• 제목/요약/키워드: local control

검색결과 3,855건 처리시간 0.038초

서울시 간호사회 가정간호시범사업 서비스 내용 및 만족도 분석 (The Contents and Satisfation of Home Care Progral Delivered by Seoul Nurses Association)

  • 임난영;김금순;김영임;김귀분;김시현;박호란
    • 대한간호
    • /
    • 제36권1호
    • /
    • pp.59-76
    • /
    • 1997
  • The purposes of this study were to identify the contents and satisfaction level of the patients received home care service, and to compare the differences of the contents by the characteristics of the patients. Seventy eight patients received home care service from 1st Jan. to 30th Sept., 1996 were data-collected to analyze the contents and outcomes of home care service. Sixty-nine patients currently receiving home care service were participated to evaluate the satisfaction level of home care service. The data were analyzed using mean, standard deviation, $x^2$ test, and ANOVA by SPSS $PC^+$ program. The findings of this study were as follow : 1. The contents & outcomes of home care service 1) The mean age of the subjects was 64.4 years: 58% of them were female. Those who living in Seoul were 83% and the rest of the subjects was living in Kyung-Gi. 2) The subjects who had one diagnosis were 41%. Over 60% of them had the disease of neurologic & sensory system. 3) The mean number of visit was 6. Only one visit was 22%. The mean time of care was 79 minutes. Duration of visit from 31 minutes to 60 minutes were 47 %. The subjects who terminated the visit because of death were 67.3%. 62% of the persons who referred them to the home care service were nurses. 4) The pain after the service was more relieved than before. The amounts of intake, the degree of bed sore, edema & fracture after the service were more improved than before. Health status after the service was improved in general. 5) There were significant differences between initial and last conscious level in tracheostomy care & oxygen inhalation care. There was significant difference between initial and last degree of activity in blood sugar check. 6) There were significant differences on the number of visit in assessment of the status, evaluation & observation, vital sign check, skin care, injection, medication, bed sore care, colostomy care, relaxation therapy for pain relief, patient education, family care, exercise therapy, position change, supply of disinfected equipments and infection control. There were significant differences on visiting time in nasogastric tube care, drainage tube care and oxygen inhalation care. 2. The satisfaction level of home care service 1) 50% were male. Over 60 years of the subjects was 61 %. Those who living in Seoul were 82%. 2) The subjects who had one or two diagnosis were 32% respectively. 55% of the persons who referred them to the home care service were nurses. 3) Total level of satisfaction of home care service was very high. 4) The older the age, the higher the satisfaction level. The larger the number of visit, the higher the satisfaction level. 5) The subjects who were in cloudy state were higher level of satisfaction than in alert or coma state. The subjects whose activity were normal or who needed assistance were higher level of satisfaction than bedridden or immobilized subjects. These findings suggested that the patients had substantial need for posthospital care. They tended to be elderly and to have experienced the wide range of health problems associated with aging, chronicity, including limitations in activities, and other serious health problems. So, the nationwide home care systems beyond the limit of demonstration program by local association and the development of the effective financial system of home based health care are necessary for the clients who are in need of home care.

  • PDF

1980년대 민중미술론의 기원과 형성 (The Origin and Formation of Korean Public Art Theories in the 1980s)

