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Conservative Surgery and Primary Radiotherapy for Early Bresst Cancer: Yonsei Cancer Center Experience (조기 유방암에서 보존적 수술후 방사선치료: 연세암센터 경험)

  • Suh Chang Ok;Lee Hy De;Lee Kyung Sik;Jung Woo Hee;Oh Ki Keun;Kim Gwi Eon
    • Radiation Oncology Journal
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    • v.12 no.3
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    • pp.337-347
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    • 1994
  • Breast conserving surgery and irradiation is now accepted as preferable treatment method for the patients with stage I and II breast cancer. Our institution activated team approach for breast conservation in 1991 and treated one hundred and fourty patients during the next three years. Purpose : To present our early experience with eligibility criteria, treatment techniques, and the morbidities of primary radiotherapy. Materials and Methods: Sixty four patients with early stage breast cancer who received breast conserving treatment between January 1991 and December 1992 were evaluated. All patients received partial mastectomy(wide excision to quadrantectomy) and axillary node dissection followed by radiotherapy. Total dose of 4500-5040 cGy in 5-5 1/2 weeks was given to entire involved breast and boost dose of 1000-2000 cGy in 1-2 weeks was given to the primary tumor site. Linac 4 MV X-ray was used for breast irradiation and electron beam was used for boost. Thirty five Patients received chemotherapy before or after radiotherapy. Patients characteristics, treatment techniques, and treatment related morbidities were analyzed. Results : Age distribution was ranged from 23 to 59 year old with median age of 40. Twenty-seven patients had T1 lesions and 34 patients had T2 lesions. In three patients, pathologic diagnosis was ductal carcinoma in situ. Thirty-seven Patients were N0 and 27 patients were Nl. There were three recurrences, one in the breast and two distant metastases during follow-up period(6-30 months, median 14 months). Only one breast recurrence occured at undetected separate lesion with microcalcifications on initial mammogram. There was no serious side reaction which interrupted treatment courses or severe late complication. Only one symptomatic radiation pneumonitis and one asymptomatic radiation pneumonitis were noted. Conclusions: Conservative surgery and primary radiotherapy for early breast cancer is Proven to be safe and comfortable treatment method without any major complication. Long-term follow up is needed to evaluate our treatment results in terms of loco-regional control rate, survival rate, and cosmetic effect.

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Analysis of Prognostic Factors in Glioblastoma Multiforme (다형성 교모세포증 환자의 예후인자 분석)

  • Chang Sei Kyung;Suh Chang Ok;Lee Sang Wook;Keum Ki Chang;Kim Gwi Eon;Kim Woo Cheol
    • Radiation Oncology Journal
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    • v.14 no.3
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    • pp.181-189
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    • 1996
  • Purpose : To find the more effective treatment methods that improving the survival of patients with glioblastoma multiforme(GBM), we analyze the prognostic factors and the outcome of therapy in patients with GBM. Materials and Methods : One hundred twently-one patients with a diagnosis of GBM treated at Severance Hospital between 1973 and 1993 were analyzed for survival with respect to patients characteristics, that is, duration of symptom, age, and Karnofsky performance status, as well as treatment related variables such as extent of surgery and radiotherapy. Results : The median survival time(MST) and 2-year overall survival rate (OSR) of the patients with GBM were 13 months and $20.8\%$, respectively. Duration of symptom, age, Karnofsky performance status(KPS), radiotherapy, and extent of surgical resection were associated with improved survial in a univariate analysis. Patients whose duration of symptom was longer than 3 months, had the 2-year OSR of $47.2\%$(p=0.0082), who were younger than age 50, $32.9\%$(p=0.0003) In patients with a KPS of 80 or higher, the 2-rear OSR was $36.9\%$(p=0.0422). Patients undergoing radiotherapy had the 2-year OSR of $22.9\%$(p=0.0030), and surgical resection of $23.3\%$ (p<0.000). A Cox regression model confirmed a significant correlation of duration of symptom, age, radiotherapy, and extent of surgical resection with survival, excluding KPS(P=0.8823). The 2-year OSR were $22.3\%$ and $19.4\%$, combined with chemotherapy or without, respectively(p=0.6028). The duration of symptom of 3 months or shorter, 50 years of age or older, and undergoing stereotactic biopsy only were considered as risk factors, then patients without any risk factors had the MST of 29 months and 2-year OSR of $53.9\%$ compared to 4 months and $0\%$ for Patients who had all 3 risk factors. Most of all treatment failures occurred in the primary tumor site($80.4\%$). Conclusion : The duration of symptom, age, radiotherapy, and extent of surgical resection were a prognostically significant indeuendent variables. To get a better survival, it seems to be reasonable that the study design which improves the local control rates is warranted.

