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The Clinical Utility of Korean Bayley Scales of Infant and Toddler Development-III - Focusing on using of the US norm - (베일리영유아발달검사 제3판(Bayley-III)의 미국 규준 적용의 문제: 미숙아 집단을 대상으로)

  • Lim, Yoo Jin;Bang, Hee Jeong;Lee, Soonhang
    • Korean journal of psychology:General
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    • v.36 no.1
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    • pp.81-107
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    • 2017
  • The study aims to investigate the clinical utility of Bayley-III using US norm in Korea. A total of 98 preterm infants and 93 term infants were assessed with the K-Bayley-III. The performance pattern of preterm infants was analyzed with mixed design ANOVA which examined the differences of scaled scores and composite scores of Bayley-III between full term- and preterm- infant group and within preterm infants group. Then, We have investigated agreement between classifications of delay made using the BSID-II and Bayley-III. In addition, ROC plots were constructed to identify a Bayley-III cut-off score with optimum diagnostic utility in this sample. The results were as follows. (1) Preterm infants have significantly lower function levels in areas of 5 scaled scores and 3 developmental indexes compared with infants born at term. Significant differences among scores within preterm infant group were also found. (2) Bayley-III had the higher scores of the Mental Development Index and Psychomotor Developmental Index comparing to the scores of K-BSID-II, and had the lower rates of developmental delay. (3) All scales of Bayley-III, Cognitive, Language and Motor scale had the appropriate level of discrimination, but the cut-off composite scores of Bayley-III were adjusted 13~28 points higher than 69 for prediction of delay, as defined by the K-BSID-II. It explains the lower rates of developmental delay using the standard of two standard deviation. This study has provided empirical data to inform that we must careful when interpreting the score for clinical applications, identified the discriminating power, and proposed more appropriate cut-off scores. In addition, discussion about the sampling for making the Korean norm of Bayley-III was provided. It is preferable that infants in Korea should use our own validated norms. The standardization process to get Korean normative data must be performed carefully.

Marginal and internal fit of interim crowns fabricated with 3D printing and milling method (3D 프린팅 및 밀링 방법으로 제작된 임시 보철물 적합도 비교 분석)

  • Son, Young-Tak;Son, KeunBaDa;Lee, Kyu-Bok
    • Journal of Dental Rehabilitation and Applied Science
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    • v.36 no.4
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    • pp.254-261
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    • 2020
  • Purpose: The purpose of this study was to assess the marginal and internal fit of interim crowns fabricated by two different manufacturing method (subtractive manufacturing technology and additive manufacturing technology). Materials and Methods: Forty study models were fabricated with plasters by making an impression of a master model of the maxillary right first molar for ceramic crown. On each study model, interim crowns (n = 40) were fabricated using three types of 3D printers (Meg-printer 2; Megagen, Zenith U; Dentis, and Zenith D; Dentis) and one type milling machine (imes-icore 450i; imes-icore GmbH). The internal of the interim crowns were filled with silicon and fitted to the study model. Internal scan data was obtained using an intraoral scanner. The fit of interim crowns were evaluated in the margin, absolute margin, axial, cusp, and occlusal area by using the superimposition of 3D scan data (Geomagic control X; 3D Systems). The Kruskal-wallis test, Mann-Whitney U test and Bonferroni correction method were used to compare the results among groups (α = 0.05). Results: There was no significant difference in the absolute marginal discrepancy of the temporary crown manufactured by three 3D printers and one milling machine (P = 0.812). There was a significant difference between the milling machine and the 3D printer in the axial and occlusal area (P < 0.001). The temporary crown with the milling machine showed smaller axial gap and higher occlusal gap than 3D printer. Conclusion: Since the marginal fit of the temporary crown produced by three types of 3D printers were all with in clinically acceptable range (< 120 ㎛), it can be sufficiently used for the fabrication of the temporary crown.

