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Business Relationships and Structural Bonding: A Study of American Metal Industry (산업재 거래관계와 구조적 결합: 미국 금속산업의 분석 연구)

  • Han, Sang-Lin;Kim, Yun-Tae;Oh, Chang-Yeob;Chung, Jae-Moon
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.3
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    • pp.115-132
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    • 2008
  • Metal industry is one of the most representative heavy industries and the median sales volume of steel and nonferrous metal companies is over one billion dollars in the case America [Forbes 2006]. As seen in the recent business market situation, an increasing number of industrial manufacturers and suppliers are moving from adversarial to cooperative exchange attitudes that support the long-term relationships with their customers. This article presents the results of an empirical study of the antecedent factors of business relationships in metal industry of the United States. Commitment has been reviewed as a significant and critical variable in research on inter-organizational relationships (Hong et al. 2007, Kim et al. 2007). The future stability of any buyer-seller relationship depends upon the commitment made by the interactants to their relationship. Commitment, according to Dwyer et al. [1987], refers to "an implicit or explicit pledge of relational continuity between exchange partners" and they consider commitment to be the most advanced phase of buyer-seller exchange relationship. Bonds are made because the members need their partners in order to do something and this integration on a task basis can be either symbiotic or cooperative (Svensson 2008). To the extent that members seek the same or mutually supporting ends, there will be strong bonds among them. In other words, the principle that affects the strength of bonds is 'economy of decision making' [Turner 1970]. These bonds provide an important idea to study the causes of business long-term relationships in a sense that organizations can be mutually bonded by a common interest in the economic matters. Recently, the framework of structural bonding has been used to study the buyer-seller relationships in industrial marketing [Han and Sung 2008, Williams et al. 1998, Wilson 1995] in that this structural bonding is a crucial part of the theoretical justification for distinguishing discrete transactions from ongoing long-term relationships. The major antecedent factors of buyer commitment such as technology, CLalt, transaction-specific assets, and importance were identified and explored from the perspective of structural bonding. Research hypotheses were developed and tested by using survey data from the middle managers in the metal industry. H1: Level of technology of the relationship partner is positively related to the level of structural bonding between the buyer and the seller. H2: Comparison level of alternatives is negatively related to the level of structural bonding between the buyer and the seller. H3: Amount of the transaction-specific assets is positively related to the level of structural bonding between the buyer and the seller. H4: Importance of the relationship partner is positively related to the level of structural bonding between the buyer and the seller. H5: Level of structural bonding is positively related to the level of commitment to the relationship. To examine the major antecedent factors of industrial buyer's structural bonding and long-term relationship, questionnaire was prepared, mailed out to the sample of 400 purchasing managers of the US metal industry (SIC codes 33 and 34). After a follow-up request, 139 informants returnedthe questionnaires, resulting in a response rate of 35 percent. 134 responses were used in the final analysis after dropping 5 incomplete questionnaires. All measures were analyzed for reliability and validity following the guidelines offered by Churchill [1979] and Anderson and Gerbing [1988]., the results of fitting the model to the data indicated that the hypothesized model provides a good fit to the data. Goodness-of-fit index (GFI = 0.94) and other indices ( chi-square = 78.02 with p-value = 0.13, Adjusted GFI = 0.90, Normed Fit Index = 0.92) indicated that a major proportion of variances and covariances in the data was accounted for by the model as a whole, and all the parameter estimates showed statistical significance as evidenced by large t-values. All the factor loadings were significantly different from zero. On these grounds we judged the hypothesized model to be a reasonable representation of the data. The results from the present study suggest several implications for buyer-seller relationships. Theoretically, we attempted to conceptualize the antecedent factors of buyer-seller long-term relationships from the perspective of structural bondingin metal industry. The four underlying determinants (i.e. technology, CLalt, transaction-specific assets, and importance) of structural bonding are very critical variables of buyer-seller long-term business relationships. Our model of structural bonding makes an attempt to systematically examine the relationship between the antecedent factors of structural bonding and long-term commitment. Managerially, this research provides industrial purchasing managers with a good framework to assess the interaction processes with their partners and, ability to position their business relationships from the perspective of structural bonding. In other words, based on those underlying variables, industrial purchasing managers can determine the strength of the company's relationships with the key suppliers and its state of preparation to be a successful partner with those suppliers. Both the supplying and customer companies can also benefit by using the concept of 'structural bonding' and evaluating their relationships with key business partners from the structural point of view. In general, the results indicate that structural bonding gives a critical impact on the level of relationship commitment. Managerial implications and limitations of the study are also discussed.

