• Radiation Oncology Journal
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• v.18 no.1
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• pp.27-31
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• 2000

Purpose : The aim of this study was to investigate treatment results, toxicity and efficacy of hypefractionated radiation therapy combined with paclitaxel for paraaortic node recurrence in cervix cancer. Materials and Methods: Between September 1997 to March 1999, 12 patients with paraaortic node recurrence in cervix cancer who previously received radical or postoperative radiotherapy were treated with hypefractionated radiation therapy combined with paclitaxel. Of these, 2 patients who irradiated less than 30 Gy were excluded, 10 patients were eligible for this study. Median age was 51 years. Initial FIGO stage was 1 stage IBI, 2 stage IIA, 7 stage IIB. For initial treatment, 7 patients received radical radiotherapy and 3 received postoperative radiotherapy. The paraaortic field encompassed the gross recurrent disease with superior margin at T12, and inferior margin was between L5 and S1 with gap for previously pelvic radiation field. The radiation field was initially anterior and posterior opposed field followed by both lateral field. The daily dose was 1.2 Gy, twice daily fractions, and total radiotherapy dose was between 50.4 and 60 Gy(median, 58.8 Gy). Concurrent chemotherapy was done with paclitaxel as a radiosensitizer. Dose range was from 20 mg/m$^{3}$ to 30 mg/m$^{3}$ (median, 25 mg/m$^{3}$), and cycle of chemotherapy was from 3 to 6 (median, 4.5 cycle). Follow-up period ranged from 3 to 21 months. Results : Interval between initial diagnosis and paraaortic node recurrence was range from 2 to 63 months (median, 8 months). The 1 year overall survival rate and median survival were 75$\%$ and 9.5 months, respectively. The 1 year disease free survival rate and median disease free survival were 30$\%$ and 7 months, respectively. At 1 month after treatment, 4 (40$\%$) achieved a complete response and 6 (60$\%$) experienced a partial response and all patients showed response above the partial response. There was distant metastasis in 6 patients and pelvic node recurrence In 2 patients after paraaortic node irradiation. There was 2 patients with grade 3 to 4 leukopenla and 8 patients with grade 1 to 2 nausea/ vomiting which was usually tolerable with antlemetic drug. There was no chronic complication in abdomen and pelvis during follow up period. Conclusion : hypefractionated radiation therapy combined with paclitaxel chemotherapy diosensitizer showed high response rate and few complication rate in paraaortic node recurrence in cervix cancer Therefore, present results suggest that hypefractionated radiation therapy combined with paclitaxel chemotherapy can be used as optimal treatment modality in this patients.

• Tuberculosis and Respiratory Diseases
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• v.43 no.1
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• pp.14-21
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• 1996

Objectives: Although outbreak of MDR Tb has been a recent problem in western countries, it has been a longstanding problem in Korea. The poor outcome of MDR Tb is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. Thus, to improve the outcome of MDR Tb, it is crucial to make individualized adequate prescription based on the knowledge of the patterns of resistance to each drugs in the community as well as the natural history. The purpose of present study is to evaluate the clinical features of Korean MDR Tb patients including patterns of drug resistance and success rate of treatment which was prescribed according to the sensitivity tests. Methods: Retroscpective analysis of 71 Korean patients with MDR Tb was made. All strains isolated from patients showed resistence to at least two first line drugs. Patients profile, previous treatment history, patterns of drug resistance, outcome of treatment was analysed. Initial treatment regimen was selected according to the previous treatment history and was modified according to the sensitivity reports. The regimen was composed to include at least 4 sensitive drugs when possible. Results: The patients showed resistance to 4.1 drugs on average. 90% of them were resistant to INH and RFP. Among 71 patients, 35 patients(49%) had cavitary lesions in CXR. Treatment outcome was analysed in 55 patients. 35 patients(67%) were improved after treatment and 18 patients(33%) showed treatment failure. 5 patients showed primary resistance. Treatment outcome could be evaluated in 4 of them and all showed improvement after treatment. 14 patients(20%) had to change their regimens due to drug side effects. The most frequent side effect was elevation of liver enzymes(6 patients). Others included dizziness, hyperuricemia, tinnitus, skin rash, GI troubles. More than 50% of side effects developed within 3 months. In repeated drug sensitivity test, the concordance rate of resistance to INH was 100% and RFP 98%. EMB, PZA showed 80% concordance rate. But in the other drugs, the concordances were less than 50%. Operation was done in 5 patient - 1 patients as a adjunctive means of chemotherapy -. In that case, negative conversion of sputum AFB was done. Conclusion: 2/3 patients of multidrug-resistant tuberculosis were improved by appropriate prescription and regular medication suggesting that more aggressive management and monitoring is indicated in multidrug-resistant tuberculosis.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.669-674
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• 2010

