• Title/Summary/Keyword: 병원인지도

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Clinical Study of Corrosive Injury of the Esophagus (식도부식증의 임상적 고찰)

  • 박철원;송기준;이형석;안경성;김선곤
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1981.05a
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    • pp.5.3-6
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    • 1981
  • There are too many kinds of esophageal corrosive agents, such as sodium hydrochloride, acetic acid, hydrochloric acid, etc. Esophageal burn due to above chemical agents are decreasing recently, but still many patients visited to the hospital because of swallowing corrosive agents for the purpose of suicide or accidentally. Among the treatment of corrosive injury of the esophagus, prevention of esophageal stricture is the key point. Recently various methods are using as the treatment of corrosive esophagitis and prevention of esophageal stricture. 51 cases of corrosive injury of the esophagus who had been admitted and treated at the Dept. of Otolaryngology, Han Yang University Hospital during past 9 years (from May 1972 to Dec. 1980) were evaluated and report the result about age distribution, sex incidence, monthly distribution, cause of swallowing, swallowing agents, arriving time at hospital after swallowing, changes on oral and pharyngeal mucosa, laboratory findings, emergency treatment and treatment during admission, treatment follow up results and complications with review of liter ature. Following results were obtained; 1. Female patients 27 cases (52.9%) were more than male patients 24 cases (47.1%) and its ratio was 1.13 : 1. 2. Age distribution showed predilection for age of 21-30 with 20 cases(39.2%), and 11-20 with 11 cases (21.6%), 31-40 with 7 cases(13.7%), over 50 with 7 cases (13.7%) were following. 3. Monthly distribution showed predilection for March with 8 cases(15.7%), and April, July with 7 cases (13.7%), September with 6 cases(l1.8%), October 5 cases(9.8%) were following. 4. For the purpose of suicide was the most cause of swallowing with 40 cases(78.4%), and accidentally swallowing 11 cases(21.6%). 5. Acetic acid was the most swallowing agent with 24 cases (47.0%), and hydrochloric acid 11 cases (21.5%), lye 8 cases(15.7%), iodine 2 cases(3.9%) were following. 6. Arriving time at the hospital after swallowing showed predilection for within 12 hours with 42 cases (82.4%), and from 12 hours to 24 hours with 4 cases(7.8%) was next. 7. Moderate change with injection and swelling was the prevalent change on oral and pharyngeal mucosa with 20 cases(39.2%) and severe cases with ulceration 18 cases (35.3%), mild cases with injection 10 cases (19.6%) were following. 8. Leukocytosis was seen on 40 cases (78.4%), and increased Hct. was seen 31 cases (60.8%). On urine analysis, 14 cases(27.5%) showed over 1.030 S.G., and proteinuria was seen on 25 cases(49.0%), glycosuria was seen on 5 cases(9.8%) and hematuria was seen on 6 cases(11.8). 9. Gastric lavage was done on 30 cases (58.8%) as emergency treatment and on 3 cases(5.9%) tracheostomy was done for the airway keeping. 10. As methods of treatment during admission, L-tube insertion was done on 50 cases (98.0%), antibiotics was given to 49 cases (96.1%), steroid and antacid were given to 46 cases(90.2%). 11. 36 cases(70.6%) were in favorable condition after proper treatment, but 2 cases (3.9%) were expired during admission, 4 cases (7.8%) showed esophageal stricture in-spite of treatment, and 1 case(2.0%) showed pyloric stenosis. 12. Complications were observed in 8 cases (17.7%). Renal failure (4 cases), aspiration pneumonia (2 cases), upper G-I bleeding (1 cases), and diabetic coma (1 cases) were seen in order of frequency.

