Purpose : To evaluate the efficacy of hyperfractionated radiation therapy in carcinoma of the cervix, especially on huge exophytic and endophytic stage Ib, IIa and IIb Materials and Materials : Fourty one patients with carcinoma of the cervix treated with hyperfractionated radiation therapy at the Department of Therapeutic Radiology, Dongsan Hospital, Keimyung University. School of Medicine from Jul, 1991 to Apr, 1994. According to FIGO s1aging system, therewere stage Ib (3 patients) IIa (6 patients) with exophytic ($\geq$5cm in dinmeter) and huge endophytic mass. and IIb (32 patients) with median age of 55 yeavs old. Radiation therapy consisted of hyperfractionated external irradition to the whole pelvis (120cGy/fraction, 2 fraction/day (minimum interval of 6 hours), 3600-5520cGy) and boost parametrial doses (for a total of 4480-6480cGy) with midline shield $(4\times10cm)$, and combined with intracavitary irradiation (up to 7480-8520cGy in Ib, IIa and 8480-9980cGy in IIb to point A). The maximum and mean follow up durations were 70 and 47 months respectively . Results : Five year local control rate was $78\%$ and the actuarial overall five year survival rate was $66.1\%$ for all patients, $44.4\%$ for stage Ib, IIa and $71.4\%$ for stage IIb. In bulky IIb (above 5cm in tumor size, 11 patients) five year local control rate and five rear survival rate was $88.9\%,\;73\%$ respectively Pelvic lymph node status (negative : $74\%,\;positive:25\%$, p=0.0015) was significant Prognostic factor affecting to five rear survival rate. There was marginally significant survival difference by total dose to A point ($>84Gy\;:\;70\%,\;>84Gy\;:\;42.8\%$, p=0.1). We consider that the difference of total dose to A point by stage (mean Ib,IIa : 79Gy. IIb 89Gy P=0.001) is one of the causes in worse local control and survival of Ib,IIa than IIb The overall recurrence rate was $39\%$ (16/41). The rates of local failure alone. distant failure alone. and combined local and distant failure were $9.7\%,\;19.5\%,\;and\;9.7\%$, respectively. Two Patients developed leukopenia ($\geq$ grade 3) and Three patients develoued grade 3 gastrointestinal complication. Above grade 3 complication was not noted. There was no treatment related death noted. Conclusion : We thought that it may be necessary to increase A point dose to more than 85Gy in hyperfractionated radiotherapy of huge exophytic and endophvtic stage Ib,IIa. We considered that hyperfractionated radiation therapy may be tolerable in huge exophytic and endophytic stage IIb cervical carcinoma with acceptable morbidity and possible survival gain but this was results in small patient group and will be confirmed by long term follow up in many patients.
Ryu Mi Ryeong;Kay Chul Seung;Kang Ki Moon;Kim Yeon Shil;Chung Su Mi;Namkoong Sung Eun;Yoon Sei Chul
Radiation Oncology Journal
/
v.17
no.3
/
pp.217-222
/
1999
Purpose : To evaluate prognostic factors and survival rates of the patients who received radiation therapy for locally recurrent uterine cervical cancer after curative surgery. Materials and Methods : Between October 1983 and July 1990, fifty three patients who received radiation therapy for locally recurrent cervical cancer after curative surgery at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, The Catholic University of Korea were analysed retrospectively. Age at diagnosis ranged from 33 to 69 years (median 53 years). Pathological analysis showed that forty five ($84.9\%$) patients had squamous cell carcinoma, seven ($13.2\%$) patients had adenocarcinoma, and one (1.9%) patient had adenosquamous cell carcinoma. The interval between hysterectomy and tumor recurrence ranged from 2 months to 25 years (mean 34.4 months). The recurrent sites were vaginal stump in 41 patients ($77.4\%$) and pelvic side wall in 12 patients ($22.6\%$). Recurrent tumor size was devided into two groups : less than 3 cm in 43 patients ($81.1\%$) and more than 3 cm in 10 patients ($18.9\%$). External beam irradiation of whole pelvis was done first up to 46.8 Gy to 50.4 Gy in 5 weeks to 6 weeks, followed by either external beam boost to the recurrent site in 18 patients ($34\%$) or intracavitary irradiation in 24 patients ($45.3\%$). Total dose of radiation ranged from 46.8 Gy to 111 Gy (median 70.2 Gy). Follow up period ranged from 2 to 153 months with a median of 35 months. Results : Overall response rate was $66\%$ (35/53). Among them, six patients ($17.1\%$) relapsed between 7 months and 116 months after radiation therapy (mean 47.7 months), Therefore overall recurrence rate was $45.3\%$. Overall five-year actuarial survival rate was $78.9\%$ and distant failure rate was $10\%$ (5/50). The significant prognostic factors affecting survival rate were interval between primary surgery and tumor recurrence (p=0.0055), recurrent tumor size (p=0.0039), and initial response to radiation therapy (p=0.0428). Complications were observed in 10 ($20/%$) patients, which included mild to moderate lower gastrointestinal, genitourinary, or skin manifestations. One patient died of pulmonary embolism just after intracavitary irradiation. Conclustion : Radiation therapy is the effective treatment for the patients with locally recurrent cervical cancer after curative surgery. These results suggest that interval between primary surgery and tumor recurrence, recurrent tumor size, and initial response to radiation therapy were significant prognostic factors for recurrent cervical cancer.
