Purpose :We peformed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. Methods and Materials : One hundred and six Patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (94%) and ranged from 1 month to 92 months (median; 6 months). Results :The median age was 62 years old and male to female ratio was 104 2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was peformed in 83%. Mean tumor dose delivered with curative aim was 58.6 Gy (55\~70.8 Gy) and median duration of the radiation therapy was 53 days. The median survival of all patients was 6 months and )-year and 2-year overall survival rate was 27% and 12%, respectively, Improvement of dysphagia was obtained in most patients except for 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32% (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30% respectively, while those of the nonresponder was 4 months and 0% respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 months and 16% while those of the patients who could not tolerate regular diet was 3 months and 0%, respectively (p=0.004). The survival difference between the patients with S cm or less tumor length and those with more than 5 cm tumor length was marginally statistically significant (u=0,06). However, the survival difference according to the periesophageal invasion or mediastinal tyrnphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9%). Conclusion :The survival outcome for advanced esophageal cancer patients treated by external beam radiotherapy alone was very poor. In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.
Purpose: This study evaluated the pretreatment expression patterns of MDM2, p53, and pRb proteins to determine if the expression patterns could predict the outcome of concurrent chemoradiotherapy (CCRT) for esophageal squamous cell carcinoma and aid in the decisions for the selection of treatment modalities. Materials and Methods: Fifty-one patients that were treated with definitive chemoradiotherapy for stage I∼IVa esophageal squamous cell carcinoma were selected for this study. Radiotherapy was administered with daily 1.8∼2Gy fractions up to a median dose of 54 Gy for primary tumors, and with four cycles of cisplatin/5-fluorouracil chemotherapy that was administered every 4 weeks, the first two cycles of which were administered concurrently with radiotherapy. Expression of MDM2, p53, and pRb was investigated by immunohistochemical analysis using pretreatment biopsy specimens. Results: MDM2, p53, and pRb were detected with high immunoreactivity in 19.6%, 27.5%, and 66.7% of the patients, respectively. However, there was no significant correlation between expression of these factors and clinical outcome. By the use of multivariate analysis with nine covariates-age, tumor location, tumor length, stage, pathological response, clinical response, MDM2 expression, p53 expression, and pRb expression, only pathological response and stage were significant factors for cause-specific survival. Conclusion: Expression of MDM2, p53, and pRb was not found to be clinically significant for predicting outcomes after CCRT in this study. Further studies with a larger patient population and longer follow-up periods are needed to re-evaluate the expression pattern and to identify new predictors for CCRT response.
Kim, Ee-Kyung;Nah, Song-Yi;Park, Jin-Young;Choi, Eun-Hwa;Lee, Hoan-Jong
Pediatric Infection and Vaccine
/
v.5
no.1
/
pp.69-78
/
1998
Purpose : The risk of severe tuberculous disease such as meningitis or miliary tuberculosis increases as younger is the child at the time of infection. Therefore, the early diagnosis and prompt treatment is mandatory for infants with tuberculosis. This study was undertaken to describe the epidemiology, clinical and radiographic manifestations, and response to therapy in infants with tuberculous disease. Methods : Medical records of 29 infants with tuberculosis diagnosed at the Seoul National University Children's Hospital from July, 1985, to April, 1997, were reviewed, retrospectively. A case of tuberculosis was confirmed if M. tuberculosis was isolated from any body site or if there was histologic proof of tuberculosis. Otherwise, the diagnoses were individualized considering history of contact with contagious adult case, clinical manifestations, chest X-ray findings, result of a Mantoux test reaction with 5 tuberculin unit of PPD, and the response to therapy. Results : The mean age at diagnosis was 7.00±2.65 months (range, 3 to 12 months). Twelve cases had isolated pulmonary diseases, and the rest had pulmonary disease and meningitis, 5 cases; pulmonary disease and cervical lymphadenitis, 3; isolated meningitis, 3; and miliary tuberculosis, 6. Source case was identified in 19 cases, 7 of which were detected with retrograde manner. Twenty seven of 29 were symptomatic at their initial visit. The presenting symptoms were mainly respiratory or neurologic, and respiratory difficulty was accompanied in 7 cases. Physical examination revealed wheezing in 7 cases and decreased breath sounds in 9. Hepatomegaly or hepatosplenomegaly were frequent. Chest radiographs showed lung parenchymal disease with hilar lymphadenopathy in 18 cases, and focal or generalized emphysematous change in 7 cases. Conclusion : Most of the infants with tuberculosis are symptomatic at diagnosis, and many of infants with intrathoracic tuberculosis presented with symptoms of bronchial obstruction. When tuberculosis is suspected in an infant, the adult source case should be vigorously investigated to aid in diagnosis and for the prevention of further transmission of tuberculous disease. Almost half of infant tuberculosis are preventable if prophylaxis were given when adult cases were diagnosed.
