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Radiotherapy in Medically Inoperable Early Stage Non-small Cell Lung Cancer (내과적 문제로 수술이 불가능한 조기 비소세포성 폐암에서의 방사선치료)

  • Kim, Bo-Kyoung;Park, Charn-Il
    • Radiation Oncology Journal
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    • v.18 no.4
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    • pp.257-264
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    • 2000
  • Purpose: For early stage non-small-cell lung cancer, surgical resection is the treatment of choice. But when the patients are not able to tolerate it because of medical problem and when refuse surgery, radiation therapy is considered an acceptable alternative. We report on the treatment results and the effect of achieving local control of primary tumors on survival end points, and analyze factors that may influence survival and local control. Materials and Method : We reviewed the medical records of 32 patients with medically inoperable non-small cell lung cancer treated at our institution from June, 1987 through June, 1997. All patients had a pathologic diagnosis of non-small cell lung cancer and were not candidate for surgical resection because of either patients refusal (4), old age (2), lung problem (21), chest wail invasion (3) and heart problems (3). In 8 patients, there were more than 2 problems. The median age of the patients was 68 years (ranging from 60 to 86 years). Histologic cell type included souamous (24), adenocarcinoma (6) and unclassiried squamous cell (2). The clinical stages of the patients were 71 in 5, 72 in 25, 73 in 2 patients. Initial tumor size was 3.0 cm in 11, between 3.0 cm and 5.0 cm in 13 and more than 5.0 cm in 8 patients. Ail patients had taken chest x-rays, chest CT, abdomen USG and bone scan. Radiotherapy was delivered using 6 MV or 10 MV linear accelerators. The doses of primary tumor were the ranging from 54.0 Gy to 68.8 Gy (median; 61.2 Gy). The duration of treatment was from 37 days through 64 days (median; 0.5 days) and there was no treatment interruption except 1 patient due to poor general status. In 12 patients, concomitant boost technique was used. There were no neoadjuvant or adjuvant treatments such as surgery or chemotherapy. The period of follow-up was ranging from 2 months through 93 months (median; 23 months). Survival was measured from the date radiation therapy was initiated. Results : The overall survival rate was 44.6$\%$ at 2 years and 24.5$\%$ at 5 years, with the median survival time of 23 months. of the 25 deaths, 7 patients died of intercurrent illness, and cause-specific survival rate was 61.0$\%$ at 2 years and 33.5$\%$ at 5 years. The disease-free survival rate was 38.9$\%$ at 2 years and 28.3$\%$ at 5 years. The local-relapse-free survival rate was 35.1$\%$, 28.1$\%$, respectively. On univariate analysis, tumor size was significant variable of overall survival (p=0.0015, 95$\%$ C.1.; 1.4814-5.2815), disease-free survival (P=0.0022, 95$\%$ C.1., 1.4707-5.7780) and local-relapse-free survival (p=0.0015, 95$\%$ C.1., 1.2910- 4.1197). 7 stage was significant variable of overall survival (p=0.0395, 95$\%$ C.1.; 1.1084-55.9112) and had borderline significance on disease-free survival (p=0.0649, 95$\%$ C.1.; 0.8888-50.7123) and local-relapse-free survival (p=0.0582, 95$\%$ C,1.; 0.9342-52.7755). On multivariate analysis, tumor size had borderline significance on overall survival (p=0.6919, 955 C.1., 0.9610-5.1277) and local-relapse-free survival ( p=0.0585, 95$\%$ C.1.; 0.9720-4.9657). Tumor size was also significant variable of disease-free survival (p=0.0317, 95% C.1.; 1.1028-8.4968). Conclusion : Radical radiotherapy is an effective treatment for small (71 or f3 cm) tumors and can be offered as alternative to surgery in elderly or infirmed patients. But when the size of tumor is larger than 5 cm, there were few long-term survivors treated with radiotherapy alone. The use of hypefractionated radiotherapy, endobronchial boost, radisensitizer and conformal or IMRT should be consider to improve the local control rate and disease-specific survival rate.

