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The Use of Analgesics in the Last 24 hours of Life of Patients with Advanced Cancer : A Comparison of Medical Physicians and Surgeons (말기 암 환자의 마지막 24시간 동안 진통제 사용의 분석 : 내과의사와 외과의사의 비교)

  • Choi, Youn-Seon;Kim, Jong-Min;Lee, Young-Mee;Lim, Jong-Kuk;Lee, Tai-Ho;Hong, Myung-Ho
    • Journal of Hospice and Palliative Care
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    • v.1 no.1
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    • pp.47-55
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    • 1998
  • Background : It is almost important therapy modality to control pain for the terminal cancer patients for the last 24 hours because those terminally illed patient deserved to have pain free and peaceful time before death. Physician who is deal with terminal cancer patients for their last 24 hours does not need to worry about drug addiction or other untoward side reactions of pain medications. The purpose of this study was to evaluate if terminally illed cancer patient was given pain medication properly and sufficiently and if there was any different behavior to control pain of terminal cancer patients between medical physicians and surgeons in terms of type, amount and administration route and frequency. Methods : A retrospective chart audit of analgesic type, amount and administration route was performed on the medical recorders of 160 hospitalized terminal cancer patients who had died in the Korea University Medical Center Anam Hospital during the period of July 1, 1994 to June 30, 1995. Patients were classified into 103 patients were cared for by medical physicians and 57 patients were cared for by surgeons. After then, we analysed the difference of pain control pattern between them. Different types and amount of analgesics were converted to a common standard, an oral morphine equivalents(OME) relative to 1mg of oral morphine. Results : 1) The total number of patients was 160, male 102 cases(63.8%), and the female was 58 cases(36.2%) respectively. 2) The mean age was 56.4(${\pm}14.62$) years old and mean admission period was 27.8 days(${\pm}34.85$). 3) The frequent cancer site was stomach 42 cases(26.315), lung and liver 29 cases(18.1%) each, pancreas 10 cases(6.2%) in order 4) 125 out of 160 subjects (78.13%) complained pain, and 66 out of 103(64.08%) and 31 out of 57(54.39%) were treated with analgesics to relieve pain. 50 out of 97(51.55%) were able to continue on oral medication. 5) 86 cases(53.75%) were well oriented 24 hours prior to death. 6) The frequent analgesics for regular basis were long acting form of oral morphine 34 cases(Medical phsicians 24, Surgeons 10), intravenous morphine 26 cases(Medical physicians 20, Surgeons 6) in order, and the most common p.r.n.(pro re nata) analgesics used was intravenous morphine. 7) The mean amount of analgesics on regular basis was 115.41 OME by medical physicians and 52.7 OME by surseons(P<0.05). The mean amount of p.r.n. analgesics was significantly larger in patients are for by surgeons(66.64 OME) than medical physicians 23.49 OME(P<0.01). 8) The mean frequency of administrated number of p.r.n. analgesics was 0.62 times/day on medical part and 1.88 times/day on surgical part (P<0.001). Conclusion : Of the 97 patients with advanced cancer, 51.55% were able to take oral medications in the last day of life. The parenteral analgesics were more frequently used in the patients cared for by surgeons than medical physicians. Over the half of terminal cancer patients were well oriented in the last day of life. Doctor's knowledge and attitude towards pain is very important to mange the pain, effectively.

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Implant Isolation Characteristics for 1.25 Gbps Monolithic Integrated Bi-Directional Optoelectronic SoC (1.25 Gbps 단일집적 양방향 광전 SoC를 위한 임플란트 절연 특성 분석)

  • Kim, Sung-Il;Kang, Kwang-Yong;Lee, Hai-Young
    • Journal of the Institute of Electronics Engineers of Korea SD
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    • v.44 no.8
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    • pp.52-59
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    • 2007
  • In this paper, we analyzed and measured implant isolation characteristics for a 1.25 Gbps monolithic integrated hi-directional (M-BiDi) optoelectronic system-on-a-chip, which is a key component to constitute gigabit passive optical networks (PONs) for a fiber-to-the-home (FTTH). Also, we derived an equivalent circuit of the implant structure under various DC bias conditions. The 1.25 Gbps M-BiDi transmit-receive SoC consists of a laser diode with a monitor photodiode as a transmitter and a digital photodiode as a digital data receiver on the same InP wafer According to IEEE 802.3ah and ITU-T G.983.3 standards, a receiver sensitivity of the digital receiver has to satisfy under -24 dBm @ BER=10-12. Therefore, the electrical crosstalk levels have to maintain less than -86 dB from DC to 3 GHz. From analysed and measured results of the implant structure, the M-BiDi SoC with the implant area of 20 mm width and more than 200 mm distance between the laser diode and monitor photodiode, and between the monitor photodiode and digital photodiode, satisfies the electrical crosstalk level. These implant characteristics can be used for the design and fabrication of an optoelectronic SoC design, and expended to a mixed-mode SoC field.

