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Results of Postoperative Radiation Therapy of Rectal Cancers - with the Emphasis of the Overall Treatment Time - (직장암의 수술 후 방사선치료의 성적 - 예후 인자와 전체 치료기간이 미치는 영향에 관한 고찰 -)

  • Kim Joo-Young;Lee Myung-Hag;Lee Kyu-Chan
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.303-310
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    • 1998
  • Purpose : To evaluate the results of the treatment of locally advanced but resectable rectal cancers and to analyze prognostic factors. especially with the emphasis on the treatment time factor. Materials and Methods : There were 71 patients with rectal cancer who had been treated by curative surgical procedure and postoperative radiotherapy from August 1989 to December 1993. The minimum follow up period was 24 months and the median follow-up was 35 months Radiation therapy had been given by 6 MV linear accelerator by parallel opposing or four-box portals. Whole pelvis was treated up to 5040 cGy in most cases. Systemic chemotherapy had been given in 94$\%$ of the patients, mostly with 5-FU/ACNU regimen. Assessment for the overall and disease-free survival rates were done by life-table method and prognostic factors by Log-Rank tests. Results : Five-year overall survival, disease-free survival were 58.8$\%$ and 57$\%$, respectively. Two-year local control rate was 76.6$\%$. Stage according to Modified Astler-Coller (MAC) system, over 4 positive lymph nodes, over 6weeks interval between definitive surgery and adjuvant radiotherapy and over 7 days of interruption during radiotherapy period were statistically significant, or borderline significant prognostic factors. Conclusion : The treatment results of patients with rectal cancers are comparable to those of other large institutes. The treatment results for the patients with bowel wall penetration and/or positive regional lymph nodes were still discouraging for their high local recurrence rate for the patients with MAC 'c' stage diseases and high distant metastases rate even for the patients with node-negative diseases. Maybe more effective regimen of chemotherapy would be needed with proper route and schedule. To maximize postoperative adjuvant treatment. radiotherapy should be started at least within 6 weeks after surgery and preferably as soon as wound healing is completed. Interruption of treatment during radiotherapy course affects disease-free survival badly, especially if exceeds 7 days. So, the total treatment period trout definitive surgery to the completion of radiotherapy should be kept as minimal as possiable.

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Learning Material Bookmarking Service based on Collective Intelligence (집단지성 기반 학습자료 북마킹 서비스 시스템)

  • Jang, Jincheul;Jung, Sukhwan;Lee, Seulki;Jung, Chihoon;Yoon, Wan Chul;Yi, Mun Yong
    • Journal of Intelligence and Information Systems
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    • v.20 no.2
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    • pp.179-192
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    • 2014
  • Keeping in line with the recent changes in the information technology environment, the online learning environment that supports multiple users' participation such as MOOC (Massive Open Online Courses) has become important. One of the largest professional associations in Information Technology, IEEE Computer Society, announced that "Supporting New Learning Styles" is a crucial trend in 2014. Popular MOOC services, CourseRa and edX, have continued to build active learning environment with a large number of lectures accessible anywhere using smart devices, and have been used by an increasing number of users. In addition, collaborative web services (e.g., blogs and Wikipedia) also support the creation of various user-uploaded learning materials, resulting in a vast amount of new lectures and learning materials being created every day in the online space. However, it is difficult for an online educational system to keep a learner' motivation as learning occurs remotely, with limited capability to share knowledge among the learners. Thus, it is essential to understand which materials are needed for each learner and how to motivate learners to actively participate in online learning system. To overcome these issues, leveraging the constructivism theory and collective intelligence, we have developed a social bookmarking system called WeStudy, which supports learning material sharing among the users and provides personalized learning material recommendations. Constructivism theory argues that knowledge is being constructed while learners interact with the world. Collective intelligence can be separated into two types: (1) collaborative collective intelligence, which can be built on the basis of direct collaboration among the participants (e.g., Wikipedia), and (2) integrative collective intelligence, which produces new forms of knowledge by combining independent and distributed information through highly advanced technologies and algorithms (e.g., Google PageRank, Recommender systems). Recommender system, one of the examples of integrative collective intelligence, is to utilize online activities of the users and recommend what users may be interested in. Our system included both collaborative collective intelligence functions and integrative collective intelligence functions. We analyzed well-known Web services based on collective intelligence such as Wikipedia, Slideshare, and Videolectures to identify main design factors that support collective intelligence. Based on this analysis, in addition to sharing online resources through social bookmarking, we selected three essential functions for our system: 1) multimodal visualization of learning materials through two forms (e.g., list and graph), 2) personalized recommendation of learning materials, and 3) explicit designation of learners of their interest. After developing web-based WeStudy system, we conducted usability testing through the heuristic evaluation method that included seven heuristic indices: features and functionality, cognitive page, navigation, search and filtering, control and feedback, forms, context and text. We recruited 10 experts who majored in Human Computer Interaction and worked in the same field, and requested both quantitative and qualitative evaluation of the system. The evaluation results show that, relative to the other functions evaluated, the list/graph page produced higher scores on all indices except for contexts & text. In case of contexts & text, learning material page produced the best score, compared with the other functions. In general, the explicit designation of learners of their interests, one of the distinctive functions, received lower scores on all usability indices because of its unfamiliar functionality to the users. In summary, the evaluation results show that our system has achieved high usability with good performance with some minor issues, which need to be fully addressed before the public release of the system to large-scale users. The study findings provide practical guidelines for the design and development of various systems that utilize collective intelligence.

