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Gastrointestinal Complications after Lung Transplantation (폐이식 후 발생한 소화기계 합병증)

  • Haam, Seok-Jin;Paik, Hyo-Chae;Kim, Ji-Hyun;Lee, Doo-Yun;Kim, Chang-Wan;Kim, Jung-Hwan
    • Journal of Chest Surgery
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    • v.43 no.3
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    • pp.280-284
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    • 2010
  • Background: The postoperative management following lung transplantation has dramatically improved in the recent decade. However, some complications still remain as troublesome problems. We retrospectively reviewed the gastrointestinal complications and their management after lung transplantation. Material and Method: We performed a retrospective review of the medical records of 25 cases in 23 patients who underwent lung and heart-lung transplantations from July 1996 to March 2009. The definition of gastrointestinal complication was the gastrointestinal tract-related disease that occurred after lung transplantation. There were eight postoperative deaths (within postoperative 30 days) that were excluded from the analysis. Result: Twenty three gastrointestinal complications occurred in 11 (64.7%) of the 17 cases. The median follow-up period was 6.9 months (range: 2 months to 111 months), and chronic gastritis (23.5%, 4 of 17 cases) was the most common complication. Severe, prolonged (more than 2 weeks) diarrhea occurred in 3 cases. Three patients had gastric ulcer with one case requiring gastric primary closure for gastric ulcer perforation. This patient had gastric bleeding due to recurrent gastric ulcer 2 months after laparotomy. Cytomegalovirus gastritis and esophagitis occurred in 2 cases and 1 case, respectively, and esophageal ulcer occurred in 2 cases. There were esophageal strictures in 2 patients who underwent esophageal stent insertion. Other complications were one case each of ileus, early gastric cancer requiring endoscopic mucosal resection, gall bladder stone accompanied with jaundice, and pseudomembranous colitis. Conclusion: The incidence of gastrointestinal complication is relatively high in patients after they undergo lung transplantation. Since gastrointestinal complications can induce malnutrition, which might be related to considerable morbidity and mortality, close follow-up is necessary for the early detection and proper management of gastrointestinal complications.

Role of Radiation Therapy for Stage III Thymoma (제 3기 흉선종에서 방사선치료의 역할)

  • Chun, Ha-Chung;Lee, Myung-Za
    • Radiation Oncology Journal
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    • v.19 no.1
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    • pp.16-20
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    • 2001
  • Purpose : To evaluate the effectiveness and tolerance of the postoperative radiation therapy for patients with Stage III thymoma and to define the optimal radiotherapeutic regimen Materials and Methods : We retrospectively analyzed the records of 24 patients with Stage III thymoma who were referred for postoperative radiation therapy in our institution from June, 1987 to May, 1999. Surgical therapy consisted of total resection in one patient, subtotal resection in seventeen, and biopsy alone in six patients. Age of the patients was ranged from 20 to 62 years with mean age of 47 years. Male to female ratio was 14 to 10. Radiation therapy was delivered with linear accelerator producing either 6 MeV or 10 MeV photons. The irradiated volume included anterior mediastinum and known residual disease. The supraclavicular fossae were not irradiated. The delivered total dose was ranged from 30 to 56 Gy. One patient received 30 Gy and eighteen patients received minimum of 50 Gy. Follow up period was ranged from 12 months to 8 years with median follow up of 40 months. Results : The overall local control rate for entire group of patients was $67\%$ at 5 years. The cumulative local failure rates at one, three and five year were $18\%,\;28\%\;and\;33\%$, respectively. In patients treated with subtotal resection and biopsy alone, local control rate was $76\%\;and\;33\%$, respectively. The actuarial observed survival rate at 5 years was $57\%$, and actuarial adjusted survival at 5 years was $72\%$. The difference between 5 year survival rates for patients treated with subtotal resection and biopsy alone was not statistically significant $(62\%\;vs\;30\%)$. Conclusion : We might conclude that postoperative radiation therapy was safe and effective treatment for patients with Stage III thymoma. Postoperative radiation therapy is recommended in cases where tumor margin is close or incomplete resection is accomplished.

