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Prophylactic cranial irradiation in limited small-cell lung cancer : incidence of brain metastasis and survival and clinical aspects (예방적 두강내 방사선 조사후 소세포 폐암 환자의 뇌전이 빈도와 생존율에 대한 연구)

  • Suh, Jae-Chul;Kim, Myung-Hoon;Park, Hee-Sun;Kang, Dong-Won;Lee, Kyu-Seung;Ko, Dong-Seok;Kim, Geun-Hwa;Jeong, Seong-Su;Cho, Moon-June;Kim, Ju-Ock;Kim, Sun-Young
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.3
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    • pp.323-331
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    • 2000
  • Purpose: Brain metastases are present in approximately 10-16% of small cell lung cancer patients at diagnosis. Brain metastasis is an important clinical problem associated with increasing the survival rate, with a cumulative incidence of up to 80% in patients surviving 2 years. Prophylactic cranial irradiation(PCI) reduces the incidence of brain matastasis and may prolong survival in patients with limited small-cell lung cancer who achieved complete remission. This study was performed to analyze the incidence of brain metastasis, survival and clinical aspects after PCI in patients with limited small-cell lung cancer who achieved complete remission. Methods : Between 1989 and 1999, forty-two patients with limited small-cell lung cancer who achived achieved complete remission after therapy were enrolled into this study retrospectively. All patients received etoposide and cisplatin(VPP) alternating with cytoxan, adriamycin, and vincristine(CAV) every 3 weeks for at least 6 cycles initially. All patients received thoracic radiotherapy: concurrent(38.1%) and sequential(61.9%). All patients received late PCI. Results : Most patients(88.1%) were men, and the median age was 58 years. The median follow-up duration was 18.1 months. During the follow-up period, 57.1% of the patients developed relapse. The most frequent site of relapse was chest(35.7%), followed by brain(14.3%), liver(11.9%), adrenal gland(44%), and bone(2.2%). With the Kaplan-Meier method, the average disease-free interval was 1,090 days(median 305 days). The average time to development of brain relapse after PCI and other sites relapse(except brain) were 2,548 days and 1,395 days(median 460 days), respectively. The average overall survival was 1,233 days(median 634 days, 21.1 months), and 2-year survival rates was 41.7%. The average overall survival in the relapse group was 642 days(median 489 days) and in the no relapse group was 2,622 days(p<0.001). The average overall survival in the brain relapse group was 928 days(median 822 days) and in the no brain relapse group was 1,308 days(median 634 days)(p=0.772). In most patients(85.7%), relapse(except brain) or systemic disease was the usual cause of death. Brain matastasis was the cause of death in 14.3% of the cases. Conclusions : We may conclude that PCI reduces and delays brain metastasis in patients with limited small cell lung cancer who achieved complete remission. We found decreased survival in relapse group but, no significant survival difference was noted according to brain matastasis. And relapse(except brain) or systemic disease was the usual cause of death. In order to increase survival, new treatment strategies for control methods for relapse and systemic disease are required.

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The Effect of the Use of Concept Mapping on Science Achievement and the Scientific Attitude in Ocean Units of Earth Science (해양단원 개념도 활용 수업이 과학성취도 및 태도에 미치는 효과)

  • Han, Jung-Hwa;Kim, Kwang-Hui;Park, Soo-Kyong
    • Journal of the Korean earth science society
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    • v.23 no.6
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    • pp.461-473
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    • 2002
  • Concept mapping is a device for representing the conceptual structure of a subject discipline in a two dimensional form which is analogous to a road map. In the teaching and learning of earth science, each concept depends on its relationships to many others for meaning. Using concept mapping in teaching helps teachers and students to be more aware of the key concepts and relationships among them. The purpose of this study is to investigate the effect of the use of concept mapping on science achievement and the scientific attitude in ocean units of earth science. The results of this study are as follows; first, the science achievement of a group of concept mapping teaching is significantly higher than that of the group of traditional teaching. Also, when the achievement levels are compared among different cognitive ability groups, the effect is more significant in mid or lower level student groups than in high level groups. The use of concept mapping is more effective when the concepts have a distinct concept hierarchy. Second, the scores of the test of ‘attitude toward scientific inquiry’ and ‘application of scientific attitude’ of the group of concept mapping teaching are significantly higher than those of the group of traditional teaching, whereas the scores of the test of ‘interest in science learning’ of concept mapping teaching is not different from those of group of traditional teaching. Third, the survey on the use of concept mapping shows a positive response across the tested groups. The use of concept mapping is more beneficial in fostering the comprehension of the topic. A concept map of student's own construction facilitates the assessment of learning, thus promising the usefulness of concept mapping as a means of evaluation. In regard to retention aspect, concept mapping is considered to be more effective in confirming and remembering the topic, while less effective in the aspects of activity and interest. In conclusion, the use of concept maps makes learning an active meaningful process and improves student's academic achievement and scientific attitude. If the concept mapping is more effectively as an active teaching strategy, more meaningful learning will be attained.

