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Postmastectomy Radiotherapy and Chemotherapy in Patients with Breast Cancer (유방절제술을 시행한 유방암 환자에서 방사선과 항암제 치료성적)

  • Ahn Sung-Ja;Chung Woong-Ki;Nam Taek-Keun;Nah Byung-Sik;Song Ju-Young;park Seung-Jin
    • Radiation Oncology Journal
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    • v.22 no.1
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    • pp.17-24
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    • 2004
  • Purpose: To evaluate the treatment outcomes after postmastectomy radiotherapy (PMRT) and chemotherapy in patients with breast cancer. Materials and Methods: The PMRT were retrospectively analyzed in 83 patients with stage II-III female breast cancer treated between 1989 and 1995. The median age was 46 years (range, 23-77): Seventy-seven patients had modified radical mastectomies, 5 radical mastectomies and 1 simple mastectomy. Three patients ($4\%$) had pathologically negative axillae, and the remaining 80 ($96\%$) had positive axillae. Eleven, 23, 44 and 5 patients had pathological stages IIA, IIB, IIIA, and IIIB, retrospectively. Eighty ($96\%$) patients were treated with hockey-stick fields. The median dose of PMRT was 50.4 ey, in 1.8 Gy fractions. Adjuvant systemic chemotherapy was given to 74 patients ($89\%$). CMF-based or doxorubicin-containing regimens were given to 54 patients ($55\%$). The median follow-up time was 82 months (range, 8-171) after the mastectomy. Results: The 5 and 10-year overall survival rates for all patients were 65 and $49\%$, respectively. The univariate and multivariate analyses of the factors affecting the overall survival revealed the stage to be the most significant prognostic factor (p=0.002), followed by the combination of chemotherapy. Thirteen patients $16\%$ developed a LRF, at an interval of 4-84 months after radiotherapy, with a median of 20 months. The only significant prognostic factor affecting LRF was the combination of chemotherapy, in both the univariate and multivariate analyses. With respect to the sequence of chemoradiation, the sequence had no saatistical significance (p=0.90). According to the time interval from mastectomy to the onset of radiotherapy, the LRFR of the patients group treated by RT within or after 6 month postmastectomy 6 months were 14 vs. $27\%$ respectively (p=0.24). One third of the pa41en1s (26/83) developed distant metastasis, in 2-92 months, after radiotherapy, with a median of 21 months. The most commonly involved site was bone in 13 cases. The pathological staging was the only significant prognostic factor in both the univariate and multivariate analyses that affected distant failure. Radiological finding of radiation pneumonitis on a simple chest x-ray was shown in $20\%$ (17/83), with a time interval ranging from 2 to 7 months post-radiotherapy, with a median of 3 months. The stable lung fibrosis settled in 11 patients ($65\%$). Conclusion: It was concluded through this analysis that the combination of PMRT with in chemotherapy resulted in better overall survival and local control than PMRT alone in patients needing PMRT.

The Results of Hyperfractionated Radiotherapy on Locally Advanced Non-Small Cell Lung Cancer (국소적으로 진행된 비소세포 폐암에 대한 과분할 방사선 치료의 성적)

