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A Comparison of Segmental Gastrectomy and Distal Gastrectomy with Billroth I Reconstruction for Early Gastric Cancer That's Developed on the Gastric Body (위체부에 발생한 조기위암에서 위구획절제술과 Billroth I 재건술식의 비교)

  • Song, Min-Sang;Lee, Sang-Il;Sul, Ji-Young;Noh, Seung-Moo
    • Journal of Gastric Cancer
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    • v.9 no.4
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    • pp.207-214
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    • 2009
  • Purpose: Subtotal distal gastrectomy has been accepted as the standard treatment for early gastric cancer that's developed on the gastric body. EMR and ESD have been introduced to minimize the incidence of postgastrectomy syndrome, but these procedures can not detect lymph node metastasis and they have a risk for gastric perforation. Segmental gastrectomy has recently been applied for treating early gastric cancer, but its usefulness has not been clarified. The aim of this study was to compare segmental gastrectomy and distal gastrectomy with Billroth I reconstruction for treating early gastric cancer that's developed on the gastric body. Materials and Methods: We performed a retrospective review of all the patients who were diagnosed as having early gastric cancer that developed on the gastric body at Chungnam National University Hospital from January 2004 through July 2007. During this period, 41 patients received segmental gastrectomy and 40 patients underwent subtotal distal gastrectomy. All the patients were studied via a biannual review of the body systems, a physical examination, endoscopy, computed tomography and the laboratory findings. Results: There were no significantly differences of the clinicopathologic characteristics between the two groups. The changes of the nutritional status (Hb, TP, Alb and TC) and the body weight change were not significantly different between the 2 groups. There were significantly more residual food in the SG group than that in the SDG group (RGB classification, Residual>Grade 2), but there were no differences for epigastric discomfort (P>0.05). Esophagitis developed at a similar rate for both two groups (LA classification, >Grade A), and bile reflux was found in only one patient of each group. Conclusion: We expected the reduction of esophagitis and gastritis and the improvement of nutritional status according to the type of procedure. Yet the results of our study showed no significant differences between the two study groups. More patients and a longer follow up time are needed for determining the advantage sand disadvantages of segmental gastrectomy.

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A Comparative Analysis of Clinical Features and Treatment Outcomes of Intussusception according to Age Distribution (연령에 따른 장중첩증의 임상양상 및 치료에 대한 비교분석)

  • Park, Bum Chul;Kim, Seok Young;Jung, Su Jin
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.8 no.2
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    • pp.150-156
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    • 2005
  • Purpose: We divided the children diagnosed with intususception into three different age groups and compared the clinical symptoms and treatment outcomes in order to analysis diagnosis and treatment of Intusussception. Methods: A retrospective chart review was established of 159 patients diagnosed with intussuception who had been admitted to Department of Pediatrics and General Surgery, Bundang CHA hospital from January, 2000 to May, 2004. We divided the patients into three groups, according to their age. Those who were under five months of age (group I; 21 patients), those between 5~11 months of age (group II; 61 patients), and those older than 11 months of age (group III; 77 patients). Then we compared the age, sex, seasonal distribution of occurrence, the cause, the clinical features, radiologic review, the type of intusussception, surgical methods, recurrence rate and treatment outcomes, among these three groups. Results: On comparing the clinical symptoms and signs among the three groups, the most common major clinical symptom and sign was irritabiltity in all three groups. Vomiting with irritability was statistically more common in group I (p<0.05) and bloody stool was most frequent in group III. The average time taken until a diagnosis was made after the symptom onset was, 21 hours in group I, 20 hours in group II and 22 hours in group III. Which showed no significant difference. But there was a higher rate of delayed diagnosis in group I, which took over 48 hours until the diagnosis was made (group I; 23.8%, group II; 4.9%, group III; 7.8%). Simple abdominal X-rays showed more frequent instances of intestinal obstruction in group I (p<0.05). The primary treatment done was barium enema which showed a failure rate of 52.4% in group I, 26.2% in group II and 14.3% in group III. Showing the highest failure rate in group I. Conclusion: The youngest group had vague symptoms which lead to delayed diagnosis and more frequent surgical procedures. As so, we advocate the importance of further evaluation and close observation, considering intussusception in children with symptoms of irritability and vomiting, especially in the early infant group.