Clinical Results of Medial Unicompartmental Knee Arthroplasty in Elderly Patients Older than 70 Years of Age (70세 이상의 고령 환자에서 시행한 내측 슬관절 단일구획치환술의 임상 결과)

  • Kim, Kyung Tae;Lee, Song;Kim, Jin Hak;Lee, Ho Young;Kim, Myung Jin
    • Journal of the Korean Orthopaedic Association
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    • v.56 no.1
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    • pp.34-41
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    • 2021
  • Purpose: To evaluate the long-term clinical results and survivorship of unicompartmental knee arthroplasty (UKA) in elderly patients older than 70 years by analyzing cases that have been implanted for >10 years ago. Materials and Methods: The long-term follow-up results were evaluated in 39 patients (46 cases) who underwent medial UKA from March 2002 to February 2004. The mean age of the patients at the time of surgery was 74.0 years, and the preoperative diagnosis was degenerative arthritis of the knee in all cases. Results: Of the 46 cases, reoperation occurred due to the complications in four cases. In 22 cases without 14 cases of death and six cases of follow-up loss, follow-up more than 10 years was possible. The mean Knee Society knee and function scores improved significantly from 53.0 and 52.5 points pre-operatively to 89.4 and 80.9 points at the last follow-up, respectively (p<0.001). The mean range of motion of the knee recovered to 132.5°, and the mean tibiofemoral angle changed to 5.9° of valgus at the last follow-up. Complications following the UKA occurred in four cases; the most prevalent complication was mobile bearing dislocation (n=2). One case of failure occurred due to aseptic loosening and degenerative arthritis of the lateral compartment, respectively. The cumulative survival rate of the implants was 95.0% at 10 years and 85.7% at 15 years. Of the 40 cases, excluding six cases of follow-up loss, 36 cases (90.0%) could be used without reoperation until death or at the last follow-up after surgery. Conclusion: These results showed the outstanding functions of the knee and satisfactory long-term survivorship after UKA. Therefore, UKA could be a useful method for the treatment of osteoarthritis of the knee in elderly patients older than 70 years of age.

The effects of skill-utilization based underemployment on self-esteem and mental health: Employment commitment and social support as moderators (기술활용도 측면의 불완전고용이 재취업자의 자아존중감과 정신건강에 미치는 영향: 일에 대한 몰입과 사회적 지지의 조절효과를 중심으로)

  • Youn-Hee Roh ;Myung Un Kim
    • Korean Journal of Culture and Social Issue
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    • v.16 no.3
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    • pp.355-383
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    • 2010
  • In this study, the effects of skill-utilization based underemployment on self-esteem and mental health were examined. Also the moderating effects of employment commitment and social support were verified. Data obtained by a longitudinally designed survey with the reemployed (N=153) after job loss were used. The skill-utilization based underemployment was measured in two ways. One is measured in the way that use objective data, the ratio of education - 'educational requirement for the current job' divided by 'individual educational attainment.' The other is measured in the way that use psychological and self-reported measure, two factors of overqualification - the absence of opportunity for growth (no-growth) and the occupational mismatch in educational attainment, skills and experiences (mismatch). The main effect revealed that the no-growth made self-esteem lower and mental health (GHQ-social maladjustment) worse. The significant interaction of the ratio of education and employment commitment indicates that the negative effects of underemployment measured by the ratio of education on mental health (GHQ-social maladjustment, GHQ-depression/anxiety) were greater for those perceiving low employment commitment than for those perceiving high employment commitment. The significant interaction of the ratio of education and social support indicates that the negative effects of underemployment measured by the ratio of education on mental health (GHQ-depression/anxiety) were greater for those perceiving low social support than for those perceiving high social support. The two moderators also interacted with the two factors of perceived overqualification. Employment commitment had significant interaction effects with the no-growth and the mismatch on self-esteem and mental health (GHQ-depression/anxiety), whereas social support had a significant interaction only with the no-growth on mental health (GHQ-depression/anxiety). The significant interactions show that employment commitment and social support function as buffers in reducing the negative effects of skill-utilization based underemployment on self-esteem and mental health.

