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Preliminary Results of Concurrent Radiation Therapy and Chemotherapy in Locally Advanced Cervical Carcinoma (국소적으로 진행된 자궁 경부암에서 방사선과 항암화학요법 병행치료의 예비적 결과)

  • Yang KM;Ahn SD;Choi EK;Chang HS;Kim YT;Nam JH;Mok JE
    • Radiation Oncology Journal
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    • v.11 no.2
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    • pp.355-361
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    • 1993
  • Since May 1991, authors have conducted a pilot study to determine the feasibility and evaluate the effect of concurrent radiation therapy and chemotherapy with 5-FU and Cis-platinum for locally advanced cervical cancer (stage IIB-IVA). Radiation therapy consisted of external irradiation to whole pelvis (4140 cGy/23 fx) in 4.5 weeks followed by high dose rate intracavitary radiation therapy (HDR ICRT) to deliver a dose of 30 to 35 Gy to A point in 6 to 7 fractions. After the intracavitary radiation therapy, parametrial boost was delivered for B point dose of 60 Gy in Stage IIB and 65 Gy in stage IIIB. 5-FU (1000 $mg/m^2/24hr$ for 96 hour iv infusion) and Cis-platinum (20 $mg/m^2/day$ IV bolus for 3 days) were given during the second week of external RT and the second course chemotherapy administered at the first HDR ICRT with the same method as the first chemotherapy. Sixteen patients (10 stage IIB,4 stage IIIB,2 stage IVA) were registered to this protocol. Among these 16 patients, two refused treatment after 2 fractions of external irradiation, and one could not continue intracavitary irradiation because of treatment related genitourinary toxicity. So 14 patients were evaluated for toxicity and 13 patients were evaluated for response analysis. Five of 14 patients developed grade 3 gastrointestinal toxicity but 4 of them recovered at the completion of treatment. One stage IIIB patient with inguinal lymph node metastasis who received higher dose of radiation in spite of initial poor performance status did not recover from gastrointestinal toxicity at the completion of treatment. And she died of distant metastasis at one month after the completion of treatment. Two of 14 evaluable patients showed weight loss, more than $10\%$ of initial weight. One patient developed grade 3 leukopenia. In this study, the average total treatment period of completely treated patients was 75 days and three of them took more than 80 days (84, 84, 89 days). Toxicities were generally acceptable and there were no treatment related death. At the last follow-up, complete response was achieved in $62\%(8/13)$ and especially of nine patients with stage IIB, eight patients showed complete response. This study suggests that concurrent radiation therapy and chemotherapy (5-FU and Cis-platinum) is tolerable and effective. Further follow-up is needed to determine whether this protocol will have a favorable impact on survival and to evaluate the late effect on normal tissues. In future, prospective randomized trials are needed to compare the standard radiation therapy alone with concurrent chemotherapy and radiation therapy for locally advanced cervical carcinoma.

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The Clinical Comparision of Amrinone and Dopamine after Open Heart Surgery (개심술후 암리논과 도파민의 효과에 대한 임상 비교)

  • 이성호;이현재
    • Journal of Chest Surgery
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    • v.29 no.2
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    • pp.191-198
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    • 1996
  • Amrinone is a non-glycosidic, non-adrenergic positive inotropic agent with peripheral and coronary vasodilator effect. It inhibits phosphodiesterase F-III, the cardiac cyclic-AMP specific phosphodiesterase, selectively and potently. In this study, the effects of IV administered amrinone and dopamine were compared in 40 patients who had open heart surgery. Amrinone was administered as a bolus of 1 5~2mglkg for several minutes, followed by continuous infusion at 5~1 Oug/kg/min. The hemodynamic measurements including heart rate, systolic and diastolic pressure, cardiac index, pulmonary wedge pressure, and systemic vascular resistance were recorded immediately for 12~24 hours awl 7th day following operation. In amrinone group, cardiac index increased from 3.73$\pm$1.39 L/min/m2 to 5.44$\pm$2.65 L/min/m2 at the time of posterative 48 hours (n=20, p< 0.05). The decrease in systemic vascular resistance from 1237.5 $\pm$ 637.7 dyne/sec/cm2 to 1000.8 $\pm$ 608.5 dyne/sec/cm2(p<0.05). In Dopamine group, the heart rate increased from 92.1 $\pm$ 13.0/min to 101.0 $\pm$ 13.1/min and the cardiac index decreased from 3.40 $\pm$ 0.50 L/min/m2 to 2.53 $\pm$ 1.15 L/min/m2 at the time of postoperative 12 hours(p<0.05). Systemic vascular resistance increased from 1058.5 $\pm$ 234.6 dyne/sec/cm2 to 1979.7 $\pm$ 759.2 dynelsec/cm2 The comparison of the hemodynamic effects of amrinone and dopamine, both drugs improved cardiac performance. But the administration of amrinone results in a higher cardiac index, diastolic blood pressure and lower systemic vascular resistance than those achieved with dopamine (p<0.05). The uniqueness of the action of amrinone on the heart and its sustained hemodynamic effect suggest it has clinical promise, pos operative care of cardiac surgery

