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The Influence of Landscape Pavements on the WBGT of Outdoor Spaces without Ventilation or Shade at Summer Midday (조경포장이 옥외공간의 온열쾌적성지수(WBGT)에 미치는 영향 - 통풍과 차광이 배제된 하절기 주간의 조건에서 -)

  • Lee, Chun-Seok;Ryu, Nam-Hyung
    • Journal of the Korean Institute of Landscape Architecture
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    • v.38 no.2
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    • pp.1-8
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    • 2010
  • The purpose of the study was to evaluate the influence of landscaping pavements on WBGT(Wet-Bulb Globe Temperature) of outdoor spaces that lack ventilation and shade at summer midday. The relative humidity(RH), dry-bulb temperature(DT) and globe temperature(GT) were recorded every minute from June to October 2009 at a height of 1.2m above ten experimental beds with different pavements, by a measuring system consisting of an electric humidity sensor(GHM-15), resistance temperature detector(RTD, Pt-100), standard black globe(${\phi} 150mm$) and data acquisition systems(National Instrument's Labview and Compact FieldPoint). Additionally, the surface dry-bulb temperatures also were recorded and compared. The area of each experimental bed was 1.5m(W)${\times}$2.0m(L) and ten different kinds of pavement were used including grass, grass+cubic stone, grass+porous brick, brick, stone panels, cubic stone, interlocking blocks, clay brick, naked soil, gravel and concrete. To prevent interference from ventilation, a 1.5m height cubic steel frame was established around each bed and each vertical side of the frame was covered with transparent polyethylene film. Based on the records of the hottest period from noon to 3 PM on 26 days with a peak dry-bulb temperature over $30^{\circ}C$ at natural condition, the wet-bulb temperature(WT) and WBGT were calculated and compared. The major findings were as follows: 1. The average surface DT was $40.1^{\circ}C$, which is $9^{\circ}C$ higher than that of the natural condition. The surface DT of the pavements with grass were higher than those of concrete and interlocking block. The peak DT of the surface almost every pavement rose to above $50^{\circ}C$ during the hottest time. 2. The averages of DT, WT and GT were $40.1^{\circ}C$, $27.5^{\circ}C$ and $49.1^{\circ}C$, and the peak values rose to $48.1^{\circ}C$, $45.8^{\circ}C$ and $59.5^{\circ}C$, respectively. In spite of slight differences that resulted according to pavements, no coherent differentiating factor could be found. 3. The average WBGT of grass was the highest at $34.3^{\circ}C$ while the others were similar in the range of around $33{\pm}1^{\circ}C$. Meanwhile, the peak WBGT was highest with stone panel at $47.9^{\circ}C$. Though there were some differences according to pavements, and while grass seemed to be worst in terms of WBGT, it seems difficult to say ablolutely that grass was the worst because the measurement was conducted without ventilation and shade during summer daytime hours only, which had temperatures that rose to a dangerous degree(above $45^{\circ}C$ WBGT), withering the grass during the hottest period. The average WBGT resulted also showed that the thermal environment of the pavement without ventilation and shade were at an intolerable level for humans regardless of the pavement type. In summary, the results of this study show that ventilation and shade are more important factor than pavement type in terms of outdoor thermal comfort in summer daylight hours.

Electrical Stimulation Parameters in Normal and Degenerate Rabbit Retina (정상 망막과 변성 망막을 위한 전기자극 파라미터)

