• Title/Summary/Keyword: Multiple Case Study

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Granulocytic Sarcoma(Chloroma) in Leukemic Patients (백혈병 환자의 과립구 육종(녹색종양))

  • Rhee, Seung-Koo;Kang, Yong-Ku;Bahk, Won-Jong;Jung, Yang-Kuk;Lee, Sang-Wook;Jeong, Ji-Ho
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.1
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    • pp.54-61
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    • 2005
  • Purpose: The granulocytic sarcoma which developed in leukemic patients are quite rare and it will have bad prognosis, but it's tumor pathogenesis and also their treatment are not yet established. Through this study we have tried to know their clinical course, prognosis and their end result of recent treatment. Material and Methods: Total 20 patients of granulocytic sarcoma which were developed in total 2,197 leukemic patients from April, 1998 to September, 2004 were treated at the leukemic center and the orthopaedic department of St. Mary's hospital, Catholic University of Korea, and followed them for 1~78 months(average 18 months). Results: Total 20 cases of granulocytic sarcoma was found in 14 cases of total 1,331 acute myelocytic leukemic patients(AML), 4 cases of total 744 of chronic myelocytic leukemic patients(CML), and only one case in total 122 of acute biphenotype of leukemia. And so their occurrence rate in leukmic patients are actually 0.91%, total 20 cases of granulocytic sarcoma in total 2,197 leukemic patients at same period. Their ages are average 28.3 years(4~52 years), and male are predominant(13 cases) than female(7 cases). Single involvement was found in 11 cases but multiple lesions are in 9 cases, and spine, brain, extremities, chest, and pelvic bone are involved in frequency. The granulocytic sarcoma was developed in various stages of the leukemia, ie, 8 cases in complete remission of leukemia, and 12 cases in the treatment process of AML. The pathohistologic evaluation of granulocytic sarcoma was done in 6 cases which was developed in their extremities, and confirmed numerous immature myeloblasts and lymphocytes mixed. The treatment of these granulocytic sarcoma was mainly limited for the treatment of leukemia by Glivac and massive steroid therapy(19cases) and also combined with the bone marrow transplantation(13 cases), but radiation therapy with average 3,500 rads in 15 cases out of total 20 sarcomas was also done, and followed them for average 17.5 months after development of granulocytic sarcomas. Finally their prognosis was so bad that 12 patients(60%) out of total 20 granulocytic sarcoma were dead in 6.5 months after sarcoma developed and we found the granulocytic sarcoma was more fatal if they are developed during the process of CML(mortality: 100%(4/4cases). Conclusion: The prognosis of granulocytic sarcomas in leukemic patients are quite fatal, and much more studies for their pathogenesis and ways of treatment should be performed continuously.

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King Sejo's Establishment of the Thirteen-story Stone Pagoda of Wongaksa Temple and Its Semantics (세조의 원각사13층석탑 건립과 그 의미체계)

  • Nam, Dongsin
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.101
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    • pp.12-46
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    • 2022
  • Completed in 1467, the Thirteen-story Stone Pagoda of Wongaksa Temple is the last Buddhist pagoda erected at the center of the capital (present-day Seoul) of the Joseon Dynasty. It was commissioned by King Sejo, the final Korean king to favor Buddhism. In this paper, I aim to examine King Sejo's intentions behind celebrating the tenth anniversary of his enthronement with the construction of the thirteen-story stone pagoda in the central area of the capital and the enshrinement of sarira from Shakyamuni Buddha and the Newly Translated Sutra of Perfect Enlightenment (圓覺經). This paper provides a summary of this examination and suggests future research directions. The second chapter of the paper discusses the scriptural background for thirteen-story stone pagodas from multiple perspectives. I was the first to specify the Latter Part of the Nirvana Sutra (大般涅槃經後分) as the most direct and fundamental scripture for the erection of a thirteen-story stone pagoda. I also found that this sutra was translated in Central Java in the latter half of the seventh century and was then circulated in East Asia. Moreover, I focused on the so-called Kanishka-style stupa as the origin of thirteen-story stone pagodas and provided an overview of thirteen-story stone pagodas built around East Asia, including in Korea. In addition, by consulting Buddhist references, I prove that the thirteen stories symbolize the stages of the practice of asceticism towards enlightenment. In this regard, the number thirteen can be viewed as a special and sacred number to Buddhist devotees. The third chapter explores the Buddhist background of King Sejo's establishment of the Thirteen-story Stone Pagoda of Wongaksa Temple. I studied both the Dictionary of Sanskrit-Chinese Translation of Buddhist Terms (翻譯名義集) (which King Sejo personally purchased in China and published for the first time in Korea) and the Sutra of Perfect Enlightenment. King Sejo involved himself in the first translation of the Sutra of Perfect Enlightenment into Korean. The Dictionary of Sanskrit-Chinese Translation of Buddhist Terms was published in the fourteenth century as a type of Buddhist glossary. King Sejo is presumed to have been introduced to the Latter Part of the Nirvana Sutra, the fundamental scripture regarding thirteen-story pagodas, through the Dictionary of Sanskrit-Chinese Translation of Buddhist Terms, when he was set to erect a pagoda at Wongaksa Temple. King Sejo also enshrined the Newly Translated Sutra of Perfect Enlightenment inside the Wongaksa pagoda as a scripture representing the entire Tripitaka. This enshrined sutra appears to be the vernacular version for which King Sejo participated in the first Korean translation. Furthermore, I assert that the original text of the vernacular version is the Abridged Commentary on the Sutra of Perfect Enlightenment (圓覺經略疏) by Zongmi (宗密, 780-841), different from what has been previously believed. The final chapter of the paper elucidates the political semantics of the establishment of the Wongaksa pagoda by comparing and examining stone pagodas erected at neungsa (陵寺) or jinjeonsawon (眞殿寺院), which were types of temples built to protect the tombs of royal family members near their tombs during the early Joseon period. These stone pagodas include the Thirteen-story Pagoda of Gyeongcheonsa Temple, the Stone Pagoda of Gaegyeongsa Temple, the Stone Pagoda of Yeongyeongsa Temple, and the Multi-story Stone Pagoda of Silleuksa Temple. The comparative analysis of these stone pagodas reveals that King Sejo established the Thirteen-story Stone Pagoda at Wongaksa Temple as a political emblem to legitimize his succession to the throne. In this paper, I attempt to better understand the scriptural and political semantics of the Wongaksa pagoda as a thirteen-story pagoda. By providing a Korean case study, this attempt will contribute to the understanding of Buddhist pagoda culture that reached its peak during the late Goryeo and early Joseon periods. It also contributes to the research on thirteen-story pagodas in East Asia that originated with Kanishka stupa and were based on the Latter Part of the Nirvana Sutra.