  • Hur, Won-Joo;Lee, Hyung-Sik;Kim, Jeong-Ki;Choi, Young-Min;Lee, Ho-Jun;Youn-Seon-Min;Kim, Jae-seok;Kim, Hyo-Jin;Woo-Jong-Soo;Choi, Pill-Jo;Lee, Ki-Nam
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.275-282
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    • 1998
  • Purpose : The effect of hyperfractionated radiotherapy on locally advanced non-small lung cancer was studied by a retrospective analysis. Materials & Methods : We analyzed sixty one patients of biopsy-confirmed, IIIA and IIIB non-small cell lung cancer. Using the ECOG performance scale, all the patients were scored less than 2. They were treated by curative hyperfractionated radiotherapy alone from Oct. 1992 to Oct. 1995 at the Department of Radiation Oncology. All the patients received 120cGy b.i.d with more than 6 hours interval between each fraction. The total dose of radiation was reached up to 6400-7080 cGy with a mean dose of 6934 cGy. The results were analyzed retrospectively. Results : The overall survival rate was 53 1$\%$ in 1 year, 9.9$\%$ in 2 years with a median survival time (MST) of 13.9 months. The progression free survival (PFS) rate was 37.0$\%$ in 1 year, 8.9$\%$ in 2 years. Twenty two Patients were classified as complete responders to this treatment and their MST was 19.5 months When this was compared with that of partial responders (MST: 11 7months), it was statistically significant (p=0.0003). Twenty nine patients of stage IIIA showed a better overall survival rate (1yr 63.3$\%$, 2yr 16.8$\%$) than IIIB patients (1yr 43.3$\%$, 2yr 3.6$\%$), which was also statistically significant (p=0.003). Patients with adenocarcinoma showed a better survival rate (1yr 64.3$\%$, 2yr 21.4$\%$) than that of squamous cell counterpart (1yr 49.4$\%$, 2yr 7.4$\%$), although this was not significant statistically (p=0.61). Two patients developed fatal radiation-induced pneumonia right after the completion of the treatment which progressed rapidly and they all died within 2 months. One patient developed radiation-induced fibrosis after 13 months. He refused further treatment and died soon after the development of fibrosis. Conclusion : Among locally advanced NSCLC, hyperfractionated radiotherapy was effective on stage IIIA patients by increasing MST with acceptable toxicities. Acute radiation-induced pneumonia should be carefully monitored and must be avoided during or after this treatment.

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Peripheral Neutrophil Count and Respiratory Failure in Preterm Infant (조산아에서 말초혈액 중성구수와 호흡 부전증과의 연관성)

  • Lee, Kum Joo;Yun, Soo Young;Lee, Ran;Hean, Jae Ho;Jung, Ghee Young;Park, Jin Hee;Park, Young Sun
    • Clinical and Experimental Pediatrics
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    • v.45 no.5
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    • pp.596-602
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    • 2002
  • Purpose : The purpose of this study was to analyze the association of peripheral neutrophil count with the development of respiratory failure in preterm infants. Methods : A retrospective study was conducted from January 1993 to December 1999 on 44 preterm infants, who were admitted to the neonatal intensive care unit of St. Francisco hospital. Preterm infants(birth weight 500 to 1,350 gm) who had a complete blood count obtained within 2 hours after delivery. Patients in the lowest of neutrophil count(early neutropenia, < $1.0{\times}10^9/L$) were compared with patients in the remaining group. Results : Low neutrophil count were transient in early neutropenia group. The concentration the circulating neutrophil count rose from $0.85{\pm}0.11{\times}10^9/L$ at average of 2 hours after delivery to $5.3{\pm}2.7{\times}10^9/L$ at 24 hours after delivery in the early neutropenia group and from $3.6{\pm}1.6{\times}10^9/L$ to $5.8{\pm}3.2{\times}10^9/L$ in the non-neutropenia group during the same time period. Compare to the non-neutropenia group, the neutropenia group had a lower birth weight($1,046.50{\pm}180.76gm$ Vs $1,156.70{\pm}124.99gm$), a lower Apgar score(1 min : $3.41{\pm}1.18$ Vs $4.30{\pm}1.46$, 5 min : $5.41{\pm}0.87$ Vs $6.15{\pm}0.95$), and a higher incidence of bronchopulmonary dysplasia(27.27% Vs 7.0%). Patients who had early neutropenia were more likely to require mechanical ventilation, supplemental oxygen and hospital stay. Also, main effect factors for the two groups were birth weight(Odds ratio=5.457, 95% CI=1.551-27.525), initial peripheral blood white cells(odds ratio=8.308, 95% CI=2.054-52.699), and bronchopulmonary dysplasia(odds ratio=0.099, 95% CI=0.017-0.397). Conclusion : A low count of neutrophil in the systemic circulation of premature infants within 2 hours of birth is associated with more severe respiratory distress.