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Postoperative Adjuvant Chemoradiotherapy in Rectal Cancer (직장암의 근치적 수술 후 보조 화학방사선요법)

  • Chang, Sei-Kyung;Kim, Jong-Woo;Oh, Do-Yeun;Chong, So-Young;Shin, Hyun-Soo
    • Radiation Oncology Journal
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    • v.24 no.3
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    • pp.157-163
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    • 2006
  • [ $\underline{Purpose}$ ]: To evaluate the role of postoperative adjuvant chemoradiotherapy in rectal cancer, we retrospectively analyzed the treatment outcome of patients with rectal cancer taken curative surgical resection and postoperative adjuvant chemoradiotherapy. $\underline{Materials\;and\;Methods}$: A total 46 patients with AJCC stage II and III carcinoma of rectum were treated with curative surgical resection and postoperative adjuvant chemoradiotherapy. T3 and T4 stage were 38 and 8 patients, respectively. N0, N1, and N2 stage were 12, 16, 18 patients, respectively. Forty patients received bolus infusions of 5-fluorouracil ($500\;mg/m^2/day$) with leucovorin ($20\;mg/m^2/day$), every 4 weeks interval for 6 cycles. Oral Uracil/Tegafur on a daily basis for $6{\sim}12$ months was given in 6 patients. Radiotherapy with 45 Gy was delivered to the surgical bed and regional pelvic lymph node area, followed by $5.4{\sim}9\;Gy$ boost to the surgical bed. The follow up period ranged from 8 to 75 months with a median 35 months. $\underline{Results}$: Treatment failure occurred in 17 patients (37%). Locoregional failure occurred in 4 patients (8.7%) and distant failure in 16 patients (34.8%). There was no local failure only. Five year actuarial overall survival (OS) was 51.5% and relapse free survival (RFS) was 58.7%. The OS and RFS were 100%, 100% in stage N0 patients, 53.7%, 47.6% in N1 patients, and 0%, 41.2% in N2 patients (p=0.012, p=0.009). The RFS was 55%, 78.5%, and 31.2% in upper, middle, and lower rectal cancer patients, respectively (p=0.006). Multivariate analysis showed that N stage (p=0.012) was significant prognostic factor for OS and that N stage (p=0.001) and location of tumor (p=0.006) were for RFS. Bowel complications requiring surgery occurred in 3 patients. $\underline{Conclusion}$: Postoperative adjuvant chemoradiotherapy was an effective modality for locoregional control of rectal cancer. But further investigations for reducing the distant failure rate are necessary because distant failure rate is still high.

A Comparison of Herbage Use, Grazing and Social Behaviour by Livestock Grazing under Grassland Types (초지류형별(草地類型別) 방목축(放牧畜)에 의한 목초이용(牧草利用)과 방목(放牧) 및 사회습성(社會習性) 비교(比較))

  • Lee, In Duk;Myoung, Jeon;Seong, Woo Suk;Raim, Dong Chan
    • Korean Journal of Agricultural Science
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    • v.13 no.2
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    • pp.219-226
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    • 1986
  • A study was conducted to provide direct comparisons of the effect of variations in herbage use, grazing and social behaviour upon the flat, slope and forest grassland with a total 30 Korean Native Cattle and 5 Korean Native Goats under 4-year old grassland established by intensive sowing method in Daecheon. The results obtained are summarized as follows; 1. Relative intake index, dry matter intake per animal and dry matter digestibility by Korean Native Goats in flat, slope and forest grassland were 35.2%-462g-63.7%, 35.0%-459g-63.0% and 29.8%-391g-62.1%, respectively. 2. Grazing time by Korean Native Cattle was not different among the grassland types, but ruminating time was increased in slope grassland, whereas in forest grassland was decreased. Resting time was increased in forest grassland, whereas in slope grassland was decreased. Walking time was increased in flat grassland, but loafing time was increased in forest grassland. The number of rumination, chews per bolus and defecation number were decreased in forest grassland. The number of drinks, total drinking water and walking distance were increased in slope grassland. 3. Animal distance, occupied area per animal and sub group formation by Korean Native Cattle in flat, slope and forest grassland were $3.4m-11.9m^2-3.6head$, $3.56m-11.0m^2-3.7head$ and $3.70m-14.6m^2-3.4head$, respectively. The order of grazing movement was similar to the pear-shaped grazing formation, but the relations of dominance between first grazer and last grazer upon different grassland types was not clear.