Comparison of Enalapril Maleate Tablets on Bioavailability and the Time Course of Inhibition of Plasma Angiotensin-Converting Enzyme (Enalapril Maleate 정제의 동등성에 관한 연구 ; 약동학적 성상 및 혈장 ACE 활성도 억제 효과)

  • Jang, In-Jin;Jang, Byung-Soo;Shin, Sang-Goo;Shin, Jae-Gook;Rho, Il-Kun;Lee, Kyeong-Hun;Park, Chan-Woong
    • The Korean Journal of Pharmacology
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    • v.26 no.2
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    • pp.219-226
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    • 1990
  • Enalapril maleate tablets of two different producers were tested for bioequivalence. Enalapril is rapidly metabolized to an active metabolite, enalaprilat which inhibits angiotensin-converting enzyme (ACE). The pharmacokinetics of enalapril maleate and the time course of inhibition of plasma ACE activity after administration of the drugs were studied. Two single doses of 10mg each of enalapril maleate were administered orally to twelve male volunteers in a balanced, randomized, two-way crossover investigation. Plasma enalaprilat concentrations were determined over a 23-hour after the dose by enzyme inhibition assay and enalapril by the same method following in vitro hydrolysis. Urinary recoveries of enalapril and enalaprilat were determined for the calculation of renal clearance. Plasma ACE activity was determined by an enzyme assay. Peak plasma levels of enalapril were observed about 1 hour after the doses, and practically all enalapril had disappeared from plasma within 6 hour. Peak enalapril concentrations of both formulations were almost identical ($Vasotec^{\circledR}$, 61.38 ng/ml; $Beartec^{\circledR}$, 64.27 ng/ml). The values of the pharmacokinetic parameters of enalaprilat computed for $Vasotec^{\circledR}$ and $Beartec^{\circledR}$ tablets are presented in that order; area under the curve=330.63:320.96 $ng{\cdot}hr/ml$; peak concentration=38.63:39.43 ng/ml; time to peak=3.83:4.08 hour; elimination half-life=3.95:3.92 hours. No statistically significant difference was detected when area under the curve and all other parameters were compared. Using criteria of 95% confidence interval for the comparison of these parameters, only the upper limits of area under the curve and time to peak of enalapril were over 120%. All the parameters of enalaprilat were acceptable. Percent inhibition of plasma ACE to plasma enalaprilat concentration showed the sigmoid concentration-inhibition relationship. Time courses of plasma ACE inhibition after the administration of both formulations were quite similar. The formulations were found to be equivalent when compared on the premise that no significant difference was detected when pharmacokientic parameters and inhibition of ACE activity were compared, based on the confidence limits analysis.

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The Effect of Radiation Therapy on Oligodendrogliomas (회돌기교종의 방사선치료 효과)

  • Yoon Sei Chul;Kim Sung Whan;Chung Soo Mi;Gil Hok Jun;Shinn Kyung Sub;Bahk Yong Whee;Kang Joon Ki;Song Jin Un
    • Radiation Oncology Journal
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    • v.9 no.1
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    • pp.47-52
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    • 1991
  • From April,1983 through April,1989, we have treated histologically proven 21 patients with oligodendroglioma using 6 MV linear accelerator at the Division of Radiation Therapy, Kangnam 51. Mary's Hospital Catholic University Medical College. These are 8% of the irradiated 246 primary brain tumors during the same period. To investigate influencing factors on the survival of irradiated U patients with oligodendroglioma, we analyzed the cerebral location of the involvements, initial symptoms, CT findings and survival rates, retrospectively. One case was lost to follow up and excluded from survival data. Of the 28 patients, thirteen were male and 8 female. Ages ranged from 5 to 68 years with a median age of 38 years. Radiation doses varied from 3900 cGy to 0480 cGy and were given for 5 to 8 weeks. All but one were supratentorial. The involvement of the frontal and parietal lobes were 10 (48%) patients in each and temporal lobe in 8 (38.1%). Histological diagnosis was made by stereotactic biopsy in 3 and postoperatively in 18. The type of surgery was divided into partial, subtotal and total resection in 7,9 and 2 cases respectively. In 6 cases, chemotherapy was also tried during or after radiation therapy. Major presenting symptoms were headache, cerebral motor, nausea & vomiting and epilepsy in 18,12, 7 and 5 respectively in decreasing order. In CT analysis, low density (02%), cystic mass (33%), calcifiestion (66%) and positive contrast enhancement (42.8%) were observed as the highest frequency. Mean survival duration after radiation therapy was 38 months (K-M methods). We could not achieve statistically significant factors influencing on the survival rate after radiation therapy for oligodendrogliomas by one or two tail test.

