• Title/Summary/Keyword: EXTENSIVE MANAGEMENT

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A Clinicopathological Study of Rapidly Progressive Glomerulonephritis in Children (소아 급속 진행성 사구체 신염의 임상-병리학적 고찰)

  • Cho Hee-Yeon;Chung Dae-Lim;Kang Ju-Hyung;Ha Il-Soo;Choi Yong;Cheong Hae-Il
    • Childhood Kidney Diseases
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    • v.8 no.2
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    • pp.176-185
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    • 2004
  • Purpose: Rapidly progressive glomerulonephritis (RPGN) is a clinicopathologic entity characterized by extensive crescent formation and rapid deterioration of renal function within few months. For better understanding of its clinical course and designing better treatment strategies, a clinicopathological study of childhood RPGN was performed. Methods: The clinical manifestations and pathological findings were reviewed retrospectively in 12 children who were diagnosed as having RPGN by clinical manifestations and renal biopsy during a period from 1991 to 2003. Several clinicopathological parameters were analyzed as prognostic factors. Results: Among a total of 12 patients, 4 were male and 8 were female. The median onset age was 11.5 years(range 5.5-14.6 years), and the median period of follow-up was 25 months(range 7 months-6.6 years). According to the pathological classification, 10 patients (83%) were type II RPGN(immune-complex mediated glomerulonephritis), 2 patients were type III RPGN(pauci-immune glomerulonephritis), and none was type I RPGN(anti-glomerular basement membrane nephritis). All patients were treated with oral steroid in various combinations with methylprednisolone pulse therapy(10 patients, 83%), cyclophosphamide(8 patients, 67%), or plasmapheresis(4 patients, 33%). Clinical outcomes of 12 patients were complete remission in 1(8%), end-stage renal disease in 2(17%), chronic renal insufficiency with persistent proteinuria in 2(17%), and normal renal function with persistent proteinuria in 7(58%) at the last follow-up. Poor prognosis is associated with increased serum creatinine level, severe anemia and younger age at the time of diagnosis. Conclusion: Immune-complex mediated glomerulonephritis is the major cause RPGN in children and most cases showed improvement of renal function with aggressive management. For better understanding of this rare disease, a prospective multicenter study should be done.

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Scapular Free Flap (유리 견갑 피판 이식술)

  • Chung, Duke-Whan;Han, Chung-Soo;Yim, Chang-Moo
    • Archives of Reconstructive Microsurgery
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    • v.5 no.1
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    • pp.24-34
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    • 1996
  • There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

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Rice Cultivation and Demographi Development in Korea : 1429-1918 (조선시대(朝鮮時代) 도작농업(稻作農業)의 발전(發展)과 인구증가(人口增加))

