• Title/Summary/Keyword: 미만형

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Analysis of the Radiation Therapy Outcomes and Prognostic Factors of Thymoma (흉선종에 대한 방사선치료 성적 및 예후인자분석)

  • Lee, Seok-Ho;Lee, Kyu-Chan;Choi, Jin-Ho;Lee, Jae-Ik;Sym, Sun-Jin;Cho, Eun-Kyung
    • Radiation Oncology Journal
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    • v.28 no.1
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    • pp.1-8
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    • 2010
  • Purpose: This retrospective study was performed to evaluate the efficacy of radiation therapy (RT) and to investigate the prognostic factors for thymoma when treated with RT. Materials and Methods: We analyzed 21 patients with thymoma and also received RT from March 2002 to January 2008. The median follow-up time was 37 months (range, 3 to 89 months). The median patient age was 57 years (range, 24 to 77 years) and the gender ratio of males to females was 4:3. Of the 21 patients, complete resections (trans-sternal thymectomy) and R2 resections were performed in 14 and 1 patient, respectively. A biopsy was performed in 6 patients (28.7%). The WHO cell types in the 21 patients were as follows: 1 patient (4.8%) had type A, 10 patients (47.6%) had type B1-3, and 10 patients (47.6%) had type C. Based on Masaoka staging, 10 patients (47.6%) were stage II, 7 patients (33.3%) were stage III, and 4 patients (19.1%) were stage IVa. Three-dimensional RT was adminstered to the tumor volume (planned target volume), including the anterior mediastinum and the residual disease. The total RT dose ranged from 52.0 to 70.2 Gy (median dose, 54 Gy). Consistent with the WHO criteria, the response rate was only analyzed for the 6 patients who received a biopsy only. The prognostic factors analyzed for an estimate of survival included age, gender, tumor size, tumor pathology, Masaoka stage, the possibility of treatment by performing surgery, the presence of myasthenia gravis, and RT dose. Results: The 3-year overall survival rate (OS) and the progression free survival rate (PFS) were 80.7% and 78.2%, respectively. Among the 10 patients with WHO cell type C, 3 of 4 patients (75%) who underwent a complete resection and 3 of 6 patients (50%) who underwent a biopsy survived. Distant metastasis developed in 4 patients (19.1%). The overall response rate in the 6 patients who received biopsy only were as follows: partial remission in 4 patients (66.7%), stable disease in 1 patient (16.6%), and progressive disease in 1 patient (16.6%). Acute RTOG radiation pneumonitis occurred in 1 patient (4.8%), grade 2 occurred in 2 patients (9.5%), grade 3 occurred in 1 patient (4.8%), and grade 4 occurred in 1 patient (4.8%). A univariate analysis revealed that the significant prognostic factors for OS were age (${\geq}60$, 58.3%; <60, 100%; p=0.0194), pathology (WHO cell type A-B3, 100%; C, 58.3%; p=0.0194) and, whether the patient underwent surgery (yes, 93.3%; no, 50%; p=0.0096). Conclusion: For the 15 patients who received surgery, there was no local failure within the radiation field. In patients with WHO cell type C, surgical procedures could have resulted in a more favorable outcome than biopsy alone. We report here our clinical experience in 21 patients with thymoma who were treated by radiation therapy.

Usefulness of video-EEG monitoring in paroxysmal nonepileptic events of children and adolescents (소아와 청소년의 돌발적 비간질 발작의 진단에 있어 비디오-뇌파 모니터링의 유용성)