Physicochemical Properties of Pearl Oyster Muscle and Adductor Muscle as Pearl Processing Byproducts (진주 가공부산물(육 및 패주)의 이화학적 특성)

  • Kim, Jin-Soo;Kim, Hye-Suk;Oh, Hyeun-Seok;Kang, Kyung-Tae;Han, Gang-Uk;Kim, In-Soo;Jeong, Bo-Young;Moon, Soo-Kyung;Heu, Min-Soo
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.35 no.4
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    • pp.464-469
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    • 2006
  • This study was conducted to evaluate a knowledge on food components of muscle and adductor muscle of pearl oyster (Pinctada fucata martensii) as pearl processing byproducts. The concentrations of mercury and chromium as heavy metal were not detected in both pearl oyster muscle and adductor muscle, and those of cadmium and lead were 0.06 ppm and 0.11 ppm in only pearl oyster muscle, respectively. Thus, the heavy metal levels of pearl processing byproducts were below the reported safety limits. The volatile basic nitrogen (VBN) content and pH of pearl oyster muscle were 11.6 mg/100g and 6.31 and those of abductor muscle were 8.6 mg/100 g and 6.33, respectively. It was concluded that pearl oyster muscle and adductor muscle might not invoke health risk in using food resource. The contents of crude protein (16.5%) and total amino acid (15,691 mg/100 g) of adductor muscle were higher than those of muscle (11.2% and 10,131 mg/100 g) and oyster (12.1% and 11,213 mg/100 g) as a control. The contents of calcium and phosphorus were 95.4 mg/100 g and 116.0 mg/100 g in muscle, 75.2 mg/100g and 148.1 mg/100 g in adductor muscle, respectively. The calcium level based on phosphorus was a good ratio for absorbing calcium. The free amino acid contents and taste values were 635.5 mg/100 g and 40.2 in muscle, and 734.9 mg/100 g and 24.1 in adductor muscle, respectively, but that (882.8 mg/100 g and 40.2) of oyster was higher than those of pearl processing byproducts. Based on the results of physicochemical and nutritional properties, pearl oyster muscle and adductor muscle can be utilized as a food resource.

Effects of the Seed Treatment on Field Germination and Seedling Growth in four useful species, Euonymus alatus, Nandina domestica, Thea sinensis and Zanthoxylum piperitum (화살, 남천, 차, 초피나무 4유용수종(有用樹種)의 종자(種子) 발아촉진처리(發芽促進處理)가 포지발아(圃地發芽)와 유묘(幼苗) 생장(生長)에 미치는 효과)