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Comparative Analysis of Absorption Doses between Exposed and Unexposed Area on Major Organs During CT Scan (전산화 단층촬영시 주선속내 외의 주요장기 흡수선량 비교분석)

  • 사정호;서태석;최보영;정규회
    • Progress in Medical Physics
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    • v.11 no.1
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    • pp.59-71
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    • 2000
  • It is possible to obtain a fast CT scan during breath holding with spiral technique. But the risk of radiation is increased due to detailed and repeated scans. However, the limitation of X-ray doses is not fully specified on CT, yet. Therefore, the purpose of the present study is to define the limitation of X-ray doses on CT The CT unit was somatom plus 4. Alderson Rando phantom, Solenoid water phantom, TLD, and reader were used. For determining adequate position and size of organs, the measurement of distance(${\pm}$2mm) from the midline of vertebral body was performed in 40 women(20~40 years). On the brain scan for 8:8(8mm slice thickness, 8mm/sec movement velocity of the table) and 10:10(10mm slice thickness, 10mm/sec movement velocity of the table) methods, the absorption doses of exposed area of the 10:10 were slightly higher than those of 8:8. The doses of unexposed uterus were negligible on the brain scan for both 8:8 and 10:10. On the chest scan for 8:8, 8:10(8mm slice thickness, 10mm/sec movement velocity of the table), 10:10, 10:12(10mm slice thickness, 12mm/sec movement velocity of the table) and 10:15(10mm slice thickness, 15mm/sec movement velocity of the table) methods, 8:8 method of the absorption doses of exposure area was the most highest and 10:15 method was the most lowest. The absorption doses of 8:10 method was relatively lower than those of the other methods. In conclusion, the 8:10 method is the most suitable to give a low radiation burden to patient without distorting image quality.

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A Study for the Refractive Error in Middle and High School Pupils on the Basis of Their Glasses Power (안경도수를 근거로 한 중·고등학생의 굴절이상에 관한 연구)

  • Sung, Duk-Yong
    • Journal of Korean Ophthalmic Optics Society
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    • v.8 no.2
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    • pp.169-175
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    • 2003
  • This research reviewed that 83 male subjects. 89 female subjects of middle and high school visited D Optical shop at the downtown of Daegu more than twice from January, 1999 to January, 2003 and obtained the following results by using the visual acuity prescription of them for which D Optical shop was keeping. 1. The classification of correction power for 190 myopia eyes was examined (87 male eyes, 103 female eyes) showed 89 eyes(46.82%) between $0.25D{\leq}3.00D$, 86 eyes(45.26%) between $3.25D{\leq}6.00D$, 15 eyes(7.89%) for over 6.25D. 2. The kind of 154 astigmatism subjects(79 male eyes, 75 female eyes) was direct astigmatism 83.77%, reverse astigmatism 11.69%, oblique astigmatism 4.55%. The cylindrical correction power for astigmatic eyes was 61 eyes(39.61%) between $0.25D{\leq}0.50D$, 60 eyes(38.96%) between 0.50D<1.00D, 121 eyes(78.57%) for less than 1.06D, 6 eyes(0.65%) for over 3.00D. 3. The variation of spherical power showed 161 eyes(46.80%) between $0.00D{\leq}0.50D$, 109 eyes(31.69%) between $0.51D{\leq}1.00D$, 17 eyes(4.94%) for over 2.01D variation. 4. The variation of astigmatic power showed 92 eyes(59.74%) between $0.00D{\leq}0.50D$, 39 eyes(25.32%) between $0.26D{\leq}0.50D$, 10eyes (6.49%) between $0.51D{\leq}0.75D$, 13 eyes(8.44 %) for over 0.76D astigmatic variation. 5. The variation of equivalent spherical power showed 137 eyes(39.83%) between $0.00D{\leq}0.50D$, 126 eyes(36.63%) between $0.51D{\leq}1.00D$, 40 eyes(11.63%) between $1.01D{\leq}1.50D$, 21 eyes(6.10%) between $1.51D{\leq}2.00D$, 20 eyes(5.81%) for over 2.01D variation.