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Contact dermatitis among male workers exposed to metalworking fluids (금속가공유를 취급하는 남성 근로자의 접촉피부염)

  • Jin, Young-Woo;Lee, Jun-Young;Kim, Eun-A;Park, Seung-Hyun;Chai, Chang-Ho;Choi, Yong-Hyu;Kim, Kyoo-Sang
    • Journal of Preventive Medicine and Public Health
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    • v.30 no.2 s.57
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    • pp.381-391
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    • 1997
  • In an epidemiological study of metal workers exposed to metalworking fluids (MWF), the prevalence time of Evolution, seasonal occurrence and clinical type of contact dermatitis were investigated. Compostional analysis of MWF with HPLC, dermatological examination and two consecutive questionnaire surveys were conducted. Study population was divided into two groups ; workers contact to cutting oil and workers contact to rust preventive oil. In the analysis of MWF, aliphatic hydrocarbons, having 12-20 carbons, was most common composition(49.04%) of cutting oil otherwise, major contents (90.99%) of the rust preventives oil were aliphatic hydrocarbons composed of 6-9 carbons. The frequency (point prevalence) of contact dermatitis(CD) was 7(12.7 per 100 subjects) in the dermatological examination of 55 workers. As the result of second survey for contact dermatitis, cumulative prevalence of oil working full-time and recent 1 year prevalence in two groups were 28.0, 16.7 and 15.1, 12.5 per 100 subjects. There were no difference in the prevalence of CD by oil, age, oil contact duration. Summer is the most common evolution season in workers exposed to cutting oil, but not in workers exposed to rust preventive oil. Major clinical type of CD was erythematous papules in both groups. It presents the importance of preventive measures that 51.1% suffer from contact dermatitis had medical care at their own expense, and 47.1% of them felt serious about their contact dermatitis. From the fact that 68.6% think cotton gloves protective apparatus, we emphasize the need for health education.

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Usefulness of Troponin-I, Lactate, C-reactive protein as a Prognostic Markers in Critically Ill Non-cardiac Patients (비 순환기계 중환자의 예후 인자로서의 Troponin-I, Lactate, C-reactive protein의 유용성)

  • Cho, Yu Ji;Ham, Hyeon Seok;Kim, Hwi Jong;Kim, Ho Cheol;Lee, Jong Deok;Hwang, Young Sil
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.6
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    • pp.562-569
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    • 2005
  • Background : The severity scoring system is useful for predicting the outcome of critically ill patients. However, the system is quite complicated and cost-ineffective. Simple serologic markers have been proposed to predict the outcome, which include troponin-I, lactate and C-reactive protein(CRP). The aim of this study was to evaluate the prognostic values of troponin-I, lactate and CRP in critically ill non-cardiac patients. Methods : From September 2003 to June 2004, 139 patients(Age: $63.3{\pm}14.7$, M:F = 88:51), who were admitted to the MICU with non-cardiac critical illness at Gyeongsang National University Hospital, were enrolled in this study. This study evaluated the severity of the illness and the multi-organ failure score (Acute Physiologic and Chronic Health EvaluationII, Simplified Acute Physiologic ScoreII and Sequential Organ Failure Assessment) and measured the troponin-I, lactate and CRP within 24 hours after admission in the MICU. Each value in the survivors and non-survivors was compared at the 10th and 30th day after ICU admission. The mortality rate was compared at 10th and 30th day in normal and abnormal group. In addition, the correlations between each value and the severity score were assessed. Results : There were significantly higher troponin-I and CRP levels, not lactate, in the non-survivors than in the survivors at 10th day($1.018{\pm}2.58ng/ml$, $98.48{\pm}69.24mg/L$ vs. $4.208{\pm}10.23ng/ml$, $137.69{\pm}70.18mg/L$) (p<0.05). There were significantly higher troponin-I, lactate and CRP levels in the non-survivors than in the survivors on the 30th day ($0.99{\pm}2.66ng/ml$, $8.02{\pm}9.54ng/dl$, $96.87{\pm}68.83mg/L$ vs. $3.36{\pm}8.74ng/ml$, $15.42{\pm}20.57ng/dl$, $131.28{\pm}71.23mg/L$) (p<0.05). The mortality rate was significantly higher in the abnormal group of troponin-I, lactate and CRP than in the normal group of troponin-I, lactate and CRP at 10th day(28.1%, 31.6%, 18.9% vs. 11.0%, 15.8 %, 0%) and 30th day(38.6%, 47.4%, 25.8% vs. 15.9%, 21.7%, 14.3%) (p<0.05). Troponin-I and lactate were significantly correlated with the SAPS II score($r^2=0.254$, 0.365, p<0.05). Conclusion : Measuring the troponin-I, lactate and CRP levels upon admission may be useful for predicting the outcome of critically ill non-cardiac patients.