  • 최열
    • 미술이론과 현장
    • /
    • 제7호
    • /
    • pp.37-64
    • /
    • 2009
  • The theories of Korean Public Art originated by the artists who were against dictatorship and they associated with democratic politicians. They criticized the Fine art that were supported by the dictatorship and gave their efforts for restoration of 'resistance paintings(against dictatorship)', 'proletarian painting', 'realism painting'. In addition, they participated new social ideology(democracy) movement and demonstrated for their rights in arts. These became the main kernel the public art theory was initiated. The public artists splitted into several different parts and participated in the democratic social movement as well as the art movement for freedom. They opened various art exhibitions within different genre, diverse space for various art section such as an exhibition hall, a factories, a university, or a congregation square. Furthermore, the public art theorists published their divergent views through newspaper/broadcasting or unauthorized printed materials. Most of the public artist and the theorists kept their relationship strongly until 1985, the time when 'National Arts Association' started. In 1983 and 1984, they were clearly separated into two parts; artists(move only in art museums) and activists(move in public spaces like school, convention square etc). Their ideological separation also took out national problems. The division; professional artists and armatures, became the social issue as a social stratification matter. And in creating method, there are also other conflicts; critical realism, and public realism as well as western painting and traditional one. These kinds of separation and conflicts made different Public artists associations, under divergent names; 'Reality and Speak'(R&S), 'KwangJu Art Association', 'Durung', 'Dang(Land)', and 'Local Youth Students Association'. In addition, their ideology and pursuit toward art movements were very difference. However, the differences and conflicts weakened When the oppression of democratic education from new dictatorship(Pres. Jun, Doo Hwan) came out. In August. 1985 the government opened to the public so called, 'The draft of School stabilization law'(Hankwon Anjung Bup) to control the teachers' rights and that initiated bigger street demonstration and conflicts between police and educators. In November.1985, assembly meeting of National Arts Association in democracy opened as 'ONE' combined organization. In this presentation, I'd like to summarize the stream of art movement until 1984, and clarify the main art theories that lead the Public Art Movements in 1980s. The main theories in 1980s are crucial because they become the origin of public art theories. This presentation started with O,youn's "Hyunsil Dong In the first declaration" and explained the absent of practice in 1970s. In addition, Won, Dong Suk 's theory was mentioned as all over struggles in theories before 1980s. GA and R&S 's founding declarations in 1970s were the start of public art theorists' activities and this article reported the activities after the declarations. First, realism base on the consciousness of reality. Second, practice art democratization based on the ideology. Third, the subject of public art movement based on understanding people's social stratification structure. Fourth, the matters of national forms and creative ways in arts based on showing reality. Fifth, the strong points in arts that the practitioners accepted. About the public art theories around 1984, I discussed the dividing point of public art theories that were shown in 'generation theory', 'organization theory', and 'popularization theory' by the practitioners. The public realism theory that subjects the contradiction of reality and point out the limits of critical realism not only showing the new creative ways but also giving the feeling of solidarity to the public art activist groups. After that, public art movements expressed 'Dismentlement of Capitalism' and 'Public revolution'. In addition, the direction of public art movements were established strongly. There were various opinions and views during the start and formation of the public art theories. The foundation of theorists activities derived from the practitioners who had the concept based on stratification and nationalism. The strong trend of group division spreaded out by practitioners who opened art work together in factories, universities, squares and rural areas. Now many lively active practitioners are gone to the other field not related with arts, and others join into professional art field not public art one with unknown reason. The theorists have the same situation with the practitioners. It means to me that theory always have to be based on the practice.

  • PDF

저작권법에 준한 도서관봉사에 관한 연구 -미국과 한국의 저자재산권의 제한규정을 중시으로- (Limitations on Exclusive Rights of Authors for Library Reprography : A Comparative Examination of the Draft Revision of Korean Copyright Law with the New American Copyright Act of 1976)