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Consideration of the Effect according to Variation of Material and Respiration in Cone-Beam CT (Cone-Beam CT에서 물질 및 호흡 변화가 영상에 미치는 영향에 대한 고찰)

  • Na, Jun-Young;Kim, Jung-Mi;Kim, Dae-Sup;Kang, Tae-Young;Baek, Geum-Mun;Kwon, Gyeong-Tae
    • The Journal of Korean Society for Radiation Therapy
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    • v.24 no.1
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    • pp.15-21
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    • 2012
  • Purpose: Image Guided Radiation Therapy (IGRT) has been carried out using On-Board Imager system (OBI) in Asan Medical Center. For this reason, This study was to analyze and evaluate the impact on Cone-Beam CT according to variation of material and respiration. Materials and Methods: This study was to acquire and analyze Cone-Beam CT three times for two material: Cylider acryl (lung equvalent material, diameter 3 cm), Fiducial Marker (using clinic) under Motion Phantom able to adjust respiration pattern randomly was varying period, amplitude and baseline vis-a-vis reference respiration pattern. Results: First, According to a kind of material, when being showed 100% in the acryl and 120% in the Fiducial Marker under the condition of same movement of the motion phantom. Second, According to the respiratory alteration, when being showed 1.13 in the baseline shift 1.8 mm and 1.27 in the baseline shift 3.3 mm for acryl. when being showed 1.01 in 1 sec of period and 1.045 in 2.5 sec of period for acryl. When being showed 0.86 in 0.7 times the standard of amplitude and 1.43 in 1.7 times the standard of amplitude for acryl. when being showed 1.18 in the baseline shift 1.8 mm and 1.34 in the baseline shift 3.3 mm for Fiducial Marker. when being showed 1.0 in 1 sec of period and 1.0 in 2.5 sec of period for Fiducial Marker. When being showed 0.99 in 0.7 times the standard of amplitude and 1.66 in 1.7 times the standard of amplitude for Fiducial Marker. Conclusion: The effect of image size of CBCT was 20% in the case of Fiducial marker. The impact of changes in breathing pattern was minimum 13% - maximum 43% for Arcyl, min. 18% - max. 66% for Fiducial marker. This difference makes serious uncertainty. So, Must be stabilized breathing of patient before acquiring CBCT. also must be monitored breathing of patient in the middle of acquire. If you observe considerable change of breathing when acquiring CBCT. After Image Guided, must be need to check treatment site using fluoroscopy. If a change is too big, re-acquiring CBCT.

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Preliminary Study on the Development of a Platform for the Optimization of Beach Stabilization Measures Against Beach Erosion III - Centering on the Effects of Random Waves Occurring During the Unit Observation Period, and Infra-Gravity Waves of Bound Mode, and Boundary Layer Streaming on the Sediment Transport (해역별 최적 해빈 안정화 공법 선정 Platform 개발을 위한 기초연구 III - 단위 관측 기간에 발생하는 불규칙 파랑과 구속모드의 외중력파, 경계층 Streaming이 횡단표사에 미치는 영향을 중심으로)

  • Chang, Pyong Sang;Cho, Yong Jun
    • Journal of Korean Society of Coastal and Ocean Engineers
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    • v.31 no.6
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    • pp.434-449
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    • 2019
  • In this study, we develop a new cross-shore sediment module which takes the effect of infra-gravity waves of bound mode, and boundary layer streaming on the sediment transport into account besides the well-known asymmetry and under-tow. In doing so, the effect of individual random waves occurring during the unit observation period of 1 hr on sediment transport is also fully taken into account. To demonstrate how the individual random waves would affect the sediment transport, we numerically simulate the non-linear shoaling process of random wavers over the beach of uniform slope. Numerical results show that with the consistent frequency Boussinesq Eq. the application of which is lately extended to surf zone, we could simulate the saw-tooth profile observed without exception over the surf zone, infra-gravity waves of bound mode, and boundary-layer streaming accurately enough. It is also shown that when yearly highest random waves are modeled by the equivalent nonlinear uniform waves, the maximum cross-shore transport rate well exceeds the one where the randomness is fully taken into account as much as three times. Besides, in order to optimize the free parameter K involved in the long-shore sediment module, we carry out the numerical simulation to trace the yearly shoreline change of Mang-Bang beach from 2017.4.26 to 2018.4.20 as well, and proceeds to optimize the K by comparing the traced shoreline change with the measured one. Numerical results show that the optimized K for Mang-Bang beach would be 0.17. With K = 0.17, via yearly grand circulation process comprising severe erosion by consecutively occurring yearly highest waves at the end of October, and gradual recovery over the winter and spring by swell, the advance of shore-line at the northern and southern ends of Mang-Bang beach by 18 m, and the retreat of shore-line by 2.4 m at the middle of Mang-Bang beach can be successfully duplicated in the numerical simulation.

