• Title/Summary/Keyword: 자연인

Search Result 25,066, Processing Time 0.051 seconds

The Experimental Study for Myocardial Preservation Effect of Ischemic Preconditioning (허혈성 전조건화 유발이 심근보호에 미치는 영향에 관한 실험적 연구)

  • 이종국;박일환;이상헌
    • Journal of Chest Surgery
    • /
    • v.37 no.2
    • /
    • pp.119-130
    • /
    • 2004
  • Decrease in cardiac function after open heart surgery is due to an ischemia induced myocardial damage during surgery, and ischemic preconditioning, a condition in which the myocardial damage does not accumulate after repeated episodes of ischemia but protects itself from damage after prolonged ischemia due to myocytes tolerating the ischemia, is known to diminish myocardial damage, which also helps the recovery of myocardium after reperfusion, and decreases incidences of arrythmia. Our study is performed to display the ischemic preconditioning and show the myocardial protective effect by applying cardioplegic solution to the heart removed from rat. Material and Method: Sprague-Dawley male rats were used, They were fixed on a modified isolated working heart model after cannulation. The reperfusion process was according to non-working and working heart methods and the working method was executed for 20 minutes in which the heart rate, aortic pressure, aortic flow and coronary flow were measured and recorded. The control group is the group which the extracted heart was fixed on the isolated working heart model, recovered by reperfusion 60 minutes after infusion and preserved in the cardioplegic solution 20 minutes after the working heart perfusion and aortic cross clamp, The thesis groups were divided into group I, which ischemic hearts that were hypoxia induced were perfused by cardioplegic solution and preserved for 60 minutes; group II, the cardioplegic solution was infused 45 seconds (II-1), 1 minutes (II-2), 3 minutes (II-3), after the ischemia induction, 20 minutes after working heart perfusion and aortic cross clamp; and group III, hearts were executed on working heart perfusion for 20 minutes and aortic cross clamp was performed for 45 seconds (III-1), 1minute (III-2), 3 minutes (III-3), reperfused for 2 minutes to recover the heart, and then aortic cross clamping was repeated for reperfusion, all the groups were compared based on hemodynamic performance after reperfusion of the heart after preservation for 60 minutes. Result: The recovery time until spontaneous heart beat was longer in groups I, II-3, III-2 and III-3 to control group (p<0.01). Group III-1 (p<0.05) had better results in terms of recovery in number of heart rates compared to control group, and recovered better compared to II-1 (p<0.05). The recovery of aortic blood pressure favored group III-1 (p<0.05) and had better outcomes compared with II-1 (p<0.01). Group III-1 also showed best results in terms of cardiac output (p<0.05) and group III-2 was better compared to II-2 (p<0.05). Group I (p<0.01) and II-3 (p<0.05) showed more cardiac edema than control group. Conclusion: When the effects of other organs are dismissed, protecting the heart by infusion of cardioplegic solution after enforcing ischemia for a short period of time before the onset of abnormal heart beats for preconditioning has a better recovery effect in the cardioplegic group with preconditioning compared to the cardioplegic solution itself. we believe that further study is needed to find a more effective method of preconditioning.

Multicenter clinical study of childhood periodic syndromes that are common precursors to migraine using new criteria of the International Classification of Headache Disorders (ICHD-II) (편두통의 전 단계인 소아기주기성증후군의 다기관 임상 연구: 국제두통질환분류 제2판 제1차 수정판 적용)