  • 김향신
    • 한국도서관정보학회지
    • /
    • 제11권
    • /
    • pp.69-99
    • /
    • 1984
  • A dramatic development in the new technology of copying materials has presented us with massive problems on reconciling the conflicts between copyright owners and potential users of copyrighted materials. The adaptation to this changing condition led some countries to revise their copyright laws such as in the U. S. in 1976 and in Korea in 1984 for merging with the international or universal copyright conventions in the future. Copyright defined as exclusive rights given to copyright owners aims to secure a fair return for an author's creative labor and to stimulate artistic creativity for the general public good. The exclusive rights on copyrightable matters, generally for reproduction, preparation of derivative works, public distribution, public performance, and public display, are limited by fair use for scholarship and criticism and by library reproduction for its preservation and interlibrary loan. These limitations on the exclusive rights are concerned with all aspects of library services and cause a great burden on librarian's daily duty to provide balance between the rights of creators and the needs of library patrons. The fair use as one of the limitations on it has been coupled with enormous growth of a new technology and extended from xerography to online database systems. The implementation of the fair use and library reprography in Korean law to the local practices is examined on the basis of the new American copyright act of 1976. Under the draft revision of Korean law, librarians will face many potential problems as summarized below. 1. Because the new provision of 'life time plus 50 years' will tie up substantial bodies of material longer than the old law, until that date librarians would need permissions from the owners and should pay attention to the author's death date. 2. Because the copyright can be sold, distributed, given to the heirs, donated, as a whole or a part, librarians should chase down the heirs and other second owners. In case of a derivative work, this is a real problem. 3. Since a work has its protection from the moment of its creation, the coverage of copyrightable matter would be extended to the published or the unpublished works and librarian's work load would be heavier. Without copyright registration, no one can be certain that a work is in the public domain. Therefore, librarians will need to check with an authority. 4. For implementation of limitations on exclusive rights, fair use and library reproduction for interlibrary loan, there can be no substantial aggregate use and there can be no systematic distribution of multicopies. Therefore, librarians should not substitute reproductions for subscriptions or purchases. 5. For the interlibrary loan by photocopying, librarians should understand the procedure of royalty payment. 6. Compulsory licenses should be understood by librarians. 7. Because the draft revision of Korean law is a reciprocal treaty, librarians should take care of other countries' copyright law to protect foreign authors from Korean law. In order to solve the above problems, some suggestions are presented below. 1. That copyright clearinghouse or central agency as a centralized royalty payment mechanism be established. 2. That the Korean Library Association establish a committee on copyright. 3. That the Korean Library Association propose guidelines for each occasion, e.g. for interlibrary loan, books and periodicals and music, etc. 4. That the Korean government establish a copyright office or an official organization for copyright control other than the copyright committee already organized by the government. 5. That the Korean Library Association establish educational programs on copyright for librarians through seminars or articles written in its magazines. 6. That individual libraries provide librarian's copyright kits. 7. That school libraries distribute subject bibliographies on copyright law to teachers. However, librarians should keep in mind that limitations on exclusive rights are not for an exemption from library reprography but as a convenient access to library resources.

  • PDF

재발한 Vulvar 종양의 근접치료 시 Modified Mupit Applicator의 적용 (Application of Modified Mupit for the Recurrent Vulva Cancer in Brachytherapy)

  • 김종식;정천영;오동균;송기원;박영환
    • 대한방사선치료학회지
    • /
    • 제18권1호
    • /
    • pp.13-19
    • /
    • 2006
  • 목 적: 재발한 vulva 종양의 근접 치료 시 정상조직의 장애와 종양 체적 내의 선량 균등도를 개선하기 위해 modified MUPIT applicator를 자체 고안하였으며 이에 대한 유용성을 평가하고자 한다. 대상 및 방법: Modified MUPIT applicator는 template, cylinder, interstitial needle로 구성 되었으며, 종양 체적을 정하기 위하여 치료 전 CT를 시행하였다. CT 영상을 이용하여 Interstitial needle의 삽입 위치를 결정하고, 수술실에서 template를 치료 부위에 고정을 시키고, cylinder를 vaginal cavity에 삽입한 후, interstitial needle을 종양 체적 내에 삽입하였다. 삽입된 interstitial needle의 정확한 위치를 확인하기 위하여 확인용 CT를 시행하였으며, simulation을 통하여 얻어진 orthogonal film을 이용하여 치료 계획을 수립하였다. 일일 종양 선량은 600 cGy, BID로 3,000 cGy를 조사하였으며, 치료 시 직장 선량을 평가하기 위하여 TLD를 이용하여 anal verge를 기준으로 5개 지점에서의 직장 선량을 측정하였다. 결 과: Modified MUPIT applicator 대한 유용성을 평가하기 위하여 측정된 직장 선량은 34.1 cGy, 57.1 cGy, 103.8 cGy, 162.7 cGy, 165.7 cGy로 측정되었으며, 외부방사선치료(EBRT: External Beam Radiation Therapy), 강내방사선치료(ICR: Intracavitary radiotherapy)와 중첩되는 지점은 34.1 cGy, 57.1 cGy로 매우 우수하게 평가되었다. 결 론: 자체 제작한 modified MUPIT applicator 사용하여 조직 내 근접치료(Interstitial brachytherapy)를 시행함으로써, 외부방사선치료로 접근하기 어려운 종양에 대하여 선량 균등도를 효율적으로 개선할 수 있었고, 직장 선량을 최소화하여 직장의 부작용 발생 확률을 현저히 감소시킬 수 있었다.