Intelligent VOC Analyzing System Using Opinion Mining (오피니언 마이닝을 이용한 지능형 VOC 분석시스템)

  • Kim, Yoosin;Jeong, Seung Ryul
    • Journal of Intelligence and Information Systems
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    • v.19 no.3
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    • pp.113-125
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    • 2013
  • Every company wants to know customer's requirement and makes an effort to meet them. Cause that, communication between customer and company became core competition of business and that important is increasing continuously. There are several strategies to find customer's needs, but VOC (Voice of customer) is one of most powerful communication tools and VOC gathering by several channels as telephone, post, e-mail, website and so on is so meaningful. So, almost company is gathering VOC and operating VOC system. VOC is important not only to business organization but also public organization such as government, education institute, and medical center that should drive up public service quality and customer satisfaction. Accordingly, they make a VOC gathering and analyzing System and then use for making a new product and service, and upgrade. In recent years, innovations in internet and ICT have made diverse channels such as SNS, mobile, website and call-center to collect VOC data. Although a lot of VOC data is collected through diverse channel, the proper utilization is still difficult. It is because the VOC data is made of very emotional contents by voice or text of informal style and the volume of the VOC data are so big. These unstructured big data make a difficult to store and analyze for use by human. So that, the organization need to automatic collecting, storing, classifying and analyzing system for unstructured big VOC data. This study propose an intelligent VOC analyzing system based on opinion mining to classify the unstructured VOC data automatically and determine the polarity as well as the type of VOC. And then, the basis of the VOC opinion analyzing system, called domain-oriented sentiment dictionary is created and corresponding stages are presented in detail. The experiment is conducted with 4,300 VOC data collected from a medical website to measure the effectiveness of the proposed system and utilized them to develop the sensitive data dictionary by determining the special sentiment vocabulary and their polarity value in a medical domain. Through the experiment, it comes out that positive terms such as "칭찬, 친절함, 감사, 무사히, 잘해, 감동, 미소" have high positive opinion value, and negative terms such as "퉁명, 뭡니까, 말하더군요, 무시하는" have strong negative opinion. These terms are in general use and the experiment result seems to be a high probability of opinion polarity. Furthermore, the accuracy of proposed VOC classification model has been compared and the highest classification accuracy of 77.8% is conformed at threshold with -0.50 of opinion classification of VOC. Through the proposed intelligent VOC analyzing system, the real time opinion classification and response priority of VOC can be predicted. Ultimately the positive effectiveness is expected to catch the customer complains at early stage and deal with it quickly with the lower number of staff to operate the VOC system. It can be made available human resource and time of customer service part. Above all, this study is new try to automatic analyzing the unstructured VOC data using opinion mining, and shows that the system could be used as variable to classify the positive or negative polarity of VOC opinion. It is expected to suggest practical framework of the VOC analysis to diverse use and the model can be used as real VOC analyzing system if it is implemented as system. Despite experiment results and expectation, this study has several limits. First of all, the sample data is only collected from a hospital web-site. It means that the sentimental dictionary made by sample data can be lean too much towards on that hospital and web-site. Therefore, next research has to take several channels such as call-center and SNS, and other domain like government, financial company, and education institute.