We compared stress/rest myocardial Tc-99m-MIBl tomographic image findings with rest/stress rubidium-82 tomographic images. In 23 patients with coronary artery disease (12 of them received bypass grafts before) and 6 normal subjects, rest rubidium PET study was performed : rubidium-82 and Tc-99m-MIBI were injected simultaneously to each patient after dipyridamole stress for rubidium PET and MIBI SPECT; and rest MIBI SPECT was performed 4 hours thereafter. We scored segmental decrease of rubidium or MIBI uptakes into 5 grades for 29 segments from 3 short-axis, vertical and horizontal slices. Scores were summed for each major arterial territory. When more score than two grade-2's or one grade-3 was considered as the cue for significant stenosis for major arterial territories, 67% of 46 stenosed arteries were found with MIBI studies and 78% of them by rubidium studies. Fourteen among 28 grafted arterial territories of 12 post-CABG patients were found normal with both rubidium and MIBI. Segmental scores were concordant between rubidium and MIBI in 72% of 709 stress segments and in 80% of 825 rest segments. Stress rubidium segmental scores were less than stress MIBI scores in 9%, so were rest rubidium scores. Stress rubidium scores were more than stress MIBI scores in 20% of segments, and rest rubidium segmental scores were more than rest MIBl scores in 11%. Rank correlations (Spearman's rho's more than 0.7(stress) and 0.5(rest), slopes (MIBI/rubidium) around 0.7(stress) and 0.9 (rest)) suggested deeper and wider defects in stress with rubidium. Slope over 1 (MIBI/rubidium) with LAD segemental scores at rest and 7 territories which had much larger score with MIBI revealed exaggeration of rest defects with rest MIBI in same-day stress/rest study. Difference scores (stress-rest for each territory) suggesting Ischemia were larger with rubidium (slope of MIBI/rubidium around 0.45). As has been implied by animal or separate-day-human studies, these segmental analyses with simultaneous examination in patients told that rubidium PET flow studies disclose ischemia more often than MIBI studies and that rest MIBI studies in same-day stress/rest-sequence gave a little larger rest defect than they would have shown.
