Everolimus is a secondary medication for metastatic renal cell carcinoma when vascular endothelial growth factor inhibitor treatment fails. Everolimus is reported to cause a variety of metabolic complications but complications in the eye are rare. Although serious eye complications have not been reported, secondary complications may result from the metabolic complications. We observed a case in which central retinal vein occlusion occurred, probably caused by metabolic complications following Everolimus treatment of RCC. We report this case.

Paragonimiasis is an infectious disease caused by ingestion of freshwater crab, crayfish, or shrimp infested with Paragonimus metacercariae. Here, we report a case of extrapulmonary paragonimiasis presenting as an abscess in the abdominal cavity. A 54 year old woman presneted, compaining of severe abdominal pain. Her abdominal CT showed an abdominal abscess with peripheral rim enhancement and central hypodensity core on omentum and terminal ileum. We decided to perfom a diagnostic laparoscopic exploration for acute abdominal pain. During surgery, we saw a living adult worm in the abscess pocket. We diagnosed paragonimiasis and treated with Praziquantel. This case was confirmed by biopsy and micro-ELISA test.

Polyethylene glycol (PEG) solution is currently used to prepare the colon before colonoscopy. Hyponatremic encephalopathy is a condition with neurologic symptoms such as headache, vomiting, confusion, seizure, and sometimes respiratory arrest. A 55-year-old woman presented to our emergency department with generalized tonic-clonic seizure and mental change after ingestion of PEG solution 2 L with water. Serum sodium concentrations was 115 mmol/L. After correction with hypertonic saline for 12hrs, serum sodium concentration reached 129 mmol/L and mental status recovered. We experienced a case of acute hyponatremic encephalopathy resulting from ingestion of PEG solution 2 L for colonoscopy.

The esophageal mucosal ring, otherwise known as Schatzki’ ring or B ring is a thin, diaphragm like, circumferential mucosal fold that protrudes into the lumen of the gastroesophageal junction. Symptomatic esophageal mucosal ring is found in only 0.5% of patients who undergo an esophagogram. In Korea, symptomatic esophageal mucosal ring of adult is very rare. A 66- year-old man was admitted to the hospital with progressive dysphagia of five months' standing. The endoscopy revealed a mucosal ring with a narrowed esophageal lumen of about 4mm. Herein, we report a case of endoscopic balloon dilatation using controlled radial expansion (CRE) balloon under fluoroscopic control.

Marked neutrophilia associated with neoplasia is a relatively rare finding and has been considered as a paraneoplastic manifestation. Thyroid cancer seldom presents with paraneoplastic leukocytosis. We report on a case of a 69-year-old man who presented with paraneoplastic leukocytosis seven months after undergoing total thyroidectomy and I-131 therapy for treatment of papillary thyroidcarcinoma. We found neither bone marrow involvement of malignant cells nor hematologic malignancy. Based on elevated levels of serum granulocyte colony-stimulating factor, we concluded that the cause was paraneoplastic leukocytosis. Another interesting point was the anaplastic transformation in the pleural metastatic site. It usually occurs in the intrathyroid or regional lymph node.

Fatal pulmonary embolism occurs in 0.1% to 0.26% of cases of spine fusion surgery. Early diagnosis of pulmonary embolism is difficult, and delay in treatment can lead to a fatal outcome. We report on a case of symptomatic pulmonary embolism which developed after induction of general anesthesia in a patient who had been immobile because of a previous spinal operation one week prior to this. Despite a negative preoperative ultrasound examination for deep vein thrombosis, the patient had developed a pulmonary embolism, which was diagnosed using intraoperative transesophageal echocardiography. Despite intensive cardiopulmonary resuscitation and thrombolytic therapy, the patient died within a few hours of diagnosis.