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Surgical Treatment of Anomalous Origin of Coronary Artery from the Pulmonary Artery: Postoperative Changes of Ventricular Dimensions and Mitral Regurgitation (관상동맥-폐동맥 이상기시증(Anomalous Origin of Coronary Artery from Pulmonary Artery)의 수술적 치료: 중기 성적과 좌심실 및 승모판 기능의 변화 양상에 대한 연구)

  • Kang, Chang-Hyun;Kim, Woong-Han;Seo, Hong-Joo;Kim, Jae-Hyun;Lee, Cheul;Chang, Yoon-Hee;Hwang, Seong-Wook;Back, Man-Jong;Oh, Sam-Se;Na, Chan-Young;Han, Jae-Jin;Lee, Young-Tak;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.37 no.1
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    • pp.19-26
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    • 2004
  • Background: The aims of this study are to verify the result of the surgical treatment of ALCAPA and to identify the postoperative changes of left ventricular dimensions and mitral regurgitation (MR), Material and Method: Fifteen patients operated on since 1985 were included in the study. The patients operated on before 1998 (n=9) showed heterogeneous properties with various surgical strategies and cardiopulmonary bypass techniques. However, six patients were operated on with the established surgical strategy since 1998; 1) Dual perfusion and dual cardioplegic solution delivery through ascending aorta and main pulmonary artery, 2) Coronary transfer by rolled-conduit made of pulmonary artery wall flap, and 3) Additional mitral valvular procedure was not peformed. Result: Median age of the study group was 6 months (1 month to 34 years). The operative methods were left subclavian artery to left coronary artery anastomosis in 1, simple ligation in 2, Takeuchi operation in 2, and coronary reimplantation in 10 patients. The mean follow up period was 5.5<5.8 years (2 months 14 years), There were one early death (6.7%) and one late death. Overall 5-year survival rate was 85.6$\pm$9.6%. The Z-value of left ventricular end-diastolic and end-systolic dimensions were 6.4$\pm$3.0 and 5.1 $\pm$3.6 preoperatively, and decreased to 1.7$\pm$ 1.9 and 0.8$\pm$ 1.6 in 3 months (p<0.05). Significant preoperative MR was identified in 6 patients (40%) and all the patients showed immediate improvement of MR within f month postoperatively. There were 3 cases of reoperation due to coronary anastomosis site stenosis and recurrence of MR. However, there was no mortality nor late reoperation in the patients operated on after 1998. Conclusion: The surgical treatment of ALCAPA showed favorable survival and early recovery of ventricular dimensions and mitral valvular function. Although long-term reintervention was required in some cases of earlier period, all the cases after 1998 showed excellent surgical outcome without long-term problem.

Estimation of Availability of Whole Crop Barley and Rye Silage TMR in the Cattle (청보리 및 호밀 Silage를 이용한 거세한우 비육중기용 TMR의 소 체내 이용성 조사)

  • Qin, Wei-Ze;Jin, Guang Lin;Kim, Jong-Kyu;Oh, Young-Kyoon;Lee, Sang-Cheol;Song, Man-Kang
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.30 no.4
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    • pp.343-354
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    • 2010
  • The present study was conducted to examine the fermentation characteristics and effective degradability (ED) in the rumen, and whole tract digestibility of whole crop silage based TMR in comparison with conventional separate feeding of concentrate and roughage. Three ruminally fistulated non-lactating Holstein cattle were used in a 3 $\times$ 3 Latin square design. The cattle were fed 8kg of whole crop barley silage based TMR (BS-TMR) or 8kg (DM basis) of whole crop rye silage based TMR (RS-TMR) twice (08:00 and 18:00) daily in an equal amount. The cattle were also fed concentrate (5.6kg) and rice straw (1.4kg) seperately (DM basis, Control) twice daily in an equal amount. The both silages were included in TMR at 20% level (as fed basis). pH in the rumen fluid was not influenced by the diets but was slightly higher from TMR than from control. No difference was found in ammonia-N concentration between diets. Total VFA concentration was relatively increased in the cattle fed RS-TMR to the other diets up to 6h post feeding. The proportion of acetate was increased in the TMR feeding at right before feeding (0 h, p<0.005) and 9 h (p<0.048) post feeding compared with control. Propionate proportion was increased (p<0.046) in both TMRs while butyrate proportion was increased (p<0.029) at 1h post feeding compared to other diets. Effective degradability (ED) of DM and CP of RS-TMR was relatively increased to other diets, and EDNDF of both TMRs was higher than that of control diet due to the increased parameters b (p<0.039) and c (p<0.006) in TMR treatments. Whole track digestibility of most components in the TMRs was slightly increased compared to that in control diet, and RS-TMR had a tendency to be increased whole track digestibility except for NDF compared to BS-TMR. Based on the results observed from the present study, nutrient availability of whole crop silage based TMR looked slightly better than conventional separate feeding of concentrate and rice straw, mainly due to the improved stabilization of fermentation in the rumen and increased NDF digestibility of whole crop silage in TMR.