Factors Influencing the Therapeutic Compliance of Patients with Lung Cancer (폐암환자의 치료순응도에 영향을 미치는 요인)

  • Chae, Sang-Chul;Park, Jae-Yong;Kim, Jeong-Suk;Bae, Moon-Seob;Shin, Moo-Chul;Kim, Keon-Yeob;Kim, Chang-Ho;Shon, Sang-Kyun;Kam, Sin;Jung, Tae-Hoon
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.5
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    • pp.953-961
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    • 1998
  • Background : In recent years, lung cancer has been one of most common cause of death in Korea. Despite many physician's high degree of pessimism about the gains made in treatment, progressive improvement in the survival of lung cancer by treatment has occurred, particulary in the early stages of the disease. However, a lot of patients refuse treatment or give up in the fight against the disease. This study was done to evaluate factors influencing the compliance to therapy and to lead in the establishment of special programs to enhance compliance in patients with lung cancer. Methods: The medical records of 903 patients, whose ECOG(Eastern Cooperative Oncology Group) performance status was 3 or less and whose medical record was relatively satisfactory, among 1141 patients diagnosed with lung cancer between January 1989 and December 1996 were reviewed retrospectively. Compliance was classified into three groups based on the degree of compliance with physicians practice guideline: (a) compliants; (b) patients who initially complied but gave up of themselves midway during the course of treatment; (c) noncompliants who refused the treatment. Results: The overall compliance rate was 63.9%, which was progressively increased from 57.3-61.3% in 1989 and 1990 to 64.2-67.5% in 1995 and 1996. Age, education level and occupation of patients bore statistically significant relationship with the compliance but sex, marital status and smoking history did not. The compliance was significantly higher in patients without symptoms than with, and was also significantly higher in patients with good performance status. The compliance was significantly high in patients with NSCLC(non-small cell lung cancer) compared to SCLC(small cell lung cancer), but after exclusion of stage I and II, among NSCLC, which had higher compliance to surgery there was no significant difference of compliance by histology. The compliance was significantly lower in advanced stage. Conclusion: To enhance the compliance, special care including education programs about therapy including complication and prognosis are necessary, especially for educationally and economically disadvantaged patients.

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Gemcitabine Plus Vinorelbine as Second-line Chemotherapy of the Patients of Previously Treated Non-small Cell lung Cancer: Phase II Trial (비소세포 폐암 환자의 이차 치료로서 Gemcitabine과 Vinorelbine 혼합 요법의 효과)

  • Jang, Pil Soon;Kang, Hyun Mo;Lee, Jeong Eun;Kwon, Seon Jung;An, Jin Young;Lee, Yun Sun;Jeong, Sung Soo;Kim, Ju Ock;Kim, Sun Young
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.4
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    • pp.344-351
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    • 2005
  • Background : Both gemcitabine and vinorelbine are effective anticancer drugs with mild toxicity on non-small cell lung cancer, and monotherapy of these drugs are effective as a second-line chemotherapy. The aim of this trial was to assess the response and toxicity of a combination of gemcitabine and vinorelbine in patients of previously treated for non-small cell lung cancer. Materials and Methods : 24 patients, initial stage III A/B,IV and previously treated with platinium and taxane based regimens, were enrolled from June 2000 to March 2004. The regimens consisted of vinorelbine $25mg/m^2$ followed by an infusion of gemcitabine $1000mg/m^2$ on day 1 and day 8 every three weeks. This course was repeated more than twice. Results : Twenty-four patients were analyzed for the response, survival rate, and toxicities. The overall response was 17% with a complete remission rate of 4%. The median time-to progression (TTP) was 3.1 months (95%, CI 1-10months), and the survival time was 8.2 months (95%, CI 1-23 months). The grade 3/4 toxicities encountered were neutropenia (12.5%), anemia (0%), thrombocytopenia (0%). Non-hematological 3/4 toxicities were not observed. Conclusion : A combination of gemcitabine and vinorelbine in patients previously treated for non-small cell lung cancer provides a relatively good response rate, and a low toxicity profile. However, further study will be needed to confirm its effectiveness.