Seo, Ji-Hyoung;Kang, Seong-Min;Bae, Jin-Ho;Lee, Yong-Jin;Lee, Sang-Woo;Yoo, Jeong-Soo;Ahn, Byeong-Cheol;Cho, Yong-Geun;Lee, Jae-Tae
Nuclear Medicine and Molecular Imaging
/
v.41
no.4
/
pp.291-298
/
2007
Purpose: To investigate the feasibility of TI-201 SPECT with intra coronary injection (lC-I) in the detection of viable myocardium, we have performed SPECT imaging after direct intracoronary injection of TI-201 and images were compared with those of stress-reinjection (Re-I) SPECT. Methods: Fourteen coronary artery disease patients (male 11, mean age 54 years) who had myocardial infarction or demonstrated left ventricular wall motion abnormality on echocardiography were enrolled. Three mCi of TI-201 was injected into both coronary arteries during angiography and images were acquired between 6- and 24-hour after injection. Reinjection imaging with 1 mCi of TI-201 was performed at 4-hour after adenosine stress imaging with 3 mCi of TI-201. Images were interpreted according to 4-grade visual scoring system (grade 0-3). Segments with mild to moderated uptake (${\leq}$grade 1), and upgraded more than one score with reinjection, and were defined as viable myocardium. Results: Image quality was poor in two cases with IC-I. Numbers of non-viable segments were 60 (23.8%) with IC-I, and 38 (15.1%) with Re-I, respectively. Overall agreement for perfusion grade per myocardial segment in each IC-I and Re-I was 76.5%. Overall agreement for viable segment between IC-I and Re-I was 90.5%. Only one out of 38 segments interpreted as non-viable with Re-I were interpretated as viable with IC-I. And 23 out of 214 segments interpreted as viable with Re-I were interpreted as non-viable with IC-I. Conclusion: Intracoronary TI-201 SPECT seemed to be not advantageous over stress-rest reinjection imaging in the assessment of myocardial viability, mainly due to low count statistics at 6-hour or 24-hour delayed time points. The feasibility of intracoronary TI- 201 SPECT is considered to be limited.
Background: Off-pump coronary artery bypass grafting (OPCAB) shows fewer side effects than cardiopulmonary by. pass, and other benefits include myocardial protection, pulmonary and renal protection, coagulation, inflammation, and cognitive function. We analyzed the clinical results of our cases of OPCAB. Material and Method: From May 1999 to August 2007, OPCAB was performed in 100 patients out of a total of 310 coronary artery bypass surgeries. There were 63 males and 37 females, from 29 to 82 years old, with a mean age of $62{\pm}10$ years. The preoperative diagnoses were unstable angina in 77 cases, stable angina in 16, and acute myocardial infarction in 7. The associated diseases were hypertension in 48 cases, diabetes in 42, chronic renal failure in 10, carotid artery disease in 6, and chronic obstructive pulmonary disease in 5. The preoperative cardiac ejection fraction ranged from 26% to 74% (mean $56.7{\pm}11.6%$). Preoperative angiograms showed three-vessel disease in 47 cases, two-vessel disease in 25, one-vessel disease in 24, and left main disease in 23. The internal thoracic artery was harvested by the pedicled technique through a median sternotomy in 97 cases. The radial artery and greater saphenous vein were harvested in 70 and 45 cases, respectively (endoscopic harvest in 53 and 41 cases, respectively). Result: The mean number of grafts was $2.7{\pm}1.2$ per patient, with grafts sourced from the unilateral internal thoracic artery in 95 (95%) cases, the radial artery in 62, the greater saphenous vein in 39, and the bilateral internal thoracic artery in 2. Sequential anastomoses were performed in 46 cases. The anastomosed vessels were the left anterior descending artery in 97 cases, the obtuse marginal branch in 63, the diagonal branch in 53, the right coronary artery in 30, the intermediate branch in 11, the posterior descending artery in 9 and the posterior lateral branch in 3. The conversion to cardiopulmonary bypass occurred in 4 cases. Graft patency was checked before discharge by coronary angiography or multi-slice coronary CT angiography in 72 cases, with a patency rate of 92.9% (184/198). There was one case of mortality due to sepsis. Postoperative arrhythmias or myocardial in-farctions were not observed. Postoperative complications were a cerebral stroke in 1 case and wound infection in 1. The mean time of respirator care was $20{\pm}35$ hours and the mean duration of stay in the intensive care unit was $68{\pm}47$ hours. The mean amounts of blood transfusion were $4.0{\pm}2.6$ packs/patient. Conclusion: We found good clinical outcomes after OPCAB, and suggest that OPCAB could be used to expand the use of coronary artery bypass grafting.