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Management Plan for Humanistic and Ecological Characteristics of Suweol Village Forest in Tongyoung (통영 수월숲의 인문학적 특성 및 생태적 특성을 고려한 관리방안)

  • Lim, Eui-Jea;Lee, Soo-Dong;Kim, Mi-Jeong
    • Korean Journal of Environment and Ecology
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    • v.27 no.1
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    • pp.85-98
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    • 2013
  • In order to propose effective conservation management plan, this study verified ecological characteristics, humanities and Social characteristics. The research site is private property which is owned belonging to the Kim's of Gimhae that have long history. The study site is more than a thousand years old and was created for protecting from typhoon. There held the religious ritual what is called Dongsinje until 1960s. There have been protected and managed by the villagers. As the results of analysis, the area of windbreak are $12,392.69m^2$. The windbreak is dominated old years deciduous broad-leaved tree such as Zelkova serrata, Celtis sinensis, Aphananthe aspera. Around there were farmlands(52.1%), urbanized area(26.3%), forest area(16.6%). The vegetation communities of windbreak were classified by considering the dominant species and current status of forest. The forest types are following as; A. aspera community(I) which is using less pressure, Platycarya strobilacea-Carpinus coreana-Z. serrata community(II). Z. serrata community(III) which is using high pressure, Z. serrata-A. aspera community(IV), Z. serrata community(V) which is damaged under canopy trees. The windbreak was in good condition whereas, there were concerns the some wrong status was being undermined such as the wrong forest restoration projects in the past, the trails that is penetrating inside the forest, building up education facilities. Therefore, in order to restore the value of windbreak what is so called Suwol forest, we should improve the problems of forest ecosystem such as wrong management, forest fragmentation by facilities and decline in forest by lack of growing the next generation trees. In addition, we should remove excessive resting facilities and lead to passive use of forest. to improve the way of wrong management, moreover, we should close off he trails that is penetrating inside the forest for improving fragmentation. We should restore vegetation restoration and fostering the next generation trees for forest ecosystem. In order to restore unique of histo-cultural and ecological forest landscape, the next generation trees should be grown up that is the dominant species in Suwol forest. Moreover, as a results of comparing the between good vegetation communities and damaged vegetation communities, it is necessary to complementary planting for demeged vegetation communities, therefore there needs to 10.8 under canopy trees, 79.7 shrubs.

Analysis of Sea Route to the Jangbogo Antarctic Research Station by using Passive Microwave Sea Ice Concentration Data (수동 마이크로파 해빙 면적비 자료를 이용한 남극 장보고 과학기지로의 항해경로 분석)

  • Kim, Yeonchun;Ji, Yeonghun;Han, Hyangsun;Lee, Joohan;Lee, Hoonyol
    • Korean Journal of Remote Sensing
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    • v.30 no.5
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    • pp.677-686
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    • 2014
  • Sea ice covers wide area in Terra Nova Bay in East Antarctica where the Jangbogo Antarctic Research Station was built in 2014, which affects greatly on the sailing of an icebreaker research vessel. In this study, we analyzed the optimum sea route and sailable period of the icebreaker to visit the Jangbogo Antarctic Research Station by using sea ice concentration data observed by passive microwave sensors such as Special Sensor Microwave/Imager (SSM/I) and Special Sensor Microwave Imager/Sounder (SSMIS) for the last decade, and by using sea route of the Araon, an icebreaker of Republic of Korea, from 2010 to 2012. It is found that Araon sailed in the route of sea ice concentration up to 78%. Sailing speed of the Araon decreased due to increasing sea ice concentration. However, Araon maintained the speed close to the average speed for the entire sailing period (~11 kn) in the route of sea ice concentration up to 70%. Therefore, we confirm that the Araon can sail typically in the route which shows sea ice concentration below 70%. We derived annually available sailing period in recent 10 years for the sea route of the Araon in 2010, 2011 and 2012, which is defined as the period showing sea ice concentration below 70% through the route. Maximum sailable period was analyzed to be 61 and 62 days for the route of the Araon in 2010 and 2011, respectively. However, the typical sailing in the routes was unavailable in some years because sea ice concentration was higher than 70% through the routes. Meanwhile, the sailable period for the routes of the Araon in 2012 was observed in every year, which was a minimum of 15 days and is a maximum of 89 days. Therefore, we could suggest that optimum route of icebreaker to visit the Jangbogo Antarctic Research Station is the route of the Araon in 2012. High resolution images from SAR or optical sensors are necessary to investigate sea ice condition near shoreline of Jangbogo research station due to several kilometers of low resolution of sea ice concentration.