Pulmonary Mycoses in Immunocompromised Hosts (면역기능저하 환자에서 폐진균증에 대한 임상적 고찰)

  • Suh, Gee-Young;Park, Sang-Joon;Kang, Kyeong-Woo;Koh, Young-Min;Kim, Tae-Sung;Chung, Man-Pyo;Kim, Ho-Joong;Han, Jong-Ho;Choi, Dong-Chull;Song, Jae-Hoon;Kwon, O-Jung;Rhee, Chong-H.
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1199-1213
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    • 1998
  • Background : The number of immunocompromised hosts has been increasing steadily and a new pulmonary infiltrate in these patients is a potentially lethal condition which needs rapid diagnosis and treatment. In this study we sought to examine the clinical manifestations, radiologic findings, and therapeutic outcomes of pulmonary mycoses presenting as a new pulmonary infiltrate in immunocompromised hosts. Method : All cases presenting as a new pulmonary infiltrate in immunocompromised hosts and confirmed to be pulmonary mycoses by pathologic examination or by positive culture from a sterile site between October of 1996 and April of 1998 were included in the study and their chart and radiologic findings were retrospectively reviewed. Results : In all, 14 cases of pulmonary mycoses from 13 patients(male : female ratio = 8 : 5, median age 47 yr) were found. Twelve cases were diagnosed as aspergillosis while two were diagnosed as mucormycosis. Major risk factors for fungal infections were chemotherapy for hematologic malignancy(10 cases) and organ transplant recipients(4 cases). Three cases were receiving empirical amphotericin B at the time of appearance of new lung infiltrates. Cases in the hematologic malignancy group had more prominent symptoms : fever(9/10), cough(6/10), sputum(5/10), dyspnea(4/10), chest pain(5/10). Patients in the organ transplant group had minimal symptoms(p<0.05). On simple chest films, all of the cases presented as single or multiple nodules(6/14) or consolidations(8/14). High resolution computed tomograph showed peri-lesional ground glass opacities(14/14), pleural effusions(5/14), and cavitary changes(7/14). Definitive diagnostic methods were as follows : 10 cases underwent minithoracotomy, 2 underwent video-assisted thoracoscopic surgery, 1 underwent percutaneous needle aspiration and 1 case was diagnosed by culture of abscess fluid. All cases received treatment with amphotericin B with 1 case each being treated with liposomal amphotericin B and itraconazole due to renal toxicity. Lung lesion improved in 12 of 14 patient but 4 patients died before completing therapy. Conclusion : When a new lung infiltrate develops presenting either as a nodule or consolidation in a neutropenic patient with hematologic malignancy or in a transplant recipient, you should always consider pulmonary mycoses as one of the differential diagnosis. By performing aggressive work up and early treatment, we may improve prognosis of these patients.

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Requirement and Perception of Parents on the Subject of Home Economics in Middle School (중학교 가정교과에 대한 학부모의 인식 및 요구도)

  • Shin Hyo-Shick;Park Mi-Soog
    • Journal of Korean Home Economics Education Association
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    • v.18 no.3 s.41
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    • pp.1-22
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    • 2006
  • The purpose of this study is that I should look for a desirous directions about home economics by studying the requirements and perception of the high school parents who have finished the course of home economics. It was about 600 parents whom I have searched Seoul-Pusan, Ganwon. Ghynggi province, Choongcheong-Gyungsang province, Cheonla and Jeju province of 600, I chose only 560 as apparently suitable research. The questions include 61 requirements about home economics and one which we never fail to keep among the contents, whenever possible and one about the perception of home economics aims 11 about the perception of home economics courses and management. The collections were analyzed frequency, percent, mean. standard deviation t-test by using SAS program. The followings is the summary result of studying of it. 1. All the boys and girls learning together about the Idea of healthy lives and desirous human formulation and knowledge together are higher. 2. Among the teaching purposes of home economics, the item of the scientific principle and knowledge for improvements of home life shows 15.7% below average value. 3. The recognition degree about the quality of home economics is highly related with the real life, and about the system. we recognize lacking in periods and contents of home economics field and about guiding content, accomplishment and application qualities are higher regardless of sex. 4. The important term which we should emphasize in the subject of home economics is family part. 5. Among the needs of home economic requirement in freshman, in the middle unit, their growth and development are higher than anything else, representing 4.11, and by contrast the basic principle and actuality is 3.70, which is lowest among them. 6. In the case of second grade requirement of home economics content for parents in the middle unit young man and consuming life is 4.09 highest. 7. In the case of 3rd grade requirement of economics contents in the middle unit the choice of coming direction and job ethics is highest 4.16, and preparing meals and evaluation is lowest 3.50.