  • Lee, Jee Yeon;Lee, Hee Sun;Choi, Wook Sun;Eun, So Hee;Lee, Ki Hyung;Enu, Baik Lin;Lee, Joo Won
    • Clinical and Experimental Pediatrics
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    • v.51 no.1
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    • pp.62-66
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    • 2008
  • Purpose : In addition to epileptic seizures (ES), a variety of physiologic, organic and psychogenic disorders can manifest as paroxysmal behavioral events. Paroxysmal nonepileptic events (PNEs) are quite encountered in infants, young children, and adolescents. In a substantial proportion of cases, a careful history and examination will elucidate their nature. However, in other cases, it is necessary to differentiate PNEs from ES by video-electroencephalographic (EEG) monitoring. We report our experiences with PNEs in a group of children and adolescents who underwent video-EEG monitoring. Methods : From September, 2004 to June, 2006, one hundred thirty patients were monitored in the Pediatric Epilepsy Monitoring Units of Korea University Guro and Ansan hospitals. Their hospital charts were reviewed and video records of these events were analyzed. We observed all patients after video-EEG monitoring for more than 3 months. Results : Typical spells occurred during monitoring in 33 patients, not associated with a seizure pattern on EEG recordings. Two patients were diagnosed as frontal lobe epilepsy on basis of typical semiology and clinical characteristics, so 31 patients were documented to have PNEs finally. The mean age of patients was $7.2{\pm}5.8\;years$. The male to female ratio was 15 (48.4%) to 16 (51.6%). Among 31 patients, fifteen patients had associated disorders such as epilepsy, developmental delay, cerebral palsy, gastric ulcer, attention deficit hyperactivity disorder or depressive disorder. Somatoform disorder and factitious disorder was frequently seen in children more than 5 years old (P<0.05). Psychogenic disorder was more frequent in female (n=6) than in male (n=2) but there was no statistical significance (P>0.05). Conclusion : Our study suggests that video-EEG monitoring is an important diagnostic tool in the evaluation of paroxysmal behavioral events. With correct diagnosis of the PNEs, several unnecessary treatment could be avoided.

Clinical and Electrophysiological Study on Guillain-Barr$\acute{e}$ Syndrome (Guillain-Barr$\acute{e}$ 증후군의 임상적 및 전기생리학적 연구)

  • Yun, Sung-Hwan;Hah, Jung-Sang;Joo, Sung-Gyun;Cho, Yong-Kook;Kim, Jung-Hyun;Chung, Ji-Yeun
    • Journal of Yeungnam Medical Science
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    • v.22 no.1
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    • pp.52-61
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    • 2005
  • Background: Guillain-Barre syndrome is defined as a recognizable clinical entity that is characterized by rapidly evolving symmetric limb weakness, the loss of tendon reflexes, absent or mild sensory signs, and variable autonomic dysfunctions. This study evaluated the clinical and electrophysiological findings retrospectively. Materials and Methods: Forty-five patients with Guillain-Barre syndrome, who were admitted to the Yeungnam University Hospital for six years from Jan. 1994 to Dec. 1999 were investigated. The correlation between the clinical manifestation and the electrophysiological study was evaluated. Results: The male to female ratio was 1.8:1 and there was a peak seasonal incidence in the winter. A preceding illness was noted in 66.7 % of cases, and an upper respiratory tract infection was the most common one. The most common clinical manifestations were a loss of tendon reflex and ascending muscle weakness and paralysis. The cerebrospinal fluid examinations revealed, albuminocytologic dissociation in 33 cases (73.3 %). Intravenous immunoglobulin therapy was performed in 29 cases (64.4 %). The sequential electrophysiological abnormalities were most marked at 2 to 4 weeks after onset. At that time the most significant change was a decrease in the compound muscle action potential amplitude. These 45 patients with Guillain-Barre syndrome were subclassified using the clinical and electrophysiological data. Conclusion: The result in this study, concured with other research on the clinical and electrophysiological data of Guillain-Barre syndrome. However, an extensive and dynamic investigation is necessary to determine the reason for the peak seasonal incidence in winter.

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Mapping of the Righteous Tree Selection for a Given Site Using Digital Terrain Analysis on a Central Temperate Forest (수치지형해석(數値地形解析)에 의한 온대중부림(溫帶中部林)의 적지적수도(適地適樹圖) 작성(作成))

  • Kang, Young-Ho;Jeong, Jin-Hyun;Kim, Young-Kul;Park, Jae-Wook
    • Journal of Korean Society of Forest Science
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    • v.86 no.2
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    • pp.241-250
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    • 1997
  • The study was conducted to make a map for selecting righteous tree species for each site by digital terrain analysis. We set an algorithmic value for each tree species' characteristics with distribution pattern analysis, and the soil types were digitized from data indicated on soil map. Mean altitude, slope, aspect and micro-topography were estimated from the digital map for each block which had been calculated by regression equations with altitude. The results obtained from the study could be summarized as follows 1. We could develope a method to select righteous tree species for a given site with concern of soil, forest condition and topographic factors on Muju-Gun in Chonbuk province(2,500ha) by the terrain analysis and multi-variate digital map with a personal computer. 2. The brown forest soils were major soil types for the study area, and 29 tree species were occurred with Pinus densiflora as a dominant species. The differences in site condition and soil properties resulted in site quality differences for each tree species. 3. We tried to figure out the accuracy of a basic program(DTM.BAS) enterprised for this study with comparing the mean altitude and aspect calculated from the topographic terrain analysis map and those from surveyed data. The differences between the values were less than 5% which could be accepted as a statistically allowable value for altitude, as well as the values for aspect showed no differences between both the mean altitude and aspect. The result may indicate that the program can be used further in efficiency. 4. From the righteous-site selection map, the 2nd group(R, $B_1$) took the largest area with 46% followed by non-forest area (L) with 23%, the 5th group with 7% and the 4th group with 5%, respectively. The other groups occupied less than 6%. 5. We suggested four types of management tools by silvicultural tree species with considering soil type and topographic conditions.