Survival and Problems after Repair of Tetralogy of Fallot (Fallot 4징 교정수술후의 생존 및 문제점)

  • 손세정;한재진;이영탁;김성호
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.237-248
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    • 1999
  • Background: The late results of repair of tetralogy of Fallot(TOF) are favorable in most patients. Some portion of the patients with tetralogy, however, require reoperation for residual lesions or result in late death. The outcome of patients after tetralogy repair performed during the past 13 years was studied, with an emphasis on postrepair survival and problems including reoperations. Material and Method: A retrospective review of clinical, echocardiographic and catheterization data was performed in 569 of 775 patients with TOF who underwent corrective repair between 1983 and 1995 at Sejong General Hospital, Buchon, Korea. Result: Of 28(4.9%) early deaths(defined as 30 days postrepair), 12 deaths(42.9%) were <1 year of age, with an operative mortality of 15.4%. The surviving 541 patients(age 2.8 months to 43.4 years, median 23 months) have been followed up from 1 month to 12.6 years(median 35 months) postoperatively. Most patients were in good functional class and had normal right ventricular(RV) function. Postrepair results were compared between the transatrial-transpulmonary approach and the conventional right ventriculotomy. The former technique provided a lesser incidence of significant pulmonary regurgitation(P<0.001) and alesser degree of RV dysfunction(P<0.05) compared with those in the latter. There were 10(1.8%) late deaths during the follow-up period and 6 of the deaths were directly related to reoperation or ventricular dysfunction. The 10-year actuarial survival rate was 96.7%. There were 44 reoperations(8.1%) in 39 patients(7.2%), with an operative mortality of 10.3%. The main indications or reoperation included residual ventricular septal defect(VSD) (n=6), pulmonary stenosis(PS) (n=11), VSD with PS(n=17), pulmonary regurgitation(n=7), and tricuspid regurgitation(n=2). The 5- and 10-year freedom from reoperation were 89.4% and 76.1%, respectively. Conclusion: Although the majority of patients with repaired TOF are clinically well, with a high rate of survival, approximately 7% of patients have residual lesions that require surgical therapy. Therefore, the timely and meticulous corrective repair is mandatory to avoid reoperation, and continued close surveillance is also needed for the early detection of residual problems.

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GIS-based review of Goguryeo's defense system during the Gungnaeseong Period with the focus on the upper and middle reaches of the Amnok River and the mid-stream region of the Liohe River (GIS를 활용한 고구려 국내성 시기의 관방체계 검토 - 압록강 중상류~요하 중류를 중심으로 -)

