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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
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    • v.20 no.4
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    • pp.343-352
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    • 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.

A Study of the Impractical Area and Boundary of an Outer Royal Garden "Hamchunwon" Attached to Gyeonghuigung Palace (경희궁 별원(別苑) 함춘원의 실지(實地) 경역 고찰)

  • Jung, Woo-Jin;Hong, Hyeon-Do;So, Hyun-Su
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.40 no.1
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    • pp.26-42
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    • 2022
  • The purpose of this study is to examine and understand the area and the original outer boundaries of Hamchunwon(含春苑), which was the outer royal garden of Gyeonghuigung Palace, which existed before the site of the Russian legation. The results of the study are as follows. First, examining the 3 types of drawings prepared for securing the Russian legation's site and constructing a new building, it was confirmed that two low peaks, which appear to be the original terrain of Hamchunwon, existed in the north and south directions inside the site. According to the initial plan of the of the legation's site, it appears that the entrance of the legation building is connected to the Saemunan-ro in the northwest. However, according to the report made at the time when the Russian temporary minister Veber purchased the legation's site, it was recorded that the site already had a narrow entrance and a dirt road in place, and hence, it was connected to Saemunan-ro. This fact makes it possible to learn that the line of movement for officials and the original gate were located to the northwest of the site planned as the entrance of the legation building towards Hamchunwon. Second, the site was created by cutting the top of the high hill at the time of the construction of the legation building, and as a result, a two tiered staircase typed terrace was built. The ground on which the main building and the secretary's building, etc., were erected was made by cutting the highest peak and solidifying it flat, and a large quantity of soil was used for grading. In the case of the northern area of the main building, the traces of leveling the terrain by cutting the mountains are apparent, and an observation typed garden with a walking path and pavilion was formed by utilizing the physical environment equipped with an easy view. This may be considered as a use which is consistent with the topographical conditions of creating an outer royal garden to block the civilian views on a high terrain overlooking the palace. Third, Hamchunwon's fences were partially exposed in the photos from the 1880s through the 1890s, which demonstrate the spatial changes made around the US, UK, and the Russian legations. As a result of the photo analysis performed, Hamchunwon occupies the northern area of the Russian legation's site, and it is estimated that the north, west, and east walls of the legation resembled those of Hamchunwon. The area to the south of the Russian legation was originally a place made available for civilian houses, and it was possible to examine the circumstances of purchasing dozens of civilian houses and farmlands according to various materials. Fourth, Hamchunwon, which was formed as the outer royal garden of Gyeongdeokgung Palace of Lord Gwanghaegun, lost its sense of place as an outer royal garden when the entire building of Gyeonghuigung Palace was torn down and used as a construction members during the reconstruction of Gyeongbokgung Palace, and faded away as the site was sold to Russia around 1885. The area where Hamchunwon used to be located transformed into a core space of the Russian legation where the main building and garden were located after the construction of the new building. Hence, Hamchunwon, which was limited to the northern area of the Russian legation, does not carry the temporal and spatial context with Gyeongungung Palace and Seonwonjeon which were constructed after 1897, and it is determined that the view of Seonwonjeon as Baehoorim or Baegyeongrim is not valid.

Studies on the Repeated Toxicity Test of Food Red No.2 for 4 Weeks Oral Administration in SD Rat (SD랫드에서 식용색소 적색2호의 4주간 경구투여에 따른 반복독성시험에 관한 연구)

  • Yoo, Jin-Gon;Jung, Ji-Youn
    • Journal of Food Hygiene and Safety
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    • v.27 no.1
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    • pp.42-49
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    • 2012
  • This study was carried out to investigate the toxicity of food Red No.2 in the Sprague-Dawley (SD) female rat for 4 weeks. SD rats were orally administered for 28 days, with dosage of 500, 1,000, 2,000 mg/kg/day. Animals treated with food Red No.2 did not cause any death and show any clinical signs. They did not show any significant changes of body weight, feed uptake and water consumption. There were not significantly different from the control group in urinalysis, hematological, serum biochemical value and histopathological examination. In conclusion, 4 weeks of the repetitive oral medication of food Red No.2 has resulted no alteration of toxicity according to the test materials in the group of female rats with injection of 2,000 mg/kg. Therefore, food Red No.2 was not indicated to have any toxic effect in the SD rats, when it was orally administered below the dosage 2,000 mg/kg/day for 4 weeks.