Background: Spontaneous hemopneumothorax is characterized by the accumulation of air and more than 400 mL of blood in pleural cavity without any apparent cause. It is a rare disease and can cause life-threatening situation. We analyzed clinical reviews of two medical centers to aid in optimal management. Material and Method: Retrospective review between March 2003 and August 2010 with 18 spontaneous hemopneumothorax patients was made. Result: These 18 patients were comprised of 15 male and 3 female with average 24.6 years (range 15~46 years). Almost patients (16) underwent a closed thoracostomy initially and 15 patients received video-assisted thoracic surgery (VATS). Mean postoperative chest tube removal was 2.9 days and one complication was post-removal pneumothorax. During the follow-up periods there were no other complications and recurrence. Conclusion: Proper initial diagnosis and management of spontaneous hemopneumothorax prevent significant hypovolemic shock. Video-assisted thoracic surgery should be considered an early surgical management in spontaneous hemopneumothorax. However conservative manage without bleb excision may be effective in selected patients.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.9 no.2
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• pp.13-23
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• 2003

본 연구의 목적은 손 기능에 문제가 있는 환자들을 중심으로 splint의 효과를 알아보기 위한 기초조사로써 2명의 환자를 제주 한마음병원(Case1, 2)에서 2001년 6월부터 11월까지 조사하였다. 2명의 환자는 다음과 같다. i) 사례 1 : 뇌성마비 아동(4세, 남, 오른손)으로 한쪽 손목과 엄지손가락에 강직으로 인하여 잡기 기능에 제한이 있는 편마비 아동이다. ii) 사례 2 : 전기화상(56세, 남, 왼손)으로 4-5번째 손가락의 M.P joint와 I.P joint에 관절운동 제한으로 완전하게 주먹을 질 수가 없다. 연구를 위하여 손 기능의 평가는 표준화가 되어있는 Jebsen-hand function test, Total passive Motion(TPM)을 사용하였으며, 환자들의 만족도를 알아보기 위해서는 Canadian Occupational Performance Measure(COPM)을 사용하였다. i) 사례 1 : 두 가지 splint를 적용하였다. 즉 낮 동안에는 splint 1, 밤 동안에는 splint 2를 6시간 이상 착용하도록 하였으며 작업치료는 시행하지 않았다. ii) 사례 2 : 이 환자에게는 작업치료가 끝나는 동시에 splint. 3을 6시간 이상 착용하도록 하였으며, M.P joint와 I.P joint의 관절 변화를 조절하도록 특별히 고안된 splint를 적용하였다. 그 결과 사례 1의 Jebsen-hand function test시 초기에는 측정을 할 수가 없었으나, splint착용 후 크고 가벼운 물건 옮기기(44.15), 크고 무거운 물건 옮기기(42.66), 적목쌓기(44.63), 먹기 흉내내기(54.47) 등에서 처음 동작만 도와주면 측정이 가능할 수 있도록 진전을 보였다(그래프1), 사진(착용 전과 착용 후). 사례 2의 경우 Jebsen-hand function test의 적목쌓기와 먹기 흉내기가 가장 높았으며, 글씨 쓰기가 가능했다. 손의 관절가동 변화에서도 splint 착용전의 측정치와 착용 후 관절 가동 범위의 변화 폭이 약 $30_{\circ}$이를 보여주었다(그래프 2), (그래프3). 결론적으로 손 기능 회복에 직접적인 재활 치료뿐만 아니라, 치료 후에도 splint를 착용하여 가정에서도 계속적인 치료가 될 수 있도록 하는 것이 손의 기능회복에 도움이 됨을 알 수 있었다. 그러므로 각 환자의 문제점을 파악하여 적절한 splint를 제작해 줄 필요가 있다고 사료된다. 이 기초조사를 시작으로 하여 더 많은 환자들을 대상으로 splint가 손 기능 회복에 어떠한 영향을 미치는지 그 효과에 대하여 계속적인 연구가 필요할 것이다.