  • Park, Jae Yong;Nam, Sang-Ook;Eun, So-Hee;You, Su Jeong;Kang, Hoon-Chul;Eun, Baik-Lin;Chung, Hee Jung
    • Clinical and Experimental Pediatrics
    • /
    • v.52 no.5
    • /
    • pp.557-566
    • /
    • 2009
  • Purpose : To evaluate the clinical features and characteristics of childhood periodic syndromes (CPS) in Korea using the new criteria of the International Classification of Headache Disorders (ICHD)-II. Methods : The study was conducted at pediatric neurology clinics of five urban tertiary-care medical centers in Korea from January 2006 to December 2007. Patients (44 consecutive children and adolescents) were divided into three groups (cyclic vomiting syndrome [CVS], abdominal migraine [AM], and benign paroxysmal vertigo of childhood [BPVC]) by recurrent paroxysmal episodes of vomiting, abdominal pain, dizziness, and/or vertigo using the ICHD-II criteria and their characteristics were compared. Results : Totally, 16 boys (36.4%) and 28 girls (63.6%) were examined (aged 4-18 yr), with 20 CVS (45.5%), 8 AM (18.2%), and 16 BPVC (36.4%) patients. The mean age at symptom onset was $6.3{\pm}3.6$ yr, $8.5{\pm}2.7$ yr, and $8.5{\pm}2.9$ yr in the CVS, AM, and BPVC groups, respectively, showing that symptoms appeared earliest in the CVS group. The mean age at diagnosis was $8.0{\pm}3.4$ yr, $10.5{\pm}2.6$ yr, and $10.1{\pm}3.2$ yr the CVS, AM, and BPVC groups, respectively. Of the 44 patients, 17 (38.6%) had a history of recurrent headaches and 11 (25.0%) showed typical symptoms of migraine headache, with 5 CVS (25.0%), 2 AM (25.0%), and 4 BPVC (25.0%) patients. Family history of migraine was found in 9 patients (20.4%): 4 in the CVS group (20.0%), 2 in the AM group (25.0%), and 3 in the BPVC group (18.8%). Conclusion : The significant time lag between the age at symptom onset and final diagnosis possibly indicates poor knowledge of CPS among pediatric practitioners, especially in Korea. A high index of suspicion may be the first step toward caring for these patients. Furthermore, a population-based longitudinal study is necessary to determine the incidence and natural course of these syndromes.

A Study on Garden Design Principles in "Sakuteiki(作庭記)" - Focused on the "Fungsu Theory"(風水論) - (「사쿠테이키(作庭記)」의 작정원리 연구 - 풍수론(風水論)을 중심으로 -)

  • Kim, Seung-Yoon
    • Journal of the Korean Institute of Landscape Architecture
    • /
    • v.41 no.6
    • /
    • pp.1-19
    • /
    • 2013
  • This study tries to review 'Sakuteiki(作庭記)', the Book of Garden Making, compiled at the end of the 11th Century during the Heian Period of Japan, from the East-Asian perspective. 'Sakuteiki' is a Garden Theory Book, the oldest in the world as well as in Asia, and it contains the traditional knowledge of Japanese ancient garden culture, which originated from the continent(Korea and China). Traditional knowledge related to East-Asian garden culture reviewed in this paper is "Fungsu Theory"(風水, Asian traditional ecology: Fengshui in Chinese; Fusui in Japanese), stemmed from the culture to seek sound and blessed places to live in. Viewed from modern landscape architecture, the Fungsu Theory corresponds to ecology(science). The Fungsu Theory was established around the Han Dynasty of China together with the Yinyangwuxing(陰陽五行) Theory and widely used for making human residences including gardens. It was transmitted to Japan via Korea as well as through direct transaction between Japan and China. This study reinterprets garden design principles represented in Sakuteiki, which were selected in 5 key words according to the Fungsu Theory. The 5 key words for the Fungsu Theory are "the place in harmony of four guardian gods(四神相應地)", "planting trees in the four cardinal directions", "flow of Chi(氣)", "curved line and asymmetry", and "mountain is the king, water is the people". Garden design principles of "the place in harmony of four guardian gods(四神相應地)" and "planting trees in the four cardinal directions" are corresponding to "Myeongdang-ron(明堂論, Theory of propitious site)". The place in harmony of four guardian gods mentioned in Sakuteiki is a landform surrounded by the flow of water to the east, the great path to the west, the pond to the south, and the hill to the north. And the Theory originated from Zhaijing(宅經, Classic of dwelling Sites) of China. According to this principle, the city was planned and as a miniature model, the residence of the aristocrat during the Heian period was made. At the residence the location of the garden surrounded by the four gods(the flow of water, the great path, the pond, and the hill) is the Myeongdang(明堂, the propitious site: Mingtang in Chinese; Meido in Japanese). Sakuteiki explains how to substitute for the four gods by planting trees in the four cardinal directions when they were not given by nature. This way of planting originated from Zhaijing(宅經) and also goes back to Qiminyaoshu (齊民要術), compiled in the 6th Century of China. In this way of planting, the number of trees suggested in Sakuteiki is related to Hetu(河圖) and Luoshu(洛書), which are iconography of Yi(易), the philosophy of change, in ancient China. Such way of planting corresponds to that of Yongdoseo(龍圖墅, the villa based on the principle of Hetu) presented in Sanrimgyeongje (山林經濟), an encyclopedia on agriculture and living in the 17th Century of Korea. And garden design principles of "the flow of Chi(氣)", "curved line and asymmetry" is connected to "Saenggi Theory(生氣論, Theory of vitality)". Sakuteiki explains the right flow of Chi(氣) through the proper flow and the reverse flow of the garden stream and also suggests the curved line of the garden stream, asymmetric arrangement of bridges and stones in the garden, and indented shape of pond edges, which are ways of accumulating Chi(氣) and therefore lead to "Saenggi Theory" of the Fungsu Theory. The last design principle, "mountain is the king, water is the people", is related to "Hyeongguk Theory(形局論, Theory of form)" of the Fungsu Theory. Sakuteiki explains the meaning of garden through a metaphor, which views mountain as king, water as the people, and stones as king's retainers. It compares the situation in which the king governs the people with the help of his retainers to the ecological phenomena in which mountain(earth) controls water with the help of stones. This principle befits "Hyeongguk Theory(形局論, Theory of form)" of the Fungsu Theory which explains landform on the analogy of social systems, people, animals and things. As above, major garden design principles represented in Sakuteiki can be interpreted in the context of the Fungsu Theory, the traditional knowledge system in East Asia. Therefore, we can find the significance of Sakuteiki in that the wisdom of ancient garden culture in East-Asia was integrated in it, although it described the knowhow of a specific garden style in a specific period of Japan.