Case Study on Economical Fabrication and Erection of Steel Structure and Reduction in Field Erection Time (경제적 철골제작$\cdot$설치 및 공기단축 사례분석연구)

  • Ahn Jae-Bong;Choi Yoon ki
    • Korean Journal of Construction Engineering and Management
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    • v.5 no.5 s.21
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    • pp.183-192
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    • 2004
  • Even in Korea the number of steel structure buildings that allow internal space and easy change of their layouts in accordance with the purpose of buildings and box-type steel bridges constructed with thick plates with thickness in a rage just from a few $\beta$AE to \$100\beta$AE is increasing these days and therefore, domestic fabrication and processing technology of members for steel structures is being improved at a pace faster than in the past to meet the growing requirements of consumers for high reliability on quality control on the related steel structures. However, most domestic fabricators os steel structures who are turning out their steel products in accordance with the designs prepared by engineering companies in their respective works for the sake of cost cut more than anything else, hesitating to introduce any advanced new technology into themselves. In the case of the steel structure design application for small and mid-size buildings in particular, it is quite meaningful not only for those who are involved in steel structure business, but also for the people working at construction work fields to review the result of the study on the connections of steel structure members deigned to obtain superb quality of steel structures within short period for steel fabrication and erection at fields in economical ways, as there is a glowing tendency seeking standardization of connection of steel structure members as well as whole structure together with the development on design of construction system of buildings including their exterior and interior decoration materials, manufacture of the related members and fabrication technique structure. This paper has been prepared with the aim to review the peculiar characteristics of buildings constructed with the main frames of steel structures and actual cases of the change made ing the connections between steel structure columns and between columns and girder members in order to reduce the work period necessary for fabrication and erection of steel structures at the maximum as well as the some examples of steel structures fabricated through automatic welding by robots for box-type columns in addition to the description of the problems found in the course of fabricating those steel structures, suggesting possible counter-measures to solve them.

Burqanism from the Origin of the Pastoral Nomadic Koryo Region and the Vision of Korean Livestock Farming (고려의 원시영역 유목초지, 그 부르칸(불함)이즘과 한국축산의 비전)