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Chest CT Finding and Its Comparison with Bronchoscopic Finding in Endobronchial Tuberculosis (기관지결핵의 흉부전산화단층촬영소견 및 기관지경소견과의 비교)

  • Lee, Jae-Ho;Yoon, Hye-Kyung;Song, Jae-Woo;Yoo, Chul-Gyu;Chung, Hee-Soon;Kim, Young-Hwan;Han, Sung-Koo;Shim, Young-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.4
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    • pp.742-755
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    • 1997
  • Background : Endobronchial tuberculosis(ET) is still relatively common disease in Korea. We intended to evaluate the length of endobronchial lesion, peribronchial thickness, luminal irregularity and associated mediastinal lymph node enlargement with Chest CT to get information for such aggressive treatment as electrocautery, laser therapy and so on of bronchial stricture in ET, and also to compare the change of Chest CT finding with that of bronchoscopic finding after one month of anti-tuberculosis treatment. Method : We performed CT in 26 patients who were diagnosed as ET by bronchoscopy at Boramae Hospital from November 1991 to March 1996. After classifying ET into seven subtypes according to bronchoscopic finding, we analyzed the CT finding of each subtype. And we followed up the bronchoscopy, CT, and PIT after one month of anti-tuberculosis treatment, and compared the change of CT findings with those of bronchoscopic findings in nine patients. Results : Age of the patients was from 17 to 73 years old, and the ratio of male to female was 1 : 25 with absolute female predominance. The site(s) of bronchial involvement by tuberculosis is one in 14 cases, two in nine cases and three in one case, respectively, and the left main bronchus was the most frequently involved site (13 cases for multiple involvements and 7 cases for single involvement among 26 cases). The length of bronchial involvement by tuberculosis which was measured by CT was from 10 to 55 mm, and there was a tendency that the length of involved lesion in fibrostenotic type was shorter than that of actively caseating type. Bronchial stricture on CT was noticed in 25 (96%) cases and the range of severity was from total occlusion to near-normal and also showed wide variation even though the subtype of ET was same. The increase of peribronchial thickness which was measured by CT, was noticed in 21 cases (91%) among 23 cases (in which the measurement was possible), and there was no improvement of peribronchial thickness in those cases which showed little improvement in bronchial stricture despite anti-tuberculosis treatment. There was no difference in the luminal irregularity of involved bronchi on CT in relation to bronchoscopic subtypes. The mediastinal lymph node enlargement, defined as the diameter of lymph node was larger than 1cm on CT, was detected in 20 cases (77%), and right side was more frequently involved (L : R = 1 : 5.2). The CT finding usually showed extrinsic bronchial compression but showed direct invasion in two cases which were bronchoscopically classified as tumorous type. When follow-up bronchoscopy and CT was performed after one month of anti-tuberculosis treatment in nine patients, CT showed significant improvement in peribronchial thickness and mediastinal lymph node enlargement. Bronchial stricture was also improved in 6 cases but aggravated in 3 cases despite anti-tuberculosis therapy. In two cases which were classified as fibrostenotic type by bronchoscopy, CT showed significant improvement in bronchial stricture, interestingly. Conclusion : We concluded that the role of Chest CT was complimentary to bronchoscopy in ET, since CT was useful in evaluating the length of bronchial involvement, peribronchial thickness, and mediastinal lymph node enlargement.

