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Radiation Therapy for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis (간문맥종양혈전증을 동반한 간세포암에서의 방사선 치료)

  • Park, Seung-Gyu;Kim, Jin-Hee;Byun, Sang-Jun;Kim, Ok-Bae;Hwang, Jae-Seok;Oh, Young-Kee;Choi, Tae-Jin
    • Radiation Oncology Journal
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    • v.29 no.1
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    • pp.36-43
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    • 2011
  • Purpose: To evaluate the effectiveness of radiation therapy (RT) for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) and to analyze the prognostic factors. Materials and Methods: From December 2004 to April 2009, 70 patients who had HCC with PVTT were treated with RT at Keimyung University Dongsan Medical Center. Nineteen patients whose total dose was below 30 Gy and one patient who underwent liver transplantation were excluded. The remaining 50 patients (45 males, 5 females; median age 55 years) were analyzed. According to the LCSGJ TNM stage, there were 27 patients (54.0%) with stage III and 23 (46.0%) with stage IV. Total dose of 30~54 Gy was administered (median 45). Thirty patients (60.0%) were treated with concurrent chemoradiation therapy (CCRT). The median follow-up duration was from 13.5 months (range, 3 to 70 months). Results: The median survival time from the start of RT was 9 months. One-year and 2-year overall survival rates were 24.9% and 11.2%, respectively. At the follow-up time, three patients (6.0%) displayed no evidence of disease. Seven patients (14.0%) were alive with disease, and 40 (80.0%) patients had expired due to disease progression. CCRT was associated with worse survival than RT alone (p=0.034), Response to RT (p=0.037), CLIP stage (p=0.017), and TNM stage (p=0.041) were statistically significant prognostic factors. There was no radiation-induced liver disease. Conclusion: RT is an effective and safe modality for HCC with PVTT. Further studies such as prospective randomized trials are needed to confirm the role of RT for HCC with PVTT.

Concurrent Chemoradiotherapy in Locally Advanced Esophageal Cancer (국소적으로 진행된 식도암에서 동시항암화학방사선치료의 결과)

  • Byun, Sang-Jun;Kim, Jin-Hee;Kim, Ok-Bae;Song, Hong-Suk
    • Radiation Oncology Journal
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    • v.29 no.1
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    • pp.20-27
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    • 2011
  • Purpose: This study was designed to evaluate the results of local control, survival rate, prognostic factors, and failure pattern in locally advanced esophageal cancer. Materials and Methods: We retrospectively studied 50 patients with locally advanced esophageal cancer treated with concurrent chemoradiotherapy at Keimyung University Dongsan Medical Center from June of 1999 to August of 2008. Seven patients with inappropriate data were excluded, and 43 patients were analyzed. There were 39 males and four female patients ranging in age from 43 to 78 years (median, 63 years). There were seven patients with stage IIA and 36 with stage III. Irradiation from 46 Gy to 63 Gy (median, 54 Gy) was carried out 5 days per week, 1.8 Gy once a day. There were eight patients with neo-adjuvant chemotherapy, and we mostly used 5-fluorouracil, cisplatin with 3 cycles for concurrent chemotherapy. The range of follow up periods was from 2 to 82 months (median, 15.5). Results: There were nine patients that exhibited a cornplete response, 23 that exhibited a partial response, 9 that exhibited no response, and 2 that exhibited disease progression. The median survival time was 15 months. Two-year and 5-year survival rates were 36.5% and 17.3%, respectively. Two-year and 5-year disease-free survival rates were 32.4% and 16%, respectively. Treatment failure occurred in 22 patients (51.2%). Patterns of failure were categorized as local failure in 18 patients and distant metastasis in four patients. In a univariate analysis for prognostic factors related to overall survival and disease-free survival, the hemoglobin levels during chemoradiotherapy (${\geq}$ 12 vs. <12, p=0.02(p=0.1) and the response to the treatments (CR/PR vs. NR/PD, p=0.002/p< 0.0001) were statistically significant. In a multivariate analysis, only response to the treatments was revealed to be statistically significant. There was no statistical significance associated with patient age, gender, disease stage, T-stage, smoking history, tumor location, or neo-adjuvant chemotherapy. Conclusion: Our survival rate was similar to those of other institutions. Local recurrence was the main reason for failure. It is suggested that further prospective studies should be performed to improve local control.

