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Pre-operative Concurrent Chemoradiotherapy for Stage IlIA (N2) Non-Small Cell Lung Cancer (N2 병기 비소세포 폐암의 수술 전 동시화학방사선요법)

  • Lee, Kyu-Chan;Ahn, Yong-Chan;Park, Keunchil;Kim, Kwhan-Mien;Kim, Jhin-Gook;Shim, Young-Mog;Lim, Do-Hoon;Kim, Moon-Kyung;Shin, Kyung-Hwan;Kim, Dae-Yong;Huh, Seung-Jae;Rhee, Chong-Heon;Lee, Kyung-Soo
    • Radiation Oncology Journal
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    • v.17 no.2
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    • pp.100-107
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    • 1999
  • Purpose: This is to evaluate the acute complication, resection rate, and tumor down-staging after pre-operative concurrent chemoradiotherapy for stage IIIA (N2) non-small cell lung cancer. Materials and Methods Fifteen patients with non-small cell lung cancer were enrolled in this study from May 1997 to June 1998 in Samsung Medical Center. The median age of the patients was 61 (range, 45~67) years and male to female ratio was 12:3. Pathologic types were squamous cell carcinoma (11) and adenocarcinoma (4). Pre-operative clinical tumor stages were cT1 in 2 patients, cT2 in T2, and cT3 in 1 and all were N2. Ten patients were proved to be N2 with mediastinoscopic biopsy and five had clinically evident mediastinal Iymph node metastases on the chest CT scans. Pre-operative radiation therapy field included the primary tumor, the ipsilateral hilum, and the mediastinum. Total radiation dose was 45 Gy over 5 weeks with daily dose of 1.8 Gy. Pre-operative concurrent chemotherapy consisted of two cycles of intravenous cis-Platin (100 mg/m$^{2}$) on day 1 and oral Etoposide (50 mg/m$^{2}$/day) on days 1 through 14 with 4 weeks' interval. Surgery was followed after the pre-operative re-evaluation including chest CT scan in 3 weeks of the completion of the concurrent chemoradiotherapy if there was no evidence of disease progression. Results : Full dose radiation therapy was administered to all the 15 patients. Planned two cycles of chemotherapy was completed in 11 patients and one cycle was given to four. One treatment related death of acute respiratory distress syndrome occurred In 15 days of surgery. Hospital admission was required in three patients including one with radiation pneumonitis and two with neutropenic fever. Hematologic complications and other acute complications including esophagitis were tolerable. Resection rate was 92.3% (12/l3) in 13 patients excluding two patients who refused surgery. Pleural seeding was found in one patient after thoracotomy and tumor resection was not feasible. Post-operative tumor stagings were pT0 in 3 patients, pTl in 6, and pT2 in 3. Lymph node status findings were pN0 in 8 patients, pN1 in 1, and pN2 in 3. Pathologic tumor down-staging was 61.5% (8/13) including complete response in three patients ($23.7%). Tumor stage was unchanged in four patients (30.8%) and progression was in one (7.7%). Conclusions : Pre-operative concurrent chemoradiotherapy for Stage IIIA (N2) non-small cell lung cancer demonstrated satisfactory results with no increased severe acute complications. This treatment shceme deserves more patinet accrual with long-term follow-up.

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A Study on the Expressed Desire at Discharge of Patients to Use Home Nursing and Affecting Factors of the Desire (퇴원환자의 가정간호 이용의사와 관련 요인)