  • Lee, Ho Chol
    • Current Research on Agriculture and Life Sciences
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    • v.7
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    • pp.201-219
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    • 1989
  • Rice culture in Korea has a long history ranging over two thousand years. In the agriculture economy of pre-mordern Korea, however, its importantce was not as great as generally assumed. In fact, rice culture reached full development only after the 1920s when the Japanese colonial government carried out its drive to increase rice production in the Korea peninsula. It was not until the mid-1930s that rice became the staple in Korean diet. This can be attributed to two factors : (1) a mountainous topography that provides little irrigated fields and (2) a climate characterized by droughts in spring and heavy precipitation in summer. The present paper attempts to answer some of these questions. Specifically it will focus on these : Did the development of rice culture actually result in population growth? What are the salient features of agricultural develdpment and population grow in traditional Korea? Does the case of Korea conform the prevailing generalization about the agriculture in East Asia? I have discussed the development of rice culture and population growth in the Chos$\breve{o}$n dynasty, focusing on the relation between the rapid spread of transplanting and the rapid growth of population from the seventeenth to the nineteenth century. Here are my conclusions. (1) The spread of transplanting and other technological innovationsc contributed to the rapid growth of population in this period. However, we should also note that the impact of rice culture on population growth was rather limited, for rice culture was not the mainstay of agricultural economy in pre-modern Korea. Indeed we should consider the influence of dry field cropsn population growth. Nevertheless, it is obvious that the proliferation of rice culture was a factor crucial to population growth and regional concentration. (2) How should we characterize the spread of rice culture in the whole period? Evidently rice culture spread from less then 20% of cultivated fields in the fifteenth century to about 36% of them in the early twentieth century. Although rice as a single crop outweighed other crops, rice culture was more then counter-balanced by dry field crops as a whole, due to Korea's unique climate and geography. Thus what we have here in not a typical case of competition between rice culture and day field culture. Besides, the spread of rice culture in the seventeenth and eighteenth centuries accomplished by technological innovations that overcame severe springtime drought, rather than extensive irrigation. Althougt irrigarion facilities did proliferate to some extent, this was achieved by local landlords and peasants rather than the state. This fact contradicts the classical thesis that the productivity of rice culture increased through the state management of irrigation and that this in turn determined the type of society. (3) We should further study other aspects of the transition from the stable population and production struture in the fifteenth and sixteenth centuries to the rapid population growth and excessive density of population thereafter. We should note that there were continuing efforts to reclaim the land in order to solve the severe shortage of land. Changes also took place in the agricultural production relations. The increase in land producrivity developed tenancy based on rent in kind, and this in turn increased the independence of tenants from their landlords. There were changes in family relations-such as the shift to primogeniture as an effort to prevent progressive division of property among multiplying offspring. The rapid population growth also produced a great mass of propertyless farm laborers. These changes had much to do with the disintegration of traditional social institutions and political structure toward the end of the Chos$\breve{o}$n dynasty.

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Treatment of Carcinoma of the Uterine Cervix with High-Dose-Rate Intracavitary Irradiation using Ralstron (고선량률 강내조사를 사용한 자궁경부암의 치료)

  • Suh Chang Ok;Kim Gwi Eon;Loh John J.K.
    • Radiation Oncology Journal
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    • v.8 no.2
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    • pp.231-239
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    • 1990
  • From May 1979 through December 1981 a total of 524 patients with carcinoma of the uterine cervix were treated by radiation therapy with curative intent. Among the 524 patients, 350 were treated with a high-dose-rate (HDR), remote-controlled, afterloading intracavitary irradiation (ICR) system using a cobalt source (Ralstron), and 168 patients received a low-dose-rate (LDR) ICR using a radium source. External beam irradiation with a total dose of 40-50 Gy to the whole pelvis followed by intracavitary irradiation with a total dose of 30-39 Gy in 10-13 fractions to point A was the treatment protocol. ICR was given three times a week with a dose of 3 Gy per fraction. Five-year actuarial survival rates in the HDR-ICR group were $77.6{\%}$ in stage IB (N=20), $68.2{\%}$ in stage II (N=182), and $50.9{\%}$ in stage III (N=148). In LDR-ICR group, 5-year survival rates were $87.5{\%}$ in stage IB (N=22), $66.3{\%}$ in stage II (N=91), and $55.4{\%}$ in stage III (N=52). Survival rates showed a statistically significant difference by stage, but there was no significant difference between the two ICR groups. Late bowel complications after radiotherapy were noted in $3.7{\%}$ of the HDR-ICR group and $8.4{\%}$ of the LDR-ICR group. There was no severe complication requiring surgical management. The incidence of bladder complications was $1.4{\%}$ in the HDR-ICR group and $2.4{\%}$ in the LDR-ICR group. The application of HDR-ICR was technically simple and easily performed on an outpatient basis without anesthesia, and the patients tolerated it very well. Radiation exposure to personnel was virtually nil in contrast to that of LDR-ICR. Within a given period of time, more patients can be treated with HDR-ICR because of the short treatment time. Therefore, the HDR-ICR system is highly recommended for a cancer center, particularly one with a large number of patients to be treated. In order to achieve an improved outcome, however, the optimum dose-fractionation schedule of HDR-ICR and optimum combination of intracavitary irradiation with external beam irradiation should be determined through an extensive protocol.