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Cardiopulmonary Effects of Enflurane Combined with Propofol in Dogs (개에서 Enflurane과 Propofol의 병용이 심폐기능에 미치는 영향)

  • Chae, Hyung-gyu;Jang, Kwang-ho;Jang, In-ho
    • Journal of Veterinary Clinics
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    • v.18 no.3
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    • pp.249-256
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    • 2001
  • This study was performed to evaluate cardiopulmonary depressant effects of enflurane (1.0 vol%) combined with propofol(0.25 mg/kg/min) compared with enflurane inhalation, and propofol infusion, respectively, in 18 healthy dogs premedicated with acepromazine and atropine. After bolus injection of propofol 5 mg/kg for induction and tracheal intubation, they were randomly assigned to 3 groups: propofol 0.5 mg/kg/min infusion (Group I, n=6), enflurane 2.5 vol% (Group II, n=6) and enflurane 1.0 vol% combined with propofol 0.25 mg/kg/min (Group III, n=6). Mean arterial Pressure (MAP), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were depressed significantly in all groups, especially in Group II. MAP, SAP and DAP values of Group IIIwere higher than those of Group II, but lower than those of Group I. The changes of PaO$_2$, Pa$CO_2$and pHa were similar in all groups. Respiration rates were decreased in all groups 5 minutes after induction but maintained in normal range. Those of Group I were less depressant than those of Group II and Group III. Concentrations of $Na^+ and Cl^-$ were increased and those of $K^+$ were decreased in all groups, but their values were quitely similar. Heart rate was changed in small range and the value of Group I was higher than those of Group II and Group III. Body temperature was decreased significantly in all groups. Adverse effects like as muscle rigidity, nausea or vomiting and shivering were not appeared and apnea at induction was occured 6 dogs. From the these results, enflurane 1.0 vol% combined with propofol 0.25 mg/kg/min also could be applied for anesthesia in dogs.

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Effect of gender on the pharmacokinetics and metabolite formation of sulfamethazine in the rabbit (토끼의 성차가 sulfamethazine의 약동학 및 대사산물 생성에 미치는 영향)

  • Yun, Hyo-in;Park, Il-hyun
    • Korean Journal of Veterinary Research
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    • v.32 no.1
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    • pp.35-39
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    • 1992
  • SMZ is one of the most widely used antibacterial agents in veterinary medicine. It is also used as a growth promotant in many species of domestic animals There are marked species differences in its metabolism and pharmacokinetics. However, its pharmacokinetic and metabolism in rabbits. which are ragarded not only as good laboratorty animals hut also as good economical animals in its own, are lacking. Sex-differences in drug metabolism are well recognized in wide range of animal species including rats. Males are known to he more active than females. It is also know that there are Significant differences in the direction of metabolic pathways. But recently, female goats are reported to be more active in the metabolie capacity of SMZ than the other sex by Dutch researchers at Utrecht. Therefore, it is not easy to make general conclusicn of having higher SMZ metal-die capacity in the male compared to the opposite sex in every animal species. In this regard, the study on metabolic pattern of SMZ in rabbits, which are regarded as hervivorous, is of interest because the dietary habbits of rabbit are comparable to thai of goal, NEW Zealand White rabbits of each sex were given SMZ(35mg/kg) as a bolus injection into the marginalean, vein in order to study its pharmacokinetic profiles(using plasma) anc metabolic pattem(24h urine) as specified in the methods anc materials. 1. In the rabbit, the major metabolic pathway of SMZ was the acetylation(the formation of $N_4AcSMZ$). There were hydroxylation pathways(50HSMZ, $6CH_2OHSMZ$) as well, in the metabolism of SMZ in the rabbit, but minor pathways. 2. No sex differences in the metabolic direction of SMZ and its metabolites formation were found from the urinary excreted metabolites of SMZ out of 24h collected urine. 3. The concentration-time curves of SMZ(35mg/kg, iv) in the plasma compartment were fitted to a one-compartment open model when using a computer program(NONLIN). There was also no difference in the pharmacokinetic pattem of SMZ between two sexes. 4. The emergence of $N_4AcSMZ$ metabolized from SMZ was very fast in the plasma of the rabbit The elimination of $N_4AcSMZ$ was prolonged as compared to that of the parent drug Vie found no sex difference in the elimination pattern of $N_4AcSMZ$ in the rabbit.

