• Journal of Yeungnam Medical Science
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• v.9 no.1
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• pp.102-109
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• 1992

Bone metastases represent an important and frequent clinical problem in patients with advanced cancers. Especially, painful bone metastases are common features in these patients. Radiotherapy is an effective tool for palliative aim of painful metastatic osseous lesions. Various treatment results have been previously reported. The present retrospective study was aimed to evaluate the efficacy of palliative irradiation on pain relief, with the goal of selecting appropriate irradiation dose schedule. Radiotherapy consisted of 5times a week with a various fractional dose between 180 and 400cGy. The response of pain relief and the survival time after completion of radiotherapy are related to total dose and most of the patients have shown a similar response by the end of radiotherapy. The higher dose and the more aggressive multimodality treatment, the better pain control and the longer survival time.

• The Korean Journal of Nuclear Medicine
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• v.36 no.3
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• pp.185-194
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• 2002

Purpose: We studied clinical aspects and courses of patients with pulmonary radioactivity on liver scintigraphy and speculated the mechanism of pulmonary uptake of radiocolloids. Materials and Methods: Forty-nine patients with pulmonary radioactivity were classified into 5 disease groups-liver disease, infection, cancer, ischemic necrosis of liver, etc.- and their presence or absence of chronic liver disease (CLD), Child-Pugh class, serum levels of AST and ALT, results of follow-up liver scintigraphy and clinical course were checked. Results: Of total 49 patients 25 had CLD; there were 23 liver disease patients, 16 infection patients, 7 advanced cancer patients, 2 ischemic necrosis of liver patients, and 1 hemolytic anemia patient. Reversible rise of serum levels of AST and ALT was observed in all patients with liver disease and ischemic necrosis of liver; on one-way ANOVA, these rise were statistically significant (p<0.01). Serum level of ALT of liver disease group patients without CLD was significantly higher than that of infection group patients without CLD (p<0.05). Among 17 patients who underwent follow-up liver scintigraphy, 13 showed no pulmonary radioactivity. Total 12 patients died during follow-up and most of them were terminal cancer patients or CLD patients of Child-Pugh class C. Conclusion: Pulmonary radioactivity of radiocolloid liver scintigraphy could be attributed to the mobilization of reticuloendothelial system (RES) cells by the activation of RES cells in severe infection and terminal cancer, and also by the extensive liver destruction in liver diseases.

• 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.

• Journal of the Korean Society of Radiology
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• v.83 no.6
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• pp.1385-1393
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• 2022

Metaplastic carcinoma of the breast is a heterogeneous group of neoplasms with mixed epithelial and mesenchymal differentiation. Metaplastic carcinoma of the breast is a rare and aggressive malignancy, with high recurrence and metastasis. Metaplastic carcinoma with chondroid differentiation is an uncommon subtype that tends to have a relatively good prognosis than that of other subtypes. We report the imaging features of three cases of pathologically proven metaplastic carcinoma with chondroid differentiation as follows: a high-density mass with amorphous or coarse heterogeneous calcifications on mammography; a microlobulated or partially indistinct, complex cystic, and solid mass on sonography; and a relatively circumscribed or partially indistinct, irregular mass with heterogeneous T2 high-signal intensity and heterogeneous or rim enhancement with initial fast enhancement and delayed washout on MRI.

• Journal of Hospice and Palliative Care
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• v.17 no.4
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• pp.241-247
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• 2014

Purpose: Serum vitamin C is one of the indicators for antioxidant levels in the body and it is lower in cancer patients compared with the healthy population. However, there have been few studies on the levels of serum vitamin C in terminally ill cancer patients and related factors. Methods: We followed 65 terminal cancer patients who were hospitalized in two palliative care units. We collected data of age, sex, cancer type, functional status, clinical symptoms, history of cancer therapy, and various laboratory findings including serum vitamin C level. Patients were categorized into two groups according to the quartile of serum vitamin C level (Q1-3 vs. Q4), which were compared each other. Stepwise multiple logistic regression analysis was used to identify factors related to serum vitamin C levels. Results: The mean serum vitamin C level was $0.44{\mu}g/mL$, and all patients fell into the category of vitamin C deficiency. Univariate analysis showed that The serum vitamin C level was lower in non-lung cancer patients (P=0.041) and febrile patients (P=0.034). Multivariate analysis adjusted for potential confounders such as lung cancer, fever, dysphagia, dyspnea, C reactive protein, and history of chemotherapy demonstrated that odds for low serum vitamin C level was 3.7 for patients receiving chemotherapy (P=0.046) and 7.22 for febrile patients (P=0.02). Conclusion: Vitamin C deficiency was very severe in terminally ill cancer patients, and it was associated with history of chemotherapy and fever.