Investigation of Daily Life and Consciousness of Longevous People in Korea -(1)The Regional Features of Longevity Areas- (우리나라 장수자(長壽者)의 생활(生活) 및 의식조사(意識調査)에 관한 연구(硏究) -(1) 장수지역(長壽地域)의 지역적(地域的) 특성(特性)-)

  • Choi, Jin-Ho;Pyeun, Jae-Hyeung;Rhim, Chae-Hwan;Yang, Jong-Soon;Kim, Soo-Hyun;Kim, Jeung-Han;Lee, Byeong-Ho;Woo, Soon-Im;Choe, Sun-Nam;Byun, Dae-Seok
    • Journal of the Korean Society of Food Culture
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    • v.1 no.2
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    • pp.116-126
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    • 1986
  • This study was designed to be a link in the chain of the investigation on daily life and consciousness of longevous people in Korea, and to investigate the regional feature of longevity areas. The daily life and consciousness were investigated on 379 subjects(male 121, female 258) of the aged who were above 80 years of age, from June to November in 1985. This paper is to report the results investigated the longevity rate, distribution, classification and weather of longevity districts, and also the actual conditions such as the functions of daily life and educational degree of longevous people. 1. The number of longevous people in Korea was 171,449 (male 42,842, female 128,607), and the average longevity rate was 0.46% against total population in Korea(male 0.23%, female 0.69%). 2. Of the longevity rates of shi and/or do in Korea, Cheju(1.03%) was the highest among these districts, and decreased in the order of Chonnam(0.79%), Chonbuk(0.66%), Kyongbuk(0.65%) and Kyongnam(0.61%), whereas the large cities such as Inchon(0.22%), Seoul(0.23%), Pusan(0.23%) and Taegu(0.28%) were remarkably lower than districts in seasides and mountains. 3. The districts above 1.0% of longevity rate in Korea showed 17-guns, and the distribution of these districts was 10-guns of Chonnam, 2-guns of Kyongbuk and Kyongnam, and 1-gun of Kyonggi, Cho-nbuk and Cheju, respectively. 4. Of these districts, Pukcheju(1.65%) was the highest, and decreased in the order of Namhae(1.56%), Sungju(1.24%), Posong(1.22%) and Koksong(1.20%). The highest figure(male 0.71%, female 2.51%) was observed in Pukcheju as contrasted with 0.23%(male) and 0.69%(female) of the average longevity rate in Korea. 5. The sex ratio of longevous people in Korea showed the female/male ratio of 3.0. It is, therefore, believed that the longevity rate of female was 3 times higher than that of male. 6. The longevity districts were classified into seven districts in seasides, three districts in isolated islands, and seven rural districts in mountains. 7. The situation of weather in longevity districts was in the range of 11.2 to $14.8^{\circ}C$ at annual average temperature, and 878.5 to 1585.9mm at annual average rainfall. 8. Of the educational degree of longevous people, uneducated(71.5%) was the highest, and followed by the order of village school(15.8%) and above elementary school(4.8%). 9. In the functions of daily life, the aged moving actively(53.0%) was the highest among these longevous people, followed by the aged moving a little(23.5%). Therefore, it is believed that health degree of these longevous peoples by the functions of daily life was very gratifying.