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Analysis of Orthotropic Body under Ultimate Moment Load (극한(極限)모멘트 하중(荷重)을 받는 이방성(異方性) 구조체(構造體)의 해석(解析))

  • Chang, Suk Yoon
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.5 no.3
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    • pp.95-105
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    • 1985
  • This dissertation presents an exact solution for the normal and shearing stresses of an orthotropic plane body loaded by a moment load. The solution satisfies the conditions of equilibrium compatibility equations concurrently and is governing for the body being in the elasto-plastic state. An Airy stress function is introduced to solve the problem related to an orthotropic half-infinite plane under a moment load. All the equations for orthotropy must be degenerated into the expressions for isotropy when orthotropic constants are replaced by isotropic ones. The author has evaluated all the equations of orthotropy and succeeded in obtaining exactly identical expressions to the equations of isotropy which were derived independently by of L'hosptials rule. The analytical results of isotropy are compared with the simple results of other investigator. Since moment Load under the elastic state and plastic state only is a particular case of moment load under the elasto-plastic state. All the equations of elasto-plastic state case are degenerated into the expressions for the each case. The formal solution is expressed in terms of closed form. The orthotropic constants are evaluated for two kinds and two different orientations of the grain of wood and two kinds of structures. The numerical results for orthotropy are evaluated for one kind and two different orientations of three-layered ply wood. The distribution of normal and shearing stresses are shown in figures. It is noted that the distribution of stresses of orthotropic materials depends on the type of materials and orientations of the grain and stiffening.

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A Study on the Evaluation of Patient Dose in Interventional Radiology (중재적방사선검사에서 환자 피폭선량에 관한 연구)

  • Park, Hyung-Sin;Lim, Cheong-Hwan;Kang, Byung-Sam;You, In-Gyu;Jung, Hong-Ryang
    • Journal of radiological science and technology
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    • v.35 no.4
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    • pp.299-308
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    • 2012
  • To perform patient dose surveys in major interventional radiography procedures as a mean of inter-institutional comparison and of establishing reference dose levels with the ultimate goal of optimizing patient doses in the field of interventional radiography. We reviewed international patient dose survey data in the literature and measured patient dose in major interventional radiography procedures (TACE, AVF, PTBD, TFCA, GDC embolization). ESD(Entrance Skin Dose) was measured using TLD chips attached to the patient skin and ED(Effective Dose) was calculated using angiography unit-derived DAP. A survey of patient dose in interventional radiography procedures were also performed with a questionnaire for interventional radiologists and we proposed a guideline for optimizing patient doses in the field of interventional radiology. The patient dose survey data in interventional radiography procedures were very rare in literature compared with those in diagnostic radiography procedures. In TACE, the mean ED was 25.43 mSv and the mean ESD was 511.75 mGy. The mean ED of TACE was not high, but the cumulative dose should be checked, due to longer procedure TACE. In TFCA, the mean ED was 22.6 mSv and it was relatively high compared with data of other countries. In GDC embolization, the mean ED was not available, because GDC embolization was performed with old Image-Intensifier-type unit and there has no unit-installed ionization chamber. Also, the mean ESD of GDC embolization was up to 2,264 mGy and further studies are needed to calculate the net ED of GDC embolization. Patient dose occurred during interventional radiography procedures are high related with the difficulty of the procedure, fluoroscopy time, the number of angiographies and the treatment protocol. Therefore, continuous education and efforts should be made to optimize the patient dose in the field of interventional radiology.

Comparative evaluation of marginal and internal fit of metal copings fabricated by various CAD/CAM methods (다양한 CAD/CAM 방식으로 제작한 금속하부구조물 간의 변연 및 내면 적합도 비교 연구)

  • Jeong, Seung-Jin;Cho, Hye-Won;Jung, Ji-Hye;Kim, Jeong-Mi;Kim, Yu-Lee
    • The Journal of Korean Academy of Prosthodontics
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    • v.57 no.3
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    • pp.211-218
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    • 2019
  • Purpose: The purpose of the present study was to compare the accuracy of four different metal copings fabricated by CAD/CAM technology and to evaluate clinical effectiveness. Materials and methods: Composite resin tooth of the maxillary central incisor was prepared for a metal ceramic crown and duplicated metal die was fabricated. Then scan the metal die for 12 times to obtain STL files using a confocal microscopy type oral scanner. Metal copings with a thickness of 0.5 mm and a cement space of $50{\mu}m$ were designed on a CAD program. The Co-Cr metal copings were fabricated by the following four methods: Wax pattern milling & Casting (WM), Resin pattern 3D Printing & casting (RP), Milling & Sintering (MS), Selective laser melting (SLM). Silicone replica technique was used to measure marginal and internal discrepancies. The data was statistically analyzed with One-way analysis of variance and appropriate post hoc test (Scheffe test) (${\alpha}=.05$). Results: Mean marginal discrepancy was significantly smaller in the Group WM ($27.66{\pm}9.85{\mu}m$) and Group MS ($28.88{\pm}10.13{\mu}m$) than in the Group RP ($38.09{\pm}11.14{\mu}m$). Mean cervical discrepancy was significantly smaller in the Group MS than in the Group RP. Mean axial discrepancy was significantly smaller in the Group WM and Group MS then in the Group RP and Group SLM. Mean incisal discrepancies was significantly smaller in the Group RP than in all other groups. Conclusion: The marginal and axial discrepancies of the Co-Cr coping fabricated by the Wax pattern milling and Milling/Sintering method were better than those of the other groups. The marginal, cervical and axial fit of Co-Cr copings in all groups are within a clinically acceptable range.