As a study on the cellulase of Myriococcum albomyces the culture media for enzyme formation and properties of its crude preparation were investigated and the crude enzyme preparation was further fractionated. The results are summarized as follows: 1. Wheat bran solid culture produced stronger activities of cellulase than rice bran or defatted soy bean meal solid culture. 2. Shaking culture with wheat bran, rice bran or defatted soy bean meal produced higher cellulase activities than solid culture with the corresponding media. 3. The enzyme formation was higher at $45^{\circ}C$ than at $37^{\circ}C$ or $50^{\circ}C$ regardless of the kind of culture medium. 4. The formation of CMCase activity was more promoted by organic nitrogen source than inorganic nitrogen source. 5. The formation of cellulase activities were increased 1.5 to 3.0-fold by adding CMC, Avicel or cellulose powder as an inducer into 5% wheat bran basal medium. 6. Cellulase production using a tank culture procedure with addition of CMC or Avicel as an inducer was the highest at fifth day and thereafter decreased slightly. 7. The crude enzyme preparation showed pH optimum in 4.0 to 4.5, and pH stability in the range of 3.5 to 8.0. Optimum temperature for the activity was $65^{\circ}C$ which was higher than among other cellulases and it was stable at $60^{\circ}C$ for 120 minutes. 8. Dialyzed crude enzyme was activated by $Ca^{++}$ and $Mg^{++}$, but inhibited by $Hg^{++}$, $Cu^{++}$ and $Ag^{+}$. 9. Four different types of cellulase, i. e., fraction I, fraction II-a, fraction II-b, and fraction III were purified from the culture filtrate of Myriococcum albomyces through a sequence of ammonium sulfate fractionation, and elution chromatography on DEAE-Sephadex A-25, Amberlite CG-25 type 2 and hydroxyapatite columns. 10. These four cellulase fractions were showed to be homogenous by electrophoresis and ultracentrifugation and also gave a typical ultraviolet absorption spectrum of protein. 11. Four purified fraction showed different specificity toward substrates, fraction I has a stronger activity toward Avicel, cellulose powder, and gauze than that of other cellulase fractions. Fraction II-a had a powerful activity toward cellobiose but it was almost inactive agaisnt fibrous cellulose contrary to fraction I. On the contrary, the main component fraction II-b had a fairly higher activity on CMC and Avicel. Activity of fraction II-b toward cellobiose was about one-third of that of fraction II-a and activity on Avicel was lower than that of fraction I. Fraction III had a more powerful activity in decreasing viscosity of CMC. 12. Final hydrolysis products of fibrous cellulose by each fraction were cellobiose and glucose. Whereas oligosaccharides were predominant in the early stage of hydrolysis, prolonged reaction produced more glucose than cellobiose. Fraction I and fraction II-a acted synergically on Avicel. 13. Optimum pH for the activities of cellulase fraction I, fraction II-a, fraction II-b and fraction III were found to be 5.5, 5.0, 4.0 and $4.0{\sim}4.5$, respectively. These fractions were found to be stable in the range of pH $3.0{\sim}7.5$. 14. Optimum temperature for the activities of fraction I, fraction II-a, fraction II-b, and fraction III were $50^{\circ}C$, $55^{\circ}C$, $60^{\circ}C$ and $55^{\circ}C$, respectively. No less of activity was found by heating 120 minutes at $55^{\circ}C$ and fraction II-a was more stable than the others at $60^{\circ}C$. 15. Fraction I and fraction II-b were activated by $Ca^{++}$ and $Mg^{++}$ but inhibited by $Hg^{++}$ and $Ag^{+}$.
In order to study on the preparation of improved soysauce, Koji(soybean and wheat mash fermented by the strain Aspergillus sojae), Koji-Natto(mixed with the various proportion of Koji to Natto; 8 : 2, 6 : 4, 4 : 6, 2 : 8) and Natto (prepared using the strain: Bacillus subtilis) were prepared as soysauce materials. Sensory evaluation for the soysauces made from above-mentioned soysauce materials and the contents of total nitrogen, amino nitrogen, ammonia nitrogen, reducing sugar, total acid and enzyme activity were determined. The results were summarized as follows: 1. Protease activity of Natto was over twice higher than that of Koji and amylase activity of Koji was three times higher than that of Natto. Koji-Natto showed successive increase of amylase activity and successive decrease of protease activity as Koji proportion was increased to Natto. 2. The contents of total nitrogen and amino nitrogen in all the soysauce mashes displayed linear increases or no changes of these contents as aging. The contents of total nitrogen and amino nitrogen in the mahes were higher as Natto proportion increase to Koji during the aging period. 3. In Natto soysauce mash and Koji-Natto soysauce mashes the contents of ammonia nitrogen were gradually increased until $1{\sim}2$ months and rapidly reduced after that period, while Koji soysauce mashes were continuatively increased. 4. In all the soysauce mash the reducing sugar increased preeminently until the two months and after then there was a rapid decrease as aging the contents of reducing sugar in the mash were higher as Natto proportion increased to Koji during aging period. 5. The total acid of Koji and Koji-Natto (8 : 2) soysauce mash showed gradual increase as aging, while contents of total acid in Natto and other Koji-Natto soysauce mashes increased preeminently until 50${\sim}$70 days aging, after then decreased. 6. The results of sensory evaluation for three-month-fermented soysauces showed the most excellent in Koji-Natto (6 : 4) and successive order in the soysauces consisting of Koji and Natto proportion: 8 : 2, 10 : 0, 4 : 6, 2 : 8, 0 : 10.