Intraluminal High-Dose-Rate Brachytherapy for the Tumors of Gastrointestinal Tract (위장관 종양의 고선량율 강내 방사선치료)

  • Choi Byung Ock;Choi Ihl Bhong;Chung Su Mi;Kim In Ah;Choi Myoung Gyu;Chang Suk Kyun;Shinn Kyeong Sub
    • Radiation Oncology Journal
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    • v.13 no.3
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    • pp.243-252
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    • 1995
  • Purpose : Intraluminal high dose rate brachytherapy is an accepted treatment for the tumors of GI tract. However, there is only some limited clinical data for intraluminal high dose rate brachytherapy for the tumors of GI tract. Materials and Methods : Between February 1991 and July 1993, 18 Patients who have the tumors of GI tract (esophageal cancer-8 cases, rectal cancer-10 cases) were treated with high dose rate Iridium-192 afterloading system (Microselectron-HDR, Nucletron CO, Netherland) at the department of therapeutic radiology, St. Mary's hospital, Catholic university medical college. Age range was 47-87 years with a mean a9e 71 years. All patients were treated with intraluminal high dose rate brachytherapy within two weeks after conventional external radiation therapy and received 3-5 Gy/fraction 3-4 times per week to a total dose 12-20 Gy (mean 17 Gy). Standard fractionation and conventional dose were delivered for external radiation therapy. Total dose of external radiation therapy ranged 41.4-59.4 Gy (mean 49.6 Gy). Median follow up was 19 months Results : The analysis was based on 18 patients, The complete response and partial response in esophageal cancer was similar (38%). Two year rates for survival and median survival were 13% and 10 months, respectively. Among 10 patients of rectal cancers, partial response was obtained in 6 patients (60%). There was no complete response in the patients with rectal cancer, but good palliative results were achieved in all patients. Conclusion : Although the number of patients was not large and the follow-up period was relatively short, these findings suggested that intraluminal high dose rate brachytherapy could be useful in the treatment of the patients with advanced tumors of GI tract.

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Comparison of the Diagnostic Performance of $^{14}C$-urea Breath Test According to Counting Method for the Diagnosis of Helicobacter pylori Infection (Helicobacter pylori 감염 진단 시 $^{14}C$-요소호기검사의 계수측정 방법에 따른 진단성능 비교)

  • Kim, Min-Woo;Lim, Seok-Tae;Lee, Seung-Ok;Sohn, Myung-Hee
    • The Korean Journal of Nuclear Medicine
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    • v.39 no.1
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    • pp.21-25
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    • 2005
  • Purpose: $^{14}C$-urea breath test (UBT) is a non-invasive and reliable method for the diagnosis of Helicobacter pylori (HP) infection. In this study, we evaluated the diagnostic performance of a new and rapid $^{14}C$-UBT (Heliprobe method), which was equipped with $Geiger-M\ddot{u}ller$ counter and compared the results with those obtained by using the conventional method. Materials and Methods: Forty-nine patients with dyspepsia underwent gastroduodenoscopy and $^{14}C$-UBT. A 37 KBq $^{14}C$-urea capsule was administered to patients and breath samples were collected. In Heliprobe method, patients exhaled into a Hellprobe BreathCard for 10 min. And then the activities of the BreathCard were countered using Heliprobe analyzer. In the conventional method, results were countered using liquid scintillation counter. During gastroduodenoscopy, 18 of 49 patients were underwent biopsies. According to these histologic results, we evaluated the diagnostic performance of two different methods and compared them. Also we evaluated the concordant and disconcordant rates between them. Results: In all 49 patients, concordant rate of both conventional and Heliprobe methods was 98% (48/49) and the discordant rate was 2% (1/49). Thirteen of 18 patients to whom biopsies were applied, were found to be HP positive on histologic results. And both Heliprobe method and conventional method classified 13 of 13 HP-positive patients and 5 of 5 HP-negative patients correctly (sensitivity 100%, specificity 100%, accuracy 100%). Conclusion: The Heliprobe method demonstrated the same diagnostic performance compared with the conventional method and was a simpler and more rapid technique.