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Chest CT findings and Clinical features in Mediastinal Tuberculous Lymphadenitis (종격동 결핵성 임파선염의 흉부전산화 단층촬영 소견과 임상 양상에 대한고찰)

  • Lee, Young-Sil;Kim, Kyeong-Ho;Kim, Chang-Sun;Cho, Dong-Ill;Rhu, Nam-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.481-491
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    • 1995
  • Background: Recently there has been a trend of an increasing incidence of mediastinal tuberculous lymphadenitis(MTL) in adults. MTL often cause bronchial stenosis or esophago-mediastinal fistula. In spite of effective treatment, it is difficult to cure. Moreover, relapse frequently occurs. Authors analyzed chest CT findings and clinical features of 29 cases with MTL Methods: 29 cases with MTL were retrospectively studied with the clinical and radiologic features from April 1990 to March 1995 Results: 1) A total of 29 cases were studied. 12 cases were male and 17 cases were female. The male to female ratio was 1:1.4 Mean age was 29 years old. The 3rd decade(45%) was the most prevalent age group 2) The most common presenting symptoms and signs were palpable neck masses(62%) followed by cough(59%) and sputum(38%) 3) Except in one case of MTL, all patients had coexisting pulmonary tuberculosis, cervical tuberculous lymphadenitis, endobronchial tuberculosis and tuberculous pleurisy. Among the coexisting tuberculous diseases, Pulmonary tuberculosis was the most common(76%) 4) On simple chest X-ray, mediastinal enlargement was noted in 21 cases(72%), but it was not noted in 8 cases(28%). The most frequently involving site was the paratracheal node in 16 cases(72%). Rt side predominence(73%) was noted 5) Patterns of node appearance on a postcontrast CT scan were classified into 3 types. There were 19 cases(30%) of the Homogenous type, 30 cases(47%) of the Central low density type and 15 cases(23%) of the Peripheral fat obliteration type. The most common type was the central low density type. The most common lymph node size was 1~2 cm(88%) 6) The most frequently involved site was the paratracheal node in 26 cases(89%) by chest CT. Rt side(63%) was predominant 7) 9 cases(43%) had complete therapy and most common treatment duration was 13 - 18 months. 12 cases(57%) had incomplete continuing antituberculous medication and half of the cases had been treated above 19 months. Conclusion: Chest CT findings of MTL showed central low density area and peripheral rim enhancement, so this characteristic findings could differentiate it from other mediastinal diseases and help a diagnosis of tuberculosis. In spite of effective antituberculous medication, it is difficult to cure. Moreover, relapse frequently occurs. Further studies will be needed of the clinical features and the treatment of MTL.

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A Study on the Characteristics and Management Plan of Old Big Trees in the Sacred Natural Sites of Handan City, China (중국 한단시 자연성지 내 노거수의 특성과 관리방안)