  • PDF

토양 및 지하수 Investigation 과 Remediation에 대한 현장적용

  • Wallner, Heinz
    • 한국지하수토양환경학회:학술대회논문집
    • /
    • 한국지하수토양환경학회 2000년도 추계학술대회
    • /
    • pp.44-63
    • /
    • 2000
  • Situated close to Heathrow Airport, and adjacent to the M4 and M25 Motorways, the site at Axis Park is considered a prime location for business in the UK. In consequnce two of the UK's major property development companies, MEPC and Redrew Homes sought the expertise of Intergeo to remediate the contaminated former industrial site prior to its development. Industrial use of the twenty-six hectare site, started in 1936, when Hawker Aircraft commence aircraft manufacture. In 1963 the Firestone Tyre and Rubber Company purchased part of the site. Ford commenced vehicle production at the site in the mid-1970's and production was continued by Iveco Ford from 1986 to the plant's decommissioning in 1997. Geologically the site is underlain by sand and gravel, deposited in prehistory by the River Thames, with London Clay at around 6m depth. The level of groundwater fluctuates seasonally at around 2.5m depth, moving slowly southwest towards local streams and watercourses. A phased investigation of the site was undertaken, which culminated in the extensive site investigation undertaken by Intergeo in 1998. In total 50 boreholes, 90 probeholes and 60 trial pits were used to investigate the site and around 4000 solid and 1300 liquid samples were tested in the laboratory for chemical substances. The investigations identified total petroleum hydrocarbons in the soil up to 25, 000mg/kg. Diesel oil, with some lubricating oil were the main components. Volatile organic compounds were identified in the groundwater in excess of 10mg/l. Specific substances included trichloromethane, trichloromethane and tetrachloroethene. Both the oil and volatile compounds were widely spread across the site, The specific substances identified could be traced back to industrial processes used at one or other dates in the sites history Slightly elevated levels of toxic metals and polycyclic aromatic hydrocarbons were also identified locally. Prior to remediation of the site and throughout its progress, extensive liaison with the regulatory authorities and the client's professional representatives was required. In addition to meetings, numerous technical documents detailing methods and health and safety issues were required in order to comply with UK environmental and safety legislation. After initially considering a range of options to undertake remediation, the following three main techniques were selected: ex-situ bioremediation of hydrocarbon contaminated soils, skimming of free floating hydrocarbon product from the water surface at wells and excavations and air stripping of volatile organic compounds from groundwater recovered from wells. The achievements were as follows: 1) 350, 000m3 of soil was excavated and 112, 000m3 of sand and gravel was processed to remove gravel and cobble sized particles; 2) 53, 000m3 of hydrocarbon contaminated soil was bioremediated in windrows ; 3) 7000m3 of groundwater was processed by skimming to remove free floating Product; 4) 196, 000m3 of groundwater was Processed by air stripping to remove volatile organic compounds. Only 1000m3 of soil left the site for disposal in licensed waste facilities Given the costs of disposal in the UK, the selected methods represented a considerable cost saving to the Clients. All other soil was engineered back into the ground to a precise geotechnical specification. The following objective levels were achieved across the site 1) By a Risk Based Corrective Action (RBCA) methodology it was demonstrated that soil with less that 1000mg/kg total petroleum hydrocarbons did not pose a hazard to health or water resources and therefore, could remain insitu; 2) Soils destined for the residential areas of the site were remediated to 250mg/kg total petroleum hydrocarbons; in the industrial areas 500mg/kg was proven acceptable. 3) Hydrocarbons in groundwater were remediated to below the Dutch Intervegtion Level of 0.6mg/1; 4) Volatile organic compounds/BTEX group substances were reduced to below the Dutch Intervention Levels; 5) Polycyclic aromatic hydrocarbons and metals were below Inter-departmental Committee for the Redevelopment of Contaminated Land guideline levels for intended enduse. In order to verify the qualify of the work 1500 chemical test results were submitted for the purpose of validation. Quality assurance checks were undertaken by independent consultants and at an independent laboratory selected by Intergeo. Long term monitoring of water quality was undertaken for a period of one year after remediation work had been completed. Both the regulatory authorities and Clients representatives endorsed the quality of remediation now completed at the site. Subsequent to completion of the remediation work Redrew Homes constructed a prestige housing development. The properties at "Belvedere Place" retailed at premium prices. On the MEPC site the Post Office, amongst others, has located a major sorting office for the London area. Exceptionally high standards of remediation, control and documentation were a requirement for the work undertaken here.aken here.