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An Analytical Study on Stem Growth of Chamaecyparis obtusa (편백(扁栢)의 수간성장(樹幹成長)에 관(關)한 해석적(解析的) 연구(硏究))

  • An, Jong Man;Lee, Kwang Nam
    • Journal of Korean Society of Forest Science
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    • v.77 no.4
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    • pp.429-444
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    • 1988
  • Considering the recent trent toward the development of multiple-use of forest trees, investigations for comprehensive information on these young stands of Hinoki cypress are necessary for rational forest management. From this point of view, 83 sample trees were selected and cut down from 23-ear old stands of Hinoki cypress at Changsung-gun, Chonnam-do. Various stem growth factors of felled trees were measured and canonical correlaton analysis, principal component analysis and factor analysis were applied to investigate the stem growth characteristics, relationships among stem growth factors, and to get potential information and comprehensive information. The results are as follows ; Canonical correlation coefficient between stem volume and quality growth factor was 0.9877. Coefficient of canonical variates showed that DBH among diameter growth factors and height among height growth factors had important effects on stem volume. From the analysis of relationship between stem-volume and canonical variates, which were linearly combined DBH with height as one set, DBH had greater influence on volume growth than height. The 1st-2nd principal components here adopted to fit the effective value of 85% from the pincipal component analysis for 12 stem growth factors. The result showed that the 1st-2nd principal component had cumulative contribution rate of 88.10%. The 1st and the 2nd principal components were interpreted as "size factor" and "shape factor", respectively. From summed proportion of the efficient principal component fur each variate, information of variates except crown diameter, clear length and form height explained more than 87%. Two common factors were set by the eigen value obtained from SMC (squared multiple correlation) of diagonal elements of canonical matrix. There were 2 latent factors, $f_1$ and $f_2$. The former way interpreted as nature of diameter growth system. In inherent phenomenon of 12 growth factor, communalities except clear length and crown diameter had great explanatory poorer of 78.62-98.30%. Eighty three sample trees could he classified into 5 stem types as follows ; medium type within a radius of ${\pm}1$ standard deviation of factor scores, uniformity type in diameter and height growth in the 1st quadrant, slim type in the 2nd quadrant, dwarfish type in the 3rd quadrant, and fall-holed type in the 4 th quadrant.

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Study on the Dietary Habit, Nutrient Intake, and Health Status According to Their Majors Among College Women in Sahmyook University (삼육대학교 여대생의 전공에 따른 식습관, 영양소섭취상태 및 건강습관에 관한 비교)

  • Chung, Keun-Hee;Shin, Kyung-Ok;Jung, Tae-Hwan;Choi, Kyung-Soon;Jeon, Woo-Min;Chung, Dong-Keun;Lee, Dong-Sup
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.39 no.6
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    • pp.826-836
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    • 2010
  • This study was conducted to compare the dietary habits, nutrient intake and health status of female college students at Sahmyook University according to their majors. Specifically, women majoring in literature and science (77), food and nutrition (103) and sport (73) were evaluated. College women in the sports department were more likely to have a part-time job and had greater expenses than women in the other departments. The average height of college women in the sports department (164.3${\pm}$4.6 cm) was 2.04 cm taller than that of women with other majors (162.3${\pm}$4.7 cm). College women in the department of literature and science were more likely to have an unbalanced diet, even though they commonly ate small amounts of fruit as snacks. They were more prone to take nutrient tablets and vitamins when compared to women in the other departments. College women in the department of sport were more likely to have unbalanced meals (31.5%) and to overeat. Students in the department of food and nutrition ate more fruit, vitamin C and E but less cholesterol containing foods (p<0.05), less fast food and fried food than students in the other departments. The subjects in the department of sport ate less bread, sweet potatoes, fast foods and fried foods but more calories, fat, vitamin A, vitamin B, niacin, Ca, P and cholesterol than students in the other departments (p<0.05). They were also more likely to exercise for more than two hours a day. The most common problems among college women were going without meals, eating an unbalanced diet, overeating, intake of ill-balanced nutrients and lack of exercise. It was found that college women in the department of sport had a better intake of nutrients and maintained healthier life styles.