Ahn Sung Ja;Nam Taek Keun;Chung Woong Ki;Nah Byung Sik;Choi Ho Sun;Byun Ji Soo
Radiation Oncology Journal
/
v.13
no.1
/
pp.41-48
/
1995
Purpose : The adjuvant postoperative radiotherapy has been usually applied to the patients with unfavorable prognostic factors after radical operation in early cervical cancer. We focused on the evaluation of the survival status and failure patterns of the patients with postoperative radiotherapy. Materials and Methods : We retrospectively analyzed ninety patients with FIGO stage IB and IIA cervix cancer who received postoperative pelvic irradiation at Chonnam University Hospital between August 1985 and December 1988, Seventy-eight patients had adequate follow-up information for survival analysis. Median follow-up time of these patients was 64 months. Results : The 5 year overall and disease free survival rate of ninety patients was 80.0% and 80.2%, respectively. The prognostic significance to the survival was determined by multivariate analysis. Adequacy of resection margin(p=0.005) and lymph node status(p=0.005) appeared to be independent prognostic factors. Recurrence occurred in 13 patients, 5 in the pelvis and 8 at distant sites. The median time to recurrence was 19 months(range:3-39 months). The pelvic recurrence was more prevalent in the group of patients with adenocarcinoma, depth of stromal invasion more than 10mm and use of chemotherapy. The distant failure was more prevalent in the group of positive resection margin or positive lymph node with statistical significance. Conclusion : Patients with pelvic lymph node or surgical margin involvement clearly constitute a high risk group in this analysis and should be considered as candidates for some form of adjuvant therapy.
Purpose: To analyze the clinical result of the arthroscopic reduction and fixation for the displaced tibial spine fractures in children and report the utility of the arthroscopic treatment with the review of the literature. Methods: Between December 2000 and July 2004, five patients (average age 9.1 years) received an arthroscopic reduction and fixation of displaced tibial spine fracture. A male-to-female ratio was 3:2 and mean follow-up was 38.2(13∼56) months. All five patients were classified type III by Movers and McKeever classification. The average period from injury to operation was 4.8 days (3∼8days), the avulsed fragment was reduced by operative arthroscopy and fixated by pull-out suture in 3 patients and by cannulated screw in 2 patients. Postoperatively long leg cast was applied for 2 weeks, and then gradual range-of-motion exercise was permitted. Full weight-bearing ambulation was permitted after 6 weeks. The clinical evaluation was performed by range of motion, Lachman and pivot shift test, KT-1000 arthrometer, Lysholm knee score and the modified Feagin score. Results: All five patients had no symptom and recovered full range of motion of the affected knees. Lachman test was positive finding of 1+ laxity in one patient, the others were negative, and all patients were negative findings for pivot shift test. The result of KT-1000 arthrometric assessment is mean maximum side-to-side differences 1.9 mm. Average Lysholm knee score was 99.4. All patients had excellent results in modified Feagin score. Conclusion: Arthroscopic reduction and fixation of displaced tibial spine fracture in children showed excellent result without complication. Both pull-out suture fixation and cannulated fixation provide an effective treatment option for fixation of the displaced anterior tibial spine fracture.