  • Xi, Su-Ting;Shin, Hyun-Sil
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.41 no.2
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    • pp.35-45
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    • 2023
  • First, The spatial distribution characteristics of old big trees were analyzed using ArcGIS figures by combining basic information such as species and ages of old big trees in Handan City, which were compiled by the local bureau of landscaping. The types of species, distribution by ages of trees, ownership status, growth status, and diversity status were comprehensively analyzed. Statistically, Styphnolobium, Acacia, Gleditsia, and Albizia of Fabaceae accounted for the majority, of which Sophora japonica accounted for the highest proportion. Sophora japonica is widely and intensively distributed to each prefecture and district in Handan city. According to the age and distribution, the old big trees over 1000 years old were mainly Sophora japonica, Zelkova serrata, Juniperus chinensis, Morus australis Koidz., Dalbergia hupeana Hance, Ceratonia siliqua L., and Pistacia chinensis, and Platycladus orientalis. Second, as found in each type of old big tree status, various types of old big tree status were investigated, the protection management system, protection management process, and protection management benefits were studied, and the protection of old big tree was closely related to the growth environment. Currently, the main driving force behind the protection of old big trees is the worship of old big trees. By depositing its sacredness to the old big tree and sublimating the natural character that nature gave to the old big tree into a guiding consciousness of social activities, nature's "beauty" and personality's "goodness" are well combined. The protection state of the old big tree is closely related to the degree of interaction with the surrounding environment and the participation of various cultures and subjects. In the process of continuously interacting with the surrounding environment during the long-term growth of old big trees, it seems that a natural sanctuary was formed around old big trees in the process of voluntarily establishing a "natural-cultural-scape" system involving bottom-up and top-down cross-regions, multicultural and multi-subjects. Third, China focused on protecting and recovering old big trees, but the protection management system is poor due to a lack of comprehensive consideration of historical and cultural values, plant diversity significance, and social values of old big trees in the management process. Three indicators of space's regional characteristics, property and protection characteristics, and value characteristics can be found in the evaluation of the natural characteristics of old giant trees, which are highly valuable in terms of traditional consciousness management, resource protection practice, faith system construction, and realization of life community values. A systematic management system should be supported as to whether they can be protected and developed for a long time. Fourth, as the perception of protected areas is not yet mature in China, "natural sanctuary" should be treated as an important research content in the process of establishing a nature reserve system. The form of natural sanctuary management, which focuses on bottom-up community participation, is a strong supplement to the current type of top-down nature reserve management in China. Based on this, the protection of old giant trees should be included in the form of a nature reserve called a natural monument in the nature reserve system. In addition, residents of the area around the nature reserve should be one of the main agents of biodiversity conservation.

Research on the Chapter Titled "Gongsa" from the Jeon-gyeong (『전경』 「공사」편 연구)

  • Ko, Nam-sik
    • Journal of the Daesoon Academy of Sciences
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    • v.30
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    • pp.163-199
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    • 2018
  • Jeon-gyeong was published under the command of Dojeon Park Wudang in 1974. The scripture consists of 7 parts and each part has 17 chapters. The earliest record of Gucheon Sangje (1871~1909) can be found in Jeungsan Cheonsa Gongsagi, which was published by Lee Sangho (1888~1967) in 1926. The book was the first oral literature that he created by collecting information and materials on Jeungsan as he personally met with many direct disciples of Gucheon Sangje. In 1929, after three years, Lee complemented the book with additional materials and published the first edition of Daesoon Jeon-gyeong. It was a form of didactic literature stylistically presented as scripture. Lee continued this long journey of work by revising and publishing 6 editions of Daesoon Jeon-gyeong until he published the last one in 1965. The chapter titled, "Cheonji-gongsa (Reordering Works of the Universe)" from Daesoon Jeon-gyeong as the sixth chapter out of a total of 13 chapters in the first edition, but in the last edition, it appears as chapter 4 out of a total of 9 chapters. Here it is shown that the last edition has been shortened when compared to the first edition. Also the number of verses in the chapter has largely increased by almost twice its original size over the 37 years; as it was 81 in the first edition, 94 in the second, 148 in the third, 151 in the fifth, and 175 in the sixth. In this paper, I studied how the verses of "Gongsa (Reordering Works)" from the Jeon-gyeong, which was first published in 1974, have been revised in comparison to the chapter titled "Cheonji-gongsa" from the Daesoon Jeon-gyeong. As the result of comparing each verse of "Gongsa" from the Jeon-gyeong to those of "Cheonji-gongsa" from all six editions of the Daesoon Jeon-gyeong, I could find the following revisions or changes. First, when "Cheonji-gongsa" from the Daesoon Jeon-gyeong is compared to "Gongsa" from the Jeon-gyeong, it can be seen that the number of verses has been changed and some contents have been deleted or added. Second, the sixth edition of the Daesoon Jeon-gyeong has 69 more verses than the Jeon-gyeong, and most of the additions were made in the chapters titled "Haengrok (analects)," "Gyoun (conveyance of teachings)," and "Yesi (forseeing)". These additions show how the verses regarding religious and predictional teachings developed over the years. Third, the verses from "Gongsa" from the Jeon-gyeong contain many descriptions from chapter 2, "Enlightenment of Dao and Miraculous Deeds of Cheonsa (Heavenly Teacher)," chapter 3, "Followers in the Dao School and Precepts," and chapter 5, "Opening of New World and Paradise," from the 6 th edition of the Daesoon Jeon-gyeong. This indicates that "Cheonji-gongsa (Reordering Works of the Universe)" was related to miraculous acts, enlightenment to Dao, teachings given to the followers, the opening of new world, and the building of a paradise. Fourth, some chapters in the section "Cheonji-gongsa" from Daesoon Jeon-gyeong are omitted in "Gongsa" from Jeon-gyeong, and "Gongsa" has some new contents that were not included in previous texts. This shows that there had been adoptions of different materials in the process of transmission.