Detection and Control of Bacterial Diseases of Cultured Fishes in Korea (양식어류(養殖魚類)의 세균성질병(細菌性疾病)의 진단(診斷)과 대책(對策))

  • Chun, Seh-Kyu
    • Journal of fish pathology
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    • v.1 no.1
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    • pp.5-30
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    • 1988
  • This is a comprehensive study for considering the effective treatment and control program of bacterial disease occurring in common carp, israel carp, color carp, crucian carp, eel and tilapia by clarifying the causes, mechanism of infection and onset and the diagnostic criteria. As a first step, the authors investigated the external views, gross and histopathologic findings of diseased fish using 450 infected fishes obtained from various farmer of Korea. This infection was characterized by hyperemia, hemorrhage and swelling of body surface and fins, congestion of liver, spleen, kidney, inflammation of intestine, hemorrhagic inflammation of various tissues, and necrosis and ulcer of various tissues were accompanied in serious cases. Bacteriologically, Aeromonas hydrophila and Edwardsiella tarda were isoiated from these fishes. Particularly in the regular check on 222 eels, 177 strains were isolated as 29.94% of Aeromonas hydrophila, 48.58% of Edwardsiella tarda and 21.47% of Flexibacter columnaris. Hexibacter columnaris was isolated from corroded gill of eels. The identical disease was occurred by innoculating the isolated Aeromonas hydrophila and Edwardsiella tarda and the identical strains were isolated from infected experimental fishes. The eels which were diagnosed Aeromonas disease from Kwangju, Pusan accompanied hemorrhage, swelling of body surface and fins, inflammation of stomach and intestine containing mucous fluids mixed with the pathogens. Color carp and crucian carp which were innoculated with the isolated 5 strins of Aeromomas hydrorphil died within 3 or 4 days accompanying with the characteristics of Aeromonas disease. Edward disease was characterized by abscesses of body surface, pus formation with concentration on phagocytes. The size of absecsses increased with progression elf disease. There were also various abscesses at internal organ and white nodules appeared in kidney. Histologically, various progressive granuloma were examined without inflammation of intestine. Columnaris disease of eels showed no hemorrhage except slight white body color. In autopsy, most of internal organs appeared normal and there were no septic odors. The only character was corrosion of gills. In order to treat these bacterial diseases, infected fishes must bathe in 20ppm chloramphenicol or kanamycin solution for 1 hour. Besides, medication program in oral ingestion of 75mg/kg chloramphenicol per day continuing for 5 to 7 days. After injecting the formalin treated Aermonas hydrophila antigen into carp, relatively high agglutination titer showed between 3 weeks and 6 weeks. Though this titer decreased from that time, it was continued for 18 weeks. In the case of injecting the formalin treated Edwardsiella tarda antigen into tilapia, the titer also increased. But tilapia which were immersed in the suspension fluid of the formalin treated Edwardsiella tarda showed no increase of the titer.

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Clinical Study of Tuberculous Meningitis in Children (소아 결핵성 뇌막염의 임상적 고찰)