Investigation of Poultry Farm for Productivity and Health in Korea (한국에 있어서 양계장의 실태와 닭의 생산성에 관한 조사(위생과 질병중심으로))

  • 박근식;김순재;오세정
    • Korean Journal of Poultry Science
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    • v.7 no.2
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    • pp.54-76
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    • 1980
  • A survey was conducted to determine the status of health and productivity of poultry farms in Korea. Area included Was Kyunggido where exist nearly 50% of national poultry population. From this area, 41 layer and 34 broiler farms covering 21 Countries were selected randomly for the survey. When farms were divided in the operation size, 95.1% of layer and 82.3% of broiler farms were classified as business or industrial level while the rest were managed in a small scale as part time job. Generally layer farms had been established much earlier than broiler farms. Geographically 10.7% of layer farms were sited near the housing area such as field foreast and rice field. No farms were located near the seashore. The distance from one farm from the other was very close, being 80% of the farms within the distance of 1km and as many as 28% of the farms within loom. This concentrated poultry farming in a certain area created serious problems for the sanitation and preventive measures, especially in case of outbreak of infectious diseases. Average farm size was 5,016${\times}$3.3㎡ for layers and 1,037${\times}$3.3㎡ for broilers. 89.5% of layer ana 70.6% of broiler farms owned the land for farming while the rest were on lease. In 60% of layer farms welters were employed for farming while in the rest their own labour was used. Majority of farms were equipped poorly for taking necessary practice of hygiene and sanitation. The amount of disinfectant used by farms was considerably low. As many as 97.6% of lave. farms were practised with Newcastle(ND) and fowl pox(F$.$pox) vaccine, whereas only 43.6% and 5.1% of broiler farms were practised with ND and F$.$pox vaccine, respectively. In 17-32.7% of farms ND vaccine was used less than twice until 60 days of age and in only 14.6% of farms adult birds were vaccinated every 4months. Monthly expense for preventive measures was over 200,000W in 32% of farms. Only 4.9-2.7% of vaccine users were soaking advice from veterinarians before practising vaccination, 85% of the users trusted the efficacy of the vaccines. Selection of medicine was generally determined by the farm owner rather than by veterinarans on whom 33.3% of farms were dependant. When diseases outbroke, 49.3% of farms called for veterinary hospital and the rest were handled by their own veterinarians, salesmen or professionals. Approximately 70% of farms were satisfied with the diagnosis made by the veterinarians. Frequency of disease outbreaks varied according to the age and type of birds. The livabilities of layers during the period of brooding, rearing ana adultwere 90.5, 98.9 and 75.2%, respectively while the livalibility of broilers until marketing was 92.2%. In layers, average culling age, was 533.3 day and hen housed eggs were 232.7. Average feed conversion rates of layers and broilers were 3.30 and 2.48, respectively. Those figures were considerably higher than anticipated but still far lower than those in developed countries.

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Clinical Outcomes of Corrective Surgical Treatment for Esophageal Cancer (식도암의 외과적 근치 절제술에 대한 임상적 고찰)