• Journal of Hospice and Palliative Care
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• v.6 no.2
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• pp.172-176
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• 2003

Purpose : This study was designed to evaluate the perception of cancer in the students of Korea University. Methods : 1,000 students of Korea University were surveyed by questionnaire from March 2001 to September 2002. Nine hundred ninety two complete questionnaires were returned. The data were analyzed by descriptive statistics, and Chi-square analysis using the SPSS program. Results : 701 students (76.1%) replied that cancer is a curable disease. However, the degree of satisfaction for cancer treatment with modem clinical medicine was low (37.5%). Moreover, they thought that there was no difference between the efficacy of treatment by chemotherapy, alternative medicine, or dietary modification. But, the positive evaluation for the effectiveness of chemotherapy in the students who had cancer patients in their families was higher than that in the students without the experience of cancer patients in their families. Six hundred ninety four students (75.3%) replied positively for euthanasia in terminal cancer patients. And they thought that the dignity and the right of the patients were the most important point that should be considered in making the decision of euthanasia. Conclusions : The credibility to modem clinical medicine for cancer treatment was relatively low in the students of Korea University who had no cancer patients in their families. So, further studies and trials will be warranted to evaluate the causes of these results and improve the credibility of modem clinical medicine for cancer treatment in the general population.

• Journal of Hospice and Palliative Care
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• v.19 no.3
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• pp.249-255
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• 2016

Purpose: Up to 90% of pancreatic cancer patients suffer from neuropathic pain. In a palliative care setting, pain control in pancreatic cancer patient is one of the major goals. Ketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist, effective in neuropathic pain. Additionally, there have been studies about the opioid sparing effect of ketamine. This study was held in the palliative care unit among pancreatic cancer patients to determine the factors related to ketamine use and the opioid sparing effect. Methods: The medical records of pancreatic cancer patients admitted to St. Mary's hospital palliative care unit between January, 2013 and December, 2014 were reviewed. Patients were divided into 2 categories according to ketamine use. Also, opioid use before and after ketamine use was compared in the ketamine group. Results: Compared to the non-ketamine use group, patients in the ketamine group required a higher dose of opioid. The total opioid dose, daily opioid dose, number of daily rescue medications, and daily average rescue dose were statistically significantly higher in the ketamine group. The opioid requirement was increased after ketamine administration. Conclusion: In this retrospective study, ketamine was frequently considered in patients with severe pain, requiring higher amount of opioid. Studies about palliative use of ketamine in a larger number of patients with diverse types of cancer pain are required in the future.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.36-36
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• 2003

