• Title/Summary/Keyword: Failure locations

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Radiation Therapy for Operable Breast Cancer after Conservative Surgery (유방암환자의 유방보존수술 후 방사선 치료 성적)

  • Lee, Myung-Za;Chun, Ha-Chung
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.309-315
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    • 2002
  • Purpose : To evaluate the result of conservative management on recurrence, survival and prognostic factors of patient with operable breast cancer. Materials and Methods : Fifty three patients, treated for localized breast cancer by lumpectomy or quadrantectomy followed by radiotherapy between January 1985 and December 1996, were retrospectively studied. All patients followed up for at least five years. Their median age was 43 years $(range\;24\~72)$. The tumor stages were as follows : T1 in 30 patients, T2 in 21, Tis in 2. Thirty-eight patients had negative and 15 had positive axillary nodes. The histological types were 42 infiltrating ductal, 2 infiltrating lobular, and 2 intraductal carcinomas with 7 other histologies. The tumor locations were the outer quadrant in 38 breasts, the inner quadrant in 13 and central in 2. Radiation doses of $46\~50\;Gy$ were given to the entire breast areas with additional doses of 14-18 Gy delivered to the tumor bed areas. Results : The overall five and 10 yea actuarial and disease free survivals were $94.3\%\;and\;92.4\%,\;91.2\%\;and\;81\%$, respectively. The overall five year survivals were $100\%$ in stage I and IIa, and $66.7\%$ in stage IIb and IIIa tumors. Seven patients failed either locally or distantly. Incidence of local failure and distant metastasis for the first failure were $7.5\%\;and\;5.7\%$, respectively. Local recurrence appeared within 2 years of treatment at the primary site and after more than 8 years outside of primary lesion, whereas distant metastasis appeared between 2 and 6 years following treatment. The overall recurrences were high at a young age (< or = 35 years), with 5 out of 12 (2 local, 3 distant), and in T2 lesions with 5 out of 21 (1 local, 3 distant, and 1 in both). Distant metastasis was high in the positive axillary lymph node group with 4 out of 15 $(26.6\%)$. A high incidence in the axillary node was noted at a young age with 7 out of 12 $(58.3\%)$ and in T2 lesions with 8 out of 21 $(38.4\%)$. A young age, positive axillary node and large tumor size were all related with poor survival. Conclusion : Based on this study, lumpectomy or quadrantectomy, followed by radiation appears to be an adequate therapeutic method in operable breast cancer. A long term follow-up is necessary because a recurrence of breast can occur long time after treatment. The poor prognostic group, especially young patients with an aggressive biological behavior needs more effective treatment modalities to improve their survival.

Clinical Study of Vascular Injuries (혈관 손상의 임상적 고찰)

  • Chung, Sung-Woon;Kim, Young-Kyu
    • Journal of Chest Surgery
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    • v.40 no.7 s.276
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    • pp.480-484
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    • 2007
  • Background: Major vascular injuries can jeopardize a patient's life or imperil limb survival. We performed this study to establish an optimal management plan for vascular injuries. Material and Method: We retrospectively reviewed 26 cases of vascular injury that were treated at Pusan National University Hospital from May, 1999 to September, 2004. The age and sex distribution, the locations and causes of vascular injury, the diagnostic tools, the degree of injuries, clinical manifestations, the treatment modality and complications were reviewed. Result: The mean age was 39.5 years (range: $12{\sim}86$) and the male to female ratio was 22 : 4. The injuries were in 6 descending thoracic aortas, 4 femoral arteries, 4 popliteal veins and so on. The causes of injury were iatrogenic in 8 cases, traffic accident in 7, stab injury in 6 and industrial accident in 5. The most commonly used diagnostic tools were CT and angiography. The degrees of arterial injury were pseudoaneurysm in 10 cases, partial severance in 5, complete severance in 3 and thrombosis in 3. The degrees of venous injury were partial severance in 6 cases, complete severance in 2 and arteriovenous fistula in 2. The clinical manifestations were absence of pulse in 8 cases, coldness in 7, chest pain in 6, swelling in 5, bleeding in 5 and so on. The most frequently used type of revascularization was graft interposition in 11 cases. Two arteriovenous fistulae were repaired by endovascular procedure. There was one case of mortality due to multi-organ failure after hemorrhagic shock, There were three major amputations, and two of them were due to delayed diagnosis and treatment. Conclusion: A system for the early diagnosis and treatment is essential for improving limb salvage and patient mortality. As a consequence of the widespread application of endovascular procedures, the incidence of iatrogenic injuries has recently increased. Educating physicians is important for the prevention of iatrogenic injury. Easy communication and cooperation for earlier involvement of a vascular surgeon is also an important factor.