Treatment Outcome and Analysis of the Prognostic Factors of High Grade Glioma Treated by Postoperative Radiotherapy (고악성도 신경아교종의 수술 후 방사선 치료 성적과 예후인자 분석)

  • Lee, Sun-Min;Park, Young-Je;Yoon, Won-Sup;Lee, Suk;Yang, Dae-Sik;Jeong, Yong-Gu;Kim, Chul-Yong
    • Radiation Oncology Journal
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    • v.28 no.3
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    • pp.117-124
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    • 2010
  • Purpose: To analyze the postoperative radiotherapy results and prognostic factors in patients with WHO grade 3 and 4 gliomas. Materials and Methods: A total of 99 patients with malignant gliomas who underwent postoperative radiotherapy between 1988 and 2007 were enrolled in this study. Total resections, subtotal resections ($\geq$50%), partial resections (<50%), and biopsies were performed in 16, 38, 22, and 23 patients, respectively. In total there were 32, 63 and 4 WHO grade 3, 4, and unspecified high grade gliomas, respectively. The biologically equivalent dose was in the range of 18.6 to $83.3\;Gy_{10}$ (median dose, $72.2\;Gy_{10}$). We retrospectively analyzed survival rate, patterns of failure, prognostic factors, and adverse effects. Results: The median follow-up time was 11 months and there were 54 patients (54.5%) with local failure. The one and 2-year survival rates were 56.6% and 29.3%, respectively, and the median survival duration was 13 months. The one and 2-year progression-free survival rates (PFS) were 31.3% and 18.2%, respectively, and the median PFS was 7 months. The prognostic factors for overall survival were age (p=0.0001), surgical extents (subtotal resection, p=0.023; partial resection, p=0.009; biopsy only, p=0.002), and enhancement of tumor in postoperative imaging study (p=0.049). The factors affecting PFS were age (p=0.036), tumor enhancement of the postoperative imaging study (p=0.006). There were 3 patients with grade 3 and 4 side effects during and after radiotherapy. Conclusions: In addition to age and surgical extents, tumor enhancement of the postoperative imaging study was included in the prognostic factors. The most common relapse patterns were local failures and hence, additional studies are needed to improve local control rates.

A Critical Liquefaction Resistible Characteristic of Saturated Sands Based on the Cyclic Triaxial Test Under Sinusoidal Loadings (정현하중재하 진동삼축시험에 기초한 포화사질토의 액상화 한계저항특성)

  • 최재순;김수일
    • Journal of the Korean Geotechnical Society
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    • v.20 no.8
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    • pp.147-158
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    • 2004
  • Laboratory dynamic tests are carried out to assess the liquefaction potential of saturated sands in most countries. However, simple results such as the maximum cyclic shear stress and the number of cycles at initial liquefaction are used in the experimental assessment of liquefaction potential, even though various results can be obtained from the dynamic test. In addition, it seemed to be inefficient because more than three dynamic tests with different stress ratio have to be carried out to draw a liquefaction resistance experimental curve. To improve the present assessment method fur liquefaction potential, a new critical resistible characteristic far soil liquefaction is proposed and verified through conventional cyclic triaxial tests with Jumunjin sand. In the proposed method, various experimental data such as effective stress path, stress-strain relationship, and the change of excess pore water pressure can be used in the determination of cumulative plastic shear strains at every 1/4 cycle. Especially, the critical cumulative plastic shear strain to initiate liquefaction can be defined in a specific point called a phase change point in the effective stress path and it can be calculated from a hysteric curve of stress-strain relationship up to this point. Through this research, it is found that the proposed cumulative plastic shear strain can express the dissipated energy to resist dynamic loads and consider the realistic soil dynamic behavior of saturated sands reasonably. It is also found that the critical plastic shear strain can be used as a registible index of soils to represent the critical soil dynamic state, because it seems to include no effect of large deformation.