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Effects of ${Zn}^{2+}$ on the Activities of Electron Transport and Photophosphorylation of Barley Chloroplasts (보리 엽록체의 전자전달과 광인산화 활성에 미치는 ${Zn}^{2+}$의 영향)

  • 김지숙;홍영남;권영명
    • Journal of Plant Biology
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    • v.28 no.1
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    • pp.69-77
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    • 1985
  • The degree of The degree of The degree of ${Zn}^{2+}$ effect on the photosynthetic electron transport and photophosphorylation activities in barley chloroplasts has been tested.${Zn}^{2+}$treatment was done in the 2 ways. One was that it was added into the chloroplasts suspensions isolated from the plants grown under the normal ${Zn}^{2+}$level (10$^{-6}$ M). The other was that the different concentrations of ${Zn}^{2+}$was applied in each growth medium. Then, it was not added into the chloroplasts suspensions isolated from the plants. PS II activity in both way of the treatments was more severely inhibited than PS I by the increment of ${Zn}^{2+}$ concentration. The photophosphorylation activity measured by pH measurement was gradually decreased with the increase of ${Zn}^{2+}$concentration in both ways, too. However, it was shown that M $n^{2+}$ could be near fully overcome the inhibitory effect of ${Zn}^{2+}$in PS II, and $Mg^{2+}$ could also reduce the Z $n^{2+}$ inhibition in the photophosphorylation. In the low concentrations of $Mg^{2+}$ (3 to 5$\times$10$^{-3}$ M) in the suspension, ${Zn}^{2+}$(2$\times$10$^{-5}$ M) could increase the activity of photophosphorylation. As compares to other cations, Z $n^{2+}$ caused less inhibitory effect on the photophosphorylation activity than Cu, Cd, but more than Pb and Ni. It may be assumed that a complex from reaction of Z $n^{2+}$ and mercaptoethanol was produced and it could reduce the stability of CPI band during SDS-PAGE.effect on the photosynthetic electron transport and photophosphorylation activities in barley chloroplasts has been tested. Z $n^{2+}$ treatment was done in the 2 ways. One was that it was added into the chloroplasts suspensions isolated from the plants grown under the normal Z $n^{2+}$ level (10$^{-6}$ M). The other was that the different concentrations of Z $n^{2+}$ was applied in each growth medium. Then, it was not added into the chloroplasts suspensions isolated from the plants. PS II activity in both way of the treatments was more severely inhibited than PS I by the increment of Z $n^{2+}$ concentration. The photophosphorylation activity measured by pH measurement was gradually decreased with the increase of Z $n^{2+}$ concentration in both ways, too. However, it was shown that M $n^{2+}$ could be near fully overcome the inhibitory effect of Z $n^{2+}$ in PS II, and $Mg^{2+}$ could also reduce the Z $n^{2+}$ inhibition in the photophosphorylation. In the low concentrations of $Mg^{2+}$ (3 to 5$\times$10$^{-3}$ M) in the suspension, Z $n^{2+}$ (2$\times$10$^{-5}$ M) could increase the activity of photophosphorylation. As compares to other cations, Z $n^{2+}$ caused less inhibitory effect on the photophosphorylation activity than Cu, Cd, but more than Pb and Ni. It may be assumed that a complex from reaction of Z $n^{2+}$ and mercaptoethanol was produced and it could reduce the stability of CPI band during SDS-PAGE.effect on the photosynthetic electron transport and photophosphorylation activities in barley chloroplasts has been tested. Z $n^{2+}$ treatment was done in the 2 ways. One was that it was added into the chloroplasts suspensions isolated from the plants grown under the normal Z $n^{2+}$ level (10$^{-6}$ M). The other was that the different concentrations of Z $n^{2+}$ was applied in each growth medium. Then, it was not added into the chloroplasts suspensions isolated from the plants. PS II activity in both way of the treatments was more severely inhibited than PS I by the increment of Z $n^{2+}$ concentration. The photophosphorylation activity measured by pH measurement was gradually decreased with the increase of Z $n^{2+}$ concentration in both ways, too. However, it was shown that M $n^{2+}$ could be near fully overcome the inhibitory effect of Z $n^{2+}$ in PS II, and $Mg^{2+}$ could also reduce the Z $n^{2+}$ inhibition in the photophosphorylation. In the low concentrations of $Mg^{2+}$ (3 to 5$\times$10$^{-3}$ M) in the suspension, Z $n^{2+}$ (2$\times$10$^{-5}$ M) could increase the activity of photophosphorylation. As compares to other cations, Z $n^{2+}$ caused less inhibitory effect on the photophosphorylation activity than Cu, Cd, but more than Pb and Ni. It may be assumed that a complex from reaction of Z $n^{2+}$ and mercaptoethanol was produced and it could reduce the stability of CPI band during SDS-PAGE.ld reduce the stability of CPI band during SDS-PAGE.