The Planting and Occurrence Status of Exotic Plants of the Folk Village as National Cultural Heritage - Focus in Hahoe.Yangdong.Hangae Villages - (국가지정 문화재 민속마을의 외래식물 식재 및 발생현황 - 하회.양동.한개마을을 대상으로 -)

  • Rho, Jae-Hyun;Oh, Hyun-Kyung;Han, Yun-Hee;Park, Kyung-Uk;Byun, Moo-Sup;Huh, Joon;Choi, Yung-Hyun;Shin, Sang-Sup;Lee, Hyun-Woo;Kim, Hyo-Jung
    • Journal of the Korean Institute of Traditional Landscape Architecture
    • /
    • v.31 no.2
    • /
    • pp.1-19
    • /
    • 2013
  • This study was carried out to analyze distribution situation of alien plants and to propose management plan in the 3 Folk village in Gyeongsangbuk-do which is Cultural property designated by the State; Hahoe, Yangdong and Hangae. This research is for improve of sincerity of historical site and provide basic information which use about administration of preservation. The results are as follows. 1. Overall flora and alien plants appearance The total flora in the 3 folk villages were listed total 752 taxa including 127 families, 430 genera, 614 species, 5 subspecies, 100 varieties and 33 forms. Among them, woody plants take 263 taxa(35.0%) and herbaceous plants take 489 taxa (65.0%). Flora in the Hahoe, Yangdong and Hangae village were total 534, 479 taxa and 408 taxa and exotic plant index was 30.1%, 38.2% and 37.0% respectively. In types of exotic plants, ornamental exotic plants were 135 taxa, deciduous exotic plants were 21 taxa, cultivating exotic plants were 64 taxa, and naturalized exotic plants were 80 taxa and those result lead that the ornamental exotic plants is the highest ratio. According to the villages, Hahoe village had 161 taxa(30.1%), Yangdong Village had 183 taxa(38.2%), and Hangae village had 151 taxa(37.0%) that Yangdong village showed the most number of exotic plants. 2. Planting of landscape exotic plants in the unit cultural assets Meanwhile, Ornamental exotic plants in old house's gardens in Andong Hahoe village which is designated as a unit assets, those are total 30 taxa; followed by the Okyeon house(8 taxa) is highest and the Yangjindang(7), the Hadong house(6) and the Chunghyodang(5). Magnolia denudata appears the most as for 4 times and Campsis grandiflora etc. each took 2 times. Based on the Yangdong village, Gyeongju, that are found total 51 taxa; followed by the Dugok house(16 taxa) the Sujoldang(14), the Mucheondang(13), and the Sangchunheon (12). High appearance rate of ornamental exotic plants were Viburnum opulus for. hydrangeoides, Lycoris squamigera, Caragagna sinica and Magnolia denudata etc. Based on the Hangae village, Seongju, that are designated total 62 taxa; followed by the Jinsa house(35 taxa), the Gyori house(25), the Hanju head family house(20), and the Hahoe house(16). Taxa with high appearance rates were Caragana sinica, Juniperus chinensis var. horizontalis, Magnolia denudata, Viburnum opulus for. hydrangeoides, Chaenomeles speciosa etc. 3. Problems of exotic plant landscapes in the outer spaces of the folk villages Problems of exotic plant landscapes in the outer spaces of the Hahoe village are as follows. In lower of the Mansongjeong forest, Ambrosia artemisifolia, which are ecosystem disturbance plants designated by the Ministry of Environment, live with high dominance value. This should be have a remove with Sicyos angulatus immediately. In the Nakdong river bed around the Mansongjeong forest is covered with a riparian vegetation forest belt of Robinia pseudoacacia L. forest, Populus nigra var. italic community, and Populus x tomentiglandulosa community colony. Based on the Yangdong village, the planted or naturally distributed Ailanthus altissima colony, sporadically distributed Robinia pseudoacacia as well as Amorpha fruticosa are detected all over the village and ecotones. Based on the Hangae village, Ailanthus altissima and Robinia pseudoacacia are sporadically distributed around the village and there is a sign of spreading. similarity of exotic plantsis 47.0% to 48.6% and a reason why this happened is all of research site in Gyeongsanbuk-do and that is why growth norm of plant is similar, exotic plant which is sales for ornamental and it infer to require related countermeasure of each villages and joint related countermeasure.

