• Title/Summary/Keyword: Organ at risk

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Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

  • Kong, Seong-Ho;Yang, Han-Kwang
    • Journal of Gastric Cancer
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    • v.13 no.1
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    • pp.3-18
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    • 2013
  • Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding.

Association between cardiovascular disease and periodontal disease prevalence (치주질환에 의한 심장질환 발생의 관련성)

  • Jeong, Mi-Ae;Kim, Jee-Hee
    • Journal of the Korea Convergence Society
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    • v.2 no.4
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    • pp.47-52
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    • 2011
  • Periodontal disease is a common inflammatory disorder that is being considered as a risk factor for atherosclerotic complication. Recent epidemiological evidence also supports that its potential association with increased blood pressure levels and hypertensive prevalence. Data from cross-sectional studies suggest that in hypertensive patients periodontal disease may enhance the risk and degree of target organ damage. So dental infections have been associated with cardiovascular diseases. There are potential pathophysiologic links between hypertension and periodontits. The role of the inflammatory pathway include C-reactive protein(CRP). CRP is an inflammatory mediator that has been shown to predict the development of hypertension independently of baseline BP and traditional risk factors, has been consistently reported as at least mildly elevated in patients with periodontal disease. Reactive oxygen species produced by locally infiltrating neutrophils participate in periodontal tissue destruction. Periodontits can lead to inflammatory responses in the atrial myocardium, which disturbs the structural and electrophysiologic properties of the atrium and facilitates atrial fibrillation in the animal experiment.

Convergence Analysis of Metabolic Syndrome Risk and Related Factors among Kidney Transplantation Recipients (신장이식 수혜자의 대사증후군 발생 위험 관련 요인에 대한 융복합적 조사연구)

  • Chong, Hye Jin
    • Journal of Digital Convergence
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    • v.18 no.5
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    • pp.375-382
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    • 2020
  • The purpose of this study was to analyze the prevalence, and determine factors associated with metabolic syndrome risk among kidney transplantation recipients. This study data were collected by means of retrospective chart reviews for 111 kidney recipients at an organ transplantation center in South Korea. Data were analyzed using descriptive statistics, t-test or chi-squared test, and Pearson's correlation or Point biserial correlation. The prevalence of metabolic syndrome in our subjects was 65.8%. Metabolic syndrome was related with age, body mass index of before and after Kidney transplantation, and smoking. Study results indicate that intervention for modifying individual lifestyle behaviors is required to prevent and reduce their prevalence of metabolic syndrome after kidney transplantation.

Worker Health Hazard and Risk Assessment of Formamide using in Workplaces in South Korea (작업장에서 사용하는 포름아미드(Formamide)의 근로자 건강 유해성과 위험성 평가)

  • Kim, Hyeon-Yeong
    • Journal of the Korean Institute of Gas
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    • v.20 no.2
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    • pp.35-42
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    • 2016
  • Formamide is a colorless fluid with ammonia odor, and irritable when inhaled. It has $LD_{50}$ value of > 5,577 mg/kg in rats for acute oral toxicity and NOAEL of 113 mg/kg/day for target organ (liver) of whole body toxicity. It is also known as reproductive toxicant (1B) and TWA(Time Weighted Average) for it is 10 ppm. Workplace measurements of work places dealing with formamide showed the ppm of all 25 samples was very lower than WEL. However, the exposure concentration can change, depending on workplace condition such as the intensity of work, operating local ventilation system, and wearing protection equipment (Respirators). Therefore, considering it with the risk of whole body toxicity and reproductive toxicity, exposure quantity of each imaginary scenario was calculated at 5.16, 1.72, and $0.43mg/m^3$. The average value was calculated at 0.02-0.58, 0.02-0.66 at 90 percent of cumulative distribution, 0.02-0.69 at 95 percent of cumulative distribution. Therefore, it was generally evaluated to be safe because all values were below 1. However, caution is required to prevent health hazard because it has hepatotoxicity and reproductive toxicity and risk of a high level momentary exposure, depending on the condition of workplace.

DNA Microarrays Analysis of Gene Expression Profiles in Diabetes-related genes using Immunosuppressant (면역억제제에 의한 당뇨 관련 유전자의 DNA microarray 분석)

  • Kim, Kyoung-Shin;Kim, Byoung-Soo
    • Journal of Haehwa Medicine
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    • v.21 no.1
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    • pp.11-21
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    • 2012
  • New onset diabetes is a major complication after kidney transplantation. However, the natural course of posttransplantation diabetes mellitus (PTDM) remains unclear. The aim of this study was to demonstrate the detailed natural courses of PTDM according to the onset and persistency of hyperglycemia, and to investigate risk factors for development of different courses of PTDM in renal allograft recipients. The purpose of this study is to develop novel immune suppressants for PTDM using of action mechanism of them. The use of immunosuppressive drugs in transplanted patients is associated with the development of diabetes, possibly due to ${\beta}$-cell toxicity. To better understand the mechanisms leading to post-transplant diabetes, we investigated the actions of prolonged exposure of ${\beta}$-cells to therapeutical levels of tacrolimus (FK506) or cyclosporin A(CsA). The immunosuppressive drug cyclosporine(CsA) is a potent agent widely used after organ transplantations and various autoimmune disorders. After using CsA, some patients suffer severe complications including renal and vascular toxicity. The renal or vascular toxicity is influenced by the degree of the endothelial damage. FK506(tacrolimus) is a widely used immunosuppressive agent in the treatment of various medical conditions, including autoimmune disease, bone marrow and organ transplantations. We found some interesting clusters and confirmed the feasibility of cDNA microarray in the study of Immunosuppressant. In this study, we investigated gene expression patterns induced by Immunosuppressant in RIN-m5F of rat insulinoma cell line. Gene expressions evaluated using cDNA microarry in two clusters were increased or decreased. this study provides comprehensive comparison of the patterns of gene expression changes induced by CsA and FK506 in ${\beta}$-cells. This study could establish that the mode of action mechanism by which currently used insulin inhibitors inducing PTDM could be elucidated at least in part, which raises the possibility that novel immune suppressive PTDM can be developed. The molecular biological study on PTDM will also contribute the progress in diabetes research field as well as in that of PTDM.