Purpose: This study was peformed to Investigate apoptosis by radiation In the developing fetal rat brain. Materials and Methods: Fetal blains were Irradiated In utero between the 17th and 19th days of fetal life (El7-19) by linear accelerator. A dose of Irradiation ranging from 1 Gy to 4 Gy was used to evaluate dose dependency. To test time dependency the ra)s were Irradiated with 2 Gy and then the fetal brain specimens were removed at variable 41me course; 1, 3, 5, 12 and 24 hours after the onset of irradiation. Immunohistochemlcal staining using in situ 707-mediated dUTP nick end labelling (TUNEL) technlfue was used for apoptotic cells. The cerebral cortex, including three zones on coriicai zone (Cf). Intermediate zone (if), and ventricular zone (VZ), was examined. Results : TUNEL positive cells revealed typical features of apoptotic cells under light microscope In the fetal rat cerebral cortex. Apoptotic cells were not found In the cerebral cortex of non-Irradiated fetal rats, but did appear In the entire cerebral cortex after 1 Gy Irradiation, and were more expensive at the ventricular and Intermediate zones than at the cortical zone. The extent of apoptosis was Increased with Increasing doses of radiation. Apoptosis reached the peak at S hours after the onset of 2 Gy Irradiation and persisted until 24 hours. Conclusion: Typical morphological features of apoplosis by irradiation were observed In the developing fetal rat cerebral cortex. It was more extensive at the ventricular and Intermediate zones than at the cortical zone, which suggested that stem cells or early differentiated cells are more radiosensitive than differentiated cells of the cortical zone.
Purpose: To identify the damage of the articular cartilage and analyze the clinical results of the partial medial meniscectomy. Materials and Methods: From January 2001 to December 2004, forty-eight patients in the degenerative arthritis and medial meniscal tear of knee who undertook arthroscopic partial meniscectomy and were able to keep pace with the times follow-up for more than 3 years were enrolled in this study. Six cases were men and 42 were women, and the mean age was 55.7 years (40~78 years). The patients were classified into two groups according to the Outerbridge grade. Grade I and II were classified into group 1 and grade III and IV into group 2. Group 1 included 30 cases and group 2 included 18 cases. The result were analyzed according to the Tapper & Hoover classification and Lysholm knee scoring scale. And we measured the distance of medial joint space in standing anteroposterior (AP) view of both sides at the pre-operative and the last follow-up. Results: According to the Tapper & Hoover classification, 28 cases were excellent, 7 cases good, 8 cases fair, and 5 cases poor. Among group 1, 25 cases were excellent, 2 cases good, 2 cases fair, 1 case poor. However, among group 2, 3 cases were excellent, 5 cases good, 6 cases fair, 4 cases poor. Average Lysholm knee score was improved from 62.4 preoperatively to 94 postoperatively in group 1, and from 58 preoperatively to 77.9 postoperatively in group 2. The joint space narrowing showed no statistically significant difference in both knees standing AP view. Conclusion: The arthroscopic partial meniscectomy for a patient with the degenerative articular cartilage was an effective treatment. However, we could not satisfy the results, in cases of Outerbridge grade III and IV. In grade III and IV, the partial meniscectomy was not aggravated the cartilage damage.
Nah Byung Sik;Nam Taek Keun;Ahn Sung Ja;Chung Woong Ki
Radiation Oncology Journal
/
v.15
no.2
/
pp.97-104
/
1997
of PLC−γ 1 activity. Results : In the immunohistochemistry, the expression of PLC−β was negative for all grnups. The expression of PLC−γ 1 was highest in the group III followed by group II in the proliferative zone of mucosa. The expression of PKC-01 was strong1y positive in group I followed by group II in the damaged surface epithelium. The above findings were also confirmed in the immunoblotting study. In the irnrnunoblotting study, the expressions of PLC−β,PLC−γ1,andPLC−δ were the same as the results of immunohistochemistry The expression of ras oncoprotein was weakly Positive in groups II, III and IV. The of EGFR was the highest in the group II, III, followed by group W and the expression of PKC was weakly positive in the group II and III. Conclusion : PLC−γ 1 mediated signal transduction including ras oncoprotein, EGFR, and PKC play a significant role irL mucosal regeneration after irradiation. PLC−δ 1 mediated signal transduction might have an important role in mucosal damage after irradiation. Further studies will be necessary to confirm the signal transduction mediating the PLC−δ 1.