Ecological Studies on the Burned Forest - On the Germination of Remained Seed on Burned Area - (산화적지(山火跡地)의 생태학적(生態學的) 연구(硏究) - 산화후(山火後)의 잔여종자(殘餘種子) 발아율(發芽率)에 대(對)하여 -)

  • Kim, Ok Kyung
    • Journal of Korean Society of Forest Science
    • /
    • v.10 no.1
    • /
    • pp.29-39
    • /
    • 1970
  • Forest fires often destory forests that have taken years to grow in a few minutes. Forest fire therefore, is an important problem in forest management and have caused heavy losses to the nations economy. In order to resolve this problem many investigations have been made in many countries. However, ecological studies on the forest after accidental fire have not yet been made in Korea. In order to conduct such a study, a burned area on Mt. Samak which is located at Dukduwon-ri, Seo-myon, Chunsung-gun, Kangwon-do, was chosen as experimental plot in 1967. The remaining seeds were collected from the burned area, and investigations on their germination rate and their productivity were made comparing to those of the seeds of undemaged area, and following results were obtained. 1. The number of seed collected from the control plots were 740 while it was 537 from the test plots (Table 3, 4). It was considered that this difference between burned and unburned area was mainly due to the fact that some of the seeds had been burnt by the fire, and the unfavorable environmental conditions in the burned area was also considered to be a reason. In the germination rate in the control plots showed 28.1% while it was 3.2% in the test plots. This difference was considered to be due to complete loss of viability of the seed by burning and high heat. 2. In the test plots, sixteen seeds of the Alnus japonica were collected and six of these seeds germinated (index number 100) which was the highest germination rate among the species of collected seeds. From these results, it was considered that a high temperature (above $150^{\circ}C$) caused reduction of the germination rate (Quadrat. 1.2). Seeds of Carex lanceolata var. Nana, were appeared much more in the higher plots than in the lower plots and it seemed to be due to the fact that the forest floor plants were much more abundant in the lower plots than in the higher plots which is covered with shrubbery. And some small seeds midght be able to avoid the effect of fire being burried in the soil or under the gravel. 3. With Pinus densiflora, 43 seeds were collected, and 11 of these germinated in the control plots. However in the test plots, 11 seeds were collected and no seed germinated. This shows that the Pinus densiflora was the weakest in resisting to heat among the observed species in this study. 4. Without exception the germination rate showed a higher index in the herbs than in the woody plants and it is believed that the herbs produced more seed than the wood plants because of the abundance of herbs colony.

