• Title/Summary/Keyword: Multi-therapy

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Efficacy and Safety of Bolus 5-Fluorouracil and L-Leucovorin as Salvage Chemotherapy for Oral Fluoropyrimidine-Resistant Unresectable or Recurrent Gastric Cancer: A Single Center Experience

  • Muranaka, Tetsuhito;Yuki, Satoshi;Komatsu, Yoshito;Sawada, Kentaro;Harada, Kazuaki;Kawamoto, Yasuyuki;Nakatsumi, Hiroshi;Sakamoto, Naoya
    • Journal of Gastric Cancer
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    • v.16 no.3
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    • pp.177-181
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    • 2016
  • Purpose: The International Organization for Standardization-5fluorouracil (FU) 10 trial found that bolus 5-FU and l-leucovorin was not inferior to S-1 in the treatment of gastric cancer (GC). Continuous 5-FU and the rapid injection of 5-FU have different anti-cancer effects. Thus, bolus 5-FU and l-leucovorin treatment might be useful for oral FU-resistant GC. Materials and Methods: We retrospectively analyzed the medical records of all patients with S-1 or capecitabine-resistant, unresectable, or recurrent GC treated with bolus 5-FU and l-leucovorin between January 2010 and December 2015 at Hokkaido University Hospital. The bolus 5-FU and l-leucovorin regimen consisted of intravenous l-leucovorin ($250mg/m^2/2h$) and bolus 5-FU ($600mg/m^2$) administered once weekly followed by a 2-week rest period; each cycle was repeated every 8 weeks. Results: A total of 14 patients were identified. The disease control rate was 35.7%. The median progression-free survival was 1.6 months (95% confidence interval [CI], 1.3~2.0 months), and the median overall survival was 6.3 months (95% CI, 4.7~7.9 months). No patient died from treatment-related causes. The most common severe adverse event associated with bolus 5-FU and l-leucovorin was neutropenia, which occurred in 21.4% of patients. Conclusions: Bolus 5-FU and l-leucovorin treatment might be useful for oral FU-resistant GC. We are planning a multi-center prospective phase II trial to evaluate the efficacy and safety of bolus 5-FU and l-leucovorin treatment for pre-treated unresectable or recurrent GC to confirm the results of this limited, retrospective study.

The Post-occupancy Evaluation of Roofgarden at Hospital - A Case Study of Asan Medical Center - (병원 옥상정원의 이용후 평가 - 서울아산병원을 대상으로 -)

  • 김인혜;허근영;최아현;김유일
    • Journal of the Korean Institute of Landscape Architecture
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    • v.31 no.5
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    • pp.58-72
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    • 2003
  • Rooftop greenery has been used as a way to solve urban environmental problems by creating green space in densely populated cities. This study was carried out to suggest more effective designs for roof-garden at hospitals through a post-occupancy evaluation. The roofgarden of Asan Medical Center was evaluated with regards to setting, proximate environmental context, users, and design activity by a multi-method including plan investigations, observations, in-depth interviews and questionnaires. The results are summarized as follows; the users' main activities included resting, walking, and talking. A number of users were observed at shaded spaces sitting on such things as benches, pergolas, and shelters. The satisfaction of the users showed high satisfaction level except in the amount of shade, facilities, and shelter. The variables affecting a overall satisfaction were ‘accessibility’, ‘safety’, ‘quality of surroundings’, and ‘suitability for speculation’. By comparing the design concept with using pattern, designer's intention was not reflected sufficiently in several aspects such as ‘event deck for therapy programs’, ‘grove and path’, and ‘low planters’. This study suggests some design implications; it is necessary to furnish shaded sitting places for passive behaviors and pathways for walking or a light exercise. A wind-break wall with glass windows could widen the users' views in a limited space. Natural shade like tree shade or pergola are more desirable than artificial shades. As for the vertical location of the roofgarden, the middle floor could be better than top area for accessibility. Characteristics of building and users should be considered in detail to provide distinct spaces. Proper technical standards for the greening of artificial ground should be established.