  • Goo, Gwan Hyo;Choi, Jai Sik;Youn, Ki Sik
    • Journal of Korean Society of Forest Science
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    • v.84 no.1
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    • pp.87-96
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    • 1995
  • We examined the effects of seed treatment on field germination rate and seedling growth for four woody species, Euonymus alatus, Thea sinensis, Zanthoxylum piperitum, Nandina domestia which are economically useful in Korea. The seeds of each species were purified carefully after collection during Oct. and Nov.. E. alatus, T. sinensis, and Z. piperitum were sowed in the experimental field after stored in open ground with treatment of Pon-Pon. $H_2O_2$, $GA_3$, scarification. and N. domestica was sowed in container within green house after treatment of three different periods(7, 15, 21days) in growth chamber(4, 25, $32^{\circ}C$). Germination rate and seedling growth were measured in mid-Oct.. In E. alatus germination rate was higher in storaging in open ground after soaking in $GA_3$(67.1%) than in only storaging in open ground(18.4%). But the rate in T. sinensis showed no differences between storage in open ground after treatment of $GA_3$, and scarification, and only storage in open ground, Germination rate of Z. piperitum was much higher in storaging in open ground after treatment of Pon-Pon(80.3%) than in only storaging in open ground(12.4%). In N. domestica. seeds stored for 7 days at $32^{\circ}C$ were germinated faster than those stored for 7 days at $4^{\circ}C$, and germination rate of the former was also higher than that of the latter. Peak Times of seed germination in field were order of E. alatus (32 days). Z. piperitum (49 days). T. sinensis (83 days), N. domestica (87 days). The growth of seedling germinated in field showed a good result because of early germination following the effect of seed treatment. The periods of highest growth performances of the seedlings were 72 days in late Jun.-mid Jul. in E. alatus. 59 days in late Jun.- mid Jul. in Z. Piperitum, and 45 days in mid Aug.- mid Sep. in T. sinensis.

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Wind and Flooding Damages of Rice Plants in Korea (한국의 도작과 풍수해)

  • 강양순
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.34 no.s02
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    • pp.45-65
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    • 1989
  • The Korean peninsular having the complexity of the photography and variability of climate is located within passing area of a lots of typhoon occurring from the southern islands of Philippines. So, there are various patterns of wind and flooding damages in paddy field occuring by the strong wind and the heavy rain concentrated during the summer season of rice growing period in Korea. The wind damages to rice plants in Korea were mainly caused by saline wind, dry wind and strong wind when typhoon occurred. The saline wind damage having symptom of white head or dried leaves occurred by 1.1 to 17.2 mg of salt per dry weight stuck on the plant which was located at 2. 5km away from seashore of southern coastal area during the period(from 27th to 29th, August, 1986) of typhoon &Vera& accompanying 62-96% of relative humidity, more than 6 m per second of wind velocity and 22.5 to 26.4$^{\circ}C$ of air temperature without rain. Most of the typhoons accompanying 4.0 to 8. 5m per second of wind and low humidity (lesp an 60%) with high temperature in the east coastal area and southen area of Korea. were changed to dry and hot wind by the foehn phenomenon. The dry wind damages with the symptom of the white head or the discolored brownish grain occurred at the rice heading stage. The strong wind caused the severe damages such as the broken leaves, cut-leaves and dried leaves before heading stage, lodging and shattering of grain at ripening stage mechanically during typhoon. To reduce the wind damages to rice plant, cultivation of resistant varieties to wind damages such as Sangpoongbyeo and Cheongcheongbyeo and the escape of heading stage during period of typhoon by accelerating of heading within 15th, August are effective. Though the flood disasters to rice plant such as earring away of field, burying of field, submerging and lodging damage are getting low by the construction of dam for multiple purpose and river bank, they are occasionally occurred by the regional heavy rain and water filled out in bank around the river. Paddy field were submerged for 2 to 4 days when typhoon and heavy rain occurred about the end of August. At this time, the rice plants that was in younger growing stage in the late transplanting field of southern area of Korea had the severe damages. Although panicles of rice plant which was in the meiotic growing stage and heading stage were died when flooded, they had 66% of yield compensating ability by the upper tilling panicle produced from tiller with dead panicle in ordinary transplanting paddy field. It is effective for reduction of flooding damages to cultivate the resistant variety to flooding having the resistance to bacterial leaf blight, lodging and small brown planthopper simultaneously. Especially, Tongil type rice varieties are relatively resistant to flooding, compared to Japonica rice varieties. Tongil type rice varieties had high survivals, low elongation ability of leaf sheath and blade, high recovering ability by the high root activity and photosynthesis and high yield compensating ability by the upper tillering panicle when flooded. To minimize the flooding and wind damage to rice plants in future, following research have to be carried out; 1. Data analysis by telemetering and computerization of climate, actual conditions and growing diagnosis of crops damaged by disasters. 2. Development of tolerant varieties to poor natural conditions related to flooding and wind damages. 3. Improvement of the reasonable cropping system by introduction of other crops compensating the loss of the damaged rice. 4. Increament of utilization of rice plant which was damaged.