  • Jin, Gye-Hwan;Goo, Yong-Sook
    • Progress in Medical Physics
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    • v.19 no.1
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    • pp.73-79
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    • 2008
  • Retinal prosthesis is regarded as the most feasible method for the blind caused by retinal diseases such as retinitis pigmentosa (RP) or age related macular degeneration (AMD). Recently Korean consortium launched for developing retinal prosthesis. One of the prerequisites for the success of retinal prosthesis is the optimization of the electrical stimuli applied through the prosthesis. Since electrical characteristics of degenerate retina are expected to differ from those of normal retina, we performed voltage stimulation experiment both in normal and degenerate retina to provide a guideline for the optimization of electrical stimulation for the upcoming prosthesis. After isolation of retina, retinal patch was attached with the ganglion cell side facing the surface of microelectrode arrays (MEA). $8{\times}8$ grid layout MEA (electrode diameter: $30{\mu}m$, electrode spacing: $200{\mu}m$, and impedance: $50k{\Omega}$ at 1 kHz) was used to record in-vitro retinal ganglion cell activity. Mono-polar electrical stimulation was applied through one of the 60 MEA channel, and the remaining channels were used for recording. The electrical stimulus was a constant voltage, charge-balanced biphasic, anodic-first square wave pulse without interphase delay, and 50 trains of pulse was applied with a period of 2 sec. Different electrical stimuli were applied. First, pulse amplitude was varied (voltage: $0.5{\sim}3.0V$). Second, pulse duration was varied $(100{\sim}1,200{\mu}s)$. Evoked responses were analyzed by PSTH from averaged data with 50 trials. Charge density was calculated with Ohm's and Coulomb's law. In normal retina, by varying the pulse amplitude from 0.5 to 3V with fixed duration of $500{\mu}s$, the threshold level for reliable ganglion cell response was found at 1.5V. The calculated threshold of charge density was $2.123mC/cm^2$. By varying the pulse duration from 100 to $1,200{\mu}s$ with fixed amplitude of 2V, the threshold level was found at $300{\mu}s$. The calculated threhold of charge density was $1.698mC/cm^2$. Even after the block of ON-pathway with L-(1)-2-amino-4-phosphonobutyric acid (APB), electrical stimulus evoked ganglion cell activities. In this APB-induced degenerate retina, by varying the pulse duration from 100 to $1200{\mu}s$ with fixed voltage of 2 V, the threshold level was found at $300{\mu}s$, which is the same with normal retina. More experiment with APB-induced degenerate retina is needed to make a clear comparison of threshold of charge density between normal and degenerate retina.

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Bilateral Sequential Lung Transplantation in Dogs (황견에서 동종 순차적 양측 폐이식 수술에 관한 연구)

  • 이두연;김해균;문동석;윤용한;홍윤주;이성수
    • Journal of Chest Surgery
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    • v.31 no.2
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    • pp.108-112
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    • 1998
  • Experimental trials of unilateral lung transplantation in dogs have been attempted and satisfactory results were obtained without any noticeable difficulty in surgical techniques. Fourteen dogs with the body weight of around 25 kg were anesthesized by 20~30 mg/kg of intravenous Entobar,; one was sacrificed to make available blood for use during transplantation for the recipient dog. A mid-sternotomy incision was performed and 20 mg/kg of Prostaglandin E1 was infused through the pulmonary artery and Euro-Collin's(E-C) preservation solution, cooled down to 4$^{\circ}C$, was perfused at the rate of 70cc/kg by a pressure of 30 cmH2O. The heart-lung block was then resected out and promptly immersed in the prepared preservation solution at 4$^{\circ}C$. One lung preserved in the EC solution at 4$^{\circ}C$ was anastomosed to the recipient dog in the order of the pulmonary vein, bronchus then pulmomary artery and the thoracotomy incision was closed after the bleeding control and tube thoracostomy. Then the pneumonectomy in the opposite side was perfomed in the same manner and the tailored lung was transplanted in the order of the pulmonary vein, bronchus, then pulmonary artery. We conclude that in the bilateral sequential lung transplantation, the right lung transplantation should precede to better expose the operative field and to prevent reperfusion injury; also, the cardiopulmonary bypass should be consider for certain appropriate cases.

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Dose Distribution and Characterization for Radiation Fields of Multileaf Collimateor System (방사선 입체조형치료용 다엽콜리메이터의 특성과 조직내 선량분포 측정)