  • Kim, Woo Sik;Kim, Jong Hyun;Kim, Dong Un;Lee, Won Bae;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.4 no.1
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    • pp.64-72
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    • 1997
  • Purpose : The incidence of tuberculous meningitis in Korean children has been markedly decreased after 1980s, but this disease has still occurred with low rate. Therefore, it may be suspected that delayed diagnosis and treatment will be happened because of lacking of clinical experiences and indistinguishable other meningitis, so it is important to make early diagnosis and treatment of tuberculous meningitis concerning with the prognosis. In this aspect, we conducted study to concern and investigate sustainly about the diagnostic criteria, clinical characteristics, radiological findings, complications, and prognosis of typical or atypical tuberculous meningitis in children. Methods : Forty four children who were hospitalized and treated due to tuberculous meningitis in pediatric wards of Our Lady of Mercy Hospital, St. Holy Hospital, St. Vincent Hospital and Uijungbu St. Mary Hospital from January 1985 to June 1996 were included in this study. We reviewed medical records of these patients retrospectively. Results : 1) The tuberculous meningitis has occured continuosly since mid-1980s. The highest 2) The diagnosis was made by contact history of active tuberculous patients, positive tuberculin test, responses of antituberculous antibiotics and discovery of Mycobacterium tuberculosis from CSF or other specimens. Among patients, 7 children(16%) were not vaccinated with BCG, and only 18 children(40%) were positive in tuberculin test. 3) The symptoms and signs of our patients on initial examinations were fever, vomiting, headache, lethargy, poor feeding, weight loss, neck stiffness, convulsion, abdominal pain and motor deficits. 4) The findings of initial CSF samples revealed leukocyte $239.5/mm^3$(mean) with lymphocyte predominant, elevated protein levels(mean;259.5mg%) and low sugar level(mean;40.7mg%). And the ratio of CSF/blood sugar was 0.407. But, atypical CSF findings were seen in 31.8% patients. 5) On brain imaging study, 34 out of 39 children had findings of hydrocephalus, basilar meningeal enhancement, infarction and subarachnoidal inflammations etc. On chest X-ray, the findings of miliary tuberculosis(34.1%), normal finding(29.5%), parenchymal infiltrations (11.4%) and calcifications(9.1%) were showed. 6) In neurological clinical stage, there were twenty-six children(59%) in stage 1, fourteen children(32%) in stage 2 and four children(9%) in stage 3. The late sequeles were encountered by 29.5% with mild and 4.6% with severe neurological injury. The most common neurological injury was quadriplegia and the mortality rate was 6.8%. 7) The SIADH was developed in 20 children(45.5%) after the 4th hospital day. Half of all SIADH patients were symptomatic. Conclusion : Tuberculosis meningitis is still an important extrapulmonary disease with high morbidity and mortality. Early diagnosis with clinical contact history of active tuberculosis and radiological imaging examinations and early treatments are essential in order to prevent and decrase the rate of late sequeles and death.

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Study of nosocomial rotavirus infection in neonates admitted to a postpartum-care center (서울시내 1개 산후 조리원에서 시행한 로타바이러스 선별검사에 대한 분석)

  • Park, Ji Young;Kim, Dong Hwan;Bae, Seung Young;Choi, Chang Hee;Cho, Eun Young;Choi, Jeong Hoon;Kim, Sun Mi
    • Pediatric Infection and Vaccine
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    • v.14 no.2
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    • pp.145-154
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    • 2007
  • Purpose : Rotavirus is one of the most important etiologic agents of nosocomial infections among the neonates. This study was designed to investigate nosocomial rotavirus infection in neonates who were admitted to a postpartum-care center after birth. Methods : From March 2005 to September 2006, 957 healthy neonates were examined for rotavirus antigen in stool by immunochromatographic method and 216 neonates were rotavirus antigen positive within 24 hours after admitted to a postpartum-care center. We reviewed the nursing charts retrospectively such as characteristics, monthly distribution, birth hospitals, delivery methods, feeding types and clinical manifestations. Results : Among 957 neonates, 216 neonates (22.6%) were rotavirus antigen positive and there were no differences in sex, birth weight, gestational age. Monthly positive rate of rotavirus antigen showed diversity from 10% to 36%. According to birth hospitals, positive rate showed diversity from 3.5% to 53.6%. Out of 957 neonates, 655 cases (68.4%) were born of vaginal delivery and mean hospitalized duration was 2.4 days, 302 cases (31.6%) were born of cesarean section and mean hospitalized duration was 5.7 days. 17.6% of vaginal delivery and 33.4% of cesarean section were rotavirus antigen positive. The positive rate was higher in neonates by cesarean section than vaginal delivery (P<0.001). According to feeding types, positive rate of rotavirus antigen was lower in breast-fed group than formula-fed group (P<0.001). Proportion of symptomatic case among rotavirus antigen positive was 34.7%. Most common clinical manifestation was diarrhea (61.3%), following poor feeding (45.3%), fever (40.0%), vomiting (25.3%), delayed weight gain (12.0%), and decreased urine amount (5.3%). Conclusion : Some neonates were already infected before admission to a postpartum-care center. Without meticulous management, nosocomial rotavirus infection would transmit rapidly in a postpartum-care center spreading to the community. Recommendation of breast-feeding, routine rotavirus screeing test with or without symptom, and isolation of all rotavirus antigen positive neonates in a postpartum-care center seem to be necessary. Also attentive hygiene education and further investigations of rotavirus infection in a postpartum-care center would be needed.