  • Lee, Ji-Hyun;Lee, Young-Eun;Lee, Myung-Hwa;Sohn, Sue-Kyung
    • The Korean Journal of Rehabilitation Nursing
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    • v.2 no.2
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    • pp.257-270
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    • 1999
  • The purpose of this study is to investigate factors related to the intent of using home nursing of chronic disease patients who got out of a university hospital. For the purpose, the study selected 153 patients who were hospitalized and left K university hospital with diagnoses of cancer, hypertension, diabetes and cerebral vascular accident and ordered to be discharged and performed interviews with them and surveys on their medical records to obtain the following results. For this study a direct-interview survey and medical record review was conducted from June 28 to Aug. 30, 1998. The frequency and mean values were computed to find the characteristics of the study subjects, and $X^2$-test, t-test, factor analysis and multiple logistic regession analysis were applied for the analysis of the data. The following results were obtained. 1) When characteristics of the subjects were examined, men and women occupied for 58.8% and 41.2%, respectively. The subjects were 41.3 years old in aver age and had the monthly aver age earning of 0.99 million won or below, which was the most out of the total subjects at 34.6%. Among the total, 87.6% resided in cities and 12.4 in counties. The most left the hospital with diagnosis of cancer at 51.6%, followed by hyper tension at 24.2%, diabetes at 13.7% and cerebral vascular accident at 7.2%. 2) 93.5% of the selected patients had the intent of using home nursing and 6.5%, didn't. Among those patients having the intent, 85.6% had the intent of paying for home nursing and 14.4%, didn't. The subjects expected that the nursing would be paid 9,143 won in aver age and 47.7% of them preferred national authorities as the main servers. 86.3% of the subjects thought that home nursing business had the main advantage of making it possible to learn nursing methods at home and thereby contributing to improving the ability of patients and their facilities to solve health problems. 3) Relations between the intent of use and characteristics of the subjects such as demography-related social, home environment, disease and physical function characteristics did not show statistically significant differences among one another. Compared to those who had no intent of using home nursing, the group having the intent had more cases of male patients, the age of 39 or below, residence in cities, 5 family member s or more, no existence of home nursing servers, leaving the hospital from a non-hospitalized building, disease development for five months or below, hospitalization for ten days or more, non-hospitalization with in the recent one month, two times or over of hospitalization, leaving the hospital with no demand of special treatment, operation underwent, poor results of treatment, leaving the hospital with demand of rehabilitation services, physical disablement and high evaluation point of daily life. 4) Among those patients having the intent of using home nursing, 47.6% demanded technical nursing and 55.9%, supportive nursing. As technical nursing,' inject into a blood vessel ' and 'treat pustule and teach basic prevention methods occupied for 57.4%, respectively, topping the list. Among demands of supportive nursing, 'observe patients 'status and refer them to hospitals or community resources as available, if necessary' was the most with percent age point of 59.5. Regarding the intent of paying for home nursing, 39.2% of those patients wishing to use the nursing responded paying for technical services and 20.2, supportive services. In detail, 70.0% wanted to pay for a service stated as 'inject into a blood vessel', highest among the former services and 30.7%, a service referred to as 'teaching exercises needed to make the body of patients move', highest among the latter. When this was analyzed in terms of a relation between the need(the need for home nursing) and the demand(the intent of paying for home nursing), The rate of the need to the demand was found two or three times higher in technical nursing(0.82) than in supportive nursing(0.35). In aspects of tech ical nursing, muscle injection(1.26, the 1st rank) was highest in the rate while among aspects of supportive nursing, a service referred to as 'teach exercises needed for making patients move their bodies normally'(0.58, the 1st rank). 5) factors I(satisfaction with hospital services), II(recognition of disease state), III(economy) and IV(period of disease) occupied for 34.4, 13.8, 11.9 and 9.2 percents, respectively among factors related to the intent by the subjects of using home nursing, totaled 59.3%. In conclusion, most of chronic disease patients have the intent of using hospital-based home nursing and satisfaction with hospital services is a factor affecting the intent most. Thus a post-management system is needed to continue providing health management to those patients after they leave the hospital. Further, supportive services should be provided in order that those who are satisfied with hospital services return to their community and live their in dependent lives. Based on these results, the researcher would make the following recommendation. 1) Because home nursing becomes more and more needed due to a sharp increase in chronic disease patients and elderly people, related rules and regulations should be made and implemented. 2) Hospital nurses specializing in home nursing should be cultivated.

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Comparison of Average Glandular Dose in Screen-Film and Digital Mammography Using Breast Tissue-Equivalent Phantom (유방조직등가 팬텀을 이용한 Screen-Film과 Digital Mammography에서의 평균 유선선량)