  • Chu Chae Hyok
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.25 no.1
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    • pp.71-82
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    • 2005
  • Khori(高麗) refers to the Chaabog(reindeer) that live on lichens(蘚) on Mt. Soyon(鮮) in which pastures are the cold and dry plateau of North Eurasia. Thus, the origin region of the Khori or Koguryo that are the ancestors of the reindeer-herding pastoral nomads(馴鹿 遊牧民) can be said to be the Steppe-Taiga-Tundra pastoral areas of North Eurasia and North America. When the pastoral nomads moved on to the great mountain(大山) zone of the Jangbaek(長白) to the Baekdu(白頭) Mountains, they could have been in contact with pastoral farmers or agricultural farmers living there and they became the farmers remaining on agricultural farms. They were the Koryo people, the ancestors of Korea. Staying in one place, they gradually forgot the origin of their reindeer-herding pastoral nomadic history in the Northwest area of Mt. Soyon, the small mountain(小山) zone of the Steppe-Taiga-Tundra pastoral areas. In other words, they lost their identity as reindeer-herding pastoral nomads when they entered the agricultural area after leaving the pastoral area. However, since their basic genes had already formed when they lived on the cold and dry plateau of North Eurasia, it is possible to study their pastoral nomadic history focusing on 'the minority living in the broad area(廣域少數)', by utilizing highly advanced biotechnological science and focusing on genes and information technology innovation, and removing various past hindrances in research. Therefore, it is not so difficult to restore the reindeerherding pastoral nomadic history of the Koguryo(高句麗) people and secure their pastoral nomadic identity, of which the first steps have already been taken into their historical stages. The Eurasian continent and the Korean peninsula, especially the cold and dry plateau of North Eurasia and the Korean peninsula have been closely related to each other ecologically and historically. They can never be a separate space at all. The Eurasian continent lies horizontally east to west and thus, the continent forms an isothermal zone. Also, since the time of producing their own foods, it was relatively easy for people with their technology to move to other places owing to the pastoral nomadic characteristic of mobility. Unlike the Chungyen(中原) region, western Asia and the regions covering the Siberia-Manchu-Korean peninsula where food production revolution was first made were connected to the Mongolian lichens route(蘚苔之路: Ni, ukinii jam) and steppe roads. Although the ecological conditions of nature have changed a bit throughout a long history, it was natural for the many tribes in North Asia living on the largest Steppe-Taiga-Tundra area in the world to have believed 'the legends related to animals in relation to their founders and ancestors(獸祖傳說)'. Assuming that Siberian tigers and the tigers living on Mt. Baekdu were connected ecologically and genetically because of the ecological characteristics of the animals, and their migration from plateau to plateau, we would suspect that the Chosun(朝鮮) tribe living on Mt. Baekdu were ethnically and culturally more closely connected to the farther removed Ural-Altai tribes that lived on the cold and dry plateau region than to the Han(i14;) tribe who lived in Chungyen(中原) that was close to Mt. Baekdu. More evidence is the structure of the Korean language which has the form of 'Subject + Object + Verb', which is assumed to have originated from the speedy lifestyle of the reindeer-herding pastoral nomads. The structure is quite different from that of the Han(漢) language, which is based on agricultural life. Also, it is natural for reindeer riding reindeerherding pastoral nomads or horse-riding sheep-herding pastoral nomads(騎馬, 羊遊牧民) to have held military and political power over the region and eventually to have established an ancient pastoral nomadic empire in the process of their conquest of agricultural regions. The stages for founding global empires in the history of mankind maybe largely divided into two, in terms of ecological conditions and occupations. They are the steppes and the oceans. Of course, the steppe-based empires were established based on the skills to deal with horses and the ability to shoot arrows while riding horses, along with the use of iron ware in the 8th century BC. The steppe-based empires became the foundation for an oceanic empire, which could have been established by the use of warships and warship guns since the 15th Century. Based on those facts, we know that Chosun, Puyo(夫餘), and Koguryo are the products of a developmental process of pastoral nomadic empires on the steppes. Maybe we can easily find the pastoral nomadic identity of the Koguryo more than we expected when we trace the origins and history of the Korean tribe living in the pastures located in the northwest area of Mt. Jangbaek by focusing on pastoral nomadic mobility and organization just as we have investigated the historic origins of Anglo-Saxons in America by focusing on the times before the 15th Century. In the process, we should keep in mind that English culture originated from the Industrial Revolution and was directly delivered to the American continent, although America was far from England and was not an intermediate point on long sojourns either. Further, American culture came back to England in a more advanced form later. The most important thing currently to be resolved is to cause Koreans to look back on their own history in a freer way of thinking and with diverse, profound, and sharp insight, taking away the old and existing conventional recognition that is entangled with complicated interests with Korean people and other countries. The meanings of Chosun, Khori, and Solongos have been interpreted arbitrarily without any historic evidence by the scholars who followed conventional tradition of fixed-minded aristocrats in an agricultural society. If the Siberian cultural properties of the stone age, the earthenware age, the bronze age, and the iron age are analyzed in such a way, archaeological discovery will never be able to contribute to the restoration of the Koguryo's pastoral nomadic identity. One should transcend the errors that tend to interpret the cultural properties discovered in the pastoral nomadic regions as not being differentiated from those of agricultural regions and just interpret them altogether from the agricultural point of view. A more careful intention is required in the interpretation of cultural properties of ancient Korean empires that seem to have been formed due to mutual interactions of pastoral nomadic and agricultural cultures. Also, it is required that the conventional recognition chain of 'reverse-genes' be severed, which has placed more weight on agricultural properties than pastoral nomadic ones, since their settlement on agricultural farms was made after the establishment of their ancient pastoral nomadic empires. There is no reason at all to place priority on stoneware, earthenware, bronze ware, and iron ware than on wooden ware(木器) and other ware which were made of animal skins(皮器), bones and horns(骨角器), in analyzing the history in the regions of reindeer or sheep pastures. Reading ancient Korean history from the perspective of pastoral nomadic history, one feels strongly the instinctive emotions to return to the natural 'mother place'. The reindeer-herding pastoral nomadic identity of the Koguryo people that has been accumulated in volumes in their genes and hidden deep inside and have interacted organically could be reborn with Burqanism(Burqan refers to 不咸 in Chinese), which was their religion by birth and symbolized as the red willow(紅柳=不咸). The mother place of the Koguryo's people is the endless vast green pastures of North Eurasia and North America, where we anticipated the development of Korean livestock farming following the inherent properties in the genes of the reindeer-herding pastoral nomads with Korean ancestors. We anticipate that the place would be the core resource that could contribute to the development of life of living creatures following the inherent properties of their genes and biotechnological factors. In other words, biotechnology used for a search for clues on the well-being of humans could be the fruit brought by Burqanism of the Koguryo people and the fruit of the globalization of Korean livestock farming. It is the Chosun farmer in China come from the vast nomadic reindeer pastures of North Eurasia that resolved the food problem of a billion Chinese people with lowland paddy rice seeds (水稻) by transforming Heilongjiang Province(黑龍江省) into an oceanic lowland paddy rice field(水田). Even Mao Tse-tung(毛擇東) could not resolve the food problem by his revolution campaigns for tens of years. Today is the very time that requires the development of special livestock farming following the inherent properties of the ancient Korean reindeer-herding pastoral nomads that respected the dignity of life on the cold and dry plateau of North Eurasia and the America continent. I suggest that research should be started from the pastures of the Dariganga Steppe in East Mongolia that was the homeland of Hanwoo(韓牛) and the central horse-herding steppe place(牧馬場) of Chingis Khan's Mongolia. The Dariganga Steppe is awash with an affluent natural environment for pastoral nomadic living however, the quality of life of the pastoral nomads there is still low. I suggest we Koreans, the descendents of the Koguryo, should take our first steps for our livestock farming business project and develop the Northern nomadic pastures, here at the pastures of the Dariganga Steppe, which is the Mongolian core place of state-of-the-art technology for military weapons.