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The Distribution of Catch by Korean Tuna Purse Seiners in the Western Pacific Ocean (서부태평양(西部太平洋)에서 조업(操業)한 한국(韓國) 다랑어 선망어선(旋網漁船)의 어획량분포(漁獲量分布))

  • Kim, Seon-Woong;Kim, Jin-Kun
    • Journal of Fisheries and Marine Sciences Education
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    • v.7 no.2
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    • pp.182-200
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    • 1995
  • Thirty two vessels of the Korean purse seiner had been operated in the Western Pacific Ocean for mainly skipjack tuna, Katsuwonus pelmis LINNAEUS and yellowfin tuna, Thunnus albacares BONNATERRE from January to December in 1991. Among them, fourteen vessels were chosen for this research. During the year their daily operated vessels totalled 4,153 vessels, their total casting net were 2,982 times, in caught 1,798 times, and their total catch was 106,300 M/T. We investigate the distribution of their catch by species, by body size, and by surfance water temperature, and also investigate the distribution of their catch by month and section of the sea, where the sections are separated by 30' of longitude and latitude from the monthly operated sea. We summarize these as follows : 1. The rate of catch by species is 75r/o skipjack tunas, 22.3% yellowfin tunas, and 2.7% bigeye and other tunas. 2. Of the caught skipjack tunas, those of weight 2.0~10kg are most and 68%, those of 1.5~8kg are 11.6%, and those of 3.0~8kg are 9.9%. Of the caught yellowfin tunas, those of weight 5~50kg and 10~50kg are most and 23.1%, and 28.3% respectively, those of 20~50kg are 15.8%, weight 30~50kg are 12.5%, and weight 2~50kg are 9.7%. 3. On the distribution of catch by surface water temperature, 49% of catch are taken between $29.0^{\circ}C$ and $29.4^{\circ}C$, 37% are taken between $29.5^{\circ}C$ and $29.9^{\circ}C$, and about 6% are taken between $28.5^{\circ}C$ and $28.9^{\circ}C$, but very little, only about 1% are taken below $28.4^{\circ}C$ and above $30.5^{\circ}C$. 4. On the distribution of catch by month and section of sea, skipjack tunas are most caught 10,618M/T in August and 10,412M/T in September in the section of Lat. $3^{\circ}{\sim}6^{\circ}S$ and Long. $174^{\circ}E{\sim}176^{\circ}W$, caught much 8,825M/I' in June and 8,057M/T in January in section of Lat. $1^{\circ}S{\sim}3^{\circ}N$ and Long. $142^{\circ}{\sim}151^{\circ}$E, but caught very little in May, November and December in the costal area of New Guinea. Yellowfin tunas are mostly caught 4,070M/T in June in the section of Lat. $0^{\circ}{\sim}4^{\circ}$N and Long. $142^{\circ}{\sim}151^{\circ}$E, and caught much over 2,000M/T in February~April and October~December in the section of coastal area and near islands, but caught very little in distant water area.

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Neonatal Sepsis and Antimicrobial Susceptibilities in the Neonatal Intensive Care Unit and Nursery (신생아 패혈증의 원인 및 항생제 감수성)