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The Effects of Autologous Blood Pleurodesis in the Pneumothorax with Persistent Air Leak (지속성 기흉에서 자가혈액을 이용한 흉막유착술의 효과)

  • Yoon, Su-Mi;Shin, Sung-Joon;Kim, Young-Chan;Shon, Jang-Won;Yang, Seok-Chul;Yoon, Ho-Joo;Shin, Dong-Ho;Chung, Won-Sang;Park, Sung-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.6
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    • pp.724-732
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    • 2000
  • Background : In patients with severe chronic lung diseases even a small pneumothorax can result in life-threatening respiratory distress. It is important to treat the attack by chest tube drainage until the lung expands. Pneumothorax with a persistent air leak that does not resolve under prolonged tube thoracostomy suction is usually treated by open operation to excise or oversew a bulla or cluster of blebs to stop the air leak. Pleurodesis by the instillation of chemical agents is used for the patient who has persistent air leak and is not good candidate for surgical treatment. When the primary trial of pleurodesis with common agent fails, it is uncertain which agent should be used f or stopping the air leak by pleurodesis. It is well known that inappropriate drainage of hemothorax results in severe pleural adhesion and thickening. Based on this idea, some reports described a successful treatment with autologous blood instillation for pneumothorax patients with or without residual pleural space. We tried pleurodesis with autologous bood for pneumothorax with persistent air leak and then we evaluated the efficacy and safety. Methods : Fifteen patients who had persistent air leak in the pneumothorax complicated from the severe chronic lung disease were enrolled. They were not good candidates for surgical treatment and doxycycline pleurodesis failed to stop up their air leaks. We used a mixture of autologous blood and 50% dextrose for pleurodesis. Effect and complications were assessed by clinical out∞me, chest radiography and pulmonary function tests. Results : The mean duration of air leak was 18.4${\pm}$6.16 days before ABP (autologous blood and dextrose pleurodesis) and $5.2{\pm}1.68$ days after ABP. The mean severity of pain was $2.3{\pm}0.70$ for DP(doxycycline pleurodesis) and $1.7{\pm}0.59$ for ABDP (p<0.05). There was no other complication except mild fever. Pleural adhesion grade was a mean of $0.6{\pm}0.63$. The mean dyspnea scale was $1.7{\pm}0.46$ before pneumothrax and $2.0{\pm}0.59$ after ABDP (p>0.05). The mean $FEV_1$ was $1.47{\pm}1.01$ before pneumothorax and $1.44{\pm}1.00$ after ABDP (p>0.05). Except in 1 patient, 14 patients had no recurrent pneumothorax. Conclusion : Autologous blood pleurodesis (ABP) was successful for treatment of persistent air leak in the pneumothorax. It was easy and inexpensive and involved less pain than doxycycline pleurodesis. It did not cause complications and severe pleural adhesion. We report that ABP can be considered as a useful treatment for persistent air leak in the pneumothorax complicated from the severe chronic lung disease.