This study was conducted to clarify progressed changes of plant types and the effects of the physiological and ecological components on improving ideotype of winter wheat. 12 wheat varieties were planted at the experimental farm of Wheat and Barley Research Institute in Suwon in 1990. As results of intensive wheat breeding for early maturity since 1959, heading, flowering and maturing dates have been shortened by 17, 15 and 14 dagys, respectively. The shortened days from sowing to heading and from heading to flowering contributed to the early maturity to improved. Physiological factors associated with heading time of wheat could be reprsented by growth habit, photoperiod responses, earliness in narrow sense and winter hardiness. For improving an early maturity of winter wheat, it would desired to maintain some degree of winter habit(III-IV), and recombination of more insensitivity to short day length and more shortened earliness in narrow sense than that of Saemil and Chugoku 81, and higher degree of winter hardiness. For improving the early maturity the more effective way must be of shortened days from sowing to heading, and days from flowering to maturity than days from heading to flowering. Ideotype of wheat will be desired to recombine two semi-dwarf genes with erect plant type being about 70-80cm, less stem elongation by late spring, long spike and many grains per spikelet. Average spike weight ratio was about 45-49% in high-yielding varieties, stem fresh weight was lighter, but spike fresh weight was heavier in new one while leaf fresh weight was similar to each other during the maturing periods. Average spike dry weight ratio was higher about 40~48%, and stem and leaf blade dry weights were lower in the newly bred varieties. Stem dry weight was heavier than spike or leaf dry weight in the old varieties of Yungkwang, Jangwang and Jinkwang. Leaf area index for the varieties showed normal distribution curve as the maximum point in booting stage. The maximum point of this curve come in early maturing wheat, and late in old one. The maximum points of LAI were 6.4~6.8 in the high-yielding varieties. Totals of LAI in each period investigated of old one were higher than those of newly bred being 24.6~28.8. Chlorophyll content of the high-yielding varieties of Chokwang, Geurumil and Saemil as higher than that of the old varieties Jangkwang, Jinkwang, Wonkwang and Sinkwang from regrowing period to April 21. after then slightly and even after heading. Net assimilation rate (NAR) was higher in high-yielding varieties with good plant type, and lower in old ones. Grain yield of the newly released varieties increased rapidly but slowly in the old ones. Change in water content of grain at the growing stage in newly bred was lower than that of the old bred. Diminishing rate of water content of grain in establishment per day was 1.2% average that of the old varieties including Yungkwang was 1.5%, and those of the newly bred including Chokwang were 0.9~1.1%. Chokwang, Naemil, and Saemil were the highest-yielding varieties of the Korean cultivars. Yields were increased by spikes per m$^2$, grain weight for the varieties bred in Suwon, and by spikes per m$^2$ for the varieties bred in Milyang.