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A Study on medical Qigong mentioned in ${\ll}$Samilshingo${\gg}$ (三一神誥) (${\ll}$삼일신고(三一神誥)${\gg}$에 나타난 의료기공(醫療氣功)에 관(關)한 연구(硏究))

  • Ban, Chang-Yul
    • Journal of Korean Medical Ki-Gong Academy
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    • v.7 no.2
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    • pp.40-94
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    • 2004
  • Recently, meditation, Zen meditation and Qigong became popular in western. For that reason, Value of Korea traditional methods for health promotion have been evaluated but theoretical evidence about that is insufficient. ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經). So, I reviewed history of Korea Qigong according to period, in order to produce theoretical evidence of Korea medical Qigong and investigated ${\ulcorner}$Han${\lrcorner}$ thought (${\ulcorner}$${\lrcorner}$ 思想) as theoretical evidence of Korea Qigong. I have obtained following results by comparing meaning of god, a view of human body and practice method of the ${\ll}$Samilshingo${\gg}$ (三一神誥) with ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經). Sinsundo(神仙道) of native to race became active during the period of the Three Kingdoms but more disappeared due to under the influence of Taoism. So only has been remained in existence since the period of the unity silla. There could accept positively the foreign ideas belonging to Confucianism, Buddhism and Taoism have been brought since the period of the Three Kingdoms because ${\ll}$Samilshingo${\gg}$ (三一神誥), one of three the scriptures as the origin of ${\ulcorner}$Han${\lrcorner}$ thought(${\ulcorner}$${\lrcorner}$ 思想) included the original form of three religion belonging to Confucianism, Buddhism, Taoism. Three common results as theoretical evidence of Qigong were found out by comparing ${\ll}$Samilshingo${\gg}$ (三一神誥) with ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經). First, in meaning of god, there is not only different from the gods of heaven and the gods of human but also keep understanding with each other and there was common feature of logical structure that function of god was divided into three. Second, In a view of human body, there were in common with ${\ll}$Samilshingo${\gg}$ (三一神誥) as theory of only as energy(氣一元論), theory of bisection as truth false(眞妄二分論), theory of trisection as spirit(性) destiny(命) nature(精) and mind(心) energy(氣) body(身)(性 命 精, 心 氣 身의 三分論) and ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經) as theory of only as energy(氣一元論), theory of bisection as shape and god(形神二分論), theory of trisection as nature(精) energy(氣) god(神) or shape(形) energy(氣) god(神)(精 氣 神, 形 氣 神의 三分論) according to formal part. Also, spirit(性) destiny(命) nature(精) as truths of three(三眞) were understand as nature(精) energy(氣) god(神) as treasure of three(三寶) by part of reason and mind(心) energy(氣) body(身) as false of three(三妄) were understand as nature(精) energy(氣) god(神) as treasure of three(三寶) by part of function. Third, In practice method, pause of thinking(止感) modulation of breath(調息). prohibition of sensibility(禁觸) mentioned in ${\ll}$Samilshingo${\gg}$ (三一神誥) as practice method each were understand regulation of an etiological cause as an internal cause, an external cause and not internal and external cause in oriental medicine. Namely, pause of thinking(止感) was understand as regulation method of emotion, mind and nature. modulation of breath(調息) was not only as modulation of energy from the inner parts of the body but also that from the internal and external parts of the body, prohibition of sensibility(禁觸) was understand as regulation method of ear, eye, mouth, and nose and posture, life style. These results suggest that ${\ll}$Samilshingo${\gg}$ (三一神誥) is worth meaning of Korea medical Qigong because meaning of god, a view of human body, practice method of mentioned in ${\ll}$Samilshingo${\gg}$ (三一神誥) is common with that of ${\ll}$The Yellow Emperor's Inner Classic${\gg}$ (黃帝內經) as theoretical evidence of Qigong.

Inflammatory Reponse of the Lung to Hypothermia and Fluid Therapy after Hemorrhagic Shock in Rats (흰쥐에서 출혈성 쇼크 후 회복 시 저체온법 및 수액 치료에 따른 폐장의 염증성 변화)