  • Moon, Jin Hwa;Oh, Sung Hee;Kim, Hak Won;Moon, Su Jee;Choi, Tae Yeol
    • Pediatric Infection and Vaccine
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    • v.9 no.2
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    • pp.163-174
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    • 2002
  • Background : To delineate the changes in the causative agents of neonatal sepsis and their antimicrobial susceptibilities in the neonatal intensive care unit and nursery of Hanyang University Hospital during the past 10 years. Methods : Hospital records of 15,144 patients hospitalized at the NICU and nursery of Hanyang University Hospital from 1989 to 1998 were reviewed and neonates diagnosed of neonatal sepsis were sorted and included in the study. The study period was divided into Period A(the first 5 years) and Period B(the second 5 years) to analyse causative agents and their antimicrobial susceptibilities. Results : Neonatal sepsis was diagnosed in 170 patients(1.1%{Period A 1.2%, Period B 1.0%}) among the total of 15,144 inpatients. Two hundred isolates(Period A 109 isolates, Period B 91 isolates) were identified in 186 blood cultures(Period A 99 cultures, Period B 87 cultures) from 170 patients(Period A 91 patients, Period B 79 patients). The average age at the onset of the disease, when the initial blood culture was drawn, was 12.3 days old(Period A 8.8 days, Period B 16.3 days), and the proportion of the early onset disease was 34.7% in Period A and 23.0% in Period B, indicating that neonatal sepsis developed earlier during Period A. Among the isolated organisms including Gram positive bacteria[132(66.0%)], Gram negative bacteria [60(30.0%)], and fungi[8(4.0%)], coagulase negative Staphylococcus(CNS) was the most common organism(69/34.5%), followed by Staphylococcus aureus(36/18.0%), Klebsiella pneumoniae(17/8.5%), Enterococcus(12/6.0%), Enterobacter cloacae(8/4.0%), Escherichia coli(6/3.0%), and Pseudomonas aeruginosae(5/2.5%). The isolated fungi were Candida parapsilosis, Candida albicans, and Trichosporon pullulans. CNS, S. aureus and Acinetobacter baumannii were isolated more frequently in Period A compared to Period B. Antimicrobial susceptibilities of CNS and S. aureus to methicillin and the first generation cephalo sporins were decreased in Period B compare to Period A, those to aminoglycosides were increased in Period B, and vancomycin resistant strains were not identified. K. pneumoniae, Enterococcus, E. coli, and P. aeruginosa were isolated less frequently in Period B, compared to Period A. For K. pneumoniae, antimicrobial susceptibilities to the first generation cephalosporins were low in both Periods A and B, those to tobramycin and gentamicin were increased in Period B, and those to amikacin, ceftriaxone, and trimethoprim-sulfamethoxazole were high in both Periods A and B. Antimicrobial susceptibilities of Enterococcous to ampicillin, penicillin, and the first generation cephalosporins were decreased in Period B, but vancomycin resistant strains were not identified. Conclusion : The occurrence rate of neonatal sepsis during the past 10 years in the NICU and nursery of the Hanyang University hospital was 1.1%, and the most common causitive agents were CNS and S. aureus, to which the antimicrobial susceptibilities to the first line drugs decreased in the later half of the study period with no vancomycin resistant isolates identified. Group B Streptococcus known to be the most common agent causing neonatal sepsis was not identified, and K. pneumoniae was isolated more commonly during the later half of the study period without decreased antimicrobial susceptibilities.

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A Survey on Physical Complaints Related with Farmers' Syndrome of Vinylhouse and Non-vinylhouse Farmers (비닐하우스 재배농민과 일반농민의 농부증 관련 신체증상 호소율 조사)