  • Chu, Sung-Sil;Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.14 no.1
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    • pp.77-85
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    • 1996
  • Purpose : Multileaf collimator(MLC) is very suitable tool for conformal radio-therapy and commissioning measurements for a multileaf collimator installed on a dual energy accelerator with 6 and 10MV photons are required, For modeling the collimator with treament planning software, detailed dosimetric characterization of the multileaf collimator including the penumbra width, leaf transmission between leaf leakage and localization of the leaf ends and sides is an essential requirement. materials and Methods : Measurement of characteristic data of the MLC with 26 pair block leaves installed on CLINAC 2100C linear accelerator was performed. Low sensitive radiographic film(X-omatV) was used for the penumbra measurement and separate experiments using radiographic film and thermoluminescent dosimeters were performed to verify the dose distribution, Measured films were analized with a photodensitometer of WP700i scanner. Results : For 6 & 10 MV x-ray energies, approximately $2.0\%$ of photons incident on the multileaf collimator were transmitted and an additional $0.5\%$ leakage occurs between the leaves. Localizing the physical end of the leaves showed less than 1mm deviation from the $50\%$ decrement line and this difference is attributed to the curved shaped end on the leaves One side of a sin히e leaf corresponded to the $50\%$ decrement line, but the opposite face was aligned with a lower value. This difference is due to the tongue and groove used to decrease between leaf leakage. Alignment of the leaves to form a straight edge resulted larger penumbra at far position from isocenter as compare with divergent alloy blocks. When the MLC edge is stepped by sloping field, the isodose lines follow the leaf pattern and Produce scalloping isodose curves in tissue. The effective penumbra by 45 degree stepped MLC is about 10mm at 10cm depth for 6MV x-ray. The difference of effective penumbra in deep tissue between MLC and divergent alloy blocks is small (5mm). Conclusion : Using the characteristic data of MLC, the MLC has the clinlical acceptability and suitability for 3-D conformal radiotherapy except small field size.

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A Study on the External Treatment of Dysmenorrhea using the Method of applying Herb-medicine at the acupoints (월경통(月經痛)의 약물혈위첩부치료법(藥物穴位貼敷治療法)에 대한 고찰(考察))

  • Lim, Eun-Mee
    • The Journal of Korean Medicine
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    • v.16 no.2 s.30
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    • pp.134-148
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    • 1995
  • Dysmenorrhea is probably the most common of all Gynecologic disorders. In the oriental medicine the etiology of Dysmenorrhea is very various, but its mechanism is just that the block of the flow makes the pain. So its treatment is removing the pain by promoting menstrual flow, promoting the flow of qi and by warming channel and activating blood flow. In the various treatments of dysmenorrhea, the method of applying drug at the acupoints which could be combined with feeding herb-medicine by oral was studied. The results obtained here were as follows; 1. In the treatments of dysmenorrhea, the method of applying drug at the acupoints was mainly applied to the type dued to stagnancy of qi and blood stasis, menorrhalgia dued to to cold and dampness, and primary dysmenorrhea. 2. The acupoint used in this treatment was Shin-gwol$(CV_8)$, the umbilicus. 3. The drugs used in this treatment were almost same as oral herb-medicine mainly to activate the blood flow and remove the blood stasis and to promote the flow of qi by warming the channel and remove the pain. 4. The duration of the treatment is, from 3 days before menstration till its period or a few days after it., usually concentrated on fore-postmenstration. 5. The effect of this treatment was reported as excellent. It is more effective to the type of stagnancy of qi and blood stasis, cold and dampness than dued to deficiency of both qi and blood, and dued to the impaired liver-kidney essence. 6. The method of applying drug at the acupoint was as an external treatment, easy, economical, and had no pain and side effect. 7. In the treatments of dysmenorrhea, the method of applying drug at the acupoint could be used as emergency treatment and symptomatic treatment in fore-postmenstration.

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Physical Geography of Munkyung (문경의 자연지리)

  • Bak, Byeong-Su;Son, Myoung-Won
    • Journal of the Korean association of regional geographers
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    • v.4 no.2
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    • pp.15-30
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    • 1998
  • Physical geography is the discipline which deals with the relationship between man and natural environment. Therefore, it should be studied as the organized unity. In this paper I recognize the drainage basin as a framework outlining physical geography, describe the difference of inhabitant's life style due to the difference of natural environment in the drainage basin, and consider the meaning of drainage basin as a unit of life(and unit of regional geography). Munkyung is divided into three regions(intermontane basin region, middle mountainous region, marginal hilly region of the great basin) owing to the topographic characteristics. Subdivision in these regions is related closely to drainage network distribution, specially in intermontane basin region. And small regions have developed with the confluence point of $3{\sim}4$ order streams as the central figure. Intermontane basin region is the valley floor of Sinbuk-Soya-Kauun-Nongam stream located in the limestone region which is exposed according to Munkyung fault at its northern part. Small streams are affected strongly by the influence of the NNE-SSE or WNW-ESE tectolineament. Thus Kaeripryungro(鷄立嶺路), Saejaegil(새재길), Ewharyungro(伊火嶺路) and so on are constructed through the tectolineament. In the valley floors of small streams which flow into the intermontane basin, there are large floodplains. Floodplain in Sinbuk, Joryung, and Yangsan stream is used to paddy field or orchard, and in Nongam stream is used to paddy field or vegetable field. Hills are distributed largely in the periphery of intermontane basin. Limestone hills in Kauun and Masung basin are not continuous to the present low and flat floodplain, and most of those are used to forest land and field. On the other side. granite hills in Koyori are continuous to be used to the present floodplain, and they are used to residential area and field. In the middle mountainous region are there hilly mountains constructed in the geology of Palaeozoic Pyeongan System in northern area and Chosun System's Limestone Series in southern area, and banded gneiss and schist among Sobaeksan Gneiss Complex. In Palaeozoic Pyeongan System region are there relatively rugged mountains and ingrown meanders developed along tectolineaments. Chosun System's Limestone Series region builds up a geomorphic surface, develops various karst landforms. Mountainous area is used to field. On the other hand, especially in case of Hogye, valley bottom is wide, long, and discontinuous to slope, is used to paddy field dominantly. And schist region in Youngnam Block of Pre-Cambrian is rugged mountainous. Marginal hilly region of the great basin is hilly zone located in the margin of erosional basin(Bonghwa-Youngju-Yechon-Hamchang-Sangju). This region is lower geomorphic surface which is consisted of hills of $50{\sim}100$m height. Hills are used to field or orchard, and dissected gentle depression is used to paddy field.