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A comparative study on the correlation between Korean foods and the fractures of PFG and all ceramic crowns for posterior applications (구치용 도재소부금관과 전부도재관에 파절을 일으키는 한국음식에 관한 연구)

  • Kim, Jeong-Ho;Lee, Jai-Bong
    • The Journal of Korean Academy of Prosthodontics
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    • v.47 no.2
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    • pp.156-163
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    • 2009
  • Statement of problem: Recently, there have been increased esthetic needs for posterior dental restorations. The failure of posterior dental ceramic restoration are possible not only by the characters of the component materials but also by the type of food. Purpose: The research aim was to compare the in vitro fracture resistance of simulated first molar crowns fabricated using 4 dental ceramic systems, full-porcelain-occlusal-surfaced PFG, half-porcelain-occlusal-surfaced PFG, Empress 2, Ice Zirkon and selected Korean foods. Material and methods: Eighty axisymmetric crowns of each system were fabricated to fit a preparation with 1.5- to 2.0-mm occlusal reduction. The center of the occlusal surface on each of 15 specimens per ceramic system was axially loaded to fracture in a Instron 4465, and the maximum load(N) was recorded. Afterwards, selected Korean foods specimens(boiled crab, boiled chicken with bone, boiled beef rib, dried squid, dried anchovy, round candy, walnut shell) were prepared. 15 specimens per each food were placed under the Instron and the maximum fracture loads for them were recorded. The 95% confidence intervals of the characteristic failure load were compared between dental ceramic systems and Korean foods. Afterwards, on the basis of previous results, 14Hz cyclic load was applied on the 4 systems of dental ceramic restorations in MTS. The reults were analyzed by analysis of variance and Post Hoc tests. Results: 95% confidence intervals for mean of fracture load 1. full porcelain occlusal surfaced PFG Crown: 2599.3 to 2809.1 N 2. half porcelain occlusal surfaced PFG Crown: 3689.4 to 3819.8 N 3. Ice Zirkon Crown: 1501.2 to 1867.9 N 4. Empress 2 Crown: 803.2 to 1188.5 N 5. boiled crab: 294.1 to 367.9 N 6. boiled chicken with bone: 357.1 to 408.6 N 7. boiled beef rib: 4077.7 to 4356.0 N 8. dried squid: 147.5 to 190.5 N 9. dried anchovy: 35.6 to 46.5 N 10. round candy: 1900.5 to 2615.8 N 11. walnut shell: 85.7 to 373.1 N under cyclic load(14Hz) in MTS, fracture load and masticatory cycles are: 1. full porcelain occlusal surfaced PFG Crown fractured at 95% confidence intervals of 4796.8-9321.2 cycles under 2224.8 N(round candy)load, no fracture under smaller loads. 2. half porcelain occlusal surfaced PFG Crown fractured at 95% confidence intervals of 881705.1-1143565.7 cycles under 2224.8 N(round candy). no fracture under smaller loads. 3. Ice Zirkon Crown fractured at 95% confidence intervlas of 979993.0-1145773.4 cycles under 382.9 N(boiled chicken with bone). no fracture under smaller loads. 4. Empress 2 Crown fractured at 95% confidence intervals of 564.1-954.7 cycles under 382.9 N(boiled chicken with bone). no fracture under smaller loads. Conclusion: There was a significant difference in fracture resistance between experimental groups. Under single load, Korean foods than can cause fracture to the dental ceramic restorations are boiled beef rib and round candy. Even if there is no fracture under single load, cyclic dynamic load can fracture dental posterior ceramic crowns. Experimental data with 14 Hz dynamic cyclic load are obtained as follows. 1. PFG crown(full porcelain occlusion) was failed after mean 0.03 years under fracture load for round candy(2224.8 N). 2. PFG crown(half porcelain occlusion) was failed after mean 4.1 years under fracture load for round candy(2224.8 N). 3. Ice Zirkon crown was failed after mean 4.3 years under fracture load for boiled chicken with bone(382.9 N). 4. Empress 2 crown was failed after mean 0.003 years under fracture load for boiled chicken with bone(382.9 N).