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Studies on the Virus in Silkworm Bombyx mori L. -Resistance to Virus Disease- (가잠 Virus에 관한 연구 -저항성에 관한 기초조사-)

  • 박광의;강석권
    • Journal of Sericultural and Entomological Science
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    • v.9
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    • pp.67-87
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    • 1969
  • 1. Objectives and Importance. Many silkworms have been damaged by nuclear polyhedrosis virus diseases thoughout the country every year causing a decease in cocoon production by approximately ten per cent per year. The damage caused by the infections virus has occured in spite of complete disinfection. In this respect, it is well known it is impossible, at the present time, to protect the silkworm from these virus infections through chemical and physical control methods. Therefore, this author has attempted to solve this urgent problem from the view point of heredity and breeding, discovering the different resistances and heritabilities among 120 stains collected from throughout the country, and selecting the ones with highest resistance for the basic materials in the silkworm breeding. 2. Results of work 1) The strains with strong resistance to the nuclear polyhedrosis virus diseases are N$_4$, N$\sub$15/, N$\sub$48/, C$\sub$55/ and Em. the log ED$\sub$50/ values of them vary between 0.799 and 1.611. The susceptible strains are N$\sub$20/, C$\sub$62/, N$\sub$76/, N$\sub$79/ and C$\sub$108/, the log ED$\sub$50/ values of them vary between 5.159 and 7.258. (Reference Table 4) The Japanese strain with a log ED$\sub$50/, value of 3.770 is the strongest, followed by the Chinese strain with a log ED$\sub$50/ value of 3.564. The weakest is the European strain with a log ED$\sub$50/ value of 3.3381. The direction coefficient of the regression equation of the susceptibility varies between 0.1 and 0.6, the uniformness of the resistance of the preserved strains of this country is comparatively low. The hereditary henomena of the resistance of each strain and the conerete method of its application for silkworm breeding main the subjects for later studies. 2) The content of water and ash in silkworm has not been correlated with the capability for resistance to the virus diseases(Reference. Table 8). but it is very significantly correlated with mortality rate (in common reaning). In the case of the silkworms which have just completed the fourth moulting the content of water and ash is not related to the mortality rate. In the case of the silkworms which have just completed the third moulting, however, the water( +0.326) and ash (+0.362) registered a high significance. The ash content in the first ($\div$0.520) and second ($\div$0.386) moults is highly significant but water content in both cases is not significant (Reference Table 7). 3) The No. 205 strain proved to be the best in character among the various F$_1$ hybrids. No. 204 was very good in strength but a little lower in cocoon character than the control. No. 212 was a little low in coccon character and mortality was average, but the cocoon harvest was the best among all the varieties offered for (Reference Table 9). 4), In short, the above mentioned strains which are known to have strong resistance to the virus disease are expected to provide basic data for breeding strong varieties. It is proposed that continued research should be conducted on the characteristics of various strains for a satisfactory preservation of various characteristics.research should be conducted on the characteristics of various strains for a satisfactory preservation of various characteristics.

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The 1998, 1999 Patterns of Care Study for Breast Irradiation after Mastectomy in Korea (1998, 1999년도 우리나라에서 시행된 근치적 유방 전절제술 후 방사선치료 현황 조사)