Spinal Cord Partial Block Technique Using Dynamic MLC

  • Cho, Sam-Ju;Yi, Byong-Yong;Back, Geum-Mun;Lee, Sang wook;Ahn, Seung-Do;Kim, Jong-Hoon;Kwon, Soo-Il;Park, Eun-Kyung
    • Proceedings of the Korean Society of Medical Physics Conference
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    • 2002.09a
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    • pp.138-140
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    • 2002
  • The spinal cord dose is the one of the limiting factor for the radiation treatment of the head & neck (H&N) or the thorax region. Due to the fact that the cord is the elongated shaped structure, it is not an easy task to maintain the cord dose within the clinically acceptable dose range. To overcome this problem, the spinal cord partial block technique (PBT) with the dynamic Multi-Leaf Collimator (dMLC) has been developed. Three dimension (3D) conformal beam directions, which minimize the coverage of the normal organs such as the lung and the parotid gland, were chosen. The PBT field shape for each field was designed to shield the spinal cord with the dMLC. The transmission factors were determined by the forward calculation method. The plan comparisons between the conventional 3D conformal therapy plan and the PTB plan were performed to evaluate the validity of this technique. The conformity index (CI) and the dose volume histogram (DVH) were used as the plan comparison indices. A series of quality assurance (QA) was performed to guarantee the reliable treatment. The QA consisted of the film dosimetry for the verification of the dose distribution and the point measurements. The PBT plan always generated better results than the conventional 3D conformal plan. The PBT was proved to be useful for the H&N and thorax region.

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Effects of Functional Resistance Training on Gross Motor and Balance Abilities in Children with Dyskinetic Cerebral Palsy : Single Case Design (기능적인 저항훈련이 운동이상형 뇌성마비 아동의 대동작과 균형능력에 미치는 영향 : 단일사례설계)

  • Kwon, Haeyeon
    • Journal of The Korean Society of Integrative Medicine
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    • v.4 no.3
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    • pp.109-119
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    • 2016
  • Purpose : The purpose of this research is to find clinical effects of functional resistance training using weighted vest on gross motor and balance abilities of children with dyskinetic cerebral palsy. Methods : This study selects 3 subjects for 8~12 years old who were diagnosed with children with dyskinetic cerebral palsy. The Design is ABA design of single-subject research design. Baseline(A) and TypeII Baseline(A : 12weeks) phases were received with NDT treatment, Intervention(B : 12weeks) phase provided with 40 minute functional resistance training using weighted vest in a session twice a week. In order to analyze the measure results of gross motor function and performance, balance abilities in children dyskinetic cerebral palsy during baseline, intervention and typeII baseline phase. Result : A statistically significant differences in the total GMFM including walking/running/jumping during baseline, intervention, typeII baseline, but no significant differences in the lying/rolling, sitting, crawling/kneeling and standing. A statistically significant differences in the total GMPM including dissociated movement, coordination, weight shift, stability during baseline, intervention, typeII baseline, but no significant differences in the body alignment domains. A statistically significant differences in the length and surface area ellipse of center of pressure during baseline, intervention, typeII baseline. Conclusion : The intervention method to facilitate multi-joint and closed kinematic chain movement equipped weighted vest applied functional resistance training on children with dyskinetic cerebral palsy effectively improve on gross motor function and performance, balance abilities.

Association of Human Epidermal Growth Factor Receptor-2 Expression and Clinicopathological Findings in Patients with Colorectal Cancer

  • Karaca, Halit;Deniz, Kemal;Berk, Veli;Inanc, Mevlude;Ozkan, Metin
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.12
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    • pp.6221-6225
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    • 2012
  • Background: To determine the frequency of HER-2 overexpression in colorectal cancer (CRC) patients, and to explore the relationship between clinicopathological prognostic factors and their effects on survival, based on immunohistochemistry (IHC) and fluorescent in situ hybridization (FISH) analysis. Materials and Methods: The study included 80 patients with a histologically proven diagnosis of CRC that received adjuvant FOLFOX-4 chemotherapy at our department between March 2006 and September 2010. Patient data were analyzed retrospectively. Results: The median follow-up period and age of the patients were 24 months and 59 years, respectively. In immunohistochemical staining, 3+ staining was found in 2 patients (2.5%) while 2+ was in 13 (16%). FISH for HER-2 was performed for all of these 15 patients; samples which were 3+ showed positivity but the ones with 2+ were negative. There was no significant correlation between HER-2 expression and age, gender, tumor localization, histological subtype, grade, lymphovascular and perineural invasion, or pTN stage (P>0.05), even when the patients with HER-2 overexpression were analyzed separately. There was also no significant relationship between progression-free survival (PFS) and overall survival (OS), and HER-2 expression, gender, tumor localization, obstruction-perforation, bleeding, histological type, grade, lymphovascular and perineural invasion, or pT staging (P>0.05); however, there was a significant relationship between lymph node involvement, and PFS and OS (P<0.05). Conclusions: Evaluation of HER-2 overexpression in a more comprehensive, multi-center, prospective trial with standardized methods will be an appropriate approach.