Comparison of Single-Breath and Intra-Breath Method in Measuring Diffusing Capacity for Carbon Monoxide of the Lung (일산화탄소 폐확산능검사에서 단회호흡법과 호흡내검사법의 비교)

  • Lee, Jae-Ho;Chung, Hee-Soon;Shim, Young-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.555-568
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    • 1995
  • Background: It is most physiologic to measure the diffusing capacity of the lung by using oxygen, but it is so difficult to measure partial pressure of oxygen in the capillary blood of the lung that in clinical practice it is measured by using carbon monoxide, and single-breath diffusing capacity method is used most widely. However, since the process of withholding the breath for 10 seconds after inspiration to the total lung capacity is very hard to practice for patients who suffer from cough, dyspnea, etc, the intra-breath lung diffusing capacity method which requires a single exhalation of low-flow rate without such process was devised. In this study, we want to know whether or not there is any significant difference in the diffusing capacity of the lung measured by the single-breath and intra-breath methods, and if any, which factors have any influence. Methods: We chose randomly 73 persons without regarding specific disease, and after conducting 3 times the flow-volume curve test, we selected forced vital capacity(FVC), percent of predicted forced vital capacity, forced expiratory volume within 1 second($FEV_1$), percent of forced expiratory volume within 1 second, the ratio of forced expiratory volume within 1 second against forced vital capacity($FEV_1$/FVC) in test which the sum of FVC and $FEV_1$ is biggest. We measured the diffusing capacity of the lung 3 times in each of the single-breath and intra-breath methods at intervals of 5 minutes, and we evaluated which factors have any influence on the difference of the diffusing capacity of the lung between two methods[the mean values(ml/min/mmHg) of difference between two diffusing capacity measured by two methods] by means of the linear regression method, and obtained the following results: Results: 1) Intra-test reproducibility in the single-breath and intra-breath methods was excellent. 2) There was in general a good correlation between the diffusing capacity of the lung measured by a single-breath method and that measured by the intra-breath method, but there was a significant difference between values measured by both methods($1.01{\pm}0.35ml/min/mmHg$, p<0.01) 3) The difference between the diffusing capacity of the lung measured by both methods was not correlated to FVC, but was correlated to $FEV_1$, percent of $FEV_1$, $FEV_1$/FVC and the gradient of methane concentration which is an indicator of distribution of ventilation, and it was found as a result of the multiple regression test, that the effect of $FEV_1$/FVC was most strong(r=-0.4725, p<0.01) 4) In a graphic view of the difference of diffusing capacity measured by single-breath and intra-breath method and $FEV_1$/FVC, it was found that the former was divided into two groups in section where $FEV_1$/FVC is 50~60%, and that there was no significant difference between two methods in the section where $FEV_1$/FVC is equal or more than 60% ($0.05{\pm}0.24ml/min/mmHg$, p>0.1), but there was significant difference in the section, less than 60%($-4.5{\pm}0.34ml/min/mmHg$, p<0.01). 5. The diffusing capacity of the lung measured by the single-breath and intra-breath method was the same in value($24.3{\pm}0.68ml/min/mmHg$) within the normal range(2%/L) of the methane gas gradient, and there was no difference depending on the measuring method, but if the methane concentration gradients exceed 2%/L, the diffusing capacity of the lung measured by single-breath method became $15.0{\pm}0.44ml/min/mmHg$, and that measured by intra-breath method, $11.9{\pm}0.51ml/min/mmHg$, and there was a significant difference between them(p<0.01). Conclusion: Therefore, in case where $FEV_1$/FVC was less than 60%, the diffusing capacity of the lung measured by intra-breath method represented significantly lower value than that by single-breath method, and it was presumed to be caused largely by a defect of ventilation-distribution, but the possibility could not be excluded that the diffusing capacity of the lung might be overestimated in the single-breath method, or the actual reduction of the diffusing capacity of the lung appeared more sensitively in the intra-breath method.

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