The efficacy of Quantitative Analysis of Basal/Acetazolamide SPECT Using SPM and Statistical Probabilistic Brain Atlas in Patients with Internal Carotid Artery Stenosis (뇌혈관 협착 환자에서 SPM과 확률뇌지도를 이용한 기저/아세타졸아미드 SPECT의 정량적 분석법의 유용성)

  • Lee, Ho-Young;Lee, Dong-Soo;Paeng, Jin-Chul;Oh, Chang-Wan;Cho, Maeng-Jae;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.6
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    • pp.357-367
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    • 2002
  • Purpose: While cerebral blood flow and cerebrovascular reserve could be evaluated with basal/acetazolamide Tc-99m-HMPAO SPECT in cerebrovascular disease, objective quantification is necessary to assess the efficacy of the revascularization. In this study we adopted the SPM method to quantify basal cerebral blood flow and cerebrovascular reserve on basal/acetazolamide SPECT in assessment of the patients who underwent bypass surgery for linternal carotid artery (ICA) stenosis. Materials and Methods: Twelve patients ($51{\pm}15$ years) with ICA stenosis were enrolled. Tc-99m-HMPAO basal/acetazolamide perfusion SPECT was peformed before and after bypass surgery. After spatia1 and count normalization to cerebellum, basal cerebral blood flow and cerebrovascular reserve were compared with 21 age-matched normal controls and postoperative changes of regional blood flow and reserve were assessed by Statistical Parametric Mapping method. Mean pixel values of each brain region were calculated using probabilistic anatomical map of lobes. Perfusion reserve was defined as the % changes after acetazolamide over basal counts. Results: Preoperative cerebral blood flow and cerebrovascular reserve were significantly decreased in involved ICA territory, comparing with normal control (p<0.05). Postoperative improvement of cerebral blood flow and cerebrovascular reserve was observed in grafted ICA territories, but cerebrovasculr reserve remained with significant difference with normal control. Improvement of the cerebrovascular reserve was most prominent in the superior temporal and the angular gyrus, nearest to the anastomosis sites. Conclusion: Using SPM quantification method on hasal/acetazolamide Tc-99m-HMPAO SPECT, the cerebral blood flow and cerebrovascular reserve could be assessed before revascularization and so could the efficacy of the bypass surgery.

The Role of Tc-99m HMPAO Brain Perfusion SPECT in the Psychiatric Disability Evaluation of Patients with Chronic Traumatic Brain Injury (만성 외상성 뇌 손상 환자의 정신의학적 후유 장애 평가에서 Tc-99m HMPAO 뇌혈류 SPECT의 역할)

  • So, Young;Lee, Kang-Wook;Lee, Sun-Woo;Ghi, Ick-Sung;Song, Chang-June
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.4
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    • pp.232-243
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    • 2002
  • Purpose: We studied whether brain perfusion SPECT is useful in the psychiatric disability evaluation of patients with chronic traumatic brain injury (TBI). Materials and Methods: Sixty-nine patients (M:F=58:11, age $39{\pm}14$ years) who underwent Tc-99m HMPAO brain SPECT, brain MRI and neuropsychological (NP) tests during hospitalization in psychiatric wards for the psychiatric disability evaluation were included; the severity of injury was mild in 31, moderate in 17 and severe in 21. SPECT, MRI, NP tests were peformed $6{\sim}61$ months (mean 23 months) post-injury. Diagnostic accuracy of SPECT and MRI to show hypoperfusion or abnormal signal intensity in patients with cognitive impairment represented by NP test results were compared. Results: Forty-two patients were considered to have cognitive impairment on NP tests and 27 not. Brain SPECT showed 71% sensitivity and 85% specificity, while brain MRI showed 62% sensitivity and 93% specificity (p>0.05, McNemar test). SPECT found more cortical lesions and MRI was superior in detecting white matter lesions. Sensitivity and specificity of 31 mild TBI patients were 45%, 90% for SPECT and 27%, 100% for MRI (p>0.05, McNemar test). Among 41 patients with normal brain MRI, SPECT showed 63% sensitivity (50% for mild TBI) and 88% specificity (85% for malingerers). Conclusion: Brain SPECT has a supplementary role to neuropsychological tests in the psychiatric disability evaluation of chronic TBI patients by detecting more cortical lesions than MRI.