Clinical Study of Corrosive Esophagitis (부식성 식도염에 관한 임상적 고찰)

  • 이원상;정승규;최홍식;김상기;김광문;홍원표
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1981.05a
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    • pp.6-7
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    • 1981
  • With the improvement of living standard and educational level of the people, there is an increasing awareness about the dangers of toxic substances and lethal drugs. In addition to the above, the governmental control of these substances has led to a progressive decrease in the accidents with corrosive substances. However there are still sporadic incidences of suicidal attempts with the substances due to the unbalance between the cultural development in society and individual emotion. The problem is explained by the fact that there is a variety of corrosive agents easily available to the people due to the considerable industrial development and industrialization. Salzen(1920), Bokey(1924) were pioneers on the subject of the corrosive esophagitis and esophageal stenosis by dilatation method. Since then there had been a continuing improvement on the subject with researches on various acid(Pitkin, 1935, Carmody, 1936) and alkali (Tree, 1942, Tucker, 1951) corrosive agents, and the use of steroid (Spain, 1950) and antibiotics. Recently, early esophagoscopic examination is emphasized on the purpose of determining the way of the treatment in corrosive esophagitis patients. In order to find the effective treatment of such patients in future, the authors selected 96 corrosive esophagitis patients who were admitted and treated at the ENT department of Severance hospital from 1971 to March, 1981 to attempt a clinical study. 1. Sex incidence……male: female=1 : 1.7, Age incidence……21-30 years age group; 38 cases (39.6%). 2. Suicidal attempt……80 cases(83.3%), Accidental ingestion……16 cases (16.7%). Among those who ingested the substance accidentally, children below ten years were most numerous with nine patients. 3. Incidence acetic acid……41 cases(41.8%), lye…20 cases (20.4%), HCI……17 cases (17.3%). There was a trend of rapid rise in the incidence of acidic corrosive agents especially acetic acid. 4. Lavage……57 cases (81.1%). 5. Nasogastric tube insertion……80 cases (83.3%), No insertion……16 cases(16.7%), late admittance……10 cases, failure…4 cases, other……2 cases. 6. Tracheostomy……17 cases(17.7%), respiratory problems(75.0%), mental problems (25.0%). 7. Early endoscopy……11 cases(11.5%), within 48 hours……6 cases (54.4%). Endoscopic results; moderate mucosal ulceration…8 cases (72.7%), mild mucosal erythema……2 cases (18.2%), severe mucosal ulceration……1 cases (9.1%) and among those who took early endoscopic examination; 6 patients were confirmed mild lesion and so they were discharged after endoscopy. Average period of admittance in the cases of nasogastric tube insertion was 4 weeks. 8. Nasogastric tube indwelling period……average 11.6 days, recently our treatment trend in the corrosive esophagitis patients with nasogastric tube indwelling is determined according to the finding of early endoscopy. 9. The No. of patients who didn't given and delayed administration of steroid……7 cases(48.9%): causes; kind of drug(acid, unknown)……12 cases, late admittance……11 cases, mild case…9 cases, contraindication……7 cases, other …8 cases. 10. Management of stricture; bougienage……7 cases, feeding gastrostomy……6 cases, other surgical management……4 cases. 11. Complication……27 cases(28.1%); cardio-pulmonary……10 cases, visceral rupture……8 cases, massive bleeding……6 cases, renal failure……4 cases, other…2 cases, expire and moribund discharge…8 cases. 12. No. of follow-up case……23 cases; esophageal stricture……13 cases and site of stricture; hypopharynx……1 case, mid third of esophagus…5 cases, upper third of esophagus…3 cases, lower third of esophagus……3 cases pylorus……1 case, diffuse esophageal stenosis……1 case.