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A Study of Accommodative Response on Emmetropia (정시안의 조절반응량에 관한 연구)

  • Shim, Hyun-Seog;Shim, Moon-Sik;Joo, Seog-Hee
    • Journal of Korean Ophthalmic Optics Society
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    • v.11 no.3
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    • pp.187-192
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    • 2006
  • The purpose of this research was to measurement real accmmnodative response amount of emmetropia using both eyes open-view auto-refractometer. We classified 377(male 146, female 231)eyes showing good naked vision at least 1.0, with a spherical equivalent refraction of under ${\pm}0.50D$ and cylindercal refraction of under -0.75D, from 10 to 59(mean $25.8{\pm}12.4$) years into 5 groups with 10 year interval and analyzed change of the near astigmatism and accommodative response amount to distinction of age. Age comparison, total mean 1.47D, 10 years age group 1.63D, 20 years age group 1.57D, 30 years age group 1.71D, 40 years age group 0.97D, and 50 years age group 0.05D. It was no difference between 10 to 30 years age group, But it showed the decre8.se which is remarkable from above 40 years age group and it does not almost response from above 50 years age group. Sexual difference, the man appeared some highly in male(mean $26.4{\pm}12.3$ years) 1.56D m female(mean $26.4{\pm}12.3$) 1.43D. Near-astigmatism power change, mean +0.12D, 10 years age group +0.06D, 20 years age group +0.16D, 30 years age group +0.09D, 40 years age group +0.05D, and 50 years age group +0,06D. No significant difference of astigmatism powers among the an groups, but from all years age group the astigmatism power appeared more highly far-astigmatism than near-astigmatism. Near-astigmatism axis change in the far-astigmatism changes at under ${\pm}10^{\circ}$ 103 eyes, above ${\pm}10^{\circ}$ rotation clockwise direction 108 eyes, above ${\pm}10^{\circ}$ rotation counter-clockwise direction 101 eyes. It was analyzed near-astigmatism axis change.

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The Association between Excessive Daytime Sleepiness and Blood Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome (폐쇄성 수면 무호흡-저호흡증후군 환자에서 과도한 주간졸음증과 혈압 사이의 연관성)

  • Kim, Cheon-Sik;Kim, Dae-Sik
    • Korean Journal of Clinical Laboratory Science
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    • v.48 no.3
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    • pp.255-261
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    • 2016
  • The purpose of this study was to investigate the relationship between excessive daytime sleepiness (EDS) and blood pressure (BP) in patients with obstructive sleep apnea-hypopnea (OSAH). Patients were classified into four groups based on their severity of polysomnographic data: the snoring group (n=108)-characterized by Apnea-Hypopnea Index (AHI<5); the mild OSA group (n=186)-AHI $5{\leq}AHI$<15; the moderate OSA group (n=179)- AHI $15{\leq}AHI$<30; and the severe OSA group (n=233)-$AHI{\geq}30$. On the same night of polysomnography (PSG), BP levels were measured before sleeping (bedtime BP) and immediately after waking up on the following morning (morning BP). EDS was recognized as ESS (epworth sleepiness scale)${\geq}9$. The differences and correlations between BP and PSG parameters in the EDS and non-EDS groups of OSAH patients were analyzed. MAP was positively correlated with BMI, AHI, and total arousal (r=0.099, r=0.142, r=0.135, p<0.01, p<0.01, p<0.01), while negatively correlated with mean $SaO_2$ (r=-0.258, p<0.01). The EDS group had overall younger population ($47.2{\pm}11.3$ vs $50.3{\pm}11.4$, p=0.023), higher DBP (both bedtime and morning, $83.1{\pm}9.7$ vs $81.4{\pm}8.8$ and $86.4{\pm}9.2$ vs $83.6{\pm}9.7$)(p=0.031, p=0.047), and higher SBP (both bedtime and morning, $126.7{\pm}11.2$ vs $123.4{\pm}12.4$, $128.9{\pm}12.4$ vs $125.3{\pm}12.9$)(p=0.021, p=0.021) than compared with the non-EDS group. In hypertensive OSAH patients, patients with EDS were also younger and had higher total arousal number, as well as higher morning and bedtime DBP and SBP than compared with the non-EDS group (p<0.005, p=0.008, p<0.001 and p<0.001). EDS in OSAHS patients is a special phenotype characterized by younger age, higher DBP, more severe desaturation, and hypertension.