An Assessment of the Utility of Respiratory Synchronized Systems in the PET/CT Examination (PET-CT 검사 시 호흡 동조 시스템들의 유용성 평가)

  • Seong, Yong-Jun;Yoon, Seok-Hwan;Hyun, Jun-Ho;Lee, Hong-jae;Kim, Jin-Eui
    • The Korean Journal of Nuclear Medicine Technology
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    • v.21 no.1
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    • pp.34-38
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    • 2017
  • Purpose During PET/CT examinations, the movements of internal organs caused by respiration are captured in images during multiple breathing cycles, resulting in the increases in tumor size and effects on SUV. Respiratory synchronized systems were used to evaluate tumor sizes and SUV changes. Materials and Methods Biograph mCT 64 was used for the equipment, and RPM and Anzai systems were used for the respiratory synchronized systems. We used point source and micro-phantom for an experimentation. We were performed on 12 patients who had solid tumors discovered at the base of the lung or at the top of the liver from August through September 2016. The PET images of the exhalation-to-breathing state and the CT images of the post-exhalation suspension state were gained to evaluate changes in radioactivity concentration (KBq/mL), SUVmax, cylinder diameter (mm), and tumor diameter (cm) under the conventional Static, RPM, and Anzai methods. Results The result of measuring the radioactivity concentration of the point source was RPM 94% and Anzai 91% against Static, respectively. In the two cylinders of different radioactivity in the micro-phantom, the SUVmax increased to RPM 61% and 78%, and Anzai 58% and 77% against Static, whereas the cylinder diameters decreased by RPM -26% and -28%, and Anzai -28% and -26%, each respectively. Among the patients, the SUVmax increased from a minimum of RPM 8.2% to a maximum of 94.4% against Static, and from a minimum of Anzai 7.6% to a maximum of 68.3%, respectively. As for the tumor diameters, a minimum of RPM -7.6% to a maximum of -28.9% were achieved, while the Anzai fell by a minimum of -9.6% to a maximum of -27.7%, respectively. There was no significant difference discovered in the phantom study between the RPM and Anzai, yet there was a meaningful difference in the patients' tumors (P<0.05). Conclusion The respiratory synchronized systems of RPM and Anzai yielded no significant difference in the phantom study in which the respiration was executed at regular intervals. However, it was discovered that the patients had a meaningful difference for the irregular respiratory cycle and inter-system differences. Still, the respiratory synchronized systems would be useful for the accurate diagnosis and SUV measurement as the tumor decreased in size against the existing Static and the SUV increased.

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The evaluation of color and color difference according to the layering placement of Incisal shade composites on the body composites of the indirect resin restoration (간접 수복용 복합레진의 Incisal 색상 적층 두께에 따른 표면 색상 및 색차의 평가)

  • Park, Su-Jung;Lee, Han-Young;Nah, Myong-Yun;Chang, Hoon-Sang;Hwang, Yun-Chan;Oh, Won-Mann;Hwang, In-Nam
    • Restorative Dentistry and Endodontics
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    • v.36 no.1
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    • pp.37-49
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    • 2011
  • Objectives: The aim of this study was to evaluate the surface color of indirect resin restoration according to the layering placement of different shade of incisal composite. Materials and Methods: In this study, CIE $L^*a^*b^*$ value of 16 Body composite of Tescera ATL (Bisco, Schaumburg IL,USA) was measured by spectrophotometer (NF999, Nippon Denshuku, Japan), and compared to CIE $L^*a^*b^*$ value of Vitapan shade guide. Nine shade Incisal composite of Tescera ATL were buildup to 1 mm thickness on Body composites inlay block, and CIE $L^*a^*b^*$ value was measured. Incisal composite was ground to 0.5 mm thickness and CIE $L^*a^*b^*$ value was re-measured. Color difference between Body composite and Incisal composites layered on Body composite was calculated as a function of thickness. Results: Color difference between corresponding shade of Tescera Body composite and Vitapan shade guide was from 6.88 to 12.80. $L^*$ and $b^*$ value was decreased as layering thickness of Incisal composite on Body composite was increased. But, $a^*$ value did not show specific change tendency. Conclusions: Surface color difference between Body composites and Incisal composites layered on Body composite was increased as the layering thickness of Incisal composite increased (p < 0.05).