  • Shin, Gwi-Soon;Kim, Jung-Min;Kim, You-Hyun;Choi, Jong-Hak;Kim, Chang-Kyun
    • Journal of radiological science and technology
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    • v.30 no.1
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    • pp.13-23
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    • 2007
  • In recent years, mammography system is changed rapidly from conventional screen-film system to digital system for application to screening and diagnosis. Digital mammography system provides several advantages over screen-film mammography system. According to the information provided by the manufacturer, digital mammography system offers radiation dose reduction in comparison with screen-film mammography system, because of digital detector, particularly direct digital detector has higher x-ray absorption efficiency than screen-film combination or imaging plate(IP). We measured average glandular doses(AGD) in screen-film mammography(SFM) system with slow screen-film combination, computed mammography(CM) system, indirect digital mammography(IDM) system and direct digital mammography(DDM) system using brest tissue-equivalent phantom(glandularity 30%, 50% and 70%). The results were shown as follows : AGD values for DDM system were highest than those for other systems. Although automatic exposure control(AEC) mode was selected, the curve of the AGD values against thickness or glandularity increased significantly for the SFM system with the uniform target/filter(Mo/Mo) combination. Therefore, the AGD values for the high energy examinations were highest in the SFM system, and those for the low energy examinations were highest in the DDM system. But the curve of the AGD values against thickness and glandularity increased gently for CM system with the automatic selection of the target/filter combination (from Mo/Mo to Mo/Rh or from Mo/Rh to Rh/Rh), and the AGD values were lowest. Consequently, the parameters in mammography for each exposure besides detection efficiency play an important role in oder to estimate a patient radiation dose.

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A Comparative Analysis of Clinical Features and Treatment Outcomes of Intussusception according to Age Distribution (연령에 따른 장중첩증의 임상양상 및 치료에 대한 비교분석)

  • Park, Bum Chul;Kim, Seok Young;Jung, Su Jin
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.8 no.2
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    • pp.150-156
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    • 2005
  • Purpose: We divided the children diagnosed with intususception into three different age groups and compared the clinical symptoms and treatment outcomes in order to analysis diagnosis and treatment of Intusussception. Methods: A retrospective chart review was established of 159 patients diagnosed with intussuception who had been admitted to Department of Pediatrics and General Surgery, Bundang CHA hospital from January, 2000 to May, 2004. We divided the patients into three groups, according to their age. Those who were under five months of age (group I; 21 patients), those between 5~11 months of age (group II; 61 patients), and those older than 11 months of age (group III; 77 patients). Then we compared the age, sex, seasonal distribution of occurrence, the cause, the clinical features, radiologic review, the type of intusussception, surgical methods, recurrence rate and treatment outcomes, among these three groups. Results: On comparing the clinical symptoms and signs among the three groups, the most common major clinical symptom and sign was irritabiltity in all three groups. Vomiting with irritability was statistically more common in group I (p<0.05) and bloody stool was most frequent in group III. The average time taken until a diagnosis was made after the symptom onset was, 21 hours in group I, 20 hours in group II and 22 hours in group III. Which showed no significant difference. But there was a higher rate of delayed diagnosis in group I, which took over 48 hours until the diagnosis was made (group I; 23.8%, group II; 4.9%, group III; 7.8%). Simple abdominal X-rays showed more frequent instances of intestinal obstruction in group I (p<0.05). The primary treatment done was barium enema which showed a failure rate of 52.4% in group I, 26.2% in group II and 14.3% in group III. Showing the highest failure rate in group I. Conclusion: The youngest group had vague symptoms which lead to delayed diagnosis and more frequent surgical procedures. As so, we advocate the importance of further evaluation and close observation, considering intussusception in children with symptoms of irritability and vomiting, especially in the early infant group.

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Changes of Cold Tolerance and it Mechanisms at Young Microspore Stage caused by Different Pre-growing Conditions in Rice (벼 수잉기내냉성의 전역조건에 따른 변동과 기구)

  • 이선용;박석홍
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.36 no.5
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    • pp.394-406
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    • 1991
  • It was proved that cold tolerance of rice plants at the young microspore stage was affected by water temperature and nitrogen application from the spikelet differentiation stage to the young microspore stage, and this mechanism could be explained in the point of view of pollen developmental physiology. The cold tolerance of rice plants at the young microspore stage was severely affected by water temperature (Previous water temperature) and nitrogen application(Previous nitrogen application) from the spikelet differentiation stage to the spikelet differentiation stage. Although the duration is only 10 days or so from the spikelet differentiation stage to the young microspore stage, these days are very important period to confirm the cold tolerance of rice plants at the young microspore stage. The higher previous water temperature up to $25^{\circ}C$ and the deeper previous water depth up to 10cm caused the more cold tolerance of rice plants. Water irrigation of 10cm before the cretical stage showed lower cool injury than that of water irrigation of 20cm during the critical stage. The preventive effect of cool injury by combined treatment of the deep water irrigation before and during the critical stage was not additive but synergistic. The cold tolerance of rice plants grown in previous heavy nitrogen level was rapidly decreased when nitrogen content of leaf blade at the young microspore stage was excessive over the critical nitrogen level. Nitrogen content of leaf blade at the changing point of cold tolerance was estimated as about 3.5% for Japonica cultivars and about 2.5% for Indica x Japonica cultuvars. It is considered that these critical nitrogen contents of leaf blade can be used as a index of the safe critical nitrogen level for the preventive practices to cool injury. It was summarized that increase of engorged pollens per anther by high previous water temperature resulted from the increase of number of differentiated microspores per anther, otherwise, the increase of engorged pollens by the decrease of previous nitrogen level was caused by the decrease of the number of aborted microspores per anther.