  • Hong, Balgeum;Kang, Dongseok
    • Korean Journal of Heritage: History & Science
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    • v.54 no.1
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    • pp.260-279
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    • 2021
  • The Goguryeo kingdom established a unique defense system centered on a series of mountain fortresses. However, modern-day studies on its defense system have tended to focus on how they were positioned and generally consist of little more than individual surveys or introductions to the relevant materials, leaving much to be desired. This study attempts to extend the scope of studies about fortresses dating back to the Goguryeo period, taking into account the limitations of the available materials. As such, this study reviews the defense system of Goguryeo during the Gungnaeseong Period (i.e., the period when Gungnaeseong was the capital of Goguryeo) using the GIS system, with the focus on fortresses that are thought to have been built in the area extending from the middle and upper reaches of the Amnok River to the mid-stream region of the Liohe River, based on the aforementioned studies. The results of the study are as follows. First, the major roads built during the Gungnaeseong Period were as stated in the foregoing studies to some extent. Researchers believed that during the middle period of the dynasty, a major road ran along the Suzihe, Fuer and Xinkai rivers before finally reaching Jian. The study found that fortified walls and fortress strongholds were built along this road. Second, there were seven fortresses between the middle and upper reaches of the Amnokgang River and the midstream region of the Liaohe River. A primary defense line was closely established between the strongholds and the nearby walls, with secondary and tertiary defense lines established more loosely and encompassing a much wider area. Third, regarding the defense system along the major roads, the Choejinbosanseong, Goisanseong and Cheolbaesanseong fortresses served as strongholds along the 60-kilometer-long primary defense line, with 80-kilometer-long secondary and tertiary defense lines set up behind it. The final 120-kilometer-long defense line of the capital was established along with the Onyeosanseong Fortress, while a stumbling block was set up close to the capital as a defense system, rather than building a fortified wall. To summarize, a primary defense system was established centered on a series of fortresses, with each stronghold maintaining a closely-knit defense system in connection with other nearby strongholds to repel invaders.

Blended IT/STEM Education for Students in Developing Countries: Experiences in Tanzania (개발도상국 학생들을 위한 블랜디드 IT/STEM교육: 탄자니아에서의 경험 및 시사점)

  • Yoon Rhee, Ji-Young;Ayo, Heriel;Rhee, Herb S.
    • Journal of Appropriate Technology
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    • v.6 no.2
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    • pp.151-162
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    • 2020
  • Education is one of the priority sectors specified in Tanzania, and it has committed to provide 11 years of compulsory free basic education for all from pre-primary to lower secondary level. Despite the Government's efforts to provide free basic education to all children, there are 2.0 million (23.2 per cent) out of 8.5 million children at the primary school age of 7-13, who are out of school in Tanzania. The ICT class should be offered as a regular class in all secondary schools in Tanzania, recommended by the ministry of education. However, many schools are struggling to implement this mandate. Most of schools offer the ICT class with theory without any real hardware. Some schools were given with computers but they were not maintained for operation. There is a huge task to make ICT education universal. Main issues include: remoteness (off-grid area), lack of ICT teachers, lack of resources such as hardware, infrastructure, and lack of practical lessons or projects to be used at schools. An innovative blended ICT/STEM education program is being conducted not only for Tanzanian public and private/international schools, but also for out-of-school adolescents through institutions, NGO centers, home visits and at the E3 Empower academy center. For effective STEM education to take place and remain sustainable, more practical curriculum, and close-up teacher support need to be accompanied concurrently. Practical, project-based simple coding lessons have been developed and employed that students experience true learning. The effectiveness of the curriculum has been demonstrated in various project centers, and it showed that students are showing new interests in exploring new discovery, even though this was a totally new area for them. It has been designed for an easy replication, thus students who learned can repeat the lessons themselves to other students. The ultimate purpose of this project is to have IT education offered as universally as possible throughout the whole Tanzania. Quality education for all children is a key for better future for all. Previously it was hoped that education with discipline will improve the active learning. But now more than ever, we believe that children have the ability to learn on their own with given proper STEM education tools, guidelines and environment. This gives promising hope to all of us, including those in the developing countries.