A Study on the Legislative Guidelines for Airline Consumer Protection (항공소비자 보호제도의 입법방향)

  • Lee, Chang-Jae
    • The Korean Journal of Air & Space Law and Policy
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    • v.32 no.1
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    • pp.3-51
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    • 2017
  • From a historical point of view, while the Warsaw Convention was passed in 1924 to regulate the unified judicial responsibility in the global air transportation industry, protection of airline consumers was somewhat lacking in protecting air carriers. In principle, the air carrier does not bear any obligation or liability when the aircraft is not operated normally due to natural disasters such as typhoon or heavy snowfall. However, in recent years, in developed countries such as the US and Europe, there has been a movement in which regulates the air carriers' obligation to protect their passengers even if there is no misconduct or negligence. Furthermore, the legislation of such advanced countries imposes an obligation on the airlines to compensate the loss separately from damages in case the abnormal operation of the aircraft is not caused by force majeure but caused by their negligence. Under this historical and international context, Korea is also modifying the system of aviation consumer protection by referring to other foreign legislation. However, when compared with foreign countries, our norm has a few drawbacks. First, the airline's protection or care obligations are mixed with the legal liability for damages in the provision, which seems to be due to the lack of understanding of the airline's passenger protection obligation. The liability for damages, which is governed by the International Convention or the Commercial Act, shall be determined by judging the cause of the airline's liability in respect of the damage of the individual passenger in the course of the air transportation. However, the duty to care and the burden for compensation shall be granted to all passengers who feel uncomfortable with the abnormal operation regardless of the cause of the accident. Also, our compensation system for denied boarding due to oversale is too low compared to the case of foreign countries, and setting the compensation amount range differently based on the time for the re-routing is somewhat unclear. Regarding checked-baggage claim, it will be necessary to refund the fee only from the fact that the baggage is delayed without asking whether there is any damage occurred from the delayed baggage. This is the content of the duty to care, which is different from the current Commercial Act or the international convention, in which responsibility is different depending on whether the airline takes all the necessary measures in order to prevent delaying of the baggage. The content of force majeure, which is a requirement for exemption from the obligation to care passengers on the airplane, shall be reconsidered. Maintenance for safe navigation is not considered to be included in force majeure, and connection to airplanes, airport conditions are disputable. According to the EC Regulation, if the cause of the abnormal operation of the airline is force majeure, the airline's compensation obligation is exempted but the duty to care of airline company is still meaningful. Furthermore, even if the main role of aviation consumer protection is on an airline, it is the responsibility of government agencies to supervise the fulfillment of such protection obligations. Therefore, it is necessary for the Korean government to actively take measures such as enforcing incentives for airlines that faithfully fulfill their obligation to care and imposed penalties on the contrary.