Oriental Medicine papers review on Anticancer Effect of Ginseng (인삼의 항암작용에 대한 한의학 관련 논문 분석)

  • Jang, Sung-Ill;Yoo, Hwa-Seung
    • Journal of Haehwa Medicine
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    • v.19 no.2
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    • pp.145-151
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    • 2011
  • Backgrounds: Multidisciplinary approaches including surgery, chemotherapy, and radiation therapy are currently being performed to target various cancers in Western Medicine. However, some cancers still remain difficult to battle, which has long attracted many scientists for the discovery of new agents to fight cancers. Ginseng is one of the herbs used in Oriental Medicine including Korea, China and Japan. We have further investigated ginseng for its anticancer effect. Objective: This is a comprehensive review summary of anticancer effect of ginseng and ginsenoids as a possible agent for future cancer treatment. Methods: Data were retrieved from two web sites; www.pubmed.com and www.riss.kr, and authorized texts concerning anticancer effects of ginseng. From collected data, information on anticancer effect of ginseng was thoroughly sorted, restructured, then assessed. Results: Panax Ginseng C.A. Meyer belongs to Araliaceae Panax family, a perennial prairie plant with its root known as Ginseng Radix. Ginseng induces anticancer effect through cell cycle arrest, acceleration of apoptosis, anti-angiogenesis, and suppression of metastasis. Anticancer effect of ginseng may be due to single compound or multi-compound actions. Many studies report involvement of immune mechanisms of cytokines, Natural Killer (NK) cells, macrophages and some antibodies in enhancing anticancer effect of ginseng. In near future, possibility of applying these mechanisms into clinical trials is convinced. There were some important findings on saponin in ginsenoids in reviewing for this article; First, eradication of metastatic tumors were influenced by macrophage activation. Second, suppression of malignant melanoma cell metastasis to lung were induced by macrophage and NK cell activation in spleen with red ginseng acidic polysaccharide (RGAP). Third, final metabolites of M1, M4 had exerted anticancer effect of ginseng. Conclusion: Unknown anticancer mechanisms of ginseng have been studied for many years up until now. Ginseng is comprised of multiple bio-chemical compounds that create complex pharmaceutical interactions. Therefore, for its proper usage and safe prescription, studies on different types of ginseng and patients' susceptibility to ginseng according to their constitution and stages of the disease should be further pursued. More efforts are needed to understand the anticancer mechanisms of ginseng as well.

A Case of Recurrent Pulmonary Inflammatory Myofibroblastic Tumor with Aggressive Metastasis after Complete Resection

  • Moon, Chae Ho;Yoon, Jong Ho;Kang, Geon Wook;Lee, Seong Hyeon;Baek, Jeong Su;Kim, Seo Yun;Kim, Hye-Ryoun;Kim, Cheol Hyeon
    • Tuberculosis and Respiratory Diseases
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    • v.75 no.4
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    • pp.165-169
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    • 2013
  • An inflammatory myofibroblastic tumor (IMT) is a rare disease entity reported to arise in various organs. It is thought to be a neoplastic or reactive inflammatory condition, controversially. The treatment of choice for myofibroblastic tumor is surgery, and recurrence is known to be rare. The optimal treatment method is not well-known for patients ineligible for surgery. We report a 47-year-old patient with aggressive recurrent IMT of the lungs. The patient had been admitted for an evaluation of back-pain two years after a complete resection of pulmonary IMT. Radiation therapy was performed for multiple bone recurrences, and the symptoms were improved. However the patient presented again with aggravated back-pain six months later. High-dose steroid and non-steroidal anti-inflammatory drugs were administered, but the disease progressed aggressively, resulting in spinal cord compression and metastasis to intra-abdominal organs. This is a very rare case of aggressively recurrent pulmonary IMT with multi-organ metastasis.