  • Jang, Won-Chae;Beom, Min-Sun;Jeong, In-Seok;Hong, Young-Ju;Oh, Bong-Suk
    • Journal of Chest Surgery
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    • v.39 no.12 s.269
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    • pp.879-890
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    • 2006
  • Background: The dysfunction of multiple organs is found to be caused by reactive oxygen species as a major modulator of microvascular injury after hemorrhagic shock. Hemorrhagic shock, one of many causes inducing acute lung injury, is associated with increase in alveolocapillary permeability and characterized by edema, neutrophil infiltration, and hemorrhage in the interstitial and alveolar space. Aggressive and rapid fluid resuscitation potentially might increased the risk of pulmonary dysfunction by the interstitial edema. Therefore, in order to improve the pulmonary dysfunction induced by hemorrhagic shock, the present study was attempted to investigate how to reduce the inflammatory responses and edema in lung. Material and Method: Male Sprague-Dawley rats, weight 300 to 350 gm were anesthetized with ketamine(7 mg/kg) intramuscular Hemorrhagic Shock(HS) was induced by withdrawal of 3 mL/100 g over 10 min. through right jugular vein. Mean arterial pressure was then maintained at $35{\sim}40$ mmHg by further blood withdrawal. At 60 min. after HS, the shed blood and Ringer's solution or 5% albumin was infused to restore mean carotid arterial pressure over 80 mmHg. Rats were divided into three groups according to rectal temperature level($37^{\circ}C$[normothermia] vs $33^{\circ}C$[mild hypothermia]) and resuscitation fluid(lactate Ringer's solution vs 5% albumin solution). Group I consisted of rats with the normothermia and lactate Ringer's solution infusion. Group II consisted of rats with the systemic hypothermia and lactate Ringer's solution infusion. Group III consisted of rats with the systemic hypothermia and 5% albumin solution infusion. Hemodynamic parameters(heart rate, mean carotid arterial pressure), metabolism, and pulmonary tissue damage were observed for 4 hours. Result: In all experimental groups including 6 rats in group I, totally 26 rats were alive in 3rd stage. However, bleeding volume of group I in first stage was $3.2{\pm}0.5$ mL/100 g less than those of group II($3.9{\pm}0.8$ mL/100 g) and group III($4.1{\pm}0.7$ mL/100 g). Fluid volume infused in 2nd stage was $28.6{\pm}6.0$ mL(group I), $20.6{\pm}4.0$ mL(group II) and $14.7{\pm}2.7$ mL(group III), retrospectively in which there was statistically a significance between all groups(p<0.05). Plasma potassium level was markedly elevated in comparison with other groups(II and III), whereas glucose level was obviously reduced in 2nd stage of group I. Level of interleukine-8 in group I was obviously higher than that of group II or III(p<0.05). They were $1.834{\pm}437$ pg/mL(group I), $1,006{\pm}532$ pg/mL(group II), and $764{\pm}302$ pg/mL(group III), retrospectively. In histologic score, the score of group III($1.6{\pm}0.6$) was significantly lower than that of group I($2.8{\pm}1.2$)(p<0.05). Conclusion: In pressure-controlled hemorrhagic shock model, it is suggested that hypothermia might inhibit the direct damage of ischemic tissue through reduction of basic metabolic rate in shock state compared to normothermia. It seems that hypothermia should be benefit to recovery pulmonary function by reducing replaced fluid volume, inhibiting anti-inflammatory agent(IL-8) and leukocyte infiltration in state of ischemia-reperfusion injury. However, if is considered that other changes in pulmonary damage and inflammatory responses might induce by not only kinds of fluid solutions but also hypothermia, and that the detailed evaluation should be study.

Studies on the Kiln Drying Characteristics of Several Commercial Woods of Korea (국산 유용 수종재의 인공건조 특성에 관한 연구)