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Correlation analysis of radiation therapy position and dose factors for left breast cancer (좌측 유방암의 방사선치료 자세와 선량인자의 상관관계 분석)

  • Jeon, Jaewan;Park, Cheolwoo;Hong, Jongsu;Jin, Seongjin;Kang, Junghun
    • The Journal of Korean Society for Radiation Therapy
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    • v.29 no.1
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    • pp.37-48
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    • 2017
  • Purpose: The most basic conditions of radiation therapy is to prevent unnecessary exposure of normal tissue. The risk factors that are important o evaluate the dose emitted to the lung and heart from radiation therapy for breast cancer. Therefore, comparing the dose factors of a normal tissue according to the radion treatment position and Seeking an effective radiation treatment for breast cancer through the analysis of the correlation relationship. Materials and Methods: Computed tomography was conducted among 30 patients with left breast cancer in supine and prone position. Eclipse Treatment Planning System (Ver.11) was established by computerized treatment planning. Using the DVH compared the incident dose to normal tissue by position. Based on the result, Using the SPSS (ver.18) analyzed the dose in each normal tissue factors and Through the correlation analysis between variables, independent sample test examined the association. Finally The HI, CI value were compared Using the MIRADA RTx (ver. ad 1.6) in the supine, prone position Results: The results of computerized treatment planning of breast cancer in the supine position were V20, $16.5{\pm}2.6%$ and V30, $13.8{\pm}2.2%$ and Mean dose, $779.1{\pm}135.9cGy$ (absolute value). In the prone position it showed in the order $3.1{\pm}2.2%$, $1.8{\pm}1.7%$, $241.4{\pm}138.3cGy$. The prone position showed overall a lower dose. The average radiation dose 537.7 cGy less was exposured. In the case of heart, it showed that V30, $8.1{\pm}2.6%$ and $5.1{\pm}2.5%$, Mean dose, $594.9{\pm}225.3$ and $408{\pm}183.6cGy$ in the order supine, prone position. Results of statistical analysis, Cronbach's Alpha value of reliability analysis index is 0.563. The results of the correlation analysis between variables, position and dose factors of lung is about 0.89 or more, Which means a high correlation. For the heart, on the other hand it is less correlated to V30 (0.488), mean dose (0.418). Finally The results of independent samples t-test, position and dose factors of lung and heart were significantly higher in both the confidence level of 99 %. Conclusion: Radiation therapy is currently being developed state-of-the-art linear accelerator and a variety of treatment plan technology. The basic premise of the development think normal tissue protection around PTV. Of course, if you treat a breast cancer patient is in the prone position it take a lot of time and reproducibility of set-up problems. Nevertheless, As shown in the experiment results it is possible to reduce the dose to enter the lungs and the heart from the prone position. In conclusion, if a sufficient treatment time in the prone position and place correct confirmation will be more effective when the radiation treatment to patient.

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REPORT OF EXPERIENCE WITH KIMURA'S DISEASE (기무라씨 질환, 5 예 보고)