  • PDF

Introduction of region-based site functions into the traditional market environmental support funding policy development (재래시장 환경개선 지원정책 개발에서의 지역 장소적 기능 도입)

  • Jeong, Dae-Yong;Lee, Se-Ho
    • Proceedings of the Korean DIstribution Association Conference
    • /
    • 2005.05a
    • /
    • pp.383-405
    • /
    • 2005
  • The traditional market is foremost a regionally positioned place, wherein the market directly represents regional and cultural centered traits while it plays an important role in the circulation of facilities through reciprocal, informative and cultural exchanges while sewing to form local communities. The traditional market in Korea is one of representative retail businesses and premodern marketing techniques by family owned business of less than five members such as product management, purchase method, and marketing patterns etc. Since the 1990s, the appearance of new circulation-type businesses and large discount convenience stores escalated the loss of traditional competitiveness, increased the living standard of customers, changed purchasing patterns, and expanded the ubiquity of the Internet. All of these changes in external circulation circumstances have led the traditional markets to lose their place in the economy. The traditional market should revive on a regional site basis through the formation of a community of regional neighbors and through knowledge-sharing that leads to the creation of wealth. For the purpose of creating a wealth in a place, the following components are necessary: 1) a facility suitable for the spatial place of the present, 2)trust built through exchanges within the changing market environment, which would simultaneously satisfy customer's desires, 3) international bench marking on cases such as regionally centered TCM (England), BID (USA), and TMO (Japan) so that the market unit of store placement transfers from a spot policy to a line policy, 4)conversion of communicative conception through a surface policy approach centered around a macro-region perspective. The budget of the traditional market funding policy was operational between 2001 and 2004, serving as a counter move to solve the problem of the old traditional market through government intervention in regional economies to promote national economic strength. This national treasury funding project was centered on environmental improvement, research corps, and business modernization through the expenditure of 3,853 hundred million won (Korean currency). However, the effectiveness of this project has yet to be to proven through investigation. Furthermore, in promoting this funding support project, a lack of professionalism among merchants in the market led to constant limitations in comprehensive striving strategies, reduced capabilities in middle-and long-term plan setup, and created reductions in voluntary merchant agreement solutions. The traditional market should go beyond mere physical place and ordinary products creative site strategies employing the communicative approach must accompany these strategies to make the market a new regional and spatial living place. Thus, regarding recent paradigm changes and the introduction of region-based site functions into the traditional market, acquiring a conversion of direction into the newly developed project is essential to reinvestigate the traditional market composed of cultural and economic meanings, for the purpose of the research. Excavating social policy demands through the comparative analysis of domestic and international cases as well as innovative and expert management leadership development for NPO or NGO civil entrepreneurs through advanced case research on present promotion methods is extremely important. Discovering the seeds of the cultural contents industry cored around regional resource usages, commercializing regionally reknowned products, and constructing complex cultural living places for regional networks are especially important. In order to accelerate these solutions, a comprehensive and systemized approach research operated within a mentor academy system is required, as research will reveal distinctive traits of the traditional market in the aging society.

  • PDF

Malacological Studies on Parafossarulus manchouricus(Gastropoda: Prosobranchia) in Korea (한국산(韓國産) 왜우렁(Parafossarulus manchouricus)의 패류학적(貝類學的) 연구(硏究))