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Assessment of Environmental Impacts and $CO_2$ Emissions from Soil Remediation Technologies using Life Cycle Assessment - Case Studies on SVE and Biopile Systems - (전과정평가(LCA)에 의한 토양오염 정화공정의 환경영향분석 및 $CO_2$ 배출량 산정 - SVE 및 Biopile 시스템 중심으로 -)

  • Jeong, Seung-Woo;Suh, Sang-Won
    • Journal of Korean Society of Environmental Engineers
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    • v.33 no.4
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    • pp.267-274
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    • 2011
  • The environmental impacts of 95% remediation of a total petroleum hydrocarbon-contaminated soil were evaluated using life cycle assessment (LCA). LCA of two remediation systems, soil vapor extraction (SVE) and biopile, were conducted by using imput materials and energy listed in a remedial system standardization report. Life cycle impact assessment (LCIA) results showed that the environmental impacts of SVE were all higher than those of biopile. Prominent four environmental impacts, human toxicity via soil, aquatic ecotoxicity, human toxicity via surface water and human toxicity via air, were apparently found from the LCIA results of the both remedial systems. Human toxicity via soil was the prominent impact of SVE, while aquatic ecotoxicity was the prominent impact of biopile. This study also showed that the operation stage and the activated carbon replacement stage contributed 60% and 36% of the environmental impacts of SVE system, respectively. The major input affecting the environmental impact of SVE was electricity. The operation stage of biopile resulted in the highest contribution to the entire environmental impact. The key input affecting the environmental impact of biopile was also electricity. This study suggested that electricity reduction strategies would be tried in the contaminated-soil remediation sites for archieving less environmental impacts. Remediation of contaminated soil normally takes long time and thus requires a great deal of material and energy. More extensive life cycle researches on remedial systems are required to meet recent national challenges toward carbon dioxide reduction and green growth. Furthermore, systematic information on electricity use of remedial systems should be collected for the reliable assessment of environmental impacts and carbon dioxide emissions during soil remediation.

Clincal Manifestations of Patients Dying of Severe Community Acquired Pneumonia (중증 원외폐렴으로 사망한 환자의 임상적 분석)

  • Choi, Won-Il;Sohn, Jeong-Ho;Kwun, Oh-Yong;Heo, Jeong-Sook;Whang, Jae-Seok;Han, Seong-Beom;Jeon, Young-June
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.5
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    • pp.537-545
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    • 1994
  • Background: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with community-acquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of dying of severe community-acquired pneumonia. Methods: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. Results: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnca, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+) cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Seven patients death(70%) occured after admission within the first five days, and a mean duration of hospitaliztion was 11.2 days. Conclusion: As the results show most death occured within the first five days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.

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Drug resistance of Mycobacterium tuberculosis in children (소아 결핵 환자에서의 항결핵제 내성 II)

  • Lee, Soo Jin;Ahn, Young Min;Kim, Hee Jin
    • Clinical and Experimental Pediatrics
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    • v.52 no.1
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    • pp.61-67
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    • 2009
  • Purpose : The rate of drug-resistant tuberculosis (DR-TB) in children is an indicator of the effectiveness of TB control programs in the community. This study aimed to assess the prevalence of DR-TB in children and evaluate TB management. Methods : Between January 1999 and July 2007, drug susceptibility tests for anti-TB drugs were employed for patients aged less than 19 years with culture-positive TB. Results : A total of 607 cases (16.6%) were resistant to at least one anti-TB drug as follows: isoniazid (INH; 13.8%), rifampin (8.9%), pyrazinamide (4.2%), streptomycin (3.7%), ethambutol (EMB; 5.9%), and para-aminosalicylic acid (PAS; 1.9%). Multidrug-resistant (MDR) TB was found in 276 cases (7.6%); extensive drug resistant (XDR) TB, in 5 cases (0.2%). The rate of resistance to at least one anti-TB drug in children aged >15 years (16.1%) was significantly lower than that in children aged <15 years (20.5%) (P=0.016). The rate of resistance to at least one anti-TB drug and multidrug-resistance in this survey decreased significantly (P<0.001) as compared to the previous survey (1987-1995). The rate of resistance to INH, EMB, and PAS also significantly decreased (P<0.05). Conclusion : The rate of DR-TB in children in Korea has decreased over time; however, it remains higher than that in other countries. MDR-TB and XDR-TB are the emerging problems in Korean children. Therefore, the selection of effective drugs through drug susceptibility tests and evaluating risk factors of resistant TB is essential to successful therapy and a decreased incidence of DR-TB.