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Parotid Gland Sparing Radiotherapy Technique Using 3-D Conformal Radiotherapy for Nasopharyngeal CarcinomB (비인강암에서 방사선 구강 건조증 발생 감소를 위한 3차원 입체조형치료)

  • Lim Jihoon;Kim Gwi Eon;Keum Ki Chang;Suh Chang Ok;Lee Sang-wook;Park Hee Chul;Cho Jae Ho;Lee Sang Hoon;Chang Sei Kyung;Loh Juhn Kyu
    • Radiation Oncology Journal
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    • v.18 no.1
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    • pp.1-10
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    • 2000
  • Purpose : Although using the high energy Photon beam with conventional Parallel-opposed beams radiotherapy for nasopharyngeal carcinoma, radiation-induced xerostomia is a troublesome problem for patients. We conducted this study to explore a new parotid gland sparing technique in 3-D conformal radiotherapy (3-D CRT) in an effort to prevent the radiation-induced xerostomia. Materials and Methods : We peformed three different planning for four clinically node-negative nasopharyngeal cancer patients with different location of tumor(intracranial extension, nasal cavity extension, oropharyngeal extension, parapharyngeal extension), and intercompared the plans. Total prescription dose was 70.2 Gy to the isocenter. For plan-A, 2-D parallel opposing fields, a conventional radiotherapy technique, were employed. For plan-B, 2-D parallel opposing fields were used up until 54 Gy and afterwards 3-D non-coplanar beams were used. For plan-C, the new technique, 54 Gy was delivered by 3-D conformal 3-port beams (AP and both lateral ports with wedge compensator; shielding both superficial lobes of parotid glands at the AP beam using BEV) from the beginning of the treatment and early spinal cord block (at 36 Gy) was peformed. And bilateral posterior necks were treated with electron after 36 Gy. After 54 Gy, non-coplanar beams were used for cone-down plan. We intercompared dose statistics (Dmax, Dmin, Dmean, D95, DO5, V95, VOS, Volume receiving 46 Gy) and dose volume histograms (DVH) of tumor and normal tissues and NTCP values of parotid glands for the above three plans. Results : For all patients, the new technique (plan-C) was comparable or superior to the other plans in target volume isodose distribution and dose statistics and it has more homogenous target volume coverage. The new technique was most superior to the other plans in parotid glands sparing (volume receiving 46 Gy: 100, 98, 69$\%$ for each plan-A, B and C). And it showed the lowest NTCP value of parotid glands in all patients (range of NTCP; 96$\~$100$\%$, 79$\~$99$\%$, 51$\~$72$\%$ for each plan-A, B and C). Conclusion : We conclude that the new technique employing 3-D conformal radiotherapy at the beginning of radiotherapy and cone down using non-coplanar beams with early spinal cord block is highly recommended to spare parotid glands for node-negative nasopharygeal cancer patients.

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Failure Pattern of Pineal and Ectopic Pineal Germ Cell Tumor after Gamma Knife Radiosurgery (송과선 및 이소성 송과선 생식세포종의 감마 나이프 수술 후 재발 양상)