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A Study for Plant Community Structure and Management Plan of Pinus densiflora Forest in Byeonsanbando National Park (변산반도국립공원 소나무림 식물군집구조 및 관리방안 연구)

  • Choi, Jin-Woo;Kwak, Jeong-In;Lee, Kyong-Jae;Choi, Woon-Kyoo
    • Korean Journal of Environment and Ecology
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    • v.23 no.5
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    • pp.447-459
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    • 2009
  • This study is intended to provide basic date for the efficient management of Pinus densiflora community by analyzing ecological characteristics of Pinus densiflora inhabiting Byeonsanbando National Park. According to investigations, P. densiflora community and P. densiflora-Quercus community are widely distributed, occupying 40.3% of the total area. 21 sites ($400m^2$per site) are selected for TWINSPAN analysis, and the result indicates that the whole community of P. densiflora and P. densiflora-Quercus can be classified into 8 types, and the age of P. densiflora is 40-50 years, which is similar to that of deciduous broad-leaved trees. The 8 community types are: P. densiflora community which competes with Quercus variabilis; P. densiflora community in which Fraxinus sieboldiana and Quercus serrata grow in the understory layer; P. densifloa community in which Q. serrata grow in the understory layer and Smilax china var. microphylla in the shrub layer respectively; P. densifloa community in which P. densiflora and F. sieboldiana grow in the understory layer; P. densiflora community which competes with Q. serrata and Carpinus tschonoskii; P. densiflora community which competes with Q. variabilis and Q. serrata; P. densiflora community in which Prunus sargentii grow; P. densiflora community in which Abies holophylla grow. P. densiflora community which competes with Q. variablis and C. tschonoskii seems to be in a stage of succession to deciduous broad-leaved community. The analysis indicates that Shannon diversity index is 0.2756-1.3879. It also indicates that there is a negative correlation between P. densiflora and Q. variabilis and C. tschonoskii; there is a positive correlation between P. densiflora and F. sieboldiana and Rhododendron schlippenbachii. These investigations show that the transformation of vegetation is already under way. There is a possibility that ecological succession can take place in 30.4% of the total area from P. densiflora to Quercus and deciduous broad - leaved trees. Therefore, it is recommended that the preservation and maintenance of P. densiflora be implemented by taking control of competing species which undermine the stability of P. densiflora forest community.

Two Cases of Chemical Pneumonitis Caused by Hydrogen Sulfide (황화수소로 인한 화학성 폐렴 2예)

  • Kim, Jung Ha;Lee, Kyung Joo;Jung, Jin Yong;Lee, Eun Joo;Jung, Ki Hwan;Kang, Eun Hae;Lee, Sung Yong;Lee, Sang Yeub;Kim, Je Hyeong;Shin, Chol;Shim, Jae Jeong;In, Kwang Ho;Kang, Kyung Ho;Yoo, Se Hwa
    • Tuberculosis and Respiratory Diseases
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    • v.64 no.3
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    • pp.210-214
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    • 2008
  • Chemical pneumonitis is an occupational lung disease that's caused by the inhalation of chemical substances. Its severity depends on the characteristics of the substances, the exposure time and the susceptibility of the patients. Hydrogen sulfide is not only emitted naturally, but it also frequently found in industrial settings where it is either used as a reactant or it is a by-product of manufacturing or industrial processes. Inhalation of hydrogen sulfide causes various respiratory reactions from cough to acute respiratory failure, depending on the severity. Two pharmaceutical factory workers were admitted after being rescued from a waste water disposal site that contained hydrogen sulfide. In spite that they recovered their consciousness, they had excessive cough and mild dyspnea. The simple chest radiographs and high resolution computed tomography showed diffuse interstitial infiltrates, and hypoxemia was present. They were diagnosed as suffering from chemical pneumonitis caused by hydrogen sulfide. After conservative management that included oxygen therapy, their symptoms, hypoxemia and radiographic abnormalities were improved.