Inflammatory process leads to the well-known mucosal damage and therefore a further disturbance of the epithelial barrier function, resulting abnormal intestinal wall function, even further accelerating the inflammatory process[1]. Despite of the records, etiology and pathogenesis of IBD remain rather unclear. There are many studies over the past couple of years have led to great advanced in understanding the inflammatory bowel disease(IBD) and their underlying pathophysiologic mechanisms. From the current understanding, it is likely that chronic inflammation in IBD is due to aggressive cellular immune responses including increased serum concentrations of different cytokines. Therefore, targeted molecules can be specifically eliminated in their expression directly on the transcriptional level. Interesting therapeutic trials are expected against adhesion molecules and pro-inflammatory cytokines such as TNF-${\alpha}$. The future development of immune therapies in IBD therefore holds great promises for better treatment modalities of IBD but will also open important new insights into a further understanding of inflammation pathophysiology. Treatment of cytokine inhibitors such as Immunex(Enbrel) and J&J/Centocor(Remicade) which are mouse-derived monoclonal antibodies have been shown in several studies to modulate the symptoms of patients, however, theses TNF inhibitors also have an adverse effect immune-related problems and also are costly and must be administered by injection. Because of the eventual development of unwanted side effects, these two products are used in only a select patient population. The present study was performed to elucidate the ability of TNF-${\alpha}$ antibodies produced in sheep colostrums to neutralize TNF-${\alpha}$ action in a cell-based bioassay and in a small animal model of intestinal inflammation. In vitro study, inhibitory effect of anti-TNF-${\alpha}$ antibody from the sheep was determined by cell bioassay. The antibody from the sheep at 1 in 10,000 dilution was able to completely inhibit TNF-${\alpha}$ activity in the cell bioassay. The antibodies from the same sheep, but different milkings, exhibited some variability in inhibition of TNF-${\alpha}$ activity, but were all greater than the control sample. In vivo study, the degree of inflammation was severe to experiment, despite of the initial pilot trial, main trial 1 was unable to figure out of any effect of antibody to reduce the impact of PAF and LPS. Main rat trial 2 resulted no significant symptoms like characteristic acute diarrhea and weight loss of colitis. This study suggested that colostrums from sheep immunized against TNF-${\alpha}$ significantly inhibited TNF-${\alpha}$ bioactivity in the cell based assay. And the higher than anticipated variability in the two animal models precluded assessment of the ability of antibody to prevent TNF-${\alpha}$ induced intestinal damage in the intact animal. Further study will require to find out an alternative animal model, which is more acceptable to test anti-TNF-${\alpha}$ IgA therapy for reducing the impact of inflammation on gut dysfunction. And subsequent pre-clinical and clinical testing also need generation of more antibody as current supplies are low.
The Background and Purpose It is done the study on the public health care of oriental medicine and improvement of its system recently, I think that these effect a good health care for a people through the public health care of oriental medicine. Since Woosuk university and Chonju-Wansan health center had taken upon the oriental medicine service in the health center in 1995, we have public favor from the local population. So in other to a study on the clinical statistics of oriental medicine service in the health center, I investigated general character, style of diseases, effect of treatments and the like for a paitents received oriental medicine treatments in there. Objective and Methods This study researched into clinical statistics for paitents received oriental medicine treatments in the Chonju-Wansan health center during one year period from January 4 1996 to December 26 1996. The number of object was 238 case of 234 persons. Results and Conclusions Analyzing these 234 persons, the proportion of males to females was 1 to 6.8. As for the distribution of age, the ages of 61 to 70 occupied 34.62 per cent in the ages of 51 to 90 occupied 88.89 per cent in the whole paitons. Therefor female was very highly more than male and paitents were for the most part, old ages(51years old and over). Musculoskeletal system and connective tissue disease of 238 case occupied 82.77 per cent. were the greatest proportion. At the duration of disease, 1 year to 5 years occupied 32.35 per cent, was the highest The grade Ⅲ was the most of the sign of paitents at first visit, it occupied 55.88 per cent. The good(++) and over effect of treatments occupied 62.18 per cent, the fair(+) and over effect of treatments occupied 78.99 per cent. As for the duration of treatment, the case of 2 times to 5 times visit occupied 34.03 per cent, was the highest. And the case of 2 times to 10 times visit was 4 times as good effect as the case of only one visit. By medication of treatment, O-Juk-San(五積散) occupied 32.21 per cent, was the greatest proportion, and Pal-Mj-Hoan(八味丸) occupied the second greatest proportion. Therefor the most of paitents had the chronic diseases and was diagnosed Sin-Yang-He(腎陽虛). The average 22.58 persons received acupuctural treatment a day, the average 0.58 persons received the moxibustion a day, the average 2.28 persons received venesection (bloodletting) a day. And others treatment performed physical therapy and the like. The case received treatment of the oriental and western medicine at the same time. marked 21 persons among 30 persons and had a good effect by 70 per cent. The average 26.95 persons received treatment of oriental medicine a day, the average 3.9 persons received the first medical examination a day.
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