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Characterization and Control of Vascellum curtisii (Berkeley)Kreisel Causing the Fairy Ring Arcs in the Golf Course in Korea (골프코스에서 페어리링의 원인이되는 Vascellum curtisii의 특징과 방계)

  • Choi, Dae-Hong;Lee, Jung-Han;Kim, Hee-Kyu
    • Asian Journal of Turfgrass Science
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    • v.22 no.2
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    • pp.171-178
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    • 2008
  • We have found the clusters of tiny spiny puffball-like mushrooms growing gregariously in fairy ring (arcs) rimmed by a zone of darker green grass in the golf courses. Macroscopic as well as microscopic characters were examined for the morphology of fruiting body. Exoperidium is thin and densely spiny with minute fibrillae at early stage. The connivent spines were soft and quite persistent. In age, the fibrillae scrumble away with a powdery coating, which leaves white endoperidium becoming pale brown. It's interior was white and fleshy at first, but turns into an olive-colored dust as the gleba, the spore-producing tissue, develops to maturity and loaded with olive-brown spore mass. Then, distinct apical pore developed on the endoperidium. Rudimentary subgleba(sterile base) was narrow, chambered, delineated from the gleba by a membrane in young material. These characters suggested this fungus is a Vascellum, a member of the family Lycoperdaceae. The shapes of the spores were globose, echinulate, $3{\sim}3.5{\mu}m$ in diameter, thick-walled, and olive brown. Capillitial threads were $8-9{\mu}m$ wide, mostly colorless in KOH solution and thin-walled, which designated as "paracapillitium". This is an another character that distinguishes this mushroom from Lycoperdon spp. The spines developed on exoperidium were characteristically connivent; their apices joined together in a point, leaving a space below, which gives the appearance of vault to each group of usually 5 to 6 fibrillae. Based on the above characters, this fungus is identified as Vascellum curtisii (Berkeley). The characters distinguishable this from Lycoperdon pulcherrimum, and Vascellum pretense are discussed in detail. Control trial was also attempted. Strong vertical raking(SVR) followed by applying 500x detergent solution (Spark, Aekyung Co. Seoul) resulted in excellent control over any other treatments. In this plot, fruiting body was not developed throughout the end of mushroom growing season.

Association between physical activity measured using an accelerometer and arterial stiffness based on pulse wave velocity and ankle-brachial index in healthy adults (건강한 성인에서 가속도계로 측정한 신체활동과 맥파전달속도 및 상완-발목 간 혈압비에 기반한 동맥경화지표와의 관계)

  • Lee, Hyunju;Park, Kye Wol;Jun, Ha Yeon;Gwak, Ji Yeon;Kim, Eun Kyung
    • Journal of Nutrition and Health
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    • v.55 no.4
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    • pp.506-520
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    • 2022
  • Purpose: Physical activity (PA) has a beneficial effect on the prevention of arteriosclerosis in healthy adults. The purpose of this study was to analyze the relationship between PA measured using an accelerometer and arterial stiffness in healthy Korean adults. Methods: This study involved 87 subjects (36.8% women) aged 20-64 years. PA was evaluated using an accelerometer (wGT3X-BT, ActiGraph, Florida, USA) for 7 days. Based on the results of the accelerometer measurement, subjects were classified into active and inactive groups according to the World Health Organization (WHO) PA guidelines. The brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) to assess arterial stiffness were measured by a non-invasive vascular screening device (VP-1000 Plus, Omron). Results: The average age of the study subjects was 47.7 ± 11.3 years and the WHO PA guideline achievement rate was 29.9%. There was no significant difference in arterial stiffness (baPWV and ABI) between the active and inactive groups. In females, the time spent in light PA were positively correlated with ABI (r = 0.396; p < 0.05) and the number of sedentary bouts over 50 minutes was inversely correlated with ABI (r = -0.402; p < 0.05). However, there was no significant correlation between PA and arterial stiffness in males. Conclusions: The results of this study suggest that light PA and sedentary behavior have a positive correlation with arterial stiffness in females.