Development of Ecological Restoration Model Consider Analysis on the Vegetation Structure of Burned Area (산불지역 식생구조 분석을 통한 식생복원 모델 개발)

  • Kim, Jeong-Ho;Lee, Soo-Dong
    • Korean Journal of Environment and Ecology
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    • v.21 no.5
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    • pp.400-414
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    • 2007
  • This study has analyzed the vegetation structure to suggest a vegetation ecological restoration model by using the case of the afforestation for erosion control area with Pinus koreaiensis and Betula platyphylla, etc., on the hills of the Young-in mountains after its great fire in 2000. Of the area having a dimension of $1,152,404.3m^2$ selected as a survey site for the existing vegetation, the forest fire area accounted for 69.2% among which, brushwoods accounted the most for 24.67%. As a result of analysis of the 27 surveyed unit plots[unit dimension: $100m^2$] set up in consideration of the existing vegetation pattern and damaged state from the forest fire, the surveyed area was classified into 10 communities. Shrub layer's vegetation was found to be dominant in forest fire areas and the surveyed sites were classified into 5 plant communities, i.e. P. koraiensis community, Quercus variabilis community, P. thunbergii community, Q. serrata community, B. platyphylla community in forest fire areas, while non-forest fire areas were classified into 5 plant communities, such as P. densiflora community, Q. acutissima community, Q. serrata community, Q. mongolica-Q. serrata community, B. platyphylla community. Species diversity of forest fire areas was $0.3679{\sim}0.5907$ and that of non-forest fire areas was $0.5728{\sim}0.8865$. In addition, the number of the species in the forest fire areas was $5{\sim}8$ and that of non-forest areas was $8{\sim}12$; however, the population of forest fire areas$(156{\sim}456)$ was higher than that of non-forest fire areas$(61{\sim}227)$. In the analysis of growth density per layer$[of\;100m^2]$, there appeared $1{\sim}8$ trees of Q. mongolica and $3{\sim}5$ trees of Q. serrata in the upper layer species; $2{\sim}4$ trees of Q. serrata and one tree of Q. mongolica in the canopy layer. As for the characteristics of soil, acidity of forest fire areas was pH 5.45 and that of non-forest fire was pH 5.25. By setting up the middle D.B.H range of Q. mongolica-Q. serrata community as the vegetation restoration model, planting species, planting density and planting models are suggested.

Research on Visitor Behavior and Satisfaction with the Nature Trail in Hallasan National Park (한라산국립공원 자연학습탐방로의 이용행태와 이용객만족에 관한 연구)

  • Kim, Jeong-Min
    • Korean Journal of Environment and Ecology
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    • v.21 no.3
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    • pp.223-234
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    • 2007
  • The study, executed with Hallasan National Park, which deserves to be a typical ecotourism destination, aims to provide basic information on park management for early establishment of ecotourism in a national park by assessing its visitors' behavior and satisfaction with a nature trail established as a series of an environmental interpretation program. The questionnaire survey was conducted at Eorimok Square in the weekday and on the weekend for two months of August and September in 2006, and finally 144 valid samples were used for the analysis. As a result of the research, it revealed that the demographic characteristics of the visitors to Hallasan National Park tended to coincide with those of the visitors to other national parks In Korea. On the whole, it showed their low recognition level of nature trails built up in national parks and less experience in using them. However, the visitors' satisfaction level and intention of re-visit, and recommendation to others were comparatively higher after actually using the nature trail at the site of Hallasan National Park, which hints at the possibility of national parks' much weightier role as the ground for ecology education and the functional expansion of the environmental interpretation-related facilities and programs. As for the attributes having effects on users' satisfaction with a nature trail, substantial aspects such as accessibility, safety, uniqueness and interest in environmental interpretation, and educational quality as well as physical facility management were revealed to have equal effects on users' satisfaction level, so there still remain a lot of pending issues over the reality of national parks in the initial stage of ecotourism staying at the level of the introduction and establishment of the facilities for environmental interpretation. This research had surveyed visitors to Hallasan National Park and limited to the nature trail only. For more systematic and practical ecological management of a national park, the in-depth understanding of the attributes affecting satisfaction of ecotourists, including nature trails and other environmental interpretation programs, and more sophisticated measuring tools are needed.