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A Study on The Iron Monument in The era of Joseon Dynasty (조선시대(朝鮮時代) 철비(鐵碑)의 조영(造營) 연구(硏究))

  • Hong, Dai Han
    • The Korean Journal of Archival Studies
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    • no.24
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    • pp.215-274
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    • 2010
  • Iron-making industries of the country, regardless of age has been the focus. This makes the iron production technology and production techniques that result in increased economic activity and because of the central charge. Therefore, the social development of ancient iron-making technology is based on phase-sensitive. Modern steel making up the monopoly of the country's target under the strict control of production, distribution was. It is essential to produce iron weapons was a threat is because you can keep the throne in the hands of the forces that can cause side effects when I went was to block. This study created a rail Cholbi(iron monument) and the regional distribution pattern of the production, construction background, looked on. Cholbi(iron monument) for the production and recording "the Annals of the Joseon Dynasty" often appear in history books and many academic interests, but was off target. Compared to a stone monument that was not generally as well as the Japanese colonial period and over the course of modernization destroyed, damaged a lot of cases the cause may be found in front. Cholbi(iron monument), except for the gravestones of the Joseon Dynasty monument erected in honor of virtue, as an example of content that dominated a packman business, founding of the school and confirmed that a few were built as a special purpose. Cholbi(iron monument) compared to the production technology or the cost of the monument's difficulty in financing follows. Therefore Cholbi(iron monument) the establishment of the Joseon Dynasty through the background of the economic situation and the local government can look. And iron technology began complaining about the object of history, economic conditions, with the change of season has been a change in people's consciousness tells you. Important data of ancient history as an epigraph that has been as important, the Middle Ages to modern times ranging from newly born to the time Cholbi(iron monument) in the development of the country's documentary subject to change should have been brought. Based on these discussions changes the identity of the hero monument and production inspector, review of production through the Joseon Dynasty period Cholbi (iron monument) contemplated the significance is reflected in production.