  • Chung, Byung-Jae
    • Journal of the Korean Wood Science and Technology
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    • v.2 no.2
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    • pp.8-12
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    • 1974
  • 1. If one unity is given to the prongs whose ends touch each other for estimating the internal stresses occuring in it, the internal stresses which are developed in the open prongs can be evaluated by the ratio to the unity. In accordance with the above statement, an equation was derived as follows. For employing this equation, the prongs should be made as shown in Fig. I, and be measured A and B' as indicated in Fig. l. A more precise value will result as the angle (J becomes smaller. $CH=\frac{(A-B') (4W+A) (4W-A)}{2A[(2W+(A-B')][2W-(A-B')]}{\times}100%$ where A is thickness of the prong, B' is the distance between the two prongs shown in Fig. 1 and CH is the value of internal stress expressed by percentage. It precision is not required, the equation can be simplified as follows. $CH=\frac{A-B'}{A}{\times}200%$ 2. Under scheduled drying condition III the kiln, when the weight of a sample board is constant, the moisture content of the shell of a sample board in the case of a normal casehardening is lower than that of the equilibrium moisture content which is indicated by the Forest Products Laboratory, U. S. Department of Agriculture. This result is usually true, especially in a thin sample board. A thick unseasoned or reverse casehardened sample does not follow in the above statement. 3. The results in the comparison of drying rate with five different kinds of wood given in Table 1 show that the these drying rates, i.e., the quantity of water evaporated from the surface area of I centimeter square per hour, are graded by the order of their magnitude as follows. (1) Ginkgo biloba Linne (2) Diospyros Kaki Thumberg. (3) Pinus densiflora Sieb. et Zucc. (4) Larix kaempheri Sargent (5) Castanea crenata Sieb. et Zucc. It is shown, for example, that at the moisture content of 20 percent the highest value revealed by the Ginkgo biloba is in the order of 3.8 times as great as that for Castanea crenata Sieb. & Zucc. which has the lowest value. Especially below the moisture content of 26 percent, the drying rate, i.e., the function of moisture content in percentage, is represented by the linear equation. All of these linear equations are highly significant in testing the confficient of X i. e., moisture content in percentage. In the Table 2, the symbols are expressed as follows; Y is the quantity of water evaporated from the surface area of 1 centimeter square per hour, and X is the moisture content of the percentage. The drying rate is plotted against the moisture content of the percentage as in Fig. 2. 4. One hundred times the ratio(P%) of the number of samples occuring in the CH 4 class (from 76 to 100% of CH ratio) within the total number of saplmes tested to those of the total which underlie the given SR ratio is measured in Table 3. (The 9% indicated above is assumed as the danger probability in percentage). In summarizing above results, the conclusion is in Table 4. NOTE: In Table 4, the column numbers such as 1. 2 and 3 imply as follows, respectively. 1) The minimum SR ratio which does not reveal the CH 4, class is indicated as in the column 1. 2) The extent of SR ratio which is confined in the safety allowance of 30 percent is shown in the column 2. 3) The lowest limitation of SR ratio which gives the most danger probability of 100 percent is shown in column 3. In analyzing above results, it is clear that chestnut and larch easly form internal stress in comparison with persimmon and pine. However, in considering the fact that the revers, casehardening occured in fir and ginkgo, under the same drying condition with the others, it is deduced that fir and ginkgo form normal casehardening with difficulty in comparison with the other species tested. 5. All kinds of drying defects except casehardening are developed when the internal stresses are in excess of the ultimate strength of material in the case of long-lime loading. Under the drying condition at temperature of $170^{\circ}F$ and the lower humidity. the drying defects are not so severe. However, under the same conditions at $200^{\circ}F$, the lower humidity and not end coated, all sample boards develop severe drying defects. Especially the chestnut was very prone to form the drying defects such as casehardening and splitting.

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Korean Sentence Generation Using Phoneme-Level LSTM Language Model (한국어 음소 단위 LSTM 언어모델을 이용한 문장 생성)