Effect of the Flavonoid Luteolin for Dextran Sodium Sulfate-induced Colitis in NF-${\kappa}B^{EGFP}$ Transgenic Mice (Dextran Sodium Sulfate 유발 장염 모델에서 루테올린의 치료효과)

  • Jang, Byung-Ik
    • Journal of Yeungnam Medical Science
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    • v.23 no.1
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    • pp.26-35
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    • 2006
  • Background: Luteolin, a flavone found in various Chinese herbal medicines is known to possess anti-inflammatory properties through its ability to inhibit various proinflammatory signaling pathways including NF-${\kappa}B$ and p38 MAPK. In this study, we investigated the potential therapeutic effect of luteolin on dextran sodium sulfate (DSS)-induced colitis. Materials and Methods: We used a transgenic mouse model expressing the enhanced green fluorescent protein (EGFP) under the transcriptional control of NF-${\kappa}B$ $cis$-elements. C57BL/6 NF-${\kappa}B^{EGFP}$ mice received 2.5% DSS in their drinking water for six days in combination with daily luteolin administration (1mg/kg body weight, 0.1ml vol, intragastric) or vehicle. NF-${\kappa}B$ activity was assessed macroscopically with a Charge-Coupled Device (CCD) camera and microscopically by confocal analysis. Results: A significant increase in the Disease Activity Index (DAI), histological score (p<0.05), IL-12 p40 secretion in colonic stripe culture (p<0.05) and EGFP expression was observed in luteolin and/or DSS-treated mice compared to water-treated mice. Interestingly, a trend toward a worse colitis (DAI, IL-12p40) was observed in luteolin-treated mice compared to non-treated DSS-exposed mice. In addition, EGFP expression (NF-${\kappa}B$ activity) strongly increased in the luteolin-treated mice compared to control mice. Confocal microscopy showed that EGFP positive cells were primarily lamina propria immune cells. Conclusions: These results suggest that luteolin is not a therapeutic alternative for intestinal inflammatory disorders derived for primary defects in barrier function. Thus, therapeutic intervention targeting these signaling pathways should be viewed with caution.

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The Way of Connecting to Tradition through Content (콘텐츠를 통해 전통을 잇는 방식 - 단원미술관 전시사례를 중심으로)

  • Kim, Sangmi
    • Trans-
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    • v.9
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    • pp.17-36
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    • 2020
  • This study is aimed at discussing the possibility of content production, utilization and expansion, focusing on the exhibition case of Danwon Art Museum run by Ansan Cultural Foundation. In 1991, the Ministry of Culture, Sports and Tourism named Ansan as the City of Danwon since it is believed to be the hometown of Danwon Kim Hong-do (1745~?), a painter of the late Joseon Dynasty and a well-known master of genre painting. As a result, Ansan is making various efforts to utilize Danwon Kim Hong-do for its unique resource through internal and external business such as the creation of Danwon Sculpture Park, the operation of Danwon Art Museum, and the planning of Danwon Kim Hong-do Festival. However, the biggest problem with Ansan is that there are not many collections of Kim Hong-do. Ansan has owned a total of six works as of May this year: a deer and a boy, flowers and a bird, A view of clouds on the water, Daegwallyeong, Yeodongbin, A way to Singwangsa. Accordingly, Danwon Contents Center has set up a vision to systematically collect, preserve, and display various visual and artistic materials related to Kim Hong-do, offering high-quality information based on digital data. In other words, it is a complex cultural information agency of One-Source Multi-Use, which combines the functions of libraries, archives and art galleries so that visitors' desire is satisfied. It reflects the contemporary trend of overcoming the limitations of the ancient paintings and satisfying the role and function of the art museum. From the opening of the Danwon Contents Hall, the original work of Kim Hong-do has been interpreted and produced as media contents or recreated as a new form of art by modern artists. Exhibition using technologies such as touch screen and 'deep zoom' helps visitors to heighten their experience of the archives and get inside the world of the genius painter.

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