  • Seel David J.;Park Yoon-Kyu;Lee Kwang-Min
    • Korean Journal of Head & Neck Oncology
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    • v.5 no.1
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    • pp.39-46
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    • 1989
  • Kimura's Disease is a chronic inflammatory and proliferative condition producing subcutaneous masses especially in the head and neck area. This report of our experience with 5 patients with this disease is the first in the Korean surgical literature. Kimura's Disease is thought to be part of the larger spectrum of the entity known as angiolymphoid hyperplasia with eosinophilia (ALHE). It is characterized pathologically by hyperplastic lymphoid follicles, eosinophilic infiltration, and vase 비 ar proliferation. It produces masses which are most common in the area of the parotid, submandibular gland and upper neck. These masses occupy the subcutaneous tissues but also extend into salivary tissue and into upper neck nodes. One of our patients had masses in the groin. The tumors are extremely vascular due to the presence of new proliferative vessels and sinusoids. The average age of our 5 patients was 35, but all but one case were younger than 38 years of age. The male: female ratio was 3 : 2, and the average duration of symptoms was 5,2years. All patients had peripheral blood eosinophilia. All had multiple masses, sometimes symmetrical. The management was surgery alone in one case, surgery and steroids in one case, surgery and radiotherapy in two cases, and all three modalities in one case. The relationship of this entity to ALHE and our experience in the management of this disease are presented. A clinicopathological discrepancy alerted us to the existence of Kimura's Disease. A nineteen-year old male presented with subcutaneous masses over both mastoid areas present for 3 years (Case III). When biopsy on each side was reported as 'eosinophilic granuloma' we submitted the slides to an internationally expert pathologist. Symmetrically occurring tumors in the peri-parotid subcutaneous areas did not fit any category of neoplasm or granuloma known to us. The diagnosis, made by Dr. Gist Fan at the Ochsner Clinic, was Kimura's Disease. We found two additional cases in a review of soft tissue eosinophilic granuloma previously reported at Presbyterian Medical Center, and since then have diagnosed two new cases. These five cases constitute the basis for this, the largest series to be reported in Korea. These vascular, tumor-like lesions of the skin, subcutaneous areas and subjacent structures of the head and neck have been a variety of names, such as angiolymphoid hyperplasia with eosinophilia, eosinophilic hyperplastic lymphogranuloma, angioblastic lymphoid hyperplasia with eosinophilia, histioid hemangioma, and epithelioid hemangioma. The history of this disease spectrum dates back to 1937 when Kimm and Szeto (1) reported 7 cases of 'eosinophilic hyperplastic lymphogranuloma' in the Proceedings of the Chinese Medical Journal. In 1948 Kimura and his associates(2) reported additional cases in Japan under the title 'On the unusual granulation combined with hyperplastic changes of lymphatic tissue.' From then until 1966 several hundred cases were reported in China and Japan. The first report from the West was by Wells and Whimster(3) in the British Journal of Dermatology, in 1969. These authors coined the term, angiolymphoid hyperplasia with eosinophilia (ALHE). Since that time a debate has ensued as to whether Kimura's Disease and ALHE are distinct entities, or whether Kimura's is part of the larger spectrum of ALHE, perhaps a later or advanced phase. From the clinical perspective, surgeons should be aware of the diagnosis of Kimura's Disease not only as part of the differential diagnosis of head and neck tumors but also because these lesions are indolent, and generally require conservative surgical removal as part of the management program. CASE I. A 37-year-old female company employee presented in August 1982 with submental swelling of 12 years' duration and with inguinal swelling of 7 years' duration. The submental mass measured 5x5cm. and the inguinal mass was 8x4cm. in size. Peripheral eosinophilia varying from 14% to 40% was found. On August 20, 1982, the submental mass was removed and a superficial groin dissection was done. In May 1983 an intraoral lesion of the palate was removed. The patient is free of disease. CASE II. A 23-year-old unemployed man visited this hospital for the first time in July, 1984, with swelling of the right cheek present for 6 years. The mass was soft and ill-defined but measured 10x20cm. and extended from the submandibular upper neck to the zygomatic arch, and from the mastoid to the cheek, over the parotid gland. Eosinophilia varying from 27% to 29% was noted in the peripheral blood. On March 21, 1986, the lesion was resected. The procedure comprised an extended superficial parotidectomy from the temporalis fascia to the upper neck. Post-operatively radiotherapy 3000 rad tissue dose was administered using the 6 MeV linear accelerator. The patient remains free of disease. CASE III. A 19-year-old student came to the clinic with masses over both mastoid areas, present 3 years. On the right there were two adjacent lesions, one over the mastoid, the other in the upper jugular level of the neck. On the left it was a single mass over the mastoid. Eosinophilia varied from 13 to 32% in the peripheral blood, and 11.6% in the bone marrow. Incisional biopsy revealed 'eosinophilic granuloma' and a trial of predisolone was employed. The mass increased in size so a small dose of radiation (600 rads) was used, with substantial regression,. The lesion on the left was excised and follwed by 1000 rads radiotherapy. Finally recurrent tumor on the right side was removed on November 5, 1985. The patient remains free of disease. CASE N. A 29-year-old local merchant had had swelling of both upper necks since childhood. At the time of his first visit on March 17, 1986, the right submandibular mass measured 5x3.5cm. and the ,right upper neck and parotid tail mass measured 2.5cm. On the left there were masses in the upper neck, the largest of which measured 2.5cm, and of the parotid tail, 2.0cm. in size.(See Fig. 1) Peripheral eosinophilia of 39% was recorded. Left side partial parotidectomy and resection of the upper neck and subdigstric mases was done on May 2, 1986. The mass involving the right parotid tail and upper neck nodes was removed on Angust 7,1986. Postoperatively the patient was placed on prednisolone 30 mg. per day. No definite masses are palpable. CASE V. A 66-year-old housewife informed us, at the time of her first visit in May, 1986, that she had had multiple neck masses since 10 years ago. On the right side there was a 2.5cm. subcutaneous mass of the upper neck, over the upper jugular chain. On the left there was a 9x4.5cm. mass involving the entire parotid, the post-auricular area and the upper neck. A third mass presented in the submental area and measured 3.5cm. (See Fig. 2) Eosinophilia of 51% was noted in the peripheral blood. partial excision of the left upper neck lesion and complete excision of the submental mass were performed on june 6, 1986. post-operatively she was placed on 20 mg. of prednisolone daily, but when the mass re-grew after two months she was referred to Radiation Therapy for a 2500 rad course of treatment. A barely palpable thickening remains.