• Journal of Oral Medicine and Pain
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• v.17 no.1
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• pp.73-87
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• 1992

저자는 28명의 측두하악장애 환자와 31명의 정상인을 대상으로 최적기능교합의 개념에 입각하여 교합시의 치아접촉점을 동적이며 정량적인 방법으로 평가하여 교합안정장치의 사용으로 인한 교합안정성의 개선여부를 알아보고자 하였다. 이와 동시에 교근과 전측두근의 활성도를 측정하여 치료의 경과에 따른 근활성의 변화를 알아보기 위해 본 연구를 시행하였다. 측정항목은 개구범위, 두개하악장애지수, 치아접촉점 좌우균형치, 치아접촉점 전후균형치, 치아접촉점 평균시간간격, 치아접촉점의 개수, 접촉시간, 좌우측 교근과 좌우측 전측두근의 근활성, 근활성 비대칭 지수 등이었다. 이의 측정을 위해 T-Scan System, K-6 Diagnostic System 그리고 EM 2등을 사용하였으며 얻어진 자료에 대해 검정한 후 다음과 같은 결론을 얻었다. 1. 교합안정장치를 이용하여 측두하악장애 환자들을 4주간 치료한 결과 전반적인 임상증상이 호전되어 개구범위와 두개하악장애지수에 있어서 뚜렷한 개선이 있었다. 2. 측두하악장애 환자에서 최대 악물기시의 치아접촉점 좌우균형치및 평균시간 간격이 큰 것으로 나타나 치아접촉이 일어나는 순간의 교합안정성이 좋지 않은 것으로 평가되었다. 3. 치료 4주후 교하안정장치를 장착한 상태에서 측정한 치아접촉점 좌우균형치및 치아접촉점 평균시간간격은 치료전에 비해 개선된 것으로 나타났다. 4. 치료 4주후 치아접촉점의 전후방 분포가 구치부위로 이동되는 양상을 보였다. 5. 측두하악장애 환자에서 최대 악물기시의 좌우측 교근 및 전측두슨의 근활성은 정상인에 비해 낮에 나타났으며, 이는 치료기간 동안 감소되는 경향을 나타내었다. 6. 측두하악장애 환자에서 전측두근의 근활성 비대칭지수는 정상인에 비해 상당히 높게 나타났으며 이는 치료기간 동안 감소되는 경향을 나타내었다.

• Journal of the Korean Society of Physical Medicine
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• v.18 no.4
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• pp.97-107
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• 2023

PURPOSE: This study aimed to explore the effect of applying elastic taping and passive stretching exercises simultaneously on the muscle tone of the upper trapezius. METHODS: Thirty healthy adults were randomly divided into two groups: the 'passive stretching exercise' group (n = 15) and the 'passive stretching exercise with elastic taping' group (n = 15). Muscle tone was measured using the MyotonPRO®. The muscle tension was measured immediately after the stretching exercises and taping intervention, and again 5 minutes after the intervention. RESULTS: Within each group, there was a significant reduction in muscle tone in the upper trapezius after treatment (p < .05). However, there was no significant difference in the muscle tone reduction between the groups (p > .05). Both experimental and control groups showed a significant decrease in muscle tone in both the upper trapezius muscles over time, i.e., immediately after treatment and five minutes later (p < .05). The main effect of time was identified in the repeated measures analysis, while there was no main effect attributed to the treatment method (group) (p < .05). CONCLUSION: The simultaneous application of stretching exercises and taping as an intervention to reduce muscle tension in the upper trapezius is still considered challenging and not yet widely regarded as an essential intervention method.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.776-784
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• 1997

Background : Various combinations of treatment modalities have been reported in stage III non-small cell lung cancer (NSCLC). however, the standard treatment modality has not established yet. Recently, the efficacy of concurrent chemotherapy and radiation therapy has been reported in locally advanced lung cancer. We evaluate the response rate, toxicity, and survival of concurrent chemotherapy with etoposide and cisplatin(EP) and radiation therapy for unresectable stage III NSCLC. Method : Between October 1995 and December 1996, 32 patients with histologically proven unresectable stage III NSCLC without malignant pleural effusion were entered into this study. Twenty-nine patients were eligible for the response, survival, and toxicity analysis. Induction was two cycles of chemotherapy with etoposide and cisplatin plus concurrent chest RT to 4500cGy. Resection was attempted if the clinical response offered surgical resectability. Boost radiation therapy upto 5940cGy and one cycle of EP were performed if the disease were stable or responsive but still unresectable. Results : Of 29 eligible patients, 22(75.9%) showed partial response(PR). The progression free interval was 6.3months(range 1.1 to 19.5months). Surgical resection was performed in one patient. The median survival was 12.1months and one-year survival rate was 50.6%. The major toxicity was leukopenia($\geq$ grade 3, 46%). Thrombocytopenia over grade 3 was found in 11%. Radiation pneumonitis occurred in 13 patients(46%). Conclusion : Concurrent chemotherapy(EP) plus radiotherapy was effective and tolerable in the treatment of unresectable stage III NSCLC.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.19-26
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• 2003