  • PDF

절제연 양성 자궁경부암의 수술후 방사선치료 (Radiotherapy Results of Carcinoma of the Cervix with Positive Resection Margin)

  • 허승재;김원동;우홍균;김대용;하성환;안용찬;김일한;박찬일
    • Radiation Oncology Journal
    • /
    • 제14권4호
    • /
    • pp.317-322
    • /
    • 1996
  • 목적 : 조기 자궁경부암에서 근치적 수술 후에 절제연이 양성인 환자에서 수술후 방사선치료의 역할을 알아보기 위하여 후향적 연구를 시행하였다. 대상 및 방법 : 근치적 수술후 방사선치료를 받은 환자 809예 중에서 절제연이 양성인 환자 60예를 대상으로 하였다. 48예는 질 절제연 양성이었고 12예는 자궁방 절제연 양성이었다. 방사선치료는 외부조사와 함께 환자에 따라서 강내치료를 추가하였다. 추적 관찰 기간의 중앙값은 55개월이었다. 결과 : 전체 환자 60예의 무병생존율과 생존율은 5년에 각각 $75.2\%$, $84.1\%$였다. 질 절제연 양성인 환자 48예에 있어서는 강내치료를 추가한 43예 중 9예가 재발했고($21\%$), 외부조사만 시행한 환자 5예 중 2예가 재발했다($40\%$). 자궁방 절제연 양성이었던 12예의 환자에서는 3예의 원격전이가 관찰되었다. 모든 환자 중 19예에서 치료에 의한 후유증을 보였으며($30\%$), III도의 심한 후유증은 3예($5\%$)에서 관찰되었다. 예후인자의 분석에서는 림프절 전이 여부만이 생존율에 영향을 미치는 유일한 예후인자로 분석되었다. 결론 : 절제연이 양성인 조기 자궁경부암 환자에서 수술후 방사선치료로 $93\%$의 높은 국소제어율을 얻을 수 있었다. 절제연이 양성인 경우에 수술후 방사선치료는 필수적이며, 질 절제연이 양성인 경우에는 강내치료를 추가해야 할 것이며, 생존율을 향상시키기 위해서는 원격전이에 대해서 보다 효과적인 항암 화학요법 등이 필요할 것으로 판단된다.