Chronological observation of intestinal lesions of rots experimentally infected with Echinostoma hortense (흰쥐의 실험적 호르틴스극구흡충 감염에 있어서 장 병변에 대한 경시적 관찰)

  • 이순형;노태영
    • Parasites, Hosts and Diseases
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    • v.28 no.1
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    • pp.45-52
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    • 1990
  • Intestinal histopathological changes due to infection with Echinostcma hortense (Trematoda) were studied in rats after experimental infection with the metacercariae. The metacercariae were obtained from the tadpoles of Rana nigrcmaculata, a second intermediate host infected in the laboratory. Total 18 albino rats(Sprague-Dawley) were given 200 matacercariae each and sacrificed on the day 1, 3, 7, 11, 22 or 44 post-infection(PI) Segments of- the small intestine at 1, 3, 5, 8 and 30 cm posterior to the pylorus(PTP) were rejected and studied histopathologically. 1. The flukes were seen to have intruded into the intervillous space in the upper small intestine at early stages(1∼3 days PI), however, they were located mainly in the intestinal lumen at later stages(7∼44 days PI) . The flukes were sucking and destroying the epithelial layers of villi with their oral and ventral suckers. 2. Histopathological changes of the intestine were recognizable in as early as 1∼3 days after infection, and the changes became severer as the infection progressed. 3. The intestinal mucosa was histopathologically characterized by villous atrophy and crypt hyperplasia throughout the infection period. Major villous changes were blunting, fusion, severe destruction and loss of epithelial layers of villi. Villous/crypt(V/C) height ratio was remarkably reduced from 3 : 1 in controls to 1 : 1 in severely infected animals. In the stroma of villi, inaamma- tory cell infiltrations, vascular congestion, edema, and/or fibrosis were recognized. The goblet cells were increased in number after 11 days PI. It was revealed in the present study that the pathological changes in the intestine of rats infected with E. hortense were chieay confined to the mucosal layer of the upper small intestine, however, the changes were very severe accompanying remarkable destruction of villi and loss of mucosal integrity, and persistent until 44 days PI.

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Clinical experience of therapeutic effect of peritoneal drainage on intestinal perforation in preterm infants (미숙아의 장천공에서 복막 배액술의 치료효과에 관한 임상적 경험)

  • Lee, Jun Seok;Koo, Kyo Yeon;Lee, Soon Min;Park, Min Soo;Park, Kook In;Namgung, Ran;Lee, Chul;Choi, Seung Hoon
    • Clinical and Experimental Pediatrics
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    • v.52 no.11
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    • pp.1216-1220
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    • 2009
  • Purpose:To analyze and compare various cases in which peritoneal drainage was used as the primary treatment method in preterm infants with intestinal perforation. Methods:Among the preterm infants of less than 28 weeks of gestation who were admitted to the neonatal intensive care unit (NICU) at the Gangnam Severance Hospital from April 2006 to April 2009, 7 who had developed intestinal perforation were studied retrospectively. We investigated the clinical characteristics, secondary operation performances, morbidities, complications, and mortalities. Results:Among the 7 infants, 5 survived. Of the 5 cases, 3 received laparotomy, of which 2 were confirmed as having necrotizing enterocolitis. Of the 2 infants who died, 1 had received laparotomy before 48 h of peritoneal drainage, while the other had not received any subsequent treatment. Of the 7 children, 4 had patent ductus arteriosus (PDA), of which 3 had received indomethacin injection. Five infants had begun enteral feeding before they developed intestinal perforation. Of the 5 infants who survived, 4 were diagnosed with cholestasis. Of the 7 infants, 4 developed periventricular leukomalacia (PVL) and 3 developed rickets. Conclusion:Although the use of peritoneal drainage as the primary management of intestinal perforation in preterm infants is controversial, we suggest that it can be used for treating extreme premature neonates. Further randomized controlled study will be required to determine the feasibility of using this method.