  • Lee, Ju-Young;Park, Jung-Han;Kim, Doo-Hie
    • Journal of Preventive Medicine and Public Health
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    • v.27 no.2 s.46
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    • pp.258-273
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    • 1994
  • To compare the physical complaints of vinylhouse farmers with those of non-vinylhouse farmers, a personal interviews on 250 vinylhouse and 142 non-vinylhouse farmers were conducted in Sungjoo county in Kyungpook province selected by a random sampling from July 5 to July 10, 1993. Blood pressure of the subjects was also measured. Vinylhouse farmers had a higher average age, larger family size, shorter experience of farming, more working hours per day and working days per year and higher annual income than the non-vinylhouse farmers. The frequency of pesticide spray of the vinylhouse farmers was 3.4 times on the average in June 1993 as compared with 2.0 times of non-vinylhouse farmers, and 16.7 times for the vinylhouse farmers during the last one year while it was 8.3 times for the non-vinylhouse farmers in the same period. While 39.6% of vinylhouse farmers experienced pesticide intoxication symptoms such as headache, nausea, vomiting, dizziness, itching, and skin irritation, etc. during the month of June, 25.4% of non-vinylhouse farmers experienced such symptoms. The most frequent symptoms among eight symptoms that constitute the farmers' syndrome were lumbago, numbness of hand or foot, shoulder pain and dizziness regardless of sex and type of farming. Prevalence of the farmers' syndrome in male and female among vinylhouse farmers were 22.1%, 43.4%, respectively, and the prevalence in non-vinylhouse farmers was 23.2% for male and 50.7% for female. There was no statistically significant difference in the prevalence of farmers' syndrome between vinylhouse and non-vinylhouse farmers. However, the prevalence in female was about 2 times higher than that of male. When the effects of other factors were adjusted by multiple logistic regression for farmers' syndrome, the prevalence in female was 3.0 times higher than that of male. The prevalence of farmers' syndrome was increased as the age of farmers increased in both vinylhouse and non-vinylhouse farmers, and adjusted odds ratio of farmers' syndrome increased by 3% as the age increased by 1 year. Adjusted odds ratio for Farmers' syndrome in farmers who experienced pesticide intoxication during the month of June was 3.1 times higher than that of farmers who did not have such experience. While the prevalence of hypertension in male and female non-vinylhouse farmers were 22.4%, 13.7%, respectively, the prevalence in vinylhouse farmers were 13.5% for male and 12.0% for female. However, there was no association between farmers' syndrome and hypertension. It was found in this study that the vinylhouse farmers are at a high risk of pesticide intoxication, which is associated with tile common physical complaints. To reduce such risk it is necessary to develop farming methods which do not require the pesticide or may use less pesticide, a safer method of pesticide spraying, and the protective equipments which can be worn at a high temperature and have a better protective effect. Also education of farmers for the correct methods of ventilation after pesticide spraying in the vinylhouse and wearing the protective equipments may be considered as a supportive method. Since inappropriate posture at work and intensive labor may cause farmers' syndrome, it is recommended to develop farming tools which reduce physical burden and take a rest and exercise periodically during work. It is necessary to strengthen the hypertension management program of the Kyungpook province, because the prevalence of hypertension was as high as about 15%.

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Determination of optimum fertilizer rates for barley reflecting the effect of soil and climate on the response to NPK fertilizers (기상(氣象) 및 토양조건(土壤條件)으로 본 대맥(大麥)의 NPK 시비적량결정(施肥適量決定))

  • Park, Nae Joung;Lee, Chun Soo;Ryu, In Soo;Park, Chun Sur
    • Korean Journal of Soil Science and Fertilizer
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    • v.7 no.3
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    • pp.177-184
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    • 1974
  • An attempt was made to determine simple and the most reasonable fertilizer recommendation for barley utilizing the present knowledge about the effect of soil and climatic factors on barley response to NPK fertilizer in Korea and establishing the critical contents of available nutrients in soils. The results were summarized as follows. 1. The relationships between relative yields or fertilizers rates for maximum yields from quadratic response curves and contents of organic matter, available $P_2O_5$, exchangeable K in soils were examined. The trend was more prospective with relative yields because of smaller variation than with fertilizer rates. 2. Since the relationship between N relative yields and organic matter contents in soils was almost linear over the practical range, it was difficult to determine the critical content for nitrogen response by quadrant methods. However, 2.6%, country average of organic matter content in upland soils was recommended as the critical point. 3. There showed a trend that average optimum nitrogen rater was higher in heavy texture soils, colder regions. 4. The critical $P_2O_5$ contents in soil were 96 or 118 ppm in two different years, which were very close to the country average, 114 ppm of $P_2O_5$ contents in upland soils. The critical K content in soil was 0.32 me/100g, which was exactly coincident to the country average of exchangeable K in upland soils. 5. According to the contents of avaiiable $P_2O_5$ and exchangeable K, several ranges were established for the purpose of convenience in fertilizer recommendation, that is, very low, Low, Medium, High and very High. 6. More phosphate was recommended in the northern region, clayey soils, and paddy soils, whereas less in the southern region and sandy soils. More potash was recommended in the northern region and sandy soils, whereas less in the southern region and clayey soils. 7. The lower the PH, the more fertilizers were recommended. However, liming was considered to be more effective than increas in amount of fertilizers.