A Qualitative Study on Facilitating Factors of User-Created Contents: Based on Theories of Folklore (사용자 제작 콘텐츠의 활성화 요인에 대한 정성적 연구: 구비문학 이론을 중심으로)

  • Jung, Seung-Ki;Lee, Ki-Ho;Lee, In-Seong;Kim, Jin-Woo
    • Asia pacific journal of information systems
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    • v.19 no.2
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    • pp.43-72
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    • 2009
  • Recently, user-created content (UCC) have emerged as popular medium of on-line participation among users. The Internet environment has been constantly evolving, attracting active participation and information sharing among common users. This tendency is a significant deviation from the earlier Internet use as an one-way information channel through which users passively received information or contents from contents providers. Thanks to UCCs online users can now more freely generate and exchange contents; therefore, identifying the critical factors that affect content-generating activities has increasingly become an important issue. This paper proposes a set of critical factors for stimulating contents generation and sharing activities by Internet users. These factors were derived from the theories of folklores such as tales and songs. Based on some shared traits of folklores and UCC content, we found four critical elements which should be heeded in constructing UCC contents, which are: context of culture, context of situation, skill of generator, and response of audience. In addition, we selected three major UCC websites: a specialized contents portal, a general internet portal, and an official contents service site, They have different use environments, user interfaces, and service policies, To identify critical factors for generating, sharing and transferring UCC, we traced user activities, interactions and flows of content in the three UCC websites. Moreover, we conducted extensive interviews with users and operators as well as policy makers in each site. Based on qualitative and quantitative analyses of the data, this research identifies nine critical factors that facilitate contents generation and sharing activities among users. In the context of culture, we suggest voluntary community norms, proactive use of copyrights, strong user relationships, and a fair monetary reward system as critical elements in facilitating the process of contents generation and sharing activities. Norms which were established by users themselves regulate user behavior and influence content format. Strong relationships of users stimulate content generation activities by enhancing collaborative content generation. Particularly, users generate contents through collaboration with others, based on their enhanced relationship and specialized skills. They send and receive contents by leaving messages on website or blogs, using instant messenger or SMS. It is an interesting and important phenomenon, because the quality of contents can be constantly improved and revised, depending on the specialized abilities of those engaged in a particular content. In this process, the reward system is an essential driving factor. Yet, monetary reward should be considered only after some fair criterion is established. In terms of the context of the situation, the quality of contents uploading system was proposed to have strong influence on the content generating activities. Among other influential factors on contents generation activities are generators' specialized skills and involvement of the users were proposed. In addition, the audience response, especially effective development of shared interests as well as feedback, was suggested to have significant influence on contents generation activities. Content generators usually reflect the shared interest of others. Shared interest is a distinct characteristic of UCC and observed in all the three websites, in which common interest is formed by the "threads" embedded with content. Through such threads of information and contents users discuss and share ideas while continuously extending and updating shared contents in the process. Evidently, UCC is a new paradigm representing the next generation of the Internet. In order to fully utilize this innovative paradigm, we need to understand how users take advantage of this medium in generating contents, and what affects their content generation activities. Based on these findings, UCC service providers should design their websites as common playground where users freely interact and share their common interests. As such this paper makes an important first step to gaining better understand about this new communication paradigm created by UCC.