  • Cho, Heung-Lae;Sohn, Seung-Chang
    • Radiation Oncology Journal
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    • v.18 no.2
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    • pp.92-100
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    • 2000
  • Purpose :This study was performed to determine the optimal treatment velum of Patients treating with radiation therapy for intracranial germ cell tumor. Materials and Methods : From 1993 to 1998, 19 patients with intracranial germ cell tumors treated by gamma knife radiosurgery were analyzed. The location of tumor was as follows; 9 cases on pineal region, 1 case on suprasellar region, and 9 cases of multiple lesion. 7 patients were pathologically verified; 5 cases of germ cell tumor and 2 cases of non germinomatous germ cell tumor. Tumor volume was ranged from 2.4 cm$^{3}$ to 74 cm$^{3}$. Irradiation dose was 10 Gy to 20 Gy with 50% isodose curve. Follow up period was 10 months to 54 months. Results : Recurrences were observed in 14 cases among 19 (74%) patients. Complete remission and partial remission were achieved in 2 (11%) and 10 (53%) respectively. No response was observed in 7 (36%). 2 cases were recurred within original tumor bed. 6 cases were recurred beyond but contiguous with tumor bed. Ventricular relapses separated from pretreatment tumor bed were 3. Spinal recurrences were 4. Among 8 recurred cases of which tumor volume is smaller than 20 cm$^{3}$, 2 were recurred within original tumor bed, 4 were recurred beyond but contiguous with tumor bed, and 1 spinal recurrence. Meanwhile, 6 cases of which tumor volume larger than 20 cm3, 1 case was recurred beyond but contiguous with tumorbed, 2 ventricular recurrences separated with original tumor bed, and 3 spinal recurrences. 5 cases which did not show any recurrence sign showed characteristics of single lesion, tumor volume smaller than 20 cm$^{3}$ and normal tumor marker. All of 4 cases of spinal recurrences happened in the case having ventricular invasion or lesion. Among 9 cases having multiple lesion, only 3 cases recurred within original tumor bed or around tumor bed, the other 6 cases recurred separated from pretreatment tumor bed. Conclusion : Gamma knife radiosurgery is not recommended for the treatment of intracranial germ cell tumor. It is because of small treatment volume and inadequate radiation dose that are characteristics of gamma knife radiosurgery. Tumor volume, ventricular invasion or ventricular lesion in multiple lesion are important factors to be considered for the wide field radiation therapy Tumor volume smaller than 20 cm$^{3}$, single lesion, no ventricular lesion or invasion, and normal tumor marker are ideal indications for small involved field radiation therapy. Prophylactic spinal irradiation seems to be necessary when there is ventricular lesion, ventricular invasion, and multiple lesions. When the tumor volume is larger than 20 cm$^{3}$, multiple lesions, abnormal tumor marker, and whole ventricular irradiation or partial brain irradiation would be possible and neoadjuvant chemotherapy would be most beneficial in these group.

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A Novel in Vitro Method for the Metabolism Studies of Radiotracers Using Mouse Liver S9 Fraction (생쥐 간 S9 분획을 이용한 방사성추적자 대사물질의 새로운 체외 측정방법)

  • Ryu, Eun-Kyoung;Choe, Yearn-Seong;Kim, Dong-Hyun;Lee, Sang-Yoon;Choi, Yong;Lee, Kyung-Han;Kim, Byung-Tae
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.4
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    • pp.325-329
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    • 2004
  • Purpose: Usefulness of mouse liver S9 fraction was evaluated for the measurement of the metabolites in the in vitro metabolism study of $^{18}F$-labeled radiotracers. Materials and Methods: Mouse liver S9 fraction was isolated at au early step in the course of microsome preparation. The in vitro metabolism studies were tarried out by incubating a mixture containing the radiotracer, S9 fraction and NADPH at $37^{\ciirc}C$, and an aliquot of the mixture was analyzed at the indicated time points by radio-TLC. Metabolic defluorination was further confirmed by the incubation with calcium phosphate, a bone mimic. Results: The radiotracer $[^{18}F]1$ underwent metabolic defluorination within 15 min, which was consistent with the results of the in vivo method and the in vitro method using microsome. Radiotracer $[^{18}F]2$ was metabolized to three metabolites including $4-[^{18}F]fluorobenzoic$ acid within 60 min. It is likely that the one of these metabolites at the origin of radio-TLC was identical with the one that obtained from the in vivo and in vitro (microsome) method. Compared with the in vitro method using microsome, the method using S9 fraction gave a similar pattern of the metabolites but with a different ratio, which can be explained by the presence of cytosol in the S9 fraction. Conclusion: These results suggest that the findings of the in vitro metabolism studies using S9 fraction can reflect the in vivo metabolism of novel radiotracers in the liver. Moreover, this method can be used as a tool to determine metabolic defluorination along with calcium phosphate absorption method.