  • Ryu Se Min;Jo Won Min;Mok Young Jae;Kim Hyun Koo;Cho Yang Hyun;Sohn Young-sang;Kim Hark Jei;Choi Young Ho
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.157-163
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    • 2005
  • Background: Clinical outcomes of esophageal cancer have not been satisfactory in spite of the development of surgical skills and protocols of adjuvant therapy. We analyzed the results of corrective surgical patients for esophageal cancer from January 1992 to July 2002. Material and Method: Among 129 patients with esophageal cancer, this study was performed in 68 patients who received corrective surgery. The ratio of sex was 59 : 9 (male : female) and mean age was $61.07\pm7.36$ years old. Chief complaints of this patients were dysphagia, epigastric pain and weight loss, etc. The locations of esophageal cancer were 4 in upper esophagus, 36 in middle, 20 in lower, 8 in esophagogastric junction. 60 patients had squamous cell cancer and 7 had adenocarcinoma, and 1 had malignant melanoma. Five patients had neoadjuvant chemotherapy. Result: The postoperative stage I, IIA, IIB, III, IV patients were 7, 25, 12, 17 and 7, respectively. The conduit for replacement of esophagus were stomach (62 patients) and colon (6 patients). The neck anastomosis was performed in 28 patients and intrathoracic anastomosis in 40 patients. The technique of anastomosis were hand sewing method (44 patients) and stapling method (24 patients). One of the early complications was anastomosis leakage (3 patients) which had only radiologic leakage that recovered spontaneously. The anastomosis technique had no correlation with postoperative leakage, which stapling method (2 patients) and hand sewing method (1 patient). There were 3 respiratory failures, 6 pneumonia, 1 fulminant hepatitis, 1 bleeding and 1 sepsis. The 2 early postoperative deaths were fulminant hepatitis and sepsis. Among 68 patients, 23 patients had postoperative adjuvant therapy and 55 paitents were followed up. The follow up period was $23.73\pm22.18$ months ($1\~76$ month). There were 5 patients in stage I, 21 in stage 2A, 9 in stage IIB, 15 in stage III and 5 in stage IV. The 1, 3, 5 year survival rates of the patients who could be followed up completely was $58.43\pm6.5\%,\;35.48\pm7.5\%\;and\;18.81\pm7.7\%$, respectively. Statistical analysis showed that long-term survival difference was associated with a stage, T stage, and N stage (p<0.05) but not associated with histology, sex, anastomosis location, tumor location, and pre and postoperative adjuvant therapy. Conclusion: The early diagnosis, aggressive operative resection, and adequate postoperative treatment may have contributed to the observed increase in survival for esophageal cancer patients.

Risk Factor Analysis for Operative Death and Brain Injury after Surgery of Stanford Type A Aortic Dissection (스탠포드 A형 대동맥 박리증 수술 후 수술 사망과 뇌손상의 위험인자 분석)

  • Kim Jae-Hyun;Oh Sam-Sae;Lee Chang-Ha;Baek Man-Jong;Hwang Seong-Wook;Lee Cheul;Lim Hong-Gook;Na Chan-Young
    • Journal of Chest Surgery
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    • v.39 no.4 s.261
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    • pp.289-297
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    • 2006
  • Background: Surgery for Stanford type A aortic dissection shows a high operative mortality rate and frequent postoperative brain injury. This study was designed to find out the risk factors leading to operative mortality and brain injury after surgical repair in patients with type A aortic dissection. Material and Method: One hundred and eleven patients with type A aortic dissection who underwent surgical repair between February, 1995 and January 2005 were reviewed retrospectively. There were 99 acute dissections and 12 chronic dissections. Univariate and multivariate analysis were performed to identify risk factors of operative mortality and brain injury. Resuit: Hospital mortality occurred in 6 patients (5.4%). Permanent neurologic deficit occurred in 8 patients (7.2%) and transient neurologic deficit in 4 (3.6%). Overall 1, 5, 7 year survival rate was 94.4, 86.3, and 81.5%, respectively. Univariate analysis revealed 4 risk factors to be statistically significant as predictors of mortality: previous chronic type III dissection, emergency operation, intimal tear in aortic arch, and deep hypothemic circulatory arrest (DHCA) for more than 45 minutes. Multivariate analysis revealed previous chronic type III aortic dissection (odds ratio (OR) 52.2), and DHCA for more than 45 minutes (OR 12.0) as risk factors of operative mortality. Pathological obesity (OR 12.9) and total arch replacement (OR 8.5) were statistically significant risk factors of brain injury in multivariate analysis. Conclusion: The result of surgical repair for Stanford type A aortic dissection was good when we took into account the mortality rate, the incidence of neurologic injury, and the long-term survival rate. Surgery of type A aortic dissection in patients with a history of chronic type III dissection may increase the risk of operative mortality. Special care should be taken and efforts to reduce the hypothermic circulatory arrest time should alway: be kept in mind. Surgeons who are planning to operate on patients with pathological obesity, or total arch replacement should be seriously consider for there is a higher risk of brain injury.