목적 : 고감도 형광판과 필름을 이용하여 실시간으로 선량을 측정하여 IMRT 선량분포를 검증하는데 사용하는 가능성을 알아보고자 하였다. 대상 및 방법 : 본 연구에서 개발한 물팬텀은 지름 25cm 아크릴 원통과 원통의 중앙부분에 삽입되는 고감도 형광판으로 구성되어 있다. 이를 사용하여 dose linearity correction factor를 구하기 위해 dmax 지점에서 6MV x-ray를 고감도형광판에 조사하여 blurring correction factor를 구하였다. CCD를 이용하여 고감도 형광판에서 나오는 영상을 수집하였다. 고감도 형광판에서 수집한 영상의 x축 profile은 RTP에서 얻은 profile과 비교하였고, 이온전리함으로 scanning한 데이터를 이용하여 고감도 형광판과 물에서 빛에 의한 산란선 때문에 발생하는 blurring effect를 교정하였다. 여기서 계산된 blurring effect factor를 고감도 형광판에서 수집된 영상에 적용하였다. 결과 : CCD 카메라는 형광판의 전 영역을 감지할 수 있고, 조사시간은 형광판의 중첩된 영상의 선량에 비례하였다. 물팬텀에서 형광판의 blurring effect 는 가우시안 분포로 표현할 수 있었다. 또한 Deconvolution kernel은 원통 팬텀에서 지름 $\pm$5cm 이내의 범위에 위치하였고, 따라서 형광판 영상으로부터의 실제 선량분 포를 뽑아낼 수 있었다. RTP 에서 계산된 선량분포와 blurring correction factor로 교정한 후 중첩시켜 얻은 고감도 형광판 영상의 선량분포는 일치하였다. 결론 : 정기적인 IMRT 선량 검증에 대한 실시간 선량측정 방법이 개발되었다. 고감도 형광판 영상과 CCD 카메라를 사용한 물팬텀으로, IMRT 치료계획에 대한 선량분포를 검증할 수 있는 가능성을 보였다.비의 회전에 의한 오차 보정, 필름의 광학적 밀도에 관한 보정 등 여러 가지 계통적 오차들에 대한 보정들이 선량분포 확인과정의 이해와 그 기준마련에 도움이 되겠지만 우리가 다룬 원점 불일치에 비해서 상대적으로 무시할 수 있었다. 마지막으로 선량분포 확인의 최종목표인 3 차원 선량분포 확인의 실제 적용을 위한 연구가 최적화 알고리듬을 이용하여 실험 중에 있다.\times$5cm, 10$\times$10cm, 15$\times$l5cm, 20$\times$20cm인 경우, 측정하여 얻은 PSF가 0.8%, 0.2%, 0.4%, 0.2%로 약간 높지만, 두 값은 매우 유사한 것으로 나타났다. 그리고, 기존의 BSF를 이용해 구한 TAR과 BJR 25에서 권고하는 PSF를 이용해 구한 TAR을 비교한 결과 field size 에 따라 약 1%-1.5% 정도로 BSF를 이용하여 구한 TAR보다 PSF를 이용하여 구한 TAR이 1.3% 정도 높게 나타났지만, 이것은 두 값의 절대적인 차이일 뿐, 실제로는 PSF를 이용하여 구한 TAR이 측정해서 구한 TAR과는 매우 유사한 값을 보여주고 있다. 결론 : 기존의 BSF를 이용해 구한 TAR과 PSF를 이용해 구한 TAR을 비교하였을 때, 약 1.3% 정도 높게 내고 있지만, 기존의 TAR보다는 PSF를 이용해 구한 TAR이 BJR 25와 잘 일치하고 있으므로 Co-60 원격치료용 방사선 조사장치를 사용할 경우 BSF보다는 PSF를 사용하는 것이 타당한 것으로 사료된다.tokines의 변화는 비록 통계학적인 차이는 없지만 비타민 C를 사용한 환자의 cytokines이 모두 사용하지 않은 환자에 비해 감소하였음을 보였다. 비타민 C는 부작용이 거의 없는 안전한 약으로서 말기 암 환자에서 비타민 C사용은 임상 증상을 호전시키는 데 도움

• The Korean Society of Law and Medicine
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• v.20 no.3
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• pp.83-139
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• 2019

Recognition of liability for damages due to medical malpractice has been developed largely on the basis of two paths. First is the case where there is an error in a physician's medical practice and this infringes upon the legal interests of life and body, and the compensation for monetary and non-monetary damages incurred from such infringement on life and body becomes an issue. Second is the case where there is a breach of a physician's duty of explanation that results in a infringement on the patient's right of autonomous decision, and the compensation for non-monetary damages incurred from such infringement becomes an issue. However, even if there is a medical error, since it is difficult to prove the causation between the medical error of a physician and the infringement upon legal interests, the physician's responsibility for damage compensation is denied in some cases. Consider, for example, a case where a patient is already in the final stage of cancer and has a very low possibility of a complete recovery even if proper treatment is received from the physician. Here, it is not appropriate to refuse recognition of any damage compensation based on the reason that the possibility of the patient dying is very high even in the absence of a medical error. This is so because, at minimum, non-monetary damage such as psychological suffering is incurred due to the physician's medical error. In such a case, our courts recognize on an exceptional basis consolation money compensation for losing the chance to receive proper treatment. However, since the theoretical system has not been established in minutiae, what comes under the benefit and protection of the law is not clearly explicated. The recent discourse on compensating for damages incurred by patients, even when the causation between the physician's medical error and infringement upon the legal interests of life and body is denied, by establishing a new legal interest is based on the "legal principle of loss of opportunity for treatment." On what should be the substance of the new legal interest, treatment possibility argument, expectation infringement argument, considerable degree of survival possibility infringement argument and loss of opportunity for treatment argument are being put forth. It is reasonable to see the substance of this protected legal interest as "the benefit of receiving treatment appropriate to the medical standard" according to the loss of opportunity for treatment argument. The above benefit to the patient is a value inherent to human dignity that should not be infringed upon or obstructed by anyone, and at the same time, it is a basic desire regarding life and a benefit worthy of protection by law. In this regard, "the benefit of receiving treatment appropriate to the medical standard" can be made concrete as one of the general personal rights related to psychological legal interest.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.170-178
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• 2014

Purpose: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. Methods: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. Results: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE < 24), depression ($BDI{\geq}16$), and insomnia ($ISI{\geq}15$) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. Conclusion: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.