Chemical Composition Characteristics of Dustfall in Nakdong River Area (낙동강 하류역 강하먼지의 화학적 조성 특성)

  • Jeon, Byung-Il;Hwang, Yong-Sik
    • Journal of the Korean earth science society
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    • v.25 no.6
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    • pp.428-442
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    • 2004
  • Dustfall samples were collected by the modified American dust jar (bulk type) at 5 sampling sites in the Nakdong river area from lune 2002 to May 2003. Nineteen chemical species (Al, Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, Si, V, Zn, $Cl^-$, $NO_3^-$, $SO_4^{2-}$, and $NH_4^+$) were analyzed via the combination of ICP/AES, AAS, IC and UV. The purposes of this study were to qualitatively evaluate the chemical composition of dustfalls by examining their regional and seasonal distribution patterns. Computation of the enrichment factor showed that well-defined anthropogenic sources, particularly in Pb were found in the order Gamjeondong (industrial area), Wondong, Silla University, Samrangiin and Mulgum. The seasonal mean of soil contribution showed its highest value (16.3%) during the winter with an annual mean of 11.2%. The concentration ratio of [$SO_4^{2-}/NO_3^-$] was found to be highest (5.12) during the winter, while the lowest ratio value (3.30) was seen during the all. fall, Also regional equivalent ratios of [$SO_4^{2-}/NO_3^-$] were found in the order: Silla University (6.78), Gamjeondong (4.98), Mulgum (3.95), Wondong (3.85), and Samrangjin (2.87). Seasonal distribution of water soluble components for total dustfall were found in the order: spring (71.6%), summer (61.2%), fall (49.2%) and winter (48.6%) with a mean ratio of 57.6%. Regional contribution of sea salts of water soluble ions were found in the order: Silla university (34.5%), Gamjeondong (28.3%), Wondong (17.3%), Samrangiin (17.2%) and Mulgum (13.8%), the total mean contribution rate was 22.1%. As for the chemical composition of dustftll on the lower Nakdong river, there is a decreased influence of sea salt and artificial anthropogenic sources and increased influence of soil particle inland. Also, the total amount of deposition on the lower Nakdong river has decreased, with the river's surface serving as a confounding factor in resuspending dusts.

Estimated Exposure Dose and Usage of Radiological Examination of the National Health Screening (국가건강검진의 방사선검사 이용량 및 피폭선량 추정)

  • Gil, Jong Won;Park, Jong Hyock;Park, Min Hui;Park, Chan Young;Kim, So Young;Shin, Dong Wook;Kim, Won Dong
    • Journal of Radiation Protection and Research
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    • v.39 no.3
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    • pp.142-149
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    • 2014
  • Korea conducts a national health screening program to improve and check-up on public health and in recent years, the screening usage has been increased. Given the increased screening usage for radiographic exams, this study predicts the frequency of using radiographic exams and the exposure dose. This study estimates the usage of radiographic exams by isolating radiographic exams from the 2011 analysis of the national health insurance corporation, and estimates the public exposure dose by applying each procedure's dose table from UNSCEAR 2008. As a result of the analysis, in the 2011 National Health Screening, the average exposure dose per person is assumed to be 0.57 mSv, and depending on the type of screening program from the radiographic exam, an examinee could be exposed to between 0.2 mSv and 11.081 mSv. The frequency of using radiographic exposure was found to be 16,005,914 and the exposure dose was 6,311.76 person-Sv. The most frequent exam is the Chest X-ray, which was performed 1,070,567 (69.17%), and the UGI has the highest exposure dose at 5,217.94 person-Sv (82.67%). The outcome is categorized based on gender and age, excluding those under 39 years old. In all age groups, the screening usage and exposure dose are higher in females than in males. In particular, females between 50 and 54 years old have the highest screening usage (1,674,787, 10.5%) and exposure dose (701.59 person-Sv, 11.1%). As UGI accounts for 82.76% of procedures, except when done for medical purposes, if the government supports a voluntary UGI exam (which includes the UGI exam in the National Screening Program) or abolishes it completely, as seen overseas, the cost-effectiveness and validity of the UGI exam, as well as the exposure dose from the National Screening Program will all decrease significantly.