  • Chung, Pyung-Rim
    • The Korean Journal of Malacology
    • /
    • v.1 no.1
    • /
    • pp.24-50
    • /
    • 1985
  • Five different populations of Parafossarulus manchouricus (Chongpyung, Chinju and Kunsan, Korea; and Japan and Taiwan), a population of Bitbynia (Gabbia) misella (Gongju, Korea) and two different populations of Bithynta tentaculata (Michigan, U.S.A. and Bodensee, Germany) were compared in regard to eff-laying characteristics, morphology, chromosome cytology, natural infections of parasites and ecology of habitats. A satisfactory culture method was devised for laboratory rearing of the snails. Tropical fish food (Terra SML) and powdered green leaves (Ceralife) were used as the main food sources for the snails. Benthic diatoms such as Navicula and Gomphonema from the periphyton were also essential for satisfactory growth, especially for the baby snails. The aquaria were stabilized with small stones from a local stream. Young P. manchouricus snails grew to adult size in about 54 days after hatching. They laid eggs 150-156 days after hatching. The whole cycle (birth to egg-laying) took approximately 5 months. The three species of bithyniid snails are iteroparous and lay eggs once a year. There were no major morphological differences in the shells of genera or subgenera studied here. They did exhibit the following rather minor differences. The shell of Parafossarulus has spirally raised ridges, and its apex is usually eroded; the other two genera lack these characteristics. The shell of B. (Gabbia) misella is small, nor exceeding 7.5 mm in length, while the shells of the other two species are larger, being more than 10 mm in length. Scanning electron microscopy (SEM) of the protoconch of P. manchouricus reveals nearly smooth sculpture with small, low, spiral wrinkles. This sculpture is quite different from that of the Hydrobiidae, a family to which the bithyniids are frequently assigned. Scanning electron microscopy of the radulae of the three bithyniid species showed that their radular morphologies are very similar, but there are some small differences, which may be species-specific. There were some statistical differences in shell heights between the Korean and the other populations of P. manchouricus, and between this species and the other two bithyniids as well. The shell differences between the several populations of Korean P. manchouricus may be related to environment. Edtails of the chromosome cycle of these bithyniid snails are similar to those reported for other snails. No specific differences were observed in the chromosome cycle between the various species and populations of snails employed in this study. Reporred for the first time in molluscs are two darkly stained "nucleolar organizers" during pachyterne stages of meiosis. Two different chromosome numbers were observed in the three bithyniid species: n=17 in B. tentaculata and P. manchouricus, and n=18 in B. (G.) misella. no sex chromosomes or supernumerary chromosomes were seen. There were no morphological differences in karyotypes of three Korean strains of P. manchouricus. The infection rates of cercariae of Clonorchis sinensis in Chinju and Kunsan strains of P. manchouricus were 0.14% and 1.25%, respectively. However, Clonorchis cercariae were found in Chongpyung strain of P. manchouriceu and Gongju strain of B. (G.) misella. The habitats of P. manchouricus around Jinyang Lake were relatively clean without any heavy pollution of aquatic microorganisms and organic materials during the period of this study. The levels of dissolved oxygen (D.O.) and biochemical oxygen demand (B.O.D.) of the water specimens sampled from the study areas ranged from 6.0 to 9.6 ppm and from 0.4 to 1.6 ppm, respectively. Eight metalic constituents from the water samples were also assayed, and all metalic ions detercted were remarkably low below the legal criteria. However, calcium ion in the water samples from the habitats of P. manchouricus was considerably higher than others.

  • PDF

A Study on Dietary Behavior of Chinese Consumers Segmented by Dietary Lifestyle (중국 현지 소비자들의 식생활 라이프스타일 세분화에 따른 식행동 연구)

  • Oh, Ji Eun;Yoon, Hei-Ryeo
    • Journal of the Korean Society of Food Culture
    • /
    • v.32 no.5
    • /
    • pp.383-393
    • /
    • 2017
  • This study was conducted to analyze the dietary lifestyle of local Chinese consumers and to classify dietary characteristics according to their dietary lifestyle factors and dietary behaviors. This investigation was conducted for 1 month from 1 January 2017 targeting 300 adult males and females living in China using the online survey company surveymonkey. Four factors relating to dietary lifestyle were identified, gourmet factor, healthy factor, convenience factor and economic factor, and these were grouped into 4 clusters according to their dietary lifestyle factor scores. Group 1, the gourmet economy group, showed a high percentage of living alone and a high frequency of eating out, but a relatively low percentage of three regular meals per day. Their dietary lifestyle was sensitive to gourmet factors and economic factors, but less sensitive to health and convenience factors. Group 2, the wide interest group, contained a high percentage of individuals in their 30s, as well as more highly educated individuals and a higher income than other groups. Because their dietary lifestyle scores tended to be higher than those of other groups, they sought a variety of new foods and gourmet meals for enjoyment of dining and life, as well as well-being food materials and foods related to health. Group 3, the health economic group, constituted a family-type consumer group with lower income level than the other groups. Members of this group were seeking health food and natural food in their dietary lifestyle and tended to pursue a high economic profit ratio when purchasing food. Finally, group 4 showed a relatively higher percentage of women over 30 and individuals with a college level or higher education than the other groups. This group was more interested in health and taste than price and convenience, and showed the highest LOHAS orientation among middle aged Chinese women. Moreover, members of this group directly utilized their knowledge regarding nutrition in real life.