Heavy concrete shielding properties for carbon therapy

  • Jin-Long Wang;Jiade J Lu;Da-Jun Ding;Wen-Hua Jiang;Ya-Dong Li;Rui Qiu;Hui Zhang;Xiao-Zhong Wang;Huo-Sheng Ruan;Yan-Bing Teng;Xiao-Guang Wu;Yun Zheng;Zi-Hao Zhao;Kai-Zhong Liao;Huan-Cheng Mai;Xiao-Dong Wang;Ke Peng;Wei Wang;Zhan Tang;Zhao-Yan Yu;Zhen Wu;Hong-Hu Song;Shuo-Yang Wei;Sen-Lin Mao;Jun Xu;Jing Tao;Min-Qiang Zhang;Xi-Qiang Xue;Ming Wang
    • Nuclear Engineering and Technology
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    • v.55 no.6
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    • pp.2335-2347
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    • 2023
  • As medical facilities are usually built at urban areas, special concrete aggregates and evaluation methods are needed to optimize the design of concrete walls by balancing density, thickness, material composition, cost, and other factors. Carbon treatment rooms require a high radiation shielding requirement, as the neutron yield from carbon therapy is much higher than the neutron yield of protons. In this case study, the maximum carbon energy is 430 MeV/u and the maximum current is 0.27 nA from a hybrid particle therapy system. Hospital or facility construction should consider this requirement to design a special heavy concrete. In this work, magnetite is adopted as the major aggregate. Density is determined mainly by the major aggregate content of magnetite, and a heavy concrete test block was constructed for structural tests. The compressive strength is 35.7 MPa. The density ranges from 3.65 g/cm3 to 4.14 g/cm3, and the iron mass content ranges from 53.78% to 60.38% from the 12 cored sample measurements. It was found that there is a linear relationship between density and iron content, and mixing impurities should be the major reason leading to the nonuniform element and density distribution. The effect of this nonuniformity on radiation shielding properties for a carbon treatment room is investigated by three groups of Monte Carlo simulations. Higher density dominates to reduce shielding thickness. However, a higher content of high-Z elements will weaken the shielding strength, especially at a lower dose rate threshold and vice versa. The weakened side effect of a high iron content on the shielding property is obvious at 2.5 µSv=h. Therefore, we should not blindly pursue high Z content in engineering. If the thickness is constrained to 2 m, then the density can be reduced to 3.3 g/cm3, which will save cost by reducing the magnetite composition with 50.44% iron content. If a higher density of 3.9 g/cm3 with 57.65% iron content is selected for construction, then the thickness of the wall can be reduced to 174.2 cm, which will save space for equipment installation.

A Study of Yangshangsun(楊上善)'s theory of three-yum and three-yang(三陰三陽) - focus on attribute of three-yum and three-yang(三陰三陽), the bolt-leaf-hanges(關闔樞) theory, large of small of gi-blood(氣血多少) (양상선(楊上善)의 삼음삼양(三陰三陽) 학설(學說)에 대한 연구 - 음양속성(陰陽屬性), 관합추(關闔樞), 기혈다소(氣血多少)를 중심으로 -)