Quantitative evaluation of collapse hazard levels of tunnel faces by interlinked consideration of face mapping, design and construction data: focused on adaptive weights (막장관찰 및 설계/시공자료가 연계 고려된 터널막장 붕괴 위험도의 정량적 산정: 가변형 가중치 중심으로)

  • Shin, Hyu-Soung;Lee, Seung-Soo;Kim, Kwang-Yeom;Bae, Gyu-Jin
    • Journal of Korean Tunnelling and Underground Space Association
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    • v.15 no.5
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    • pp.505-522
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    • 2013
  • Previously, a new concept of indexing methodology has been proposed for quantitative assessment of tunnel collapse hazard level at each tunnel face with respect to the given geological data, design condition and the corresponding construction activity (Shin et al, 2009a). In this paper, 'linear' model, in which weights of influence factors are invariable, and 'non-linear' model, in which weights of influence factors are variable, are taken into account with some examples. Then, the 'non-linear' model is validated by using 100 tunnel collapse cases. It appears that 'non-linear' model allows us to have adapted weight values of influence factors to characteristics of given tunnel site. In order to make a better understanding and help for an effective use of the system, a series of operating processes of the system are built up. Then, by following the processes, the system is applied to a real-life tunnel project in very weak and varying ground conditions. Through this approach, it would be quite apparent that the tunnel collapse hazard indices are determined by well interlinked consideration of face mapping data as well as design/construction data. The calculated indices seem to be in good agreement with available electric resistivity distribution and design/construction status. In addition, This approach could enhance effective usage of face mapping data and lead timely and well corresponding field reactions to situation of weak tunnel faces.

Problems Analysis Related to Nutrition and the Development of Nutrition Education Programs for High School Students(II) - A Study Centered on the Development of Nutrition Education Programs for High School Students - (고등학생의 영양 관련 문제점 분석 및 영양 교육 프로그램 개발 ( II ) - 고등학생 대상 영양 교육 프로그램 개발 -)

  • Lee, Eun-Ju;Soh, Hye-Kyung;Choi, Bong-Soon
    • Journal of the East Asian Society of Dietary Life
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    • v.17 no.3
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    • pp.351-363
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    • 2007
  • Previously, we analyzed for nutrition knowledge and the use of nutrition knowledge in the everyday lives of students in order to develop nutrition education programs that focus on desirable behavior change. From this, we found that female students desired to participate in nutrition education more than male students, and regarding their concerns for nutrition education, 73.2% of the females and 50.0% of the males displayed interest in 'obesity and the regulation of body weight'. Therefore, this study showed female students give more attention to the obesity and the regulation of body weight than male students(p=.000<.001). In addition, female students had higher interests($8.63{\pm}1.67$) than male students ($7.45{\pm}2.03$) in nutrition knowledge(p=.000<.001). By investigating the use of nutrition knowledge in everyday life, our research indicated that the actual use of nutrition knowledge was less. To encourage students to persue dietary lives addressing the concerns confirmed above, the following needed to occur. 1) Provide them nutrition information for the main processed foodstuffs encountered when dining out(breads, cakes, cookies, and carbonated beverage). 2) Teach them to read food nutrition labels. 3) Help them find a lifestyle connection through lasting self-management methods and the generation of social support. Accordingly, this required developing effective and practical nutrition education programs that considered regional characteristics and gender differences. The most important factors considered during nutrition education program development were the need for motivation and ongoing education by stage of change, rather than temporal education through specific problem analysis, in order that those being educated may bring about a change of behavior by themselves. Therefore, from this study, we have suggested the use of multilateral operating strategies for successful nutrition education. In addition the phase model of behavior change should be applied. Our programs were aimed at self owned nutritional management so that students could master their own methods for acquiring skills and enjoying dietary life. The research may be summed up as follows. First, the purpose of education at the recognition stage of change was to attempt motivation for nutrition improvement, by analyzing the problems such as food buying habit and the main purchasing viewpoints when dining out. Second, the purpose of education at the action stage of change was to help students acquire of concrete methods for behavior modification by linking the program to their home as well as to teachers with various activities that suited the situation at school. This was done by analyzing the processes and decisions pertaining to dining out the main processed foodstuffs and principal components, etc. through data and experimental practice. Third, the purpose of education for changing of habits and values, or the maintenance stage, was to investigate the various reasons that undesirable behaviors were induced, and then determine a lasting self-management method as well as how to generate social support. If the nutrition education program developed in this study is utilized on site, someone in the primary role as the nutrition educator and trained specifically in nutrition, can help induce the health promotion in the community as well as lasting dietary management, by executing a link with families in parallel with educating teaching staff and students' parents. In addition, this program can playa role in the government policies related to the health promotion for our youth who are the foundation of our nation and who can enhance our national competitive power.