A Study on the Effect of Applying Water Seepage Lowering Method Using Swelling Waterstop for Expansion Joint in the Concrete Dam (콘크리트 댐에서 수축이음부의 수팽창성 차수재를 이용한 침투저감 공법 적용효과 연구)

  • Han, Kiseung;Lee, Seungho;Kim, Sanghoon;Kim, Sejin;Pai, Sungjin
    • Journal of the Korean GEO-environmental Society
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    • v.22 no.10
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    • pp.21-29
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    • 2021
  • Most concrete gravity-type dams in and out of the country were constructed by column method to control cracks caused by concrete hydration heat generated during construction, resulting in a certain level of leakage after impoundment through various causes, such as contraction joints and construction joints. However, due to the characteristics of concrete structures that shrink and expand according to temperature, concrete dams have vertical joints and drains to allow penetration. PVC waterproof shows excellent effects in completion of the dam, which however increases the possibility of interfacial failure due to different thermal expansion. Other causes of penetration may include problems with quality control during installation, generation of cracks due to heat of hydration of concrete, waterproofing methods, etc. In the case of Bohyunsan Dam in Yeongcheon, North Gyeongsang Province, the amount of drainage in the gallery was checked and underwater, and it was confirmed that there are many penetrations from drainage holes connected to vertical joints, and that some of the PVC waterproofs are not fully operated. As a new method to prevent penetration through vertical joints, D.S.I.M. (Dam Sealing Innovation Method) developed by World E&C was applied to Bohyunsan Dam and checked the amount of drainage in the gallery. As a result of first testing three most leaking vertical joints, the drain in the gallery was reduced by 87% on the average and then applied to the remaining 13 locations, which showed a 83% reduction effect based on the total drain in the gallery. Summing up these results, it was found that D.S.I.M. preventing water leakage from the upstream face is a valid construction method to reduce the water see-through and penetration quantity seen in downstream faces of concrete dams. If D.S.I.M. is applied to other concrete dams at domestic and abroad, it is expected that it will be very effective to prevent water leakage through vertical joints that are visible from downstream faces.

A Study on the Stress Distribution of Tooth/Implant Connected with Konus Telescope Denture Using 3-Dimensional Finite Element Method (이중관으로 연결된 자연치와 임플랜트의 악골 내응력분포에 관한 3차원 유한요소분석)

  • Lee, Su-Ok;Choi, Dae-Gyun;Kwon, Kung-Rock;Woo, Yi-Hyung
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.4
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    • pp.381-395
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    • 2008
  • Purpoose: For decades dental implants have been used widely in the field of prosthetic dentistry. However there is confusion when establishing treatment plans in cases where some teeth are remained but an insufficient number of implants can be used due to limited anatomical status and ecomomical problems. Many clinicians have tried to connect natural teeth and implants, and it still has controversy. But, there have been few studies on mechanical analysis of connecting natural teeth and implants with konus telescopic removable partial dentures. The purpose of this study was to analyze the stress distribution of prosthesis, abutment and alveolar bone when teeth and implants were connected with the konus telescopic denture, by means of 3-dimensional finite element analysis. Material and methods: The assumption of this study was that there were 2 mandibular canine (11 mm in length, 4 mm in diameter) and 2 implants(10 mm in length, 4 mm in diameter) which are located in the second premolar region. The mandible, teeth, implants, abutments, and connectors are modeled, and analyzed with the commercial software, ANSYS Version 8.1(Swanson, Inc., USA). The control group used implants instead of natural teeth. 21038 elements, 23544 nodes were used in experimental group and 107595 elements, 21963 nodes were used in control group, Stress distribution was evaluated under 150 N vertical load on 3 experimental conditions - between teeth and implants (Load case 1), posterior to implants (Load case 2), between natural teeth (Load case 3). Results: 1. In all load cases, higher von mises stress value was observed in the experimental group. 2. Maximum von miss stress observed in all load cases and all locations were as follows ; a. 929.44 Mpa in the experimental group, 640.044 Mpa in the control group in outer crown and connector - The experimental group showed 1.45 times high value compared with the control group. b. 145,051 Mpa in the experimental group, 142.338 Mpa in the control group in abutment - The experimental group showed 1.02times high value compared with the control group. c. 32.489 Mpa in the experimental group, 25.765 Mpa in the control group in alveolar bone - The experimental group showed 1.26times higher value compared with the control group. 3. All maximum von mises stress was observed in load case 2, and maxim von mises stress in alveolar bone was 32.489 Mpa at which implant failure cannot occur. 4. If maximum von mises stress is compared between two groups, the value of the experimental group is 1.02 times higher than the control group in abutment, 1.26 times higher than the control group in alveolar bone. Conclusion: If natural teeth and implants are connected with the konus telescopic denture, maximum stress will be similar in abutment, 1.26 times higher in alveolar bone than the control group. With this result, there may be possible to make to avoid konus telescopic dentures where natural teeth and implants exist together.