Verification of Mechanical Leaf Gap Error and VMAT Dose Distribution on Varian VitalBeamTM Linear Accelerator

  • Kim, Myeong Soo;Choi, Chang Heon;An, Hyun Joon;Son, Jae Man;Park, So-Yeon
    • Progress in Medical Physics
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    • v.29 no.2
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    • pp.66-72
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    • 2018
  • The proper position of a multi-leaf collimator (MLC) is essential for the quality of intensity-modulated radiation therapy (IMRT) and volumetric modulated arc radiotherapy (VMAT) dose delivery. Task Group (TG) 142 provides a quality assurance (QA) procedure for MLC position. Our study investigated the QA validation of the mechanical leaf gap measurement and the maintenance procedure. Two $VitalBeam^{TM}$ systems were evaluated to validate the acceptance of an MLC position. The dosimetric leaf gaps (DLGs) were measured for 6 MV, 6 MVFFF, 10 MV, and 15 MV photon beams. A solid water phantom was irradiated using $10{\times}10cm^2$ field size at source-to-surface distance (SSD) of 90 cm and depth of 10 cm. The portal dose image prediction (PDIP) calculation was implemented on a treatment planning system (TPS) called $Eclipse^{TM}$. A total of 20 VMAT plans were used to confirm the accuracy of dose distribution measured by an electronic portal imaging device (EPID) and those predicted by VMAT plans. The measured leaf gaps were 0.30 mm and 0.35 mm for VitalBeam 1 and 2, respectively. The DLG values decreased by an average of 6.9% and 5.9% after mechanical MLC adjustment. Although the passing rates increased slightly, by 1.5% (relative) and 1.2% (absolute) in arc 1, the average passing rates were still within the good dose delivery level (>95%). Our study shows the existence of a mechanical leaf gap error caused by a degenerated MLC motor. This can be recovered by reinitialization of MLC position on the machine control panel. Consequently, the QA procedure should be performed regularly to protect the MLC system.

Early Detection of Infiltration Induced in the Veins of Pig's Ear and Human's Forearm By Using Bioimpedance: Pilot Study

  • Kim, Jaehyung;Hwang, Youngjun;Kim, Gunho;Jeong, Ihn Sook;Jeon, Gyerok
    • Journal of Korea Multimedia Society
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    • v.21 no.1
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    • pp.34-44
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    • 2018
  • An early detection of intravenous (IV) infiltration is essential to minimize the injuries during infusion therapy, which is one of the most important tasks for nurses in nursing settings. We report that bioelectrical impedance analysis is useful in the early detection of infiltration at puncture sites. When infiltration was intentionally induced in the vein of a pig's posterior ear, impedance parameters (R, $X_C$, $C_m$) showed significant differences before and after infiltration. In particular, the relative resistance ($R/R_{BI}$) decreased significantly at infiltration and then slowly decreased. This indicates that the vein in pig's ear is thin and the amount of surrounding subcutaneous tissue, and hence the infiltrated solution accumulates slowly after infiltration. However, when infiltration was induced in the vein of human's forearm, the relative resistance at 20 kHz decreased gradually over time. In the $R-X_C$ graph, the positions in the case of infiltration induced in the pig' ear shifted rapidly before and after infiltration, whereas the positions in the case of infiltration induced in the human's forearm moved gradually during infiltration. Our findings suggest that the impedance parameters (R, $R/R_{BI}$, $X_C$, R vs. $X_C$, and $C_m$) are effective indicators to detect the infiltration early in a non-invasive and quantitative manners.

Association between Asymptomatic Urinary Tract Infection and Postoperative Spine Infection in Elderly Women : A Retrospective Analysis Study

  • Lee, Seung-Eun;Kim, Kyoung-Tae;Park, Yong-Sook;Kim, Young-Baeg
    • Journal of Korean Neurosurgical Society
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    • v.47 no.4
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    • pp.265-270
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    • 2010
  • Objective : The purpose of this study is to identify the relationship between asymptomatic urinary tract infection (aUTI) and postoperative spine infection. Methods : A retrospective review was done in 355 women more than 65 years old who had undergone laminectomy and/or discectomy, and spinal fusion, between January 2004 and December 2008. Previously postulated risk factors (i.e., instrumentation, diabetes, prior corticosteroid therapy, previous spinal surgery, and smoking) were investigated. Furthermore, we added aUTI that was not previously considered. Results : Among 355 patients, 42 met the criteria for aUTI (Bacteriuria ${\geq}\;10^5\;CFU/mL$ and no associated symptoms). A postoperative spine infection was evident in 15 of 355 patients. Of the previously described risk factors, multi-levels (p<0.05), instrumentation (p<0.05) and diabetes (p<0.05) were proven risk factors, whereas aUTI (p>0.05) was not statistically significant. However, aUTI with Foley catheterization was statistically significant when Foley catheterization was added as a variable to the all existing risk factors. Conclusion : aUTI is not rare in elderly women admitted to the hospital for lumbar spine surgery. The results of this study suggest that aUTI with Foley catheterization may be considered a risk factor for postoperative spine infection in elderly women. Therefore, we would consider treating aUTI before operating on elderly women who will need Foley catheterization.