A clinical analysis of juvenile dermatomyositis; focus on clinical manifestations at diagnosis (소아기 피부근염의 임상적 고찰; 진단시 임상증상을 중심으로 한 고찰)

  • Lee, So Young;Bang, Ji Seok;Kim, Hee Seok;Kim, Joong Gon
    • Clinical and Experimental Pediatrics
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    • v.50 no.11
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    • pp.1116-1124
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    • 2007
  • Purpose : Juvenile dermatomyositis (JDM) is the most common of the idiopathic inflammatory myopathies in children. The purpose of this study is to observe demographic, initial presentations, duration of time between disease onset and diagnosis, clinical manifestations and laboratory findings at diagnosis of patients with JDM. Methods : Forty seven patients identified at Seoul National University Children's Hospital from January 1986 to May 2007. Medical records were reviewed retrospectively focusing on initial presentations, clinical manifestations and laboratory findings at the time of diagnosis of patients with JDM. Results : Male and female patients were 25 and 22, respectively and sex ratio was 1.14:1. The average age at the time of diagnosis was 6.51 years. Skin rash (94%) was the most common symptom, followed by the proximal muscle weakness (89%). The disease activity score was 10.8. The duration between the onset of the skin rash and the muscle weakness and diagnosis was 7.18 and 4.70 months, respectively. The serum muscle enzymes, LDH, AST, CK and aldolase, were elevated in the patient with JDM. Autoimmune antibodies, antinuclear antibody, anti SSA antibody and anti SSB antibody, were negative findings. Electromyography findings were consistent with JDM in 88% of the patients, the muscle biopsy was in 91% and all MRI findings were compatible with those of patients with JDM. The most common symptom besides musculocutaneous lesions was the calcinosis (62.5%). The most common site of calcinosis was the pelvic area and buttocks. Conclusion : This study shows that the major symptoms are proximal muscle weakness and cutaneous lesion, and they are important to diagnose JDM.

Growth of Fe3O4 Particles and Their Magnetic Properties (Fe3O4 분말제조와 자기적 특성)

  • Kwon, Woo-Hyun;Lee, Seung-Wha;Chae, Kwang-Pyo;Lee, Jae-Gwang;Sur, Jung-Chul
    • Journal of the Korean Magnetics Society
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    • v.19 no.5
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    • pp.180-185
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    • 2009
  • Fe$_3$O$_4$ particles, prepared by a sol-gel method, were examined for their structural characteristic, particle shapes and sizes, and their magnetic properties. Two different chemical compositions (using a mol rate Fe$^{2+}$/Fe$^{3+}$ = 1/2 and only Fe$^{2+}$) and 2-methoxyethanol were used for making proper solutions. And the solutions were refluxed and dry in a dry oven and the samples were fired at 200$\sim$600$^{\circ}C$ in the N$_2$ atmosphere. The formation of single-phased spinel ferrite powders was identified with the X-ray diffraction measurement as they were fired at above 250$^{\circ}C$. The result of scanning electron microscopy measurement showed the increase of annealing temperature yielded the particle size increased. The magnetic transition was observed using the Mossbaur spectroscopy measurement. As the ferrite, prepared with the chemical composition (Fe$^{2+}$/Fe$^{3+}$ = 1/2), was fired at 250$^{\circ}C$, 78% of the ferrite had a ferrimagnetic property and 22% of the ferrite was non-magnetic. In case of preparing the sample with only Fe$^{2+}$ and annealed at 200$^{\circ}C$, it had a single phased spinel structure but its particle size was too small to be ferrimagnetic. The annealing temperature above 250$^{\circ}C$ made powders a spinel structure regardless of the preparation method. They had a typical soft magnetic property and their saturation magnetization and coercivity became larger as the annealing temperature increased.