Effects of Contrast Improvement on High Voltage Rectification Type of X-ray Diagnostic Apparatus (X선 진단장치의 고압정류방식이 대조도 향상에 미치는 영향)

  • Lee, Hoo-Min;Yoon, Joon;Kim, Hyun-Ju
    • Journal of radiological science and technology
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    • v.37 no.3
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    • pp.187-193
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    • 2014
  • The purpose of this study was to analyze the effect on the selectivity on of high-voltage rectification device that measured the performance of the grid, and the contrast improvement ability (K factor) by measuring the scattered radiation content of the transmitted X-rays. The scattered radiation generated when the X-ray flux comes from the diagnostic X-ray generator that passes through an object. Targeting four different rectifications of X-ray generators, the mean value of the tube voltage and the tube current was measured in order to maximize the accuracy of the generating power dose within the same exposure condition. Using fluorescence meter, the content of the scattered rays that are transmitted through the acrylic was measured depending on the grid usage. When grid is not used, the content of the scattered rays was the lowest (34.158%) with the single-phase rectifier, was increased with the inverter rectifier (37.043%) and the three-phase 24-peak rectification method (37.447%). The difference of the scattered radiation content of each device was significant from the lowest 0.404% to the highest 3.289% while using 8:1 grid, the content of the scattered ray was the lowest with the single content of the scattered ray was the lowest with the single-phase rectifier (18.258%), was increased with the rectifier (25.502%) and the 24-peaks rectification (24.217%). Furthermore, there was difference up to content 7.244% to the lowest content 1.285% within three-phase 24-peaks rectification, inverter rectifications, and single-phase rectifier depending on the selectivity of the grid. Drawn from the statistical analysis, there was a similar relationship between the contrast improvement factor and the K factor. As a result, the grid selectivity and the contrast were increased within the single-phase rectifier rather than the constant voltage rectifier.

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.

Impact of Adjuvant Chemoradiation Therapy on the Postoperative 5-year Survival Rates for Stage-II Gastric Cancer (2기 위암환자의 수술 후 보조 항암요법 및 방사선 치료가 생존율에 미치는 영향)

  • Hong, Seong-Kweon;Choi, Min-Gew;Baik, Yong-Hae;Noh, Jae-Hyung;Sohn, Tae-Sung;Kim, Sung
    • Journal of Gastric Cancer
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    • v.5 no.4 s.20
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    • pp.281-287
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    • 2005
  • Purpose: This study was conducted to evaluate the effectiveness and the role of post-operative adjuvant chemoradiation therapy in a stage-II (UICC, 1997) primary gastric cancer. Materials and Methods: From September 1994 to December 2004, 954 stage-II gastric-cancer patients were seen, and all of them underwent a curative resection with extensive (D2) lymph-node dissection. The chemotherapy consisted of fluorouracil $(400mg/m^2)$ plus leucovorin $(20mg/m^2)$ for 5 days, followed by 4,500 cGy of radiotherapy for 5 weeks with fluorourcil and leucovorin on the first 4 days and the last 3 days of radiotherapy. Two five-day cycles of chemotherapy were given four weeks after the completion of radiotherapy. The Kaplan-Meier method was used to estimate the survival rates. To assess the importance of potential prognostic factors, we performed univariate and multivariate analyses using a log-rank test and Cox's proportional hazards regression model. A P value <0.05 was considered significant. Results: Univariate analysis revealed that age, tumor size, gross type, surgical method, and postoperative adjuvant therapy had statistical significance. Among these factors, age, surgical method, tumor size, surgical method, and postoperative adjuvant therapy were found to be independent prognostic factors by using a multivariate analysis. The postoperative adjuvant chemotherapy group and the chemoradiation therapy group had survival benefit compared to the surgery-only group. However the chemoradiation therapy group had no significant survival benefit compared to the chemotherapy group. Conclusion: The postoperative adjuvant therapy in stage-II gastric-cancer patients had significant benefit. Therefore, postoperative adjuvant chemoradiation therapy has an acceptable effect. A large-scale, randomized study is needed to evaluate the effectiveness and the role of postoperative radiation therapy.

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