  • PDF

식도의 편평상피세포암 환자에서 외부방사선치료의 결과 (The Outcome of Conventional External Beam Radiotherapy for Patients with Squamous Cell Carcinoma of the Esophagus)

  • 장지영
    • Radiation Oncology Journal
    • /
    • 제26권1호
    • /
    • pp.17-23
    • /
    • 2008
  • 목적: 최근 진행된 식도암의 치료는 병행항암방사선요법 후 수술을 시행하는 것이 가장 성적이 좋은 것으로 보고되고 있다. 그러나 병행치료의 발전에도 불구하고 여전히 많은 식도암 환자에서 병행치료가 어려워 방사선치료 단독으로 치료받게 된다. 이에 저자는 통상적인 외부방사선치료를 받은 식도암 환자의 치료성적과 예후인자를 알아 보고자 하였다. 대상 및 방법: 1998년 1월부터 2005년 12월까지 식도의 편평상피세포암으로 진단받고 40 Gy 이상 외부방사선조사를 받은 30명의 환자를 대상으로 분석하였다. 총방사선량은 $44{\sim}60Gy$(중간선량 57.2 Gy)이었으며 방사선치료 기간은 $36{\sim}115$일(중간방사선치료기간 45일)이었다. 13명(43.3%)의 환자는 당뇨, 고혈압, 결핵 등의 과거력이 있었으며 그중 4명의 환자에서 식도암 진단 전 3명이 위암, 1명이 하인두암으로 진단받고 치료받은 적이 있었다. 원발병소부위는 중흉부식도에 위치한 예가 19명(63.3%)으로 가장 많았고 상흉부식도 4명(13.3%), 하흉부식도 7명(23.3%)이었다. 원발병소의 길이는 $2{\sim}11cm$이었고, 중간 길이는 6 cm이었다. 진단당시 병기는 AJCC 병기로 병기 I이 2명(6.7%), 병기 II 4명(13.3%), 병기 III 19명(63.3%), 병기 IV 5명(16.7%)이었다. 결과: 전체 환자의 중간 생존기간은 8.3개월이었고 1년 생존율 33.3%, 2년 생존율 18.7%이었다. 치료종료 $1{\sim}3$개월째 치료결과를 판정하여 완전관해를 보인 환자가 6명(20%), 부분관해 21명(70%)이었다. 치료종료 $1{\sim}3$개월 후에 평가한 연하곤란증상은 29명(96.7%)의 환자에서 호전되었다. 치료성적에 영향을 미치는 예후인자에 대한 단변량 분석결과 연령, 종양의 길이, 병기, 치료 전 식사, 치료 목적, 치료에 따른 반응정도가 통계적인 유의성을 보였다. 다변량분석에서는 종양의 길이, 치료 목적, 치료에 따른 반응정도가 생존율에 영향을 미치는 인자로 확인되었다. 치료실패는 국소 실패가 28명, 전이가 4명이었다. 추적조사기간동안 2명의 환자에서 이차적인 암이 발생하여 과거력상 식도이외의 암이 있었던 환자를 포함하면 6명(20%)에서 다발성 암으로 진단받았다. 치료로 인한 부작용 중 식도협착이 발생한 예가 3명(10%), 방사선폐렴이 발생한 예가 2명(6.7%)이었다. 결론: 식도암에서 단독 방사선치료 결과는 병행치료에 비해 만족스럽지 못하지만 부작용이 많지 않아 연하곤란증상을 완화시키기 위한 목적으로 여전히 이용되고 있다. 진행된 식도암에서 항암제 혹은 항암제 이외의 적절한 병행치료를 시행하여 완전관해율을 높인다면 생존율의 향상을 얻을 수 있으리라 기대해 본다.