  • Ahn, SungMahn;Chung, Yeojin;Lee, Jaejoon;Yang, Jiheon
    • Journal of Intelligence and Information Systems
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    • v.23 no.2
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    • pp.71-88
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    • 2017
  • Language models were originally developed for speech recognition and language processing. Using a set of example sentences, a language model predicts the next word or character based on sequential input data. N-gram models have been widely used but this model cannot model the correlation between the input units efficiently since it is a probabilistic model which are based on the frequency of each unit in the training set. Recently, as the deep learning algorithm has been developed, a recurrent neural network (RNN) model and a long short-term memory (LSTM) model have been widely used for the neural language model (Ahn, 2016; Kim et al., 2016; Lee et al., 2016). These models can reflect dependency between the objects that are entered sequentially into the model (Gers and Schmidhuber, 2001; Mikolov et al., 2010; Sundermeyer et al., 2012). In order to learning the neural language model, texts need to be decomposed into words or morphemes. Since, however, a training set of sentences includes a huge number of words or morphemes in general, the size of dictionary is very large and so it increases model complexity. In addition, word-level or morpheme-level models are able to generate vocabularies only which are contained in the training set. Furthermore, with highly morphological languages such as Turkish, Hungarian, Russian, Finnish or Korean, morpheme analyzers have more chance to cause errors in decomposition process (Lankinen et al., 2016). Therefore, this paper proposes a phoneme-level language model for Korean language based on LSTM models. A phoneme such as a vowel or a consonant is the smallest unit that comprises Korean texts. We construct the language model using three or four LSTM layers. Each model was trained using Stochastic Gradient Algorithm and more advanced optimization algorithms such as Adagrad, RMSprop, Adadelta, Adam, Adamax, and Nadam. Simulation study was done with Old Testament texts using a deep learning package Keras based the Theano. After pre-processing the texts, the dataset included 74 of unique characters including vowels, consonants, and punctuation marks. Then we constructed an input vector with 20 consecutive characters and an output with a following 21st character. Finally, total 1,023,411 sets of input-output vectors were included in the dataset and we divided them into training, validation, testsets with proportion 70:15:15. All the simulation were conducted on a system equipped with an Intel Xeon CPU (16 cores) and a NVIDIA GeForce GTX 1080 GPU. We compared the loss function evaluated for the validation set, the perplexity evaluated for the test set, and the time to be taken for training each model. As a result, all the optimization algorithms but the stochastic gradient algorithm showed similar validation loss and perplexity, which are clearly superior to those of the stochastic gradient algorithm. The stochastic gradient algorithm took the longest time to be trained for both 3- and 4-LSTM models. On average, the 4-LSTM layer model took 69% longer training time than the 3-LSTM layer model. However, the validation loss and perplexity were not improved significantly or became even worse for specific conditions. On the other hand, when comparing the automatically generated sentences, the 4-LSTM layer model tended to generate the sentences which are closer to the natural language than the 3-LSTM model. Although there were slight differences in the completeness of the generated sentences between the models, the sentence generation performance was quite satisfactory in any simulation conditions: they generated only legitimate Korean letters and the use of postposition and the conjugation of verbs were almost perfect in the sense of grammar. The results of this study are expected to be widely used for the processing of Korean language in the field of language processing and speech recognition, which are the basis of artificial intelligence systems.

Surgical Treatment of Anomalous Origin of Coronary Artery from the Pulmonary Artery: Postoperative Changes of Ventricular Dimensions and Mitral Regurgitation (관상동맥-폐동맥 이상기시증(Anomalous Origin of Coronary Artery from Pulmonary Artery)의 수술적 치료: 중기 성적과 좌심실 및 승모판 기능의 변화 양상에 대한 연구)

  • Kang, Chang-Hyun;Kim, Woong-Han;Seo, Hong-Joo;Kim, Jae-Hyun;Lee, Cheul;Chang, Yoon-Hee;Hwang, Seong-Wook;Back, Man-Jong;Oh, Sam-Se;Na, Chan-Young;Han, Jae-Jin;Lee, Young-Tak;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.37 no.1
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    • pp.19-26
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    • 2004
  • Background: The aims of this study are to verify the result of the surgical treatment of ALCAPA and to identify the postoperative changes of left ventricular dimensions and mitral regurgitation (MR), Material and Method: Fifteen patients operated on since 1985 were included in the study. The patients operated on before 1998 (n=9) showed heterogeneous properties with various surgical strategies and cardiopulmonary bypass techniques. However, six patients were operated on with the established surgical strategy since 1998; 1) Dual perfusion and dual cardioplegic solution delivery through ascending aorta and main pulmonary artery, 2) Coronary transfer by rolled-conduit made of pulmonary artery wall flap, and 3) Additional mitral valvular procedure was not peformed. Result: Median age of the study group was 6 months (1 month to 34 years). The operative methods were left subclavian artery to left coronary artery anastomosis in 1, simple ligation in 2, Takeuchi operation in 2, and coronary reimplantation in 10 patients. The mean follow up period was 5.5<5.8 years (2 months 14 years), There were one early death (6.7%) and one late death. Overall 5-year survival rate was 85.6$\pm$9.6%. The Z-value of left ventricular end-diastolic and end-systolic dimensions were 6.4$\pm$3.0 and 5.1 $\pm$3.6 preoperatively, and decreased to 1.7$\pm$ 1.9 and 0.8$\pm$ 1.6 in 3 months (p<0.05). Significant preoperative MR was identified in 6 patients (40%) and all the patients showed immediate improvement of MR within f month postoperatively. There were 3 cases of reoperation due to coronary anastomosis site stenosis and recurrence of MR. However, there was no mortality nor late reoperation in the patients operated on after 1998. Conclusion: The surgical treatment of ALCAPA showed favorable survival and early recovery of ventricular dimensions and mitral valvular function. Although long-term reintervention was required in some cases of earlier period, all the cases after 1998 showed excellent surgical outcome without long-term problem.