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The Role of Postoperative Adjuvant Radiotherapy in Resected Esophageal Cancer (식도암에서 근치적 절제술 후 방사선치료의 역할)

  • Lee Chang Geol;Kim Choong Bae;Chung Kyung Young;Lee Doo Yun;Seong Jinsil;Kim Gwi Eon;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.316-322
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    • 2002
  • Objective : A retrospective study was peformed to evaluate whether postoperative adjuvant radiotherapy can improve survival and decrease recurrence as compared with surgery alone in resected esophageal cancer. Materials and Methods : From Jan. 1985 to Dec. 1993, among 94 esophageal cancer Patients treated with surgery, fifty-one patients were included in this study. Transthoracic esophagectomy was peformed in 35 patients and transhiatal esophagectomy in 16. Postoperative adjuvant radiotherapy was peformed 4 weeks after surgery in 26 among 38 patients in stage II and III. A total dose of $30\~60\;Gy$ in 1.8 Gy daily fraction, median 54 Gy over 6 weeks, was delivered in the mediastinum+both supraclavicular lymph nodes or celiac lymph nodes according to the tumor location. Forty-seven patients$(92\%)$ had squamous histology. The median follow-up period was 38 months. Results : The overall 2-year and 5-year survival and median survival were $56.4\%,\;36.8\%$ and 45 months. Two-year and 5-year survival and median survival by stage were $92\%,\;60.3\%$ for stage I, $63\%,\;42\%$ and 51 months for stage II and $34\%,\;23\%$ and 19 months for stage III (p=0.04). For stage II and III patients, 5-year survival and median survival were $22.8\%$, 45 months for the surgery alone group and $37.8\%$, 22 months for the postoperative RT group (p=0.89). For stage III patients, 2-year survival and median survival were $0\%$, 11 months for the surgery alone group and $36.5\%$, 20 months for the postoperative RT group (p=0.14). Local and distant failure rates for stage II and III were $50\%,\;16\%$ for the surgery alone and $39\%,\;31\%$ for the postoperative RT group. For N1 patients, local failure rate was $71\%$ for the surgery alone group and $37\%$ for the postoperative RT group (p=0.19). Among 10 local failures in the postoperative RT group, in-field failures were 2, marginal failures 1, out-field 5 and anastomotic site failures 2. Conclusion : There were no statistically significant differences in either the overall survival or the patterns of failure between the surgery alone group and the postoperative RT group for resected stage II and III esophageal cancer. But this study showed a tendency of survival improvement and decrease in local failure when postoperative RT was peformed for stage III or N1 though statistically not significant. To decrease local failure, a more generous radiation field encompassing the supraclavicular, mediastinal, and celiac lymph nodes and anastomotic site in postoperative adjuvant treatment should be considered.

Air Cavity Effects on the Absorbed Dose for 4-, 6- and 10-MV X-ray Beams : Larynx Model (4-, 6-, 10-MV X-선원에서 공기동이 흡수선량에 미치는 효과 : 후두모형)