Preliminary Results of Management for Primary CNS Lymphoma (원발성 중추신경계 림프종의 치료에 관한 예비적 결과)

  • Ahn, Seung-Do;Chang, Hye-Sook;Choi, Eun-Kyong
    • Radiation Oncology Journal
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    • v.11 no.1
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    • pp.79-82
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    • 1993
  • From October 1989 to March 1992, ten patients diagnosed as primary central nervous system (CNS) lymphoma were treated with radiation therapy at Asan Medical Center. To obtain pathologic diagnosis, five patients had stereotactic biopsy and the others underwent craniotomy & tumor removal. According to the classification by International Working Formulation, seven of 10 patients showed diffuse large cell types and the remaining 3 had diffuse mixed cell types. Computed tomographic scans of the brain disclosed solitary (6 cases) or multiple (4 cases) intracranial lesions. All patients received 4000 cGy/20 fx to the whole brain followed by an additional 2000 cGy/10 fx boost to the primary lesion. Six patients with initial cerebrospinal fluid (CSF involvement were treated with whole brain irradiation and intrathecal Methotrexate (IT-MTX) chemotherapy. One of them received an additional spinal irradiation after 3 cycles of IT-MTX chemotherapy because of MTX induced arachnoiditis. One patient received 3 cycles of systemic chemotherapy prior to rodiation therapy and one received 5 cycles of salvage chemotherapy for recurrence. With a median follow up time of 8 months, all patients were followed from 7 to 26 months. Radiologically seven patients showed complete remission and the remaining three showed partial remission at one month after radiotherapy. The 1 and 2 year survival rate was $86{\%}\;and\;69{\%}$ respectively. Until now, two patients expired at 7 and 14 months. These patients developed extensive CSF seeding followed by local failure. Considering initial good response to radiation therapy and low incidence of extraneural dissemination in primary CNS lymphoma, we propose to increase total tumor dose to the primary lesion by hyperfractionated radiotherapy or stereotactic radiosurgery. For the patients with CSF involvement at diagnosis, we propose craniospinal irradiation with IT MTX chemotherapy.

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Comparison of Single vs Combined Modality Treatment in Locally Advanced Non-Small Cell Lung Cancer (국소 진행된 비소세포 폐암에서 복합요법과 단일요법의 비교)

  • Kim, Ae-Kyoung;Jeong, Seong-Su;Shin, Kyoung-Sang;Park, Sang-Gee;Jo, Hai-Jeong;Lee, Jong-Jin;Seo, Jee-Won;Kim, Ju-Ock;Kim, Sun-Young
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.502-512
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    • 1995
  • Background: One quarter to one third of patients with NSCLC present with primary tumors that although confined to the thorax are too extensive for surgical resection. Until resently standard treatment for these patients had been thoracic radiation, which produces tumor regression in most patients but few cures and dismal 5-year survival rate. The fact that death for most patients with stage III tumors is caused by distant metastases has promped a reevaluation of combined modality treatment approaches that include systemic chemotherapy. Therefore, we report the results observed in a study to evaluate the effect of multimodality treatment in locally advanced non-small cell lung cancer from 1/91 to 8/93 in CNUH. Method: We grouped the patients according to the treatment modalities and evaluated response rate, median survival and the effect of prognostic variables. Among 67 patients evaluated, twenty seven patients classified with group A, received cisplatin and etoposide containing combination chemotherapy alone, eighteen patients, classified with group B, received chemotherapy and radiotherapy, fifteen patients, group C, received neoadjuvant or adjuvant chemotherapy and surgery with/without radiation therapy, seven patients, group D, received only supportive care. Result: The major response rate for group A and B was 37% and 61% respectively. There was no statistically significant difference in response rate between A and B groups(p=0.97). The analysis of prognostic factors showed that differences of age, sex, pathology, blood type, smoking year, stage and ECOG performance did not related to improvement in survival. Median survival time was 8.6 months for group A, 13.4 months for group B, 19.2 months for group C, and 5.4 months for group D, respectively and there was statistically significant difference(p=0.003), suggesting that multimodality therapy was associated with signigicant improvement in survival. Subset survival analysis showed a significant therapeutic effect for earlier stage and good performance state(p=0.007, 0.009, respectively). A possible survival advantages were observed for major response groups. Conclusion: It was suggested that multimodality therapy for the management of patients who had stage III disease, has yielded good median survival and long survival for seleted patients. But, it is necessory to validate above result with further investigation in large scale and in prospective randomized trials.

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