GIS 사업유형을 고려한 GIS 감리의 기반 모델 연구 (A Study on a Basic Model for GIS Audit, Based on Various Types of GIS Projects)

  • 고광철;김은형
    • 한국공간정보시스템학회 논문지
    • /
    • 제2권2호
    • /
    • pp.5-23
    • /
    • 2000
  • 정부가 국가지리정보시스템(NGIS) 사업에 박차를 가하고 지자체들이 경쟁적으로 대단위 도시지리 정보시스템(UIS)사업을 발주하면서 보다 효율적인 사업관리를 위해 'GIS 감리'가 주목받고 있다. 그러나 현재 GIS 감리 제도가 정착되지 않은 상황에서 형식적인 감리 제도의 도입으로 인해 GIS 감리의 실효성을 제대로 거두지 못하고 있다. 본 연구에서는 GIS 감리 제도가 정착되고 GIS 감리 활동이 실효성을 거두기 위해서는 우선적으로 GIS 감리의 대상 및 감리 영역을 규명하는 'GIS 감리의 기반 모델'을 제시하고자 한다. 과업지시서를 중심으로 GIS 감리의 대상을 규명한 후 기존의 정보시스템 감리과 건설감리의 장점을 수용하여 GIS 감리의 영역을 프로젝트 감리, 전산기술 감리. GIS기술 감리, 데이터베이스 구축 감리, 전략 감리'의 5가지 영역으로 분류하였다. 과업지시서를 통해 분석된 GIS 사업의 유형적 분류는 개발적응 대상분야에 의한 유형, GIS활용체계 구축 범위에 의한 유형, GIS활용체계 구축 기간에 의한 유형, GIS 기술적용에 의한 유형의 4가지로 제시하였다. 이중 GIS 기술적용에 의한 유형은 GIS S/W 기술, GIS 개발방법론 기술, 공간데이터 구축 기술, 공간데이터 검수 기술로 기존의 GIS 감리관련 연구에서 종합적으로 다루지 못한 사항들이 전반적으로 제시되었다고 할 수 있다. 과업지시서를 중심으로한 사업의 유형이 GIS 감리 영역에 반영된 것은 GIS 사업의 특성에 따라 융통성 있게 GIS 감리의 영역을 재구성할 수 있으므로 해서 보다 현실적인 GIS 감리 수행이 될 수 있을 것으로 판단된다. 끝으로 효과적인 감리 수행을 위해 GIS 감리 수행 전략을 제시하였으며 이들에서 언급된 사항은 향후 GIS 감리제도 정착시 반드시 고려되어야 할 사항으로 판단된다.

  • PDF

국한성 두경부 대세포성(Diffuse Large Cell) 림프종의 적정 방사선 조사선량 (The Optimal Radiation Dose in Localized Head and Neck Diffuse Large Cell Lymphoma)