  • Lee, Yong Bum
    • Journal of Korean Medical classics
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    • v.10
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    • pp.450-493
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    • 1997
  • Three-yum and three-yang(三陰三陽) is the change state of yum-yang(陰陽) which is caused by six gi(六氣). They mean the flow of six gi(六氣) which exist throughout the viscera, the channel(經絡), and the skin. But it is not easy to understand the meaning because the contents of the attribute of three-yum and three-yang(三陰三陽), the bolt-leaf-hanges(關闔樞) theory and large or small of gi-blood(氣血多少) which is the main clue that explain it in ${\ll}$Somun(素問)${\gg}$ and ${\ll}$Yeongchu(靈樞)${\gg}$ don't coincide with each other. I, the writer, tried to understand the uncertain meaning and the contents which are written about three points above differently in each of the books that are ${\ll}$Somun(素問)${\gg}$ and ${\ll}$Yeongchu(靈樞)${\gg}$. So, from that the course that the book, ${\ll}$Huangjenegeong(黃帝內經)${\gg}$ is handed down is so relatively simple in a wood block-printed book, that the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ has less wong-words than the Somun(素問) and the Yeongchu(靈樞), and from that Yangshangsun(楊上善) wrote the note in the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ by royal order about 100 years former than Wangbing(王氷), as making projects of Yangshangsun(楊上善)'s note and the original of the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ which has relation to the yum-yang(陰陽) attribute of three-yum and three-yang(三陰三陽), the bolt-leaf-hanges(關闔樞) theory, and the large or small of gi-blood(氣血多少) and researching the Yangshangsun(楊上善)'s theory. The result is summarized like this. First, wherease the order of the change of three-yum and three-yang(三陰三陽) which is explained by Yangshangsun(楊上善) consider the change of yangi(陽氣) in body most important, the order of the change gaeggi(客氣)'s three-yum and three-yang(三陰三陽) considers chungi(天氣) most important, and the order of jugi(主氣)'s three-yum and three-yang(三陰三陽) considers jigi(地氣)'s change of ohaeng(五行) most important. If the order of change three-yum and three-yang(三陰三陽) in the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ is considered, each of taeyang(太陽) and soyum(少陰) are expressed as the base of yum-yang(陰陽) and yangmeong(陽明) and taeyum(太陰) are expressed as the palmy days of yum-yang(陰陽), soyang(少陽) and gyolyum(厥陰) are expressed as pacemaker(樞杻) which controls the change of yum-yang(陰陽). Thus, each has something in common that is fettered by the inside and outside. In the flow of channel(經絡), taeyang(太陽) and soyum(少陰) take charge of the behind of body, yangmeong(陽明) and taeyum(太陰) take charge of the front of body and soyang(少陽) and gyolyum(厥陰) take of the side of body. Second, in Yangshangsun(楊上善)'s bolt-leaf-hanges(關闔樞) theory, three-yum(三陰) is regarded as inside, three-yang(三陽) as outside, so when bolt, leaf and hanges fulfil their duties in inside and outside, the life(life force) is thought to be revealed normally. It is impossible to understand the bolt-leaf-hanges with the conception of the inside and outside which divide three-yum and three-yang(三陰三陽) into taeyang-soyum(太陽-少陰), yangmeong-taeyum(陽明-太陰), soyang-gyolyum(少陽-厥陰) according to yum-yang(陰陽) attribute, hence it need the special conception that is taeyang(太陽)-taeyum(太陰), yangmeong(陽明)-gyolyum(厥陰), soyang(少陽)-soyum(少陰) which center on their duties in inside and outside. In the denunciation of the word open(開) and bolt(關), because Yangshangsun(楊上善) said that the duities of taeyang(太陽) and taeyum(太陰) are shutter(閉禁), bolt(關) is coincided with that significance. Third, with explaining the large or small of gi-blood(氣血多少) of three-yum and three-yang(三陰三陽), Yangshangsun(楊上善) expressed the inside and outside either in the same way or differently. Because the inside and outside is interior of body and exterior of body, it is the explanation that is noticed by the fact that the property of large or small of gi-blood(氣血多少) is either able to be same or different. In this viewpoint, if we unite the contents about large or small of gi-blood(氣血多少) of ${\ll}$Somun(素問)${\gg}$, ${\ll}$Yeongchu(靈樞)${\gg}$, we will find that the descriptions of large or small of gi-blood(氣血多少) of three-yang(三陽) in ${\ll}$Somun(素問)${\gg}$ ${\ll}$Yeongchu(靈樞)${\gg}$ correspond with the ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$, but in three-yum(三陰), the contrary presentations exit. The reason is that large or small of gi-blood(氣血多少) of three-yum(三陰) isn't only expressed as che(體) in the point of che-yong(體用), but as a point of yong(用) that is a phenomenon. As researching the original of ${\ll}$Huangjenegeongtaeso(黃帝內經太素)${\gg}$ and Yangshangsun(楊上善)'s notes as a center about three problems that are yum-yang(陰陽) attribute, the bolt-leaf-hanges(關闔樞) and large or small of gi-blood(氣血多少) of three-yum and three-yang(三陰三陽), I, the writer, tried to explain the part which is written differently or has uncertain conception in the book ${\ll}$Somun(素問)${\gg}$ and the book ${\ll}$Yeongchu(靈樞)${\gg}$, but the concrete result of the work like this will be judged according to the question how many theories are correspondent with real presence at a sickbed. Hence, the work to veryfy the theories in the future will be left as assignment.

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Rectal Bleeding and Its Management after Irradiation for Cervix Cancer (자궁경부암 환자에서 방사선치료 후에 발생한 직장출혈과 치료)

  • Chun Mison;Kang Seunghee;Kil Hoon-Jong;Oh Young-Taek;Sohn Jeong-Hye;Jung Hye-Young;Ryu Hee Suk;Lee Kwang-Jae
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.343-352
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    • 2002
  • Purpose : Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. Materials and Methods : total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The Point A dose from the HDR brachytherapy was 28 Gy to 30 Gy $(4\;Gy\times7,\;or\;5\;Gy\times6)$. The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months $(12\~86\;months)$. Results : The incidence of rectal bleeding was $12.7\%$ (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was $8.5\%$. Most complications $(92.6\%)$ developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding an icruCRBED greater than 100 Gy $(19.7\%\;vs.\;4.2\%)$, an EBRT dose to the parametrium over 55 Gy $(22.1\%\;vs.\;5.1\%)$ and higher stages of III and IV $(31.8\%\;vs.\;10.5\%)$. In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was peformed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. Conclusion : Moderate and several rectal bleeding occurred in $8.5\%$ of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.