Long Term Results of Bronchial Sleeve Resection for Primary Lung Cancer (원발성 폐암 환자에서의 기관지 소매 절제술의 장기 성적)

  • Cho, Suk-Ki;Sung, Ki-Ick;Lee, Cheul;Lee, Jae-Ik;Kim, Joo-Hyun;Kim, Young-Tae;Sung, Sook-Whan
    • Journal of Chest Surgery
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    • v.34 no.12
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    • pp.917-923
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    • 2001
  • Background : Bronchial sleeve resection for centrally located primary lung cancer is a lung-parenchyma-sparing operation in patients whose predicted postoperative lung function is expected to diminished markedly. Because of its potential bronchial anastomotic complications, it is considered to be an alternative to pneumonectomy. However, since sleeve lobectomy yielded survival results equal to at least those of pneumonectomy, as well as better functional results, it became and accepted standard procedure for patients with lung cancer who have anatomically suitable tumors, regardless of lung function. In this study, from analyzing of occurrence rate of postoperative complication and survival rate, we wish to investigate the validity of sleeve resection for primary lung cancer. Material and Method : From January 1989 to December 1998, 45 bronchial sleeve resections were carried out in the Department of Thoracic Surgery of Seoul National University Hospital. We included 40 men and 5 women, whose ages ranged from 23 to 72 years with mean age of 57 years. Histologic type was squamous cell carcinoma in 35 patients, adenocarcinoma in 7, and adenosquamous cell carcinoma in 1 patients. Right upper lobectomy was peformed in 24 patients, left upper lobectomy in 11, left lower lobectomy in 3, right lower lobectomy in 1, right middle lobecomy and right lower lobectomy in 3, right upper lobectomy and right middle lobecomy in 2, and left pneumonectomy in 1 patient. Postoperative stage was Ib in 11, IIa in 3, IIb in 16, IIIa in 13, and IIIb in 2 patients. Result: Postoperative complications were as follows; atelectasis in 9, persistent air leakage for more than 7 days was in 7 patients, prolonged pleural effusion for more than 2 weeks in 7, pneumonia in 2, chylothorax in 1, and disruption of anastomosis in 1. Hospital mortality was in 3 patients. During follow-up period, bronchial stricture at anastomotic site were found in 7 patients under bronchoscopy, Average follow-up duration of survivals(n=42) was 35.5$\pm$29 months. All of stage I patients were survived, and 3 year survival rate of stage II and III patients were 63%, 21%, respectively. According to Nstage, all of N0 patients were survived and 3 year survival rates of Nl and N2 were 63% and 28% respectively. Conclusion: We suggest that this sleeve resection, which is technically demanding, should be considered in patients with centrally located lung cancer, because ttlis lung-saving operation is safer than pneumonectomy and is equally curative.

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Postoperstive Chemoradiotherapy in Locally Advanced Rectal Cancer (국소 진행된 직장암에서 수술 후 화학방사선요법)

  • Chai, Gyu-Young;Kang, Ki-Mun;Choi, Sang-Gyeong
    • Radiation Oncology Journal
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    • v.20 no.3
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    • pp.221-227
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    • 2002
  • Purpose : To evaluate the role of postoperative chemoradiotherapy in locally advanced rectal cancer, we retrospectively analyzed the treatment results of patients treated by curative surgical resection and postoperative chemoradiotherapy. Materials and Methods : From April 1989 through December 1998, 119 patients were treated with curative surgery and postoperative chemoradiotherapy for rectal carcinoma in Gyeongsang National University Hospital. Patient age ranged from 32 to 73 years, with a median age of 56 years. Low anterior resection was peformed in 59 patients, and abdominoperineal resection in 60. Forty-three patients were AJCC stage II and 76 were stage III. Radiation was delivered with 6 MV X rays using either AP-PA two fields, AP-PA both lateral four fields, or PA both lateral three fields. Total radiation dose ranged from 40 Gy to 56 Gy. In 73 patients, bolus infusions of 5-FU $(400\;mg/m^2)$ were given during the first and fourth weeks of radiotherapy. After completion of radiotherapy, an additional four to six cycles of 5-FU were given. Oral 5-FU (Furtulone) was given for nine months in 46 patients. Results : Forty $(33.7\%)$ of the 119 patients showed treatment failure. Local failure occurred in 16 $(13.5\%)$ patients, 1 $(2.3\%)$ of 43 stage II patients and 15 $(19.7\%)$ of 76 stage III patients. Distant failure occurred in 31 $(26.1\%)$ patients, among whom 5 $(11.6\%)$ were stage II and 26 $(34.2\%)$ were stage III. Five-year actuarial survival was $56.2\%$ overall, $71.1\%$ in stage II patients and $49.1\%$ in stage III patients (p=0.0008). Five-year disease free survival was $53.3\%$ overall, $68.1\%$ in stage II and $45.8\%$ in stage III (p=0.0006). Multivariate analysis showed that T stage and N stage were significant prognostic factors for five year survival, and that T stage, N stage, and preoperative CEA value were significant prognostic factors for five year disease free survival. Bowel complication occurred in 22 patients, and was treated surgically in 15 $(12.6\%)$, and conservatively in 7 $(5.9\%)$. Conclusion : Postoperative chemoradiotherapy was confirmed to be an effective modality for local control of rectal cancer, but the distant failure rate remained high. More effective modalities should be investigated to lower the distant failure rate.