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Simultaneous Analysis of 13 Pesticides in Groundwater and Evaluation of its Persistent Characteristics

  • Song, Dahee;Park, Sunhwa;Jeon, Sang-Ho;Kim, Ki-In;Hwang, Jong Yeon;Kim, Moonsu;Jo, Hun-Je;Kim, Deok-hyun;Lee, Gyeong-Mi;Kim, Hye-Jin;Kim, Tae-Seung;Chung, Hyen Mi;Kim, Hyun-Koo
    • Korean Journal of Soil Science and Fertilizer
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    • v.50 no.5
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    • pp.434-451
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    • 2017
  • For this study, groundwater samples for 3 years from 2011 through 2013 were collected at 106 groundwater monitoring site in Korea. These groundwater samples were analyzed for 13 pesticides such as cabofuran, pentachlorobenzene, hexachlorobenzene, simazine, atrazine, lindane (gamma-HCH), alachlor, heptachlor, chlordane (total), endosulfan (1, 2), dieldrin, endrin, 4,4-DDT. The objectives of this study were to determine the detection frequency and their concentrations of 13 pesticides and evaluate the health risk level considering ingestion, inhalation, and skin contact using concentrations of 13 pesticides in groundwater samples. An analysis was used for the simultaneous determination for 13 pesticides using GC-MS. GC-MS was performed on HP-5ms, using helium ($1ml\;min^{-1}$) as carrier gas. The average recoveries of the pesticides were from 92.8% to 120.8%. The limits of detection (LODs) were between $0.004{\mu}g\;L^{-1}$ and $0.118{\mu}g\;L^{-1}$ and the limits of quantification (LOQs) were between $0.012{\mu}g\;L^{-1}$ and $0.354{\mu}g\;L^{-1}$. 106 groundwater wells were selected. 54 wells were from well to monitor background groundwater quality and 52 wells were from well to monitor groundwater quality in industrial or contamination source area. Eight pesticides including pentachlorobenzene, lindane (Gamma-HCH), heptachlor, chlordane (total), Endosulfan (1, 2), dieldrin, endrin, and 4,4-DDT were not detected in groundwater samples. The detection frequency for hexachlorobenzene, alachlor, carbofuran and simazine was 23.4%, 11.4%, 7.3%, and 1.0%, respectively. Atrazine was detected once in 2011. The average concentrations were $0.00423{\mu}g\;L^{-1}$ for carbofuran, $0.000243{\mu}g\;L^{-1}$ for alachlor, $0.00015{\mu}g\;L^{-1}$ for simazine, and $0.00001{\mu}g\;L^{-1}$ for hexachlorobenzene. The detection frequency of hexachlorobenzene was high, but the average concentration was low. In the contaminated groundwater, the detection frequency for hexachlorobenzene, alachlor, carbofuran, simazine and atrazine was 26.1%, 21.3%, 7.1%, 1.9% and 0.3%, respectively. In the uncontaminated groundwater, detection frequency for hexachlorobenzene, carbofuran and alachlor were 20.2%, 7.5%, and 1.9% respectively. Simazine and atrazine were not detected at uncontaminated groundwater wells. According to the purpose of groundwater use, atrazine was detected for agricultural groundwater use. Hexachlorobenzene showed high detection frequency at agricultural groundwater use area where the animal feeding area and golf course area were located. Alachlor showed more than 50% detection frequency at cropping area, pollution concern river area, and golf course area. Atrazine was detected in agricultural water use area. By land use, the maximum detection frequency of alachlor was found near an orchard. For human risk assessment, the cancer risk for the 5 pesticides was between $10^{-7}$ and $10^{-10}$, while the non-cancer risk (HQ value) was between $10^{-4}$ and $10^{-6}$. For conclusion, these monitoring study needs to continue because of the possibility of groundwater contamination based on various purpose of groundwater use.