Some Tertiary Interactions in 5S rRNA from Xanthomonas celebensis (Xanthomonas celebensis 5S rRNA의 몇 가지 삼차상호작용)

  • Bongrae Cho;Yeonghoon Lee;Myung-Un Choi;Inwon Park
    • Journal of the Korean Chemical Society
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    • v.37 no.2
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    • pp.237-243
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    • 1993
  • The primary and secondary structure of the 5S rRNA isolated from Xanthomonas celebensis were determined by enzymatic and chemical degradation methods. It consists of 119 nucleotides and contains no modified nucleosides. As with the 5S rRNAs of X. maltophilia and X. citri, it contains an additional uridine residue on the 5'-terminus. Its secondary structure was almost identical to the models previously proposed by us for the 5S rRNA of two Xanthomonas species. Its secondary structure consists of five helices, five loops and two bulges. The tertiary interactions in the 5S rRNA molecule were analyzed by Fe(II)-EDTA treatment and hybridization method using deoxyhexamer. From the fact that some adenine residues in loop M, region $I_1-C$, loop $H_1$, and loop $H_2$ become susceptible to diethylpyrocarbonate when the 5S rRNA was hybridized with deoxyhexamer complementary to the sequence $U_{35}CCCAU_{40}$ and that some nucleotide residues in loop M, loop $H_1$ and region $D-I_2$ become resistant Fe(II)-EDTA cleavage in the presence of $Mg^{2+}$, it is presumed that loops $H_1$ and $H_2$ interact with loop M in some way. In the tertiary interaction, the regions $I_1-C$ and $D-I_2$ seem to act as hinges in folding the stems $B-I_1-C$ and $D-I_2-E.$ It was found that loop $H_1$ changes into a smaller loop of three bases by forming noncanonical A : C base-pairs ih acidic environment.

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Clinical features of human metapneumovirus infection in children with acute respiratory tract infections (급성 호흡기 감염증 소아에서 Human metapneumovirus 감염의 임상 양상)

  • Lee, Jae Sook;Seo, Hyun Joo;Woo, Jeong Ju;Jang, Sung Hee;Lee, Jin A;Song, Mi Ok;Park, Hwa Young;Ahn, Young Min
    • Pediatric Infection and Vaccine
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    • v.14 no.1
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    • pp.75-82
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    • 2007
  • Purpose : Human metapneumovirus (hMPV) is a newly identified paramyxovirus that causes a variety of clinical syndromes in children, including upper and lower respiratory tract illnesses. hMPV is considered an ubiquitous virus causing respiratory tract diseases among children especially during late winter and spring seasons. We report clinical features of human metapneumovirus infection in Korean children. Methods : hMPV infection was diagnosed by reverse transcriptase-polymerase chain reaction (RT-PCR) in respiratory specimens obtained from patients with acute respiratory tract infections from October, 2004 to May, 2005. Medical records of all hMPV-positive patients were reviewed, retrospectively. Results : A total of 15 hMPV were identified from 443 nasopharyngeal aspirations by RT-PCR (3.4%). The range of age of the patients with hMPV infection was from 1 month to 62 months (median age, 31.5 months), with similar numbers of females (8/15) and males (7/15). Among hMPV-positive children, 53.3% (8/15) were aged less than 24 months. Fever, cough, rhinorrhea, vomiting, diarrhea, tachypnea, and chest wall retractions were common findings. Most common clinical diagnosis was pneumonia (60%). Two of the 15 hMPV-positive patients were also positive for adenovirus. Fever persisted from 0 to 10 days (mean 4.9 days). The duration of hospitalization ranged from 4 to 7 days (mean 5.6 days). Conclusion : hMPV accounted for a small but significant proportion of respiratory tract infection in infants and children. Future development and application of diagnostic tools will determine the burden of disease caused by this newly discovered pathogen.

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