  • 금웅섭;서창옥;김용배;심수정;표홍렬;노재경;정현철;김귀언
    • Radiation Oncology Journal
    • /
    • 제20권4호
    • /
    • pp.303-308
    • /
    • 2002
  • 목적 : 두경부에 국한된 1기, 2기 대세포성(diffuse large cell) 비호치킨 림프종의 항암화학방사선 병용요법 시 방사선 조사영역 내의 재발을 예방하기 위한 적정 방사선 조사선량을 알아보고자 하였다. 대상 및 방법 : 1985년 5월부터 1998년 12월까지 국한성 두경부 대세포성 림프종으로 항암화학요법 후 방사선치료를 받은 53명을 대상으로 하였다. 나이는 13세부터 69세까지였으며 중앙값은 49세였다. 남녀 비는 1.65대 1이었고 1기, 2기 환자가 각각 27명, 26명이었다. 종양 크기별로 5 cm 미만이 30명, 5 cm 이상이 23명이었다. 원발부위는 경부림프절 22명, 편도 20명, 비인두 4명, 설기저부 3명, 부비동 2명, 후두 1명, 연구개 1명이었다. 항암화학요법은 1명을 제외하고 3회 이상 시행되었으며 방사선치료는 48명이 원발부위와 경부임파선을, 5명이 원발부위만 치료하였다. 생존율, 무병생존율, 조사영역 내 무재발생존율과 방사선 조사선량에 따른 방사선 조사영역 내에서의 재발빈도를 조사하였다. 결과 : 항암화학요법 후 44명$(83\%)$이 완전관해 되었고 연이은 방사선치료 후 53명 모두 완전관해 되었다. 12명$(23\%)$이 재발하였고 그중 2명은 방사선 조사영역 내 재발이었고 방사선 조사영역 바깥 재발은 11명으로 복강 및 골반내 림프절이 가장 많았다. 방사선 조사선량 별 조사영역 내 재발은 $30\~35\;Gy$에서 7명 중 1명, $35\~40\;Gy$에서 16명중 1명이었고 40 Gy 이상에서는 재발이 없었다. 방사선 조사영역 내 재발에 유의한 예후인자는 없었으나 5 cm 이상인 종양에서 재발하였고 5 cm 미만인 종양은 30 Gy에서도 재발하지 않았다. 10 년 방사선 조사영역내 무재발 생존율, 무병생존율, 전체생존율은 각각 $96\%,\;76\%,\;75\%$였다. 결론 : 국한성 두경부 대세포성 림프종에서 항암화학방사선 병용요법 시 종양의 크기가 5 cm 미만인 경우에는 30Gy의 방사선 조사선량으로도 국소제어를 할 수 있다. 따라서 방사선치료에 따르는 구강건조증을 최소화시킬 수 있을 것이다. 5 cm 이상의 종양에서는 30 Gy 이상의 방사선 조사 선량이 필요하리라 생각된다.

III 병기 비소세포성 폐암의 방사선 치료성적 (Local Control and Survival in Radiation Treatment of Locally Advanced Non-Small Cell Lung Cancer)

  • 송미희;양진영;오원용;유남수;황인순
    • Radiation Oncology Journal
    • /
    • 제11권2호
    • /
    • pp.311-319
    • /
    • 1993
  • 본 국립의료원 치료 방사선과 에서는 1986년 1월부터 1990년 12월까지 5년간 방사선 치료를 받은 III병기 비소세포성 폐암 37예를 대상으로 후향성 조사를 통하여 임상적 특징과 생존율을 분석하여 보고하는 바이다. 이중 29예가 사망시 또는 1991년 8월까지 추적 관찰이 가능하였으며 치료후 추적 조사기간은 최소10개월, 최고60개월 이었고, 추적율은 $78.4\%$이었다. Kaplan-Meier법에 따른 전체 환자 37예의 2, 5년 생존율은 각각 $20.6\%,\;6.9\%$이었으며 중앙생존 기간은 10개월 이었다. Performance status에 의하면 KPS가 $80\%$ 이상인 I군의 2,5년 생존율과 중앙생존기간은 각각 $29.2\%,\;9.7\%,$ 13개월 이었고, KPS가 $80\%$ 이하인 II군의 2년 생존율과 중앙 생존기간은 $13.7\%$와 7개월 로서, 통계학적으로 유의 한 차이를 보였다(p<0.05). AJCC 병기에 따른 생존율 및 중앙 생존기 간을 보면 $III_a$ 병기의 2, 5년 생존율 및 중앙 생존기간이 $29.2\%,9.7\%$및 12개월 이었고 $III_b$ 병기의 2년 생존율과 중앙 생존기간은 $8.6\%$와 10개월로 생존율의 유의한 차이를 보이지 않았다(p>0.1). 그외 조직 병리학적 유형별, 방사선 선량별, 방사선 반응군별, 항암화학요법 유무에 따른 생존율은 유의한 차이를 보이지 않았다. 결론적으로 overall 5년 생존율 및 중앙 생존기간은 $6.7\%$와 10개월 이었고 performance status 만이 통계적으로유의한 예후인자였으며, 병리조직학적 유형, 병기, 방사선 치료선량, 방사선 반응유무와 항암화학요법 등의 예후인자들은 통계학적으로 유의하지 않았다.

  • PDF