A study on Development Process of Fish Aquaculture in Japan - Case by Seabream Aquaculture - (일본 어류 양식업의 발전과정과 산지교체에 관한 연구 : 참돔양식업을 사례로)

  • 송정헌
    • The Journal of Fisheries Business Administration
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    • v.34 no.2
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    • pp.75-90
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    • 2003
  • When we think of fundamental problems of the aquaculture industry, there are several strict conditions, and consequently the aquaculture industry is forced to change. Fish aquaculture has a structural supply surplus in production, aggravation of fishing grounds, stagnant low price due to recent recession, and drastic change of distribution circumstances. It is requested for us to initiate discussion on such issue as “how fish aquaculture establishes its status in the coastal fishery\ulcorner, will fish aquaculture grow in the future\ulcorner, and if so “how it will be restructured\ulcorner” The above issues can be observed in the mariculture of yellow tail, sea scallop and eel. But there have not been studied concerning seabream even though the production is over 30% of the total production of fish aquaculture in resent and it occupied an important status in the fish aquaculture. The objectives of this study is to forecast the future movement of sea bream aquaculture. The first goal of the study is to contribute to managerial and economic studies on the aquaculture industry. The second goal is to identify the factors influencing the competition between production areas and to identify the mechanisms involved. This study will examine the competitive power in individual producing area, its behavior, and its compulsory factors based on case study. Producing areas will be categorized according to following parameters : distance to market and availability of transportation, natural environment, the time of formation of producing areas (leaderㆍfollower), major production items, scale of business and producing areas, degree of organization in production and sales. As a factor in shaping the production area of sea bream aquaculture, natural conditions especially the water temperature is very important. Sea bream shows more active feeding and faster growth in areas located where the water temperature does not go below 13∼14$^{\circ}C$ during the winter. Also fish aquaculture is constrained by the transporting distance. Aquacultured yellowtail is a mass-produced and a mass-distributed item. It is sold a unit of cage and transported by ship. On the other hand, sea bream is sold in small amount in markets and transported by truck; so, the transportation cost is higher than yellow tail. Aquacultured sea bream has different product characteristics due to transport distance. We need to study live fish and fresh fish markets separately. Live fish was the original product form of aquacultured sea bream. Transportation of live fish has more constraints than the transportation of fresh fish. Death rate and distance are highly correlated. In addition, loading capacity of live fish is less than fresh fish. In the case of a 10 ton truck, live fish can only be loaded up to 1.5 tons. But, fresh fish which can be placed in a box can be loaded up to 5 to 6 tons. Because of this characteristics, live fish requires closer location to consumption area than fresh fish. In the consumption markets, the size of fresh fish is mainly 0.8 to 2kg.Live fish usually goes through auction, and quality is graded. Main purchaser comes from many small-sized restaurants, so a relatively small farmer and distributer can sell it. Aquacultured sea bream has been transacted as a fresh fish in GMS ,since 1993 when the price plummeted. Economies of scale works in case of fresh fish. The characteristics of fresh fish is as follows : As a large scale demander, General Merchandise Stores are the main purchasers of sea bream and the size of the fish is around 1.3kg. It mainly goes through negotiation. Aquacultured sea bream has been established as a representative food in General Merchandise Stores. GMS require stable and mass supply, consistent size, and low price. And Distribution of fresh fish is undertook by the large scale distributers, which can satisfy requirements of GMS. The market share in Tokyo Central Wholesale Market shows Mie Pref. is dominating in live fish. And Ehime Pref. is dominating in fresh fish. Ehime Pref. showed remarkable growth in 1990s. At present, the dealings of live fish is decreasing. However, the dealings of fresh fish is increasing in Tokyo Central Wholesale Market. The price of live fish is decreasing more than one of fresh fish. Even though Ehime Pref. has an ideal natural environment for sea bream aquaculture, its entry into sea bream aquaculture was late, because it was located at a further distance to consumers than the competing producing areas. However, Ehime Pref. became the number one producing areas through the sales of fresh fish in the 1990s. The production volume is almost 3 times the production volume of Mie Pref. which is the number two production area. More conversion from yellow tail aquaculture to sea bream aquaculture is taking place in Ehime Pref., because Kagosima Pref. has a better natural environment for yellow tail aquaculture. Transportation is worse than Mie Pref., but this region as a far-flung producing area makes up by increasing the business scale. Ehime Pref. increases the market share for fresh fish by creating demand from GMS. Ehime Pref. has developed market strategies such as a quick return at a small profit, a stable and mass supply and standardization in size. Ehime Pref. increases the market power by the capital of a large scale commission agent. Secondly Mie Pref. is close to markets and composed of small scale farmers. Mie Pref. switched to sea bream aquaculture early, because of the price decrease in aquacultured yellou tail and natural environmental problems. Mie Pref. had not changed until 1993 when the price of the sea bream plummeted. Because it had better natural environment and transportation. Mie Pref. has a suitable water temperature range required for sea bream aquaculture. However, the price of live sea bream continued to decline due to excessive production and economic recession. As a consequence, small scale farmers are faced with a market price below the average production cost in 1993. In such kind of situation, the small-sized and inefficient manager in Mie Pref. was obliged to withdraw from sea bream aquaculture. Kumamoto Pref. is located further from market sites and has an unsuitable nature environmental condition required for sea bream aquaculture. Although Kumamoto Pref. is trying to convert to the puffer fish aquaculture which requires different rearing techniques, aquaculture technique for puffer fish is not established yet.