The Clinical Manifestation of Pulmonary Infection in AIDS Patients (국내 일개 대학병원에서 경험한 AIDS 환자의 폐 감염성 질환의 임상적 특성)

  • Jung, Jae Woo;Chung, Jin Won;Song, Ju Han;Jeon, Eun Ju;Lee, Young Woo;Choi, Jae Cheol;Shin, Jong Wook;Park, In Whon;Choi, Byoung Whui;Kim, Jae Yeol
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.6
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    • pp.554-561
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    • 2006
  • Background: In AIDS patients, the respiratory tract is one of the most frequently involved site of by an opportunistic infection, and an even common, casual pulmonary infection manifests in a peculiar ways in AIDS patients. In Korea, because of the low prevalence of AIDS, there is insufficient data compared with other Southeast Asian counties. However, considering the sexual behavior of the younger generation, it is expected that it will not be long before AIDS becomes a major public health issue in Korea. This study examined the clinical manifestation of HIV positive people and AIDS patients. The pulmonary manifestion of HIV-positive was evaluated. This study focused on the differences in the clinical manifestation between AIDS patients with pulmonary disease and simple HIV positive people. The characteristics of common pulmonary infections in AIDS patients were also analyzed. Method: The medical records of 28 HIV positive patients who visited the hospital of ChungAng University Hospital from January, 2001 to February, 2006 were analyzed retrospectively. Result: Twenty-seven patients out of 28 HIV positive patients were male and the average age was 40.6(23-65). Patients in their thirties were most commonly affected. Elven patients had pulmonary diseases. Pulmonary tuberculosis (4 cases) and pneumocystis pneumonia (4 cases) were the most common respiratory infection. One patient showed a peculiar type of systemic cryptococcus. which was accompanied by lung and pleural dissemination. The CD4+lymphocyte count of patients with a pulmonary infection was significantly lower in patients with a pulmonary manifestation than those with only a HIV infection ($79.5/mm^3$ vs $400/mm^3$, respectively)(p<.05). Patients with pulmonary disease were in a more severe immunosuppressive state. There were 4 patients with pulmonary tuberculosis, 4 with pneumocystis pneumonia, 4 with secondary syphilis, 2 with primary syphilis, and 2 with HZV infection. The average CD4 lymphocyte counts was $56/mm^3$ in those with pulmonary tuberculosis, $42/mm^3$ in those with pneumocystis pneumonia, and $455/mm^3$ in those with secondary syphilis. Conclusion: This study examined the clinical manifestation of HIV positive patients, particularly AIDS patients with pulmonary disease, A more severe immunosuppressive status was observed in HIV-related pulmonary compared with those with HIV-related extrapulmonary disease, and the frequency of pulmonary tuberculosis in pulmonary disease was higher than expected. Respiratory infection in AIDS manifest in uncommon ways e.g. disseminated cryptococcosis involving the lung and pleura. Evidently, AIDS patients with a respiratory infection have a more severe form of immunosuppression than those with a simple HIV infection. As expected, patients with a pulmonary infection were in a more severe immunosuppressed state than those with a simple HIV infection. Opportunistic infections can show peculiar clinical presentations in AIDS patients.