  • Kim Chang-Seon;Yang Dae-Sik;Kim Chul-Yong;Choi Myung-Sun
    • Radiation Oncology Journal
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    • v.15 no.4
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    • pp.393-402
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    • 1997
  • Purpose : When an x-ray beam of small field size is irradiated to target area containing an air cavity, such as larynx, the underdosing effect is observed in the region near the interfaces of air and soft tissue. With a larynx model, air cavity embedded in tissue-equivalent material, this study is intonded for examining Parameters, such as beam quality, field size, and cavity size, to affect the dose distribution near the air cavity. Materials and Methods : Three x-rar beams, 4-, 6- and 10-MV, were employed to Perform a measurement using a 2cm $(width){\times}L$ (length in cm, one side of x-ray field used 2cm (height) air cavity in the simulated larynx. A thin window parallel-plate chamber connected to an electrometer was used for a dosimetry system. A ratio of the dose at various distances from the cavity-tissue interface to the dose at the same points in a homogeneous Phantom (ebservedlexpected ratio, O/E) normalized buildup curves, and ratio of distal surface dose to dose at the maximum buildup depth were examined for various field sizes. Measurement for cavity size effect was performed by varying the height (Z) of the air cavity with the width kept constant for several field sizes. Results : No underdosing effect for 4-MV beam for fields larger than $5cm\times5cm$ was found For both 6- and 10-MV beams, the underdosing portion of the larynx at the distal surface was seen to occur for small fields, $4cm\times4cm\;and\;5cm\times5cm$. The underdosed tissue was increased in its volume with beam energy even for similar surface doses. The relative distal surface dose to maximum dose was changed to 0.99 from 0.95, 0.92, and 0.91 for 4-, 6-, and 10-MV, respectively, with increasing field size, $4cm\times4cm\;to\;8cm\times8cm$, For 6- and 10-MV beams, the dose at the surface of the cavity is measured less than the predicted by about two and three percent. respectively. but decrease was found for 4-MV beam for $5cm\times5cm$ field. For the $4cm\timesL\timesZ$ (height in cm). varying depth from 0.0 to 4.8cm, cavity, O/E> 1.0 was observed regardless of the cavity size for any field larger than about $8cm\times8cm$. Conclusion : The magnitude of underdosing depends on beam energy, field size. and cavity size for the larynx model. Based on the result of the study. caution must be used when a small field of a high quality x-ray beam is irradiated to regions including air cavities. and especially the region where the tumor extends to the surface. Low quality beam. such as. 4-MV x-ray, and larger fields can be used preferably to reduce the risk of underdosing, local failure. In the case of high quality beams such as 6- and 10-MV x-rays, however. an additional boost field is recommended to add for the compensation of the underdosing region when a typically used treatment field. $8cm\times8cm$, is employed.

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The Palliative Radiation Therapy in Malignant Extra-Hepatic Biliary Obstruction (간외 폐쇄성 황달 환자에서 고식적 방사선치료의 결과)

  • Kay Chul-Seoung;Jang Hong-Suk;Kim Sung-hwan;Ryu Mi-Ryeong;Kim Yeon-Shil;Chung Su-Mi;Yoon Sei-Chul
    • Radiation Oncology Journal
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    • v.17 no.3
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    • pp.209-216
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    • 1999
  • Purpose : To evaluate the effectiveness of external radiation therapy and the prognostic factors, we retrospectively analyzed therapeutic results of malignant extrahepatic biliary obstruction (EHBO). Methods and Materials : We analyzed the results of the external radiation therapy in 59 patients of inoperable malignant EHBO who had been treated with more than 10 Gy of external radiation therapy from April 1984 to December 1990. There were 21 stomach cancer ($35.6\%$), 12 pancreas cancer ($20.3\%$), 15 extrahepatic biliary cancer ($18.0\%$) and 11 another cancer ($18.0\%$). Their pathologies were confirmed in 31 patients ($52.5\%$). They divided into 27 adenocarcinoma and 4 nonadenocarcinoma. Their chief complaints were jaundice in 47 patients ($79.7\%$) and abdominal pain in 15 patients ($49.2\%$). Twelve patients had slightly increased bilirubin level in liver function test without jaundice. We treated twenty four patients ($40.6\%$) with percutaneous transhepatic biliary drainage (PTBD) and 32 patients ($54\%$) with systemic chemotherapy (CT). We performed external radiation therapy (ERT) upto $10.8\~55.8$ Gy (median 37.8 Gy) with palliative aim. Results : Overall median survival duration was $7.80\pm1.15$ months. The response rates of jaundice were $81.8\%$ in PTBO group and $66.7\%$ in non-PTBD group without statistical significance. The improving rate of jaundice was not significantly different in decreased ratio of total bilirubin level. But abdominal pain was more decreased in CT group than non-CT group (p<0.05). The significant prognostic factors were high performance status (Karnofski Performance Status >70), total radiation dose more than 35 Gy and good response of pain after therapy. There were increased in bacterial cholagitis in PTBD group and gastrointestinal complications in CT group. Conclusion : External radiotheapy could improve jaundice and abdominal pain in malignant EHBO patients, Overall survival duration was prolonged in patients with higher performance status and patients who had been treated with more than 35 Gy of total radiation dose. In the future, we expect not only better palliative role but also the prolongation of survival of using the ERT combined with other treatment method. But to achieve certain conclusion, we need luther study consisted with many kinds of treatment methods including new technologies in RT.

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