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An Analysis of Determinants of Health Knowledge, Attitude and Practice of Housewives in Korea (한국부인의 보건지식, 태도 및 실천에 영향을 미치는 제요인분석)

  • 남철현
    • Korean Journal of Health Education and Promotion
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    • v.2 no.1
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    • pp.3-50
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    • 1984
  • The levels of health knowledge, attitude and practice of housewives considerably effect to the health of households, communities and the nation. This study was designed to grasp the levels of health knowledge, attitude and practice of houswives and analyse the various factors effecting to health in order to provide health education services as well as materials for effective formulation and implementation of health policy to improve the health of the nation. This study has been conducted through interviews by trained surveyers for 4,281 housewives selected from 4,500 households throughout the country for 40 days during July 11-August 20, 1983. The results of survey were analysed by stepwise multiple regression and path analysis are summarized as follows; 1. Based on the measurement instrument applied to this study, the levels of health knowledge, attitude and practice of housewives were extremely low with 54.5 points out of 100 points in full. Higher level with 72 points and above was approximately 21 percent and lower level with 39 points and below was approx. 24 percent. The middle level was approx. 55 percent. In order to implement health programs successively, health education should be more strengthened and to improve the level of health knowledge, attitude and practice (KAP) of the nation, political consideration as a part of spiritual reformation must be concentrated on health. 2. The level of health knowledge indicated the highest points with 57.3 the level of attitude was the second with 55.0 points and the practice level was the lowest with 50.0 point. Therefore, planning and implementation of health education program must be based on the persuasion and motivation that health knowledge turn into practice. 3. Housewives who had higher level of health knowledge, showed their practice level was relatively lower and those who had middle or low level of it practice level was the reverse. 4. Correlations among health knowledge, attitude and practice (KAP) were generally higher and statistically significant at 0.1 percent level. Correlation between total health KAP level and health knowledge was the highest with r=.8092. 5. Health KAP levels showed significant differences according to the age, number of children, marital status, self-assessed health status and concern on health of the housewives interviewed (p<0.001) 6. Health KAP levels also showed significant differences according to the education level, economic status, employment before marriage and grown-up area of the housewives interviewed. (p<0.001) 7. Heath KAP levels showed significant differences according to health insurance benificiary and the existence of patients in the family. (p<0.001). 8. Health KAP levels showed significant differences according to distance to government organizations, schools, distance to health facilities, telephone possession rate, television possession rate, newspaper reading rate and activities of Ban meeting and Women's club. (p<0.001) 9. Health KAP levels showed significant differences according to electric mass communication media such as television, radio and village broadcasting etc. and printed media such as newspaper, magazine and booklets etc., IEC variables such as individual consultation and husband-wife communication, however, there was no significance with group training. 10. Health KAP of the housewives showed close correlation with personal characteristics variables, i.e., education level (r=.5302), age (r=-.3694) grown-up area (r=.3357) and employment before marriage. In general, correlation of health knowledge level was higher than the levels of attitude or practice. In case of health concern and health insurance, correlation of practice level was higher than health knowledge level. 11. Health KAP levels showed higher correlation with community environmental characteristics, Ban meeting and activity of Women's club, however, no correlation with New-village movement. 