Physical Environment Changes in the Keum River Estuary by the Dyke Gate Operation: II. Salinity Structure and Estuary Type (하구언 수문작동으로 인한 금강 하구역의 물리적 환경변화: II. 염분구조와 하구유형)

  • Lee, Sang-Ho;Kwon, Hyo-Keun;Choi, Hyun-Yong;Yang, Jae-Sam;Choi, Jin-Yong
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.4 no.4
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    • pp.255-265
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    • 1999
  • CTD castings and current observations are taken in June, July and October, 1997 and May and July, 1998 to investigate the effect of the Keum River dyke on the structure of physical properties and the type of the Keum River estuary. Tide and tidal current relation shows that the ebbing is longer than the flooding by 1.5 hours with the early current reversing before high tide. In the rainy season (May to July), frequent large fresh water discharge during the ebbing from the dyke changes vertical salinity difference and time variation of salinity greatly near the head of the estuary, where salinity becomes lower than 2‰ in summer fresh water flooding. Halocline developed by the fresh water discharge makes two-layer structure, of which strength and depth increase in the low tide. The relationship between tide phase and surface salinity variation shows the phase lag of 2.5 hours near the head of the estuary but the standing wave relation down the estuary. This phase lag implies that a low salinity water diluted by the fresh water discharge for 2-3 hours in the ebb period moves with tidal excursion. In the dry season, vertical salinity difference reduces significantly. We calculate stratification and circulation parameters using the observed salinity structure, surface current and fresh water discharge. The Keum River estuary shows a partially mixed type, changing the stratification parameter from the rainy to the dry season. Mean flows of observed tidal current at lower and upper layer are landward and seaward, which are consistent with the circulation of a partially mixed estuary. Based upon the estuary type and circulation we suggest that the suspended materials will move toward the upstream due to low-layer mean flow and then the Keum River estuary will be a deposit environment.

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Risk Factor Analysis for $SaO_2$ Instability after Systemic-pulmonary Shunt (전신-폐 단락술 후 산소포화도의 불안정성의 위험인자 분석)

  • Jung Sung-Ho;Yun Sok-Won;Park Jung-Jun;Seo Dong-Man;Kim Young-Hwue;Ko Jae-Kon;Park In-Sook;Yun Tae-Jin
    • Journal of Chest Surgery
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    • v.38 no.4 s.249
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    • pp.277-283
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    • 2005
  • Arterial oxygen saturation $(SaO_2)$ instability frequently takes place after systemic-pulmonary shunt without shunt occlusion. We analyzed actual incidence and risk factors for $SaO_2$ instability after shunt operations, and possible mechanisms were speculated on. Material and Method: Ninety three patients, who underwent modified Blalock-Taussig shunt from January 1996 to December 2000, were enrolled in this study. Adequacy of shunt was verified in all patients, either by ensuing one ventricle or biventricular repair later on or by appropriate pulmonary artery growth on postoperative angiogram. Age, body weight, hemoglobin level at operation were 3 day to 36 years (median: 1.8 months), 2.5kg to 51kg (median: 4.1kg) and $10.7\~24.3$ gm/dL (median: 15.2 gm/dL) respectively. Preoperative diagnoses were functional single ventricle with pulmonary stenosis or atresia in 39, tetralogy of Fallot in 38 and pulmonary atresia with intact ventricular septum in 16. Pulmonary blood flow (PBF) was maintained pre-operatively by patent ductus or previous shunt in 64 and by forward flow through stenotic right ventricular outflow tract (RVOT) in 29. $SaO_2$ instability was defined as $SaO_2$ less than $50\%$ for more than 1 hour with neither anatomic obstruction of shunt nor respiratory problem. Result: 10 patients $(10.7\%)$ showed $SaO_2$ instability after shunt operation. After shunt occlusion was ruled out by echocardiogram, they received measures to lower pulmonary vascular resistance (PVR), which worked within a few hours in all patients. Risk factors for $SaO_2$ instability included older age at operation (p=0.039), lower preoperative $SaO_2$ (p=0.0001) and emergency operation (p=0.001). PBF through stenotic RVOT showed marginal statistical significance (p=0.065). Conclusion: $SaO_2$ instability occurs frequently after shunt operation, especially in patients with severe hypoxia pre-operatively or unstable clinical condition necessitating emergency operation. Temporary elevation of pulmonary vascular resistance is a possible mechanism in this specific clinical setting.