Results of Definitive Chemoradiotherapy for Unresectable Esophageal Cancer (절제 불가능한 식도암의 근치적 항암화학방사선치료의 성적)

  • Noh, O-Kyu;Je, Hyoung-Uk;Kim, Sung-Bae;Lee, Gin-Hyug;Park, Seung-Il;Lee, Sang-Wook;Song, Si-Yeol;Ahn, Seung-Do;Choi, Eun-Kyung;Kim, Jong-Hoon
    • Radiation Oncology Journal
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    • v.26 no.4
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    • pp.195-203
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    • 2008
  • Purpose: To investigate the treatment outcome and failure patterns after definitive chemoradiation therapy in locally advanced, unresectable esophageal cancer. Materials and Methods: From February 1994 to December 2002, 168 patients with locally advanced unresectable or medically inoperable esophageal cancer were treated by definitive chemoradiation therapy. External beam radiation therapy (EBRT) ($42{\sim}46\;Gy$) was delivered to the region encompassing the primary tumor and involved lymph nodes, while the supraclavicular fossa and celiac area were included in the treatment area as a function of disease location. The administered cone-down radiation dose to the gross tumor went up to $54{\sim}66\;Gy$, while the fraction size of the EBRT was 1.8-2.0 Gy/fraction qd or 1.2 Gy/fraction bid. An optional high dose rate (HDR) intraluminal brachytherapy (BT) boost was also administered (Ir-192, $9{\sim}12\;Gy/3{\sim}4\;fx$). Two cycles of concurrent FP chemotherapy (5-FU $1,000\;mg/m^2$/day, days $2{\sim}6$, $30{\sim}34$, cisplatin $60\;mg/m^2$/day, days 1, 29) were delivered during radiotherapy with the addition of two more cycles. Results: One hundred sixty patients were analyzable for this review [median follow-up time: 10 months (range $1{\sim}149$ months)). The number of patients within AJCC stages I, II, III, and IV was 5 (3.1%), 38 (23.8%), 68 (42.5%), and 49 (30.6%), respectively. A HDR intraluminal BT was performed in 26 patients. The 160 patients had a median EBRT radiation dose of 59.4 Gy (range $44.4{\sim}66$) and a total radiation dose, including BT, of 60 Gy (range $44.4{\sim}72$), while 144 patients received a dose higher than 40 Gy. Despite the treatment, the disease recurrence rate was 101/160 (63.1%). Of these, the patterns of recurrence were local in 20 patients (12.5%), persistent disease and local progression in 61 (38.1%), distant metastasis in 15 (9.4%), and concomitant local and distant failure in 5 (3.1%). The overall survival rate was 31.8% at 2 years and 14.2% at 5 years (median 11.1 months). Disease-free survival was 29.0% at 2 years and 22.7% at 5 years (median 10.4 months). The response to treatment and N-stage were significant factors affecting overall survival. In addition, total radiation dose (${\geq}50\;Gy$ vs. < 50 Gy), BT and fractionation scheme (qd. vs. bid.) were not significant factors for overall survival and disease-free survival. Conclusion: Survival outcome after definitive chemoradiation therapy in unresectable esophageal cancer was comparable to those of other series. The main failure pattern was local recurrence. Survival rate did not improve with increased radiation dose over 50 Gy or the use of brachytherapy or hyperfractionation.