12. Among IEC variables, husband-wife communication showed the highest correlation with health KAP levels and printed media, electric mas communication media and health consultation in order. Therefore, encouragement of husband-wife communication and development of training program for men should be included in health education program. 13. Mass media such as electric mass com. and printed media were effective for knowledge transmission and husband-wife communication and individual consultation were effective for health practice. Group training was significant for knowledge transmission, however, but not significant for attitude formation or turning to health practice. To improve health KAP levels, health knowledge should be transmitted via mass media and health consultation with health professionals and field health workers should be strengthened. 14. Correlation of health KAP levels showed that knowledge level was generally higher than that of practice and recognized that knowledge was not linked with attitude or practice. 15. The twenty-five variables effecting health KAP levels of housewives had 41 per cent explanation variances among which education level had great contribution (β=.2309) and electric mass com. media (β=.1778), husband-wife communication (β=.1482), printed media, grown-up area, and distance to government organizations in order. Variances explained (R²) of health KAP were 31%, 15%, and 30% respectively. 16. Principal variables contributed to health KAP were education level (β=.12320, β=.1465), electric mass comm. media (β=.1762, β=.1839), printed media, (β=.1383, β=.1420) husband-wife communication (β=.1004, β=.1067), grown-up area and distance to government organizations, in order. Since education level contributes greatly to health KAP of the housewives, health education including curriculum development in primary, middle and high schools must be emphasized and health science must be selected as one of the basic liberal arts subject in universities. 17. Variences explained of IEC variables to health KAP were 19% in total, 14% in knowledge, 9% in attitude, and 10% in health practice. Contributions of IEC variables to health KAP levels were printed media (β=.3882), electric mass comm media (β=.3165), husb-band wife com. (β=.2095,) and consultation on health (β=.0841) in order, however, group training showed negative effect (β=-.0402). National fund must be invested for the development of Health Program through mass media such as TV and radio etc. and for printed materials such as newspaper, magazines, phamplet etc. needed for transmission of health knowledge. 18. Variables contributed to health KAP levels through IEC variables with indirect effects were education level (Ind E=0.0410), health concern (Ind E=.0161), newspaper reading rate (Ind E=.0137), TV possession rate and activity of Ban meeting in order, however, health facility showed negative effect (Ind E=-.0232) and other variables showed direct effect but not indirect effect. 19. Among the variables effecting health KAP level, education level showed the highest in total effect (TE=.2693) then IEC (TE=.1972), grown-up city (TE=.1237), newspaper reading rate (TE=.1020), distance to government organization (TE=.095) in order. 20. Variables indicating indirect effects to health KAP levels were; at knowledge level with R²=30%, education level (Ind E=.0344), newspaper reading rate (Ind E=.0112), TV possession rate (Ind E=.0689), activity of Ban meeting (Ind E=.0079) in order and at attitude level with R²=13%, education level (Ind E=. 0338), activity of Ban meeting (Ind E=.0079), and at practice level with R²=29%. education level (Ind E=.0268), health facility (Ind E=.0830) and concern on health (Ind E=.0105). 21. Total effect to health KAP levels and IEC by variable characteristics, personal characteristics variables indicated larger than community characteristics variables. 22. Multiple Correlation Coefficient (MCC) expressed by the Personal Characteristic Variable was .5049 and explained approximately 25% of variances. MCC expressed by total Community environment variable was .4283 and explained approx. 18% of variances. MCC expressed by IEC Variables was .4380 and explained approx. 19% of variances. The most important variable effected to health KAP levels was personal characteristic and then IEC variable, Community Environment variable in order. When the IEC effected with personal characteristic or community characteristic, the MCC or the variances were relatively higher than effecting alone. Therefore it was identified that the IEC was one of the important intermediate variable.