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Role of Postoperative Conventional Radiation Therapy in the Management of Supratentorial Malignant Glioma - with respect to survival outcome and prognostic factors - (천막상부 악성 신경교종에서 수술 후 방사선 치료의 역할 - 생존율과 예후인자 분석 -)

  • Nam Taek Keun;Chung Woong Ki;Ahn Sung Ja;Nah Byung Sik
    • Radiation Oncology Journal
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    • v.16 no.4
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    • pp.389-398
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    • 1998
  • Purpose : To evaluate the role of conventional postoperative adjuvant radiotherapy in the management of supratentorial malignant glioma and to determine favorable prognostic factors affecting survival. Materials and Methods : From Sep. 1985 to Mar. 1997, the number of eligible patients who received postoperative radiotherapy completely was 69. They ranged in age from 7 to 66 years (median, 47). Forty-two (61$\%$) patients were glioblastoma multiforme and the other 27 (39$\%$) were anaplastic astrocytoma. Twenty patients (29$\%$) had Karnofsky score equal or more than 80 preoperatively. Forty-three patients (62$\%$) had symptom duration equal or less than 3 months. Twenty-four patients (35$\%$) had gross total resection and forty patients(58$\%$) had partial resection, the remaining five patients (7$\%$) had biopsy only. Radiotherapy dose ranged from 50.4 Gy to 61.2 Gy (median, 55.8; mode, 59.4) with fraction size of 1 8 Gy-2.0 Gy for 33-83 days(median, 48) except three patients delivered 33, 36, 39 Gr, respectively with fraction size of 3.0 Gy due to poor postoperative performance status. Follow-up rate was 93$\%$ and median follow-up period was 14 months. Results : Overall survival rate at 2 and 3 years and median survival were 38$\%$, 20$\%$, and 16 months for entire patients; 67$\%$, 44$\%$, and 34 months for anaplastic astrocytoma; 18$\%$, 4$\%$, and 14 months for glioblastoma multiforme, respectively (p=0.0001). According to the extent of surgery, 3-year overall survival for gross total resection, partial resection, and biopsy only was 38$\%$, 11$\%$, and 0$\%$, respectively (p=0.02) The 3-year overall survival rates for patients age 40>, 40-59, and 60< were 52$\%$, 8$\%$, and 0$\%$, respectively (p=0.0007). For the variate of performance score 80< vs 80>, the 3-year survival rates were 53$\%$ and 9$\%$, respectively (p=0.008). On multivariate analysis including covariates of three surgical and age subgroups as above, pathology, extent of surgery and age were significant prognostic factors affecting overall survival. On another multivariate analysis with covariates of two surgical (total resection vs others) and two a9e (50> vs 50<) subgroups, then, pathology, extent of surgery and performance status were significant factors instead of age and 3-year cumulative survival rate for the five patients with these three favorable factors was 100$\%$ without serious sequela. Conclusion : We confirmed the role of postoperative conventional radiotherapy in the management of supratentorial malignant glioma by improving survival as compared with historical data of surgery only. Patients with anaplastic astrocytoma, good performance score, gross total resection and/or young age survived longest. Maximum surgical resection with acceptable preservation of neurologic function should be attempted in glioblastoma patients, especially in younger patients. But the survival of most globlastoma patients without favorable factors is still poor, so other active adjuvant treatment modalities should be tried or added rather than conventional radiation treatment alone in this subgroup.

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