Purpose : Maxillary sinus cancers are usually locally advanced, and involve the structures around sinus, but the regional lymphatic spread is uncommon. Therefore, the local control of these cancers is important for their cure. We reviewed our experience of 55 patients with squamous cell carcinomas of the maxillary sinus, treated with radiation therapy, and looked for the role of radiation therapy in maxillary sinus cancers. Materials and Methods : Between November 1982 and October 1999, 55 patients with squamous cell carcinomas of the maxillary sinus underwent either radiation therapy only, or combined with surgery or with concurrent chemoradlation therapy. All patients were restaged according to the 1997 AJCC staging systems. The T classifications of the tumors of the patients were as follows 1.8$\%$ (1/55) for 72, 81.8$\%$ (45/55) for 73 and 16.4$\%$ (9/55) for 74. Thirteen patients were diagnosed with lymph node involvement. With the surgical procedures, 12 patients were managed by biopsy only, 21 were resected by FESS (funclienal endoscopic sinus surgery) and 22 by partial/medical/total rnaxillectomies. The details of the treatments were as follows 8 patients were treated with radiation therapy only, 17 with a combination of FESS and radiation therapy, 22 with a combination of a maxillectomy and radiation therapy, 4 with a combination of preoperative radiation therapy and surgery, and 4 with concurrent chemoradiation therapy. The mean follow-up for all patients was 25 months, ranging from 2.8 to 125 months. Results : The 4-year local control and survival rates for all Patients were 45.5 and 33.3$\%$, respectively. The 4-year local control and suHival rates, due to the extent of surgery, were as follows 32.1, and 21.4$\%$ for biopsy; 41.9, and 31.7$\%$ for FESS; and 56.8, and 52.7$\%$ for maxillectomy, respectively. Twenty-nine (52.7$\%$) patients were not cured, and of these 29 patients, 23 (79.3$\%$) patients had a iocal recurrence following treatment. Conclusions :This study has shown that the major failure sites following treatment to be the local regions, and that the completeness of surgery was important for improving the local control and survival of patients with squamous cell carcinoma of the maxillary sinus.

• Journal of Hospice and Palliative Care
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• v.16 no.3
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• pp.139-144
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• 2013

Advanced cancer patients tend to present multiple concurrent symptoms which are often moderate or severe in intensity. To date, the majority of studies have focused on either a single symptom, such as pain, fatigue, or depression or associated symptoms. While this approach has advanced understanding of some symptoms, it has offered clinicians not much guidance for treating several multiple concurrent symptoms in cancer patients. So in recent years, a few symptom management studies attempted a new approach of focusing on symptom clusters instead of individual symptoms. A symptom cluster is defined as two or more concurrent symptoms that are related to each other. If we better understand symptom clusters, interrelations of symptoms, and their common mechanisms in advanced cancer patients, clinicians can more effectively control multiple, concurrent symptoms and reduce drug side effects. And clinicians can also predict any other symptoms, functional performance, and the relationship between symptom clusters and survival in advanced cancer patients. At present, there is inconsistency in symptom clusters due to many unexplained mechanisms and various means to assess and analyze symptoms. Still, with further study, the approach to symptom clusters rather than individual symptoms could more effectively control symptoms and improve patients' quality of life.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.224-229
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• 2001

Purpose : The aim of this study is to analyze the treatment failure patterns and the risk factors for locoregional or distant failure of uterine cervical carcinoma treated with radiation therapy. Materials and methods . A retrospective analysis was undertaken of 154 patients treated with curative radiation therapy in Gyeongsang National University Hospital from April 1989 through December 1997. According to FIGO classification, 12 patients were stage IB, 24 were IIA, 98 were IIB, 1 were IIIA, 17 were IIIB, 2 were IVA. Results : Overall treatment failure rate was $42.1\%$ (65/154), and that of complete responder was $31.5\%$ (41/130). Among 65 failures, 25 failed locoregionally, another 25 failed distantly, and 15 failed locoregionally and distantly. Multivariate analysis confirmed tumor size (>4 cm) as risk factor for locoregional failure, and tumor size (>4 cm), pelvic lymph node involvement as risk factors for distant failure. Conclusion : On the basis of results of our study and recent published data of prospective randomized study for locally advanced uterine cervical carcinoma, we concluded that uterine cervical carcinoma with size more than 4 cm or pelvic lymph node involvement should be treated with concurrent chemoradiation.