  • Keum,, Ki-Chang;Shim, Su-Jung;Lee, Ik-Jae;Park, Won;Lee, Sang-Wook;Shin, Hyun-Soo;Chung, Eun-Ji;Chie, Eui-Kyu;Kim, Il-Han;Oh, Do-Hoon;Ha, Sung-Whan;Lee, Hyung-Sik;Ahn, Sung-Ja
    • Radiation Oncology Journal
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    • v.25 no.1
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    • pp.7-15
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    • 2007
  • [ $\underline{Purpose}$ ]: To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment. $\underline{Materials\;and\;Methods}$: A web- based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed. $\underline{Results}$: The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases. The radiation dose to the chest wall was $45{\sim}59.4\;Gy$ (median 50.4 Gy), to the SCL was $45{\sim}59.4\;Gy$ (median 50.4 Gy), and to the PAB was $4.8{\sim}38.8\;Gy$, (median 9 Gy) $\underline{Conclusion}$: Different and various treatment methods were used for radiotherapy of the breast cancer patients after mastectomy in each hospital. Most of treatment methods varied in the irradiation of the chest wall. A separate analysis for the details of radiotherapy planning also needs to be followed and the outcome of treatment is needed in order to evaluate the different processes.

Operative Treatment of Congenitally Corrected Transposition of the Great Arteries(CCTGA) (교정형 대혈관 전위증의 수술적 치료)

  • 이정렬;조광리;김용진;노준량;서결필
    • Journal of Chest Surgery
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    • v.32 no.7
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    • pp.621-627
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    • 1999
  • Background: Sixty five cases with congenitally corrected transposition of the great arteries (CCTGA) indicated for biventricular repair were operated on between 1984 and september 1998. Comparison between the results of the conventional(classic) connection(LV-PA) and the anatomic repair was done. Material and Method: Retrospective review was carried out based on the medical records of the patients. Operative procedures, complications and the long-term results accoding to the combining anomalies were analysed. Result: Mean age was 5.5$\pm$4.8 years(range, 2 months to 18years). Thirty nine were male and 26 were female. Situs solitus {S,L,L} was in 53 and situs inversus{I,D,D} in 12. There was no left ventricular outflow tract obstruction(LVOTO) in 13(20%) cases. The LVOTO was resulted from pulmonary stenosis(PS) in 26(40%)patients and from pulmonary atresia(PA) in 26(40%) patients. Twenty-five(38.5%) patients had tricuspid valve regurgitation(TR) greater than the mild degree that was present preoperatively. Twenty two patients previously underwent 24 systemic- pulmonary shunts previously. In the 13 patients without LVOTO, 7 simple closure of VSD or ASD, 3 tricuspid valve replacements(TVR), and 3 anatomic corrections(3 double switch operations: 1 Senning+ Rastelli, 1 Senning+REV-type, and 1 Senning+Arterial switch opera tion) were performed. As to the 26 patients with CCTGA+VSD or ASD+LVOTO(PS), 24 classic repairs and 2 double switch operations(1 Senning+Rastelli, 1 Mustard+REV-type) were done. In the 26 cases with CCTGA+VSD+LVOTO(PA), 19 classic repairs(18 Rastelli, 1 REV-type), and 7 double switch operations(7 Senning+Rastelli) were done. The degree of tricuspid regurgitation increased during the follow-up periods from 1.3$\pm$1.4 to 2.2$\pm$1.0 in the classic repair group(p<0.05), but not in the double switch group. Two patients had complete AV block preoperatively, and additional 7(10.8%) had newly developed complete AV block after the operation. Other complications were recurrent LVOTO(10), thromboembolism(4), persistent chest tube drainage over 2 weeks(4), chylothorax(3), bleeding(3), acute renal failure(2), and mediastinitis(2). Mean follow-up was 54$\pm$49 months(0-177 months). Thirteen patients died after the operation(operative mortality rate: 20.0%(13/65)), and there were 3 additional deaths during the follow up period(overall mortality: 24.6%(16/65)). The operative mortality in patients underwent anatomic repair was 33.3%(4/12). The actuarial survival rates at 1, 5, and 10 years were 75.0$\pm$5.6%, 75.0$\pm$5.6%, and 69.2$\pm$7.6%. Common causes of death were low cardiac output syndrome(8) and heart failure from TR(5). Conclusion: Although our study could not demonstrate the superiority of each classic or anatomic repair, we found that the anatomic repair has a merit of preventing the deterioration of tricuspid valve regurgitations. Meticulous selection of the patients and longer follow-up terms are mandatory to establish the selective advantages of both strategies.

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