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A Study on the Nutritional Assessment and the Effects of Enteral Nutritional Supports of Tube Feeding In-patients (경관급식 중인 입원환자의 영양상태 평가와 영양 보충제 투여의 영향에 관한 연구)

  • 윤숙영;김성미
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.25 no.5
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    • pp.855-864
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    • 1996
  • The purpose of this study is to evaluate nutritional status of tube feeding patients, and to investigate the effects of giving enteral nutritional support to them. 83 in-patients have been examined for their nutritional status. The mean caloric density was 0.77kca1/m1. 36.1% to 75.9% of them were malnourished in terms of biochemical assessment. The energy intake showed the significant and positive correlation in all biochemical parameters. And the protein intake showed the significant and positive correlation in total protein, serum albumin, serum iron, hemoglobin, hematocrit and TLC. But age was correlated negatively to serum albumin and transferrin. The amount of energy and protein intake has been significantly increased as the tube feeding duration became longer. Also the effect of enteral nutritional support for 6 weeks has been investigated. Case group(n=8) was administered 250kca1 of polymeric formula in addition to their usual diet, while control group(n=8) kept the amount of their original intake. When comparing the biochemical changes of the case group and those of control group at week 0 and week 6 respectively, it showed significant differences in total protein, serum transferrin and TLC. This study suggests that the malnourished status of tube feeding patients can be improved and even prevented if nutritional support is properly administered.

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Clinical Utility of Turbo Contrase-Enhanced MR Angiography for the Major Branches of the Aortic Arch (대동맥궁 주요 분지들의 고속 조영증강 자기공명혈관조영술의 임상적 유용성)

  • Su Ok Seong
    • Investigative Magnetic Resonance Imaging
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    • v.2 no.1
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    • pp.96-103
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    • 1998
  • Purpose : To assess the clinical utility of turbo contrast-enhanced magnetic resonance angiography(CE MRA) in the evaluation of the aortic arch and its major branches and to compare the image quality of CE MRA among different coils used. Materials and Methods : Turbo three-phase dynamic CE MRA encompassing aortic arch and its major branches was prospectively performed after manual bolus IV injection of contrast material in 29 patients with suspected cerebrovascular diseases at 1.0T MR unit. the raw data were obtained with 3-D FISH sequence (TR 5.4ms, TE 2.3ms, flip angle 30, slab thickness 80nm, effective slice thickness 4.0mm, matrix size $100{\times}256$, FOV 280mm). Total data acquisition time was 4. to 60 seconds. We subjectively evaluated the imge quality with three-rating scheme : "good" for unequivocal normal finding, "fair" for relatively satisfactory quality to diagnose 'normal' despite intravascular low signal, and "poor" for equivocal diagnosis or non-visualization of the origin or segment of the vessels due to low signal or artifacts which needs catheter angiography. At the level of the carotid bifurcation, it was compared with conventional 2D-TOF MRA image. Overall image quality was also compared visually and quantitatively by measuring signal-to-noise ratios (SNRs) of the ascending aorta, the innominate artery and both common carotid arteries among the three different coils used(CP body array(n=12), CP neck array(n=9), and head-and-neck(n=8). Results : Demonstration of the aortic arch and its major branches was rated as "good" in 55% (16/29) and "fair" in 34%(10/29). At the level of the carotid bifurcation, image quality of turbo CE MRA was same as or better than conventional 2D-TOF MRA in 65% (17/26). Overall image quality and SNR were significantlygreater with CP body array coil than with CP neck array or head-and-neck coil. Conclusions : Turbo CE MRA can be used as a screening exam in the evaluation of the major branches of the aortic arch from their origin to the skull base. Overall imagequality appears to be better with CP body array coil than with CP neck array coil or head-and-neck coil.