The Role of Radiotherapy for Carcinomas of the Gall Bladder and Extrahepatic Biliary Duct: Retrospective Analysis (담낭 및 간외담도계 악성종양의 방사선치료결과)

  • Jeong Hyeon Ju;Lee Hyun Ju;Yang Kwang Mo;Suh Hyun Suk;Kim Re Hwe;Kim Sung Rok;Kim Hong Ryong
    • Radiation Oncology Journal
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    • v.16 no.1
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    • pp.43-49
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    • 1998
  • Purpose : Carcinomas arising in the gall bladder(GB) or extrahepatic biliary ducts are uncommon and generally have a poor prognosis. The overall 5-year survival rates are less than $10\%$. Early experiences with the external radiation therapy demonstrated a good palliation with occasional long-term survival. The present report describes our experience over the past decade with irradiation of primary carcinomas of the gallbladder and extrahepatic biliary duct. Materials and Methods : From Feb. 1984 to Nov. 1995, thirty-three patients with carcinoma of the GB and extrahepatic biliary duct were treated with external beam radiotherapy with curative intent at our institution. All patients were treated with 4-MV linear accelerator and radiation dose ranged from 31.44Gy to 54.87Gy(median 44.25Gy), and three Patients received additional intraluminal brachytherapy(range, 25Gy to 30Gy). Twenty-seven Patients received postoperative radiation. Among 27 patients, Sixteen patients underwent radical operation with curative aim and the rest of the patients either had bypass surgery or biopsy alone. In seventeen patients, adjuvant chemotherapy was used and eleven patients were treated with 5-FU, mitomycin and leucovorin. Results : Median follow up period was 8.5 months(range 2-97 months). The overall 2-year and 5-year survival rates in all patients were $29.9\%$ and $13.3\%$ respectively. In patients with GB and extrahepatic biliary duct carcinomas, the 2-year survival rates were $34.5\%$ and $27.8\%$ respectively. Patients who underwent radical operation showed better 2-year survival rates than those who underwent palliative operation($43.8\%\;vs.\;20.7\%$), albeit statistically insignificant(p>0.05). The 2-year survival rates in Stage I and II were higher than in Stage III and IV with statistical significance(p<0.05). Patients with good performance status in the beginning showed significantly better survival rates than those with worse status(p<0.05). The 2-year survival rates in combined chemotherapy group and radiation group were $40.5\%$ and $22.0\%$ respectively. There was no statistical differences in two groups (p>0.05). Conclusion : The survival of patients with relatively lower stage and/or initial good performance was significantly superior to that of others. We found an statistically insignificant trend toward better survival in patients with radical operation and/or chemotherapy, More radical treatment strategies, such as total resection with intensive radiation and/or chemotherapy may offer a better chance for cure in selective patients with carcinoma of gall bladder and extrahepatic biliary ducts.

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