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Clinical Outcome after Breast Conserving Surgery and Radiation Therapy for Early Breast Cancer (초기 유방암의 유방 보존수술 후 방사선 치료 결과)

  • Cho, Heung-Lae;Kim, Cheol-Jin;Park, Sung-Kwang;Oh, Min-Kyung;Lee, Jin-Yong;Ahn, Ki-Jung
    • Radiation Oncology Journal
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    • v.26 no.4
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    • pp.204-212
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    • 2008
  • Purpose: This study was performed to evaluate the disease-free survival and risk factors of recurrence in early breast cancer patients who have undergone breast conserving surgery and radiation therapy. Materials and Methods: From March 1997 to December 2002, 77 breast cancer patients who underwent breast conserving surgery and radiation therapy were reviewed retrospectively. The median follow-up time was 58.4 months (range $43.8{\sim}129.4$ months) and the mean subject age was 41 years. The frequency distribution of the different T stages, based on the tumor characteristics was 38 (49.3%) for T1, 28 (36.3%) for T2, 3 for T3, 7 for T is and 1 for an unidentified sized tumor. In addition, 52 patients (67.5%) did not have axillary lymph metastasis, whereas 14 patients (18.1%) had $1{\sim}3$ lymph node metastases and 3 (0.03%) had more than 4 lymph node metastases. The resection margin was negative in 59 patients, close (${\leq}2\;mm$) in 15, and positive in 4. All patients received radiation therapy at the intact breast using tangential fields with a subsequent electron beam boost to the tumor bed at a total dose ranging from 59.4 Gy to 66.4 Gy. Patients with more than four positive axillary lymph nodes received radiation therapy ($41.4{\sim}60.4\;Gy$) at the axillary and supraclavicular area. Chemotherapy was administered in 59 patients and tamoxifen or fareston was administered in 29 patients. Results: The 5 year overall survival and disease-free survival rates were 98.08% and 93.49%, respectively. Of the 77 patients, a total of 4 relapses (5.2%), including 1 isolated supraclavicular relapse, 1 supraclavicular relapse with synchronous multiple distant relapses, and 2 distant relapses were observed. No cases of local breast relapses were observed. Lymph node metastasis or number of metastatic lymph nodes was not found to be statistically related with a relapse (p=0.3289) nor disease-free survival (p=0.1430). Patients with positive margins had a significantly shorter disease-free survival period (p<0.0001) and higher relapse rates (p=0.0507). However, patients with close margins were at equal risk of relapse and disease-free survival as with negative margins (p=1.000). Patients younger than 40 years of age had higher relapse rates (9.3% vs. 0%) and lower disease-free survival periods, but the difference was not statistically significant (p=0.1255). The relapse rates for patients with tumors was 14% for tumor stage T2, compared to 0% for tumor stage T1 tumors (p=0.0284). A univariate analysis found that disease-free survival and relapse rates, T stage, positive resection margin and mutation of p53 were significant factors for clinical outcome. Conclusion: The results of this study have shown that breast conservation surgery and radiation therapy in early breast cancer patients has proven to be a safe treatment modality with a low relapse rate and high disease-free survival rate. The patients with a positive margin, T2 stage, and mutation of p53 are associated with statistically higher relapse rates and lower disease-free survival.