A Study on the Present Condition and Improvement of Cultural Heritage Management in Seoul - Based on the Results of Regular Surveys (2016~2018) - (서울특별시 지정문화재 관리 현황 진단 및 개선방안 연구 - 정기조사(2016~2018) 결과를 중심으로 -)

  • Cho, Hong-seok;Suh, Hyun-jung;Kim, Ye-rin;Kim, Dong-cheon
    • Korean Journal of Heritage: History & Science
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    • v.52 no.2
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    • pp.80-105
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    • 2019
  • With the increasing complexity and irregularity of disaster types, the need for cultural asset preservation and management from a proactive perspective has increased as a number of cultural properties have been destroyed and damaged by various natural and humanistic factors. In consideration of these circumstances, the Cultural Heritage Administration enacted an Act in December 2005 to enforce the regular commission of surveys for the systematic preservation and management of cultural assets, and through a recent revision of this Act, the investigation cycle has been reduced from five to three years, and the object of regular inspections has been expanded to cover registered cultural properties. According to the ordinance, a periodic survey of city- or province-designated heritage is to be carried out mainly by metropolitan and provincial governments. The Seoul Metropolitan Government prepared a legal basis for commissioning regular surveys under the Seoul Special City Cultural Properties Protection Ordinance 2008 and, in recognition of the importance of preventive management due to the large number of cultural assets located in the city center and the high demand for visits, conducted regular surveys of the entire city-designated cultural assets from 2016 to 2018. Upon the first survey being completed, it was considered necessary to review the policy effectiveness of the system and to conduct a comprehensive review of the results of the regular surveys that had been carried out to enhance the management of cultural assets. Therefore, the present study examined the comprehensive management status of the cultural assets designated by the Seoul Metropolitan Government for three years (2016-2018), assessing the performance and identifying limitations. Additionally, ways to improve it were sought, and a DB establishment plan for the establishment of an integrated management system under the auspices of the Seoul Metropolitan Government was proposed. Specifically, survey forms were administered under the Guidelines for the Operation of Periodic Surveys of National Designated Cultural Assets; however, the types of survey forms were reclassified and further subdivided in consideration of the characteristics of the designated cultural assets, and manuals were developed for consistent and specific information technologies in respect of the scope and manner of the survey. Based on this analysis, it was confirmed that 401 cases (77.0%) out of 521 cases were generally well preserved; however, 102 cases (19.6%) were found to require special measures such as attention, precision diagnosis, and repair. Meanwhile, there were 18 cases (3.4%) of unsurveyed cultural assets. These were inaccessible to the investigation at this time due to reasons such as unknown location or closure to the public. Regarding the specific types of cultural assets, among a total of 171 cultural real estate properties, 63 cases (36.8%) of structural damage were caused by the failure and elimination of members, and 73 cases (42.7%) of surface area damage were the result of biological damage. Almost all plants and geological earth and scenic spots were well preserved. In the case of movable cultural assets, 25 cases (7.1%) among 350 cases were found to have changed location, and structural damage and surface area damage was found according to specific material properties, excluding ceramics. In particular, papers, textiles, and leather goods, with material properties that are vulnerable to damage, were found to have greater damage than those of other materials because they were owned and managed by individuals and temples. Thus, it has been confirmed that more proactive management is needed. Accordingly, an action plan for the comprehensive preservation and management status check shall be developed according to management status and urgency, and the project promotion plan and the focus management target should be selected and managed first. In particular, concerning movable cultural assets, there have been some cases in which new locations have gone unreported after changes in ownership (management); therefore, a new system is required to strengthen the obligation to report changes in ownership (management) or location. Based on the current status diagnosis and improvement measures, it is expected that the foundation of a proactive and efficient cultural asset management system can be realized through the establishment of an effective mid- to long-term database of the integrated management system pursued by the Seoul Metropolitan Government.