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A Study on Transition of Rice Culture Practices During Chosun Dynasty Through Old References IX. Intergrated Discussion on Rice (주요(主要) 고농서(古農書)를 통(通)한 조선시대(朝鮮時代)의 도작기술(稻作技術) 전개(展開) 과정(過程) 연구(硏究) - IX. 도작기술(稻作技術)에 대(對)한 종합고찰(綜合考察))

  • Guh, J.O.;Lee, S.K.;Lee, E.W.;Lee, H.S.
    • Korean Journal of Weed Science
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    • v.12 no.1
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    • pp.70-79
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    • 1992
  • From the beginning of the chosun dynasty, an agriculture-first policy was imposed by being written farming books, for instance, Nongsajiksul, matched with real conditions of local agriculture, which provided the grounds of new, intensive farming technologies. This farming book was the collection of good fanning technologies that were experienced in rural farm areas at that time. According to Nongsajiksul, rice culture systems were divided into "Musarmi"(Water-Seeded rice), /"Kunsarmi"(dry-seeded rice), /transplanted rice and mountainous rice (upland rice) culture. The characteristics of these rice cultures with high technologies were based of scientific weeding methods, improved fertilization, and cultivation works using cattle power and manpower tools systematically. Reclamation of coastal swampy and barren land was possible in virtue of fire cultivation farming(火耕) and a weeding tool called "Yoonmok"(輪木). Also, there was an improved hoe to do weeding works as well as thinning and heaping-up of soil at seeding stages of rice. Direct-seeded rice culture in flat paddy fields were expanded by constructing the irrigation reservoirs and ponds, and the valley paddy fields was reclaimed by constructing "Boh(洑)". These were possible due to weed control by irrigation waters, keeping soil fertility by inorganic fertilization during irrigation, and increased productivity of rice fields by supplying good physiological conditions for rice. Also, labor-saving culture of rice was feasible by transplanting but in national-wide, rice should not basically be transplanted because of the restriction of water use. Thus, direct-seeded rice in dry soils was established, in which rice was direct-seeded and grown in dry soils by seedling stages and was grown in flooded fields when rained, as in the book "Nongsajiksul". During the middle of the dynasty(AD 1495-1725), the excellent labor-saving farmings include check-rowing transplanting because of weeding efficiency and availability in rice("Hanjongrok"), and, nurserybed techniques (early transplanting of rice) were emphasized on the basis of rice transplanting ["Nongajibsung"]. The techniques for deep plowing with cattle powers and for putting more fertilizers were to improve the productivity of labor and land, The matters advanced in "Sanlimkyungje" more than in "Nongajibsung" were, development of "drybed of rice nursery stock", like "upland rice nursery" today, transplanting, establishment of "winter barly on drained paddy field, and improvement of labor and land-productivity in rice". This resulted in the community of large-scale farming by changing the pattern of small-farming into the production system of rice management. Woo-hayoung(1741-1812) in his book "Chonilrok" tried to reform from large-scale farmings into intensive farmings, of which as eminent view was to divide the land use into transplanting (paddy) and groove-seeding methods(dry field). Especially as insisted by Seo-yugo ("Sanlimkyungjeji"), the advantages of transplanting were curtailment of weeding labors, good growth of rice because of soil fertility of both nurserybed and paddy field, and newly active growth because rice plants were pulled out and replanted. Of course, there were reestimation of transplanting, limitation of two croppings a year, restriction of "paddy-upland alternation", and a ban for large-scale farming. At that period, Lee-jiyum had written on rice farming technologies in dry upland with consider of the land, water physiology of rice, and convenience for weeding, and it was a creative cropping system to secure the farm income most safely. As a integrated considerations, the followings must be introduced to practice the improved farming methods ; namely, improvement of farming tools, putting more fertilizers, introduction of cultural technologies more rational and efficient, management of labor power, improvement of cropping system to enhance use of irrigation water and land, introduction of new crops and new varieties.

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