Rectal Bleeding and Its Management after Irradiation for Cervix Cancer (자궁경부암 환자에서 방사선치료 후에 발생한 직장출혈과 치료)

  • Chun Mison;Kang Seunghee;Kil Hoon-Jong;Oh Young-Taek;Sohn Jeong-Hye;Jung Hye-Young;Ryu Hee Suk;Lee Kwang-Jae
    • Radiation Oncology Journal
    • /
    • v.20 no.4
    • /
    • pp.343-352
    • /
    • 2002
  • Purpose : Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. Materials and Methods : total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The Point A dose from the HDR brachytherapy was 28 Gy to 30 Gy $(4\;Gy\times7,\;or\;5\;Gy\times6)$. The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months $(12\~86\;months)$. Results : The incidence of rectal bleeding was $12.7\%$ (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was $8.5\%$. Most complications $(92.6\%)$ developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding an icruCRBED greater than 100 Gy $(19.7\%\;vs.\;4.2\%)$, an EBRT dose to the parametrium over 55 Gy $(22.1\%\;vs.\;5.1\%)$ and higher stages of III and IV $(31.8\%\;vs.\;10.5\%)$. In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was peformed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. Conclusion : Moderate and several rectal bleeding occurred in $8.5\%$ of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.

The Clinical Significance of Follow Up SCC Levels in Patients with Recurrent Squamous Cell Carcinoma of the Cervix (재발성 자궁경부 편평상피암 환자들에서 Squamous Cell Carcinoma 항원의 유용성)

  • Choi Young Min;Park Sung Kwang;Cho Heung Lae;Lee Kyoung Bok;Kim Ki Tae;Kim Juree;Sohn Seung Chang
    • Radiation Oncology Journal
    • /
    • v.20 no.4
    • /
    • pp.353-358
    • /
    • 2002
  • Purpose : To investigate the clinical usefulness of a follow-up examination using serum squamous cell carcinoma antigen (SCC) for the early detection of recurrence in patients treated for conical squamous cell carcinoma. Materials and Methods : 20 patients who were treated for recurrent cervical squamous cell carcinoma between 1997 and 1998, who had experienced a complete remission after radiotherapy and who underwent an SCC test around the time when recurrence was detected, were included in this study. The levels of SCC were measured from the serum of the patients by immunoassay and values less than 2 ng/mL were regarded as normal. The sensitivity of the SCC test for use in the detection of recurrence, the association between the SCC values and the recurrence patterns and the tumor size and stage, and the temporal relation between the SCC increment and recurrence detection were evaluated. Results : The SCC values were above normal in 17 out of 20 patients, so the sensitivity of the SCC test for the detection of recurrence was $85\%$, and the mean and median of the SCC values were 15.2 and 9.5 ng/mL, respectively. No differences were observed in the SCC values according to the recurrence sites. For 11 patients, the SCC values were measured over a period of 6 months before recurrence was detected, and the mean and median values were 13.6 and 3.6 ng/mL, respectively. The SCC values of 7 patients were higher than the normal range, and the SCC values of the other 4 patients were normal but 3 among them were above 1.5 ng/mL. At the time of diagnosis, the SCC valuess were measured for 16 of the 20 recurrent patients, and the SCC values of the patients with a bulky tumor $(\geq4\;cm)$ or who were in stage IIb or III were higher than those of the patients with a non-bulky tumor or who were in stage Ib or IIa. Conclusion : The SCC test is thought to be useful for the early detection of recurrence during the follow up period in patients treated for cervical squamous cell carcinoma. When an effective salvage treatment is developed in the future, the benefit of this follow-up SCC test will be increased.