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The Correlations of Parameters Using Contrast Enhanced Ultrasonography in the Evaluation of Prostate Cancer Angiogenesis (전립선암쥐모형의 신생혈관생성의 평가를 위해 시행된 역동적 조영 증강 초음파에서 얻은 변수간의 상관성연구)

  • Hwang, Sung Il;Lee, Hak Jong;Kim, Kil Joong;Chung, Jin-haeng;Jung, Hyun Sook;Jeon, Jong June
    • Ultrasonography
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    • v.32 no.2
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    • pp.132-142
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    • 2013
  • Purpose: The purpose of this study is to investigate the correlations of various kinetic parameters derived from the time intensity curve in a xenograft mouse model injected with a prostate cancer model (PC-3 and LNCaP) using an ultrasound contrast agent with histopathologic parameters. Materials and Methods: Twenty nude mice were injected with human prostate cancer cells (15 PC-3 and five LNCaP) on their hind limbs. A bolus of $500{\mu}L$ ($1{\times}10^8$ microbubbles) of second-generation US contrast agent (SonoVue) was injected into the retroorbital vein. The region of interest was drawn over the entire tumor. The time intensity curve was acquired and then fitted to a gamma variate function. The maximal intensity (A), time to peak (Tp), maximal wash-in rate (washin), washout rate (washout), area under the curve up to 50 sec ($AUC_{50}$), area under the ascending slope ($AUC_{in}$), and area under the descending slope ($AUC_{out}$) were derived from the parameters of the gamma variate fit. Immunohistochemical staining for VEGF and CD31 was performed. Tumor volume, the area percentage of VEGF stained in a field, and the count of CD31 (microvessel density, MVD) positive vessels showed correlation with the parameters from the time intensity curve. Results: No significant differences were observed between the kinetic and histopathological parameters from each group. MVD showed positive correlation with A (r=0.625, p=0.003), washin (r=0.462, p=0.040), $AUC_{50}$ (r=0.604, p=0.005), and $AUC_{out}$ (r=0.587, p=0.007). Positive correlations were also observed between tumor volume and $AUC_{50}$ (r=0.481, p=0.032), washin (r=0.662, p=0.001), and $AUC_{out}$ (r=0.547, p=0.012). Washout showed negative correlations with MVD (r=-0.454, p=0.044) and tumor volume (r=-0.464, p=0.039). The area percentage of VEGF did not show any correlation with calculated data from the curve. Conclusion: MVD showed correlations with several of the kinetic parameters. CEUS has the potential for prediction of tumor vascularity in a prostate cancer animal model.

An Optimization Method of Measuring Heart Position in Dynamic Myocardial Perfusion SPECT with a CZT-based camera (동적 심근관류 SPECT에서 심장의 위치 측정방법에 대한 고찰)

  • Seong, Ji Hye;Lee, Dong Hun;Kim, Eun Hye;Jung, Woo Young
    • The Korean Journal of Nuclear Medicine Technology
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    • v.23 no.1
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    • pp.75-79
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    • 2019
  • Purpose Cadmium-zinc-telluride (CZT) camera with semiconductor detector is capable of dynamic myocardial perfusion SPECT for coronary flow reserve (CFR). Image acquisition with the heart positioned within 2 cm in the center of the quality field of view (QFOV) is recommended because the CZT detector based on focused multi-pinhole collimators and is stationary gantry without rotation. The aim of this study was to investigate the optimal method for measuring position of the heart within the center of the QFOV when performing dynamic myocardial perfusion SPECT with the Discovery NM 530c camera. Materials and Methods From June to September 2018, 45 patients were subject to dynamic myocardial perfusion SPECT with D530c. For accurate heart positioning, the patient's heart was scanned with a mobile ultrasound and marked at the top of the probe where the mitral valve (MV) was visible in the parasternal long-axis view (PLAX). And, the marked point on the patient's body matched with the reference point indicated CZT detector in dynamic stress. The heart was positioned to be in the center of the QFOV in rest. The coordinates of dynamic stress and rest were compared statistically. Results The coordinates of the dynamic stress using mobile ultrasound and those taken of the rest were recorded for comparative analysis with regard to the position of the couch and analyzed. There were no statistically significant differences in the coordinates of Table in & out, Table up & down, and Detector in & out (P > 0.05). The difference in distance between the 2 groups was measured at $0.25{\pm}1.00$, $0.24{\pm}0.96$ and $0.25{\pm}0.82cm$ respectively, with no difference greater than 2 cm in all categories. Conclusion The position of the heart taken using mobile ultrasound did not differ significantly from that of the center of the QFOV. Therefore, The use of mobile ultrasound in dynamic stress will help to select the correct position of the heart, which will be effective in clinical diagnosis by minimizing the image quality improvement and the patient's exposure to radiation.