Mitral Valve Repair for Mitral Regurgitation in Pediatric Patients (승모판폐쇄부전증를 가진 소아 환자에서 승모판성형술의 임상적 고찰)

  • Sim, Hyung-Tae;Yun, Tae-Jin;Park, Jeong-Jun;Jung, Sung-Ho;Uhm, Ju-Yeon;Jhang, Won-Kyoung;Kim, Young-Hwue;Ko, Jae-Kon;Park, In-Sook;Seo, Dong-Man
    • Journal of Chest Surgery
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    • v.40 no.8
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    • pp.536-545
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    • 2007
  • Background: Compared to adult patients, mitral regurgitation in pediatric patients is uncommon and it shows a wide spectrum of morphologic abnormalities. We retrospectively evaluated the midterm results of mitral valve repair in pediatric patients. Material and Method: Between December 1993 and August 2006, mitral valve repair was performed in 35 patients who were aged less than 18 years, The mean age was $5.3{\pm}5.3$ years and the mean body weight was $20,0{\pm}16.3\;kg$. 18 patients had associated cardiac anomalies. The most common pathologic finding was leaflet prolapse (n=17). The most common method of repair was the double orifice technique (n=15). Result: There was no early mortality. Eight patients underwent reoperation (24.2%), and five of them required mitral valve replacement. Among the four ring annuloplasty cases, two have developed mitral stenosis. Four out of the 14 double orifice cases required reoperation. One case of early mortality and one case of late mortality occurred in the reoperation cases. The 5-year survival rate and the freedom from reoperation rate were $93.3{\pm}4.6%$ and $76.1{\pm}8.2%$, respectively. The 5-year freedom from mitral valve replacement rate was $83.6{\pm}6.7%$. There was no significant risk factor for reoperation. Conclusion: The midterm results of mitral valve repair are very acceptable in pediatric patients compared to the adult cases, although the reoperation rate is slightly higher.

Clinical Outcomes of Off-pump Coronary Artery Bypass Grafting (심폐바이패스 없는 관상동맥우회술의 임상성적)

  • Shin, Je-Kyoun;Kim, Jeong-Won;Jung, Jong-Pil;Park, Chang-Ryul;Park, Soon-Eun
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.34-40
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    • 2008
  • Background: Off-pump coronary artery bypass grafting (OPCAB) shows fewer side effects than cardiopulmonary by. pass, and other benefits include myocardial protection, pulmonary and renal protection, coagulation, inflammation, and cognitive function. We analyzed the clinical results of our cases of OPCAB. Material and Method: From May 1999 to August 2007, OPCAB was performed in 100 patients out of a total of 310 coronary artery bypass surgeries. There were 63 males and 37 females, from 29 to 82 years old, with a mean age of $62{\pm}10$ years. The preoperative diagnoses were unstable angina in 77 cases, stable angina in 16, and acute myocardial infarction in 7. The associated diseases were hypertension in 48 cases, diabetes in 42, chronic renal failure in 10, carotid artery disease in 6, and chronic obstructive pulmonary disease in 5. The preoperative cardiac ejection fraction ranged from 26% to 74% (mean $56.7{\pm}11.6%$). Preoperative angiograms showed three-vessel disease in 47 cases, two-vessel disease in 25, one-vessel disease in 24, and left main disease in 23. The internal thoracic artery was harvested by the pedicled technique through a median sternotomy in 97 cases. The radial artery and greater saphenous vein were harvested in 70 and 45 cases, respectively (endoscopic harvest in 53 and 41 cases, respectively). Result: The mean number of grafts was $2.7{\pm}1.2$ per patient, with grafts sourced from the unilateral internal thoracic artery in 95 (95%) cases, the radial artery in 62, the greater saphenous vein in 39, and the bilateral internal thoracic artery in 2. Sequential anastomoses were performed in 46 cases. The anastomosed vessels were the left anterior descending artery in 97 cases, the obtuse marginal branch in 63, the diagonal branch in 53, the right coronary artery in 30, the intermediate branch in 11, the posterior descending artery in 9 and the posterior lateral branch in 3. The conversion to cardiopulmonary bypass occurred in 4 cases. Graft patency was checked before discharge by coronary angiography or multi-slice coronary CT angiography in 72 cases, with a patency rate of 92.9% (184/198). There was one case of mortality due to sepsis. Postoperative arrhythmias or myocardial in-farctions were not observed. Postoperative complications were a cerebral stroke in 1 case and wound infection in 1. The mean time of respirator care was $20{\pm}35$ hours and the mean duration of stay in the intensive care unit was $68{\pm}47$ hours. The mean amounts of blood transfusion were $4.0{\pm}2.6$ packs/patient. Conclusion: We found good clinical outcomes after OPCAB, and suggest that OPCAB could be used to expand the use of coronary artery bypass grafting.