STUDIES ON THE DIMORPHISM AND FERTILITY OF PERSICARIA JAPONICA (MEISSNER) GROSS ET NAKAI (Persicaria Japonica (MISSNER) Gross et Nakai의 이형화와 수정력에 관한 연구)

  • HARN, Chang Yawl
    • Journal of Plant Biology
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    • v.3 no.1
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    • pp.1-15
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    • 1960
  • HARN, Chang Yawl : Studies on the dimorphism and Fertility of Persicaria japonica (MEISSNER) Gross et Nakai. Kor Jour. Bot. 3(I) 1-15 1960 Numerous investigations, since the works of DARWIN, have been made regarding the heterostylous plants by JOST (1907), CORRENS (1924), LAIBACK (1924), LEWIS (1943), and many others. Studies on the heterostylous Polygomum, however, were not reported except for the buckwhent, Fagopyrum esculentum, which was investigated by SCHOCH-BODMER (1930), EAST (1934), FROLOVA & Co-Workers (1946), MORRIS (1947, 1951) TATEBE (1949, 1951, 1953), present author (1957), and others. It is because no heterostylous species, besides buckwheat, have been known to exist in the Polygonum family. The author, during his studies on both heterostylism and fertility of Polygonaceae, has found that the species, persicaria japonica (Meissner) Gross et Nakai, is not diecious as has been known in taxonomy, but in reality beterostylous both morphologically and physiologically. It was found that this plant, regarded by taxonomist, as a male plant setting no seed, actually set seed (botanical fruit) when legitimate combination was made. Since his brief report on the dimorphic phenomens of this plant in 1956, the author's further research on the manner of fertilization has revealed that this species is a peculiar type whose dimorphism has undergone extreme specialization structurally and physiologically, the short-styled individual behaving in nature as a male plant and the long-styled individual, as female, whereas in controllled pollination the plant shows highly differentiated typical dimorphism. When compared with the other dimorphous species of this family, F. esculentum and P. sentiosa. it has been clarified that these three species differ in the degree of differentiation of their dimorphism morphologically and physiologically. That is, P. japonica has developed such a high specialization as to mislead the taxonomists, while P. senticosa shows almost no noticeable difference between long- and shortstyled individuals retaining most of the inherent physiological character cmmon to the genus except for the fact that it has two forms of flowers. F. esculentum appears to have taken the intermediate position in every respect. The result obtained in the present experiment are summarized as follows: 1) P. japonica has two kinds of individuals, one long style-short stamened; the other, short style-long stamened. The floral structure of this plants shows typical characteristics of dimorphic heterostylism. The differentiation between the two forms of flower has proceeded so highly both in primary and secondary difference of flower structure that this may be regarded as the most specialized form of dimorphism. 2) The differences of floral structure between the long and short styled individuals are remarkable compared with the other dimorphic species of the family. 3) The stamens of long styled plants show the sign of deteriolation whereas those of the short styled flower are well-developed. 4) When legitimate combinations are made, both L- and S-styled individuals are fertilized well and set seed (fruit), while in the illegitimate combination no fertilization and seed setting occur. Physiologically this species exhibits the typical behavior of dimorphic plants. 5) The self-fertile character, so common in other species of the other non-heterostyle Polygonum family, has disappeared completely. 6) Under natural conditions, no or few seed setting is observed in short styled individuals that behave as if they were male plants. 7) In hand pollination, the combination of both $L{\times}S$ and $S{\times}L$ alike yield relatively good fertility and seed-formation, the behavior of short styled individuals in artificial pollination differing remarkably from that in nature. 8) Under controlled pollination, $L{\times}S$ combination sets far more seed than in the combination of $S{\times}L$. In the S-styled individuals, the fertilized flower has the tendency of its seed more readily falling off in every stage of seed development than in the L-styled individuals. 9) The behaviors of pollen tubes just parallels the results of fertility test. That is, in the illegitimate combination, L-selfed, $L{\times}L$, S-selfed, and $S{\times}S$, the growth of pollen tubes is checked in the style, while in legitimately combined $L{\times}S$ and $S{\times}L$, the pollen tubes grow well reaching the ovaries within 40-50 minutes after pollination. The response of short styled individuals, known as male plant among taxonomists, is identical, as far as behavior fo pollen tube growth and fertilization are concerned, to that of long styled individuals, the so-called female plant. 10) The pollen grains from the short-styled plants are complete and fertile, whereas 70% of those of L-styled are found to be abortive, i.e., empty contents. 11) The remaining 30% of pollen of L-plant shows varied degree of stainability when stained with iron-aceto-carmine......mostly light red, while the pollen grains of S-style individuals are dark brown indicating complete fertility and viability. 12) The abundance of sterile pollen in L-styled and the nature of seed-dropping which occurs in S-styled individuals appear to be the main causes why the short styled individuals bear no seed in nature. Under controlled legitimate union, $S{\times}L$, the careful and elaborate pollination would give the S-styoled flowers the opportunities to receive the fertile pollens, though few in number, from L-styled plant, thus enabling S-plant to bear seed. 13) This species is not dioecious as is regarded by taxonomists, but typical dimorphic plant which has so highly specialized in floral structures and funcitons that the long-styled plant behaves just like a female individual; and the short-styled, like a male.

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