Purpose: The purpose of this study is to present the treatment results and to identify possible prognostic indicators in patients with locally advanced hypopharyngeal carcinoma. Materials and Methods: Between October 1985 to December 2000, 90 patients who had locally advanced stage IV hypopharyngeal carcinoma were studied retrospectively. Twelve patients were treated with radiotherapy alone, 65 patients were treated with a combination of chemotherapy and radiotherapy, and 13 patients were treated with surgery and postoperative radiotherapy with or without neoadjuvant chemotherapy. Total radiation dose ranged from 59.0 to 88.2 Gy (median 70 Gy) for radiotherpay alone. Most patients had ciplatin and 5-fluorouracil, and others had cisplatin and pepleomycin or vincristin. Median follow-up period was 15 months. Kaplan-Meier method was used for survival rate and Cox proportional hazard model for multivariate analysis of prognostic factors. Results: Overall 3-and 5-year survival rates were 27% and 17%, respectively. The 2-year locoregional control rates were 33% for radiotherapy alone, 32% for combined chemotherapy and radiotherapy, and 81 % for combined surgery and radiotherapy (p=0.006). The prognostic factors affecting overall survival were T stage, concurrent chemoradiation and treatment response. Overall 3-and 5-year laryngeal preservation rates in combined chemotherapy and radiotherapy were 26% and 22%, respectively. Of these, the 5-year laryngeal preservation rates were 52% for concurrent chemoradiation group (n=11), and 16% for neoadjuvant chemotherapy and radiotherapy (n=54, p=0.012). Conclusion: Surgery and postoperative radiotherapy showed better results than radiotherapy alone or with chemotherapy. Radiotherapy combined with concurrent chemotherapy is an effective modality to achieve organ preservation in locally advanced hypopharyngeal cancer. Further prospective randomized studies will be required.
Fusarium head blight is an important disease of small grains. It is mainly caused by members of the Fusarium graminearum species complex (FGSC). Barley and wheat growers spray fungicides, especially demethylation-inhibitor fungicides, to suppress the disease. The objective of this study was to examine the changes in the sensitivity of the FGSC population to the triazole fungicide, propiconazole. A total of 124 and 350 isolates of FGSC were obtained from barley and wheat in Jeolla Province during 2010-2016 and 2020-2021, respectively. The species identity and trichothecene chemotypes of the FGSC isolates were determined based on polymerase chain reaction assays targeting translation elongation factor 1-alpha and TRI12 genes, respectively. Sensitivity to propiconazole was determined based on the effective concentration that reduced 50% of the mycelial growth (EC50) using the agar dilution method. Of all isolates, F. asiaticum with the nivalenol chemotype was the most common (83.9% in 2010-2016 and 96.0% in 2020-2021), followed by F. asiaticum with the 3-acetyl deoxynivalenol chemotype (12.1% in 2010-2016 and 2.9% in 2020-2021). The EC50 values of the isolates collected in 2010-2016 and 2020-2021 ranged from 0.0180 to 11.0166 ㎍/mL and 1.3104 to 17.9587 ㎍/mL, respectively. The mean EC50 value of the isolates increased from 3.8648 ㎍/mL in 2010-2016 to 5.9635 ㎍/mL in 2020-2021. The baseline resistance to propiconazole was determined to be 7 ㎍/mL, based on the EC50 value of isolates collected in 2010-2016, and the ratio of resistant isolates increased from 9.7% in 2010-2016 to 28.6% in 2020-2021.
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