Mineralogy and Genesis of Hydrothermal Deposits in the Southeastern Part of Korean Peninsula : (5) Deogbong Napseok Deposit (우리나라 동남부 지역의 열수광상에 대한 광물학적 및 광상학적 연구:(5) 덕봉납석광상)

  • Kim, Soo-Jin;Choo, Chang-Oh;Kim, Won-Sa
    • Journal of the Mineralogical Society of Korea
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    • v.7 no.1
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    • pp.25-39
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    • 1994
  • The Deogbong napseok clay deposit which is composed mainly of dickite and pyrophyllite has been formed by hydrothermal alteration of the Late Cretaceous volcanic rocks consisting of andesitic tuff and andesite. The mineralogy of the napseok ores and the hydrothermal alteration processes have been studied in order to know the nature of the interaction between minerals and fluids for the formation of the deposit. Chemical distribution shows that alkali elements and silica were mobile but alumina was relatively immobile during the hydrothermal processes. It is evident that enrichment of alumina and leaching of silica from the host rock led to the formation of the napseok ore, whereas the enrichment of silica in the outer zone of the deposit gave rise to the silica zone. A large amount of microcrystalline quartz closely associated with dickite and pyrophyllite suggests the increasing activity of silica. Thus Si which was released away from the argillic zone by the increasing activity of silica. Thus Si which was released away from the argillic zone by the increasing activity of silica solubility moved out precipitating in the margin of the deposit to form the silica zone. Variation in dickite crystallinity implies the local change in the stability of the system. Thermodynamic calculation shows that the invariant point of pyrophyllite-dickite (kaolinite)-diaspore-quartz assemblages at 500 bars in the system $Al_{2}O_{3}-SiO_{2}-H_{2}O$ is about 300 $^{\circ}C$. Based on the mineral assemblages and the experimental data reported, it is estimated that the main episode of hydrothermal alteration occurred at least above 270 to 300 $^{\circ}C$ and $X_{CO_2}$ <0.025. Mineral occurrence and chemical variation indicate that the activity of Al is high in the upper part of the deposit, whereas the activity of Si is high in the lower part and the margin of the deposit. The nonequilibrium phase relations observed in the Deogbong deposit might be due to local change in intensive thermodynamic variables and fluid transport properties that resulted in the formation of nonequilibrium phases b of several stages.

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Birth Weight Distribution by Gestational Age in Korean Population : Using Finite Mixture Modle (우리나라 신생아의 재태 연령에 따른 출생체중의 정상치 : Finite Mixture Model을 이용하여)

  • Lee, Jung-Ju;Park, Chang Gi;Lee, Kwang-Sun
    • Clinical and Experimental Pediatrics
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    • v.48 no.11
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    • pp.1179-1186
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    • 2005
  • Purpose : A universal standard of the birth weight for gestational age cannot be made since girth weight distribution varies with race and other sociodemographic factors. This report aims to establish the birth weight distribution curve by gestational age, specific for Korean live births. Methods : We used the national birth certificate data of all live births in Korea from January 2001 to December 2003; for live births with gestational ages 24 weeks to 44 weeks(n=1,509,763), we obtained mean birth weigh, standard deviation and 10th, 25th, 50th, 75th and 90th percentile values for each gestational age group by one week increment. Then, we investigated the birth weight distribution of each gestational age group by the normal Gaussian model. To establish final standard values of Korean birth weight distribution by gestational age, we used the finite mixture model to eliminate erroneous birth slights for respective gestational ages. Results : For gestational ages 28 weeks 32 weeks, birth weight distribution showed a biologically implausible skewed tail or bimodal distribution. Following correction of the erroneous distribution by using the finite mixture model, the constructed curve of birth weight distribution was compared to those of other studies. The Korean birth weight percentile values were generally lower than those for Norwegians and North Americans, particularly after 37 weeks of gestation. The Korean curve was similar to that of Lubchenco both 50th and 90th percentiles, but generally the Korean curve had higher 10th percentile values. Conclusion : This birth weight distribution curve by gestational age is based on the most recent and the national population data compared to previous studies in Korea. We hope that for Korean infants, this curve will help clinicians in defining and managing the large for gestational age infants and also for infants with intrauterine growth retardation.