Evaluation of Dynamic Delivery Quality Assurance Process for Internal Target Volume Based RapidArc

  • Song, Ju-Young
    • Progress in Medical Physics
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    • v.28 no.4
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    • pp.181-189
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    • 2017
  • The conventional delivery quality assurance (DQA) process for RapidArc (Varian Medical Systems, Palo Alto, USA), has the limitation that it measures and analyzes the dose in a phantom material and cannot analyze the dosimetric changes under the motional organ condition. In this study, a DQA method was designed to overcome the limitations of the conventional DQA process for internal target volume (ITV) based RapidArc. The dynamic DQA measurement device was designed with a moving phantom that can simulate variable target motions. The dose distribution in the real volume of the target and organ-at-risk (OAR)s were reconstructed using 3DVH with the ArcCHECK (SunNuclear, Melbourne, USA) measurement data under the dynamic condition. A total of 10 ITV-based RapidArc plans for liver-cancer patients were analyzed with the designed dynamic DQA process. The average pass rate of gamma evaluation was $81.55{\pm}9.48%$ when the DQA dose was measured in the respiratory moving condition of the patient. Appropriate method was applied to correct the effect of moving phantom structures in the dose calculation, and DVH data of the real volume of target and OARs were created with the recalculated dose by the 3DVH program. We confirmed the valid dose coverage of a real target volume in the ITV-based RapidArc. The variable difference of the DVH of the OARs showed that dose variation can occur differently according to the location, shape, size and motion range of the target. The DQA process devised in this study can effectively evaluate the DVH of the real volume of the target and OARs in a respiratory moving condition in addition to the simple verification of the accuracy of the treatment machine. This can be helpful to predict the prognosis of treatment by the accurate dose analysis in the real target and OARs.

A CAOPI System Based on APACHE II for Predicting the Degree of Severity of Emergency Patients (응급환자의 중증도 예측을 위한 APACHE II 기반 CAOPI 시스템)

  • Lee, Young-Ho;Kang, Un-Gu;Jung, Eun-Young;Yoon, Eun-Sil;Park, Dong-Kyun
    • Journal of the Korea Society of Computer and Information
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    • v.16 no.1
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    • pp.175-182
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    • 2011
  • This study proposes CAOPI(Computer Aided Organ Prediction Index) system based on APACHE II(Acute Physiology And Chronic Health Evaluation) for classifying disease severity and predicting the conditions of patients' major organs. The existing ICU disease severity evaluation is mostly about calculating risk scores using patients' data at certain points, which has limitations on making precise treatments. CAOPI system is designed to provide personalized treatments by classifying accurate severity degrees of emergency patients, predicting patients' mortality rate and scoring the conditions of certain organs.

ORGAN DOSE, EFFECTIVE DOSE AND RISK ASSESSMENT FROM COMPUTED TOMOGRAPHY TO HEAD AND NECK REGION (두경부 전산화 단층촬영시의 주요 장기선량, 유효선량 및 위험도)

  • Kim Ae-Jj;Cho Bong-Hae;Nah Kyung-Soo
    • Journal of Korean Academy of Oral and Maxillofacial Radiology
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    • v.25 no.1
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    • pp.27-38
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    • 1995
  • The organ or tissue doses were determined with head and neck phantom measurement for multiple axial scans (36 slices), multiple coronal scans (13 slices), 3 types of single axial scans(orbit, maxillary sinus and mandibular canal) and single coronal scan (maxillary sinus). For each scan sequence 30 TLDs were placed in selected sites(16 internal sites and 14 external sites) in a tissue-equivalent phantom. The exposure was made at 120kVp, 500mAs with 5 mm slice width. The results were as follows : 1. In multiple axial scans, the greatest effective dose recorded was that delivered to the thyroid glands(2.77 mSv) and the least was that received by the skin(0.05 mSv). From these data, stochastic effects were 202.2x10/sup -6/ and 3.7×10/sup -6/, respectively. 2. In multiple coronal scans, the greatest effective dose recorded was that delivered to the salivary glands(0.58 mSv) and the least was that received by the skin(0.01 mSv). From these data, stochastic effects were 42.2×10/sup -6/ and 0.7×10/sup -6/, repectively. 3. Among single axial scans, the greatest effective dose recorded was that delivered to the salivary gland(0.38 mSv) in maxillary sinus scan. From this data, stochastic effect was 27.7×10/sup -6/. 4. In single coronal scan, the greatest effective dose recorded was that delivered to the salivary gland(0.01 mSv). From this data, stochastic effect was 1.0×10/sup -6/. 5. The equivalent dose measured that delivered to the lens of the eyes was 69.64 mSv in multiple axial scan, 39.32 mSv in multiple coronal scan and 36.77 mSv in single axial scan(orbit).

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Study on the Developmental Toxicity of Thimerosal (Thimerosal의 발생독성에 관한 연구)

  • 곽승준;이규식;김순선;손경희;김소희;채수영;최요우;원용혁;박귀례
    • Toxicological Research
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    • v.19 no.4
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    • pp.267-275
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    • 2003
  • The purpose of our study was to evaluate the toxicity of the thimerosal in embryos and neonates. Thimerosal (also known as mercurothiolate) is a mercury-containing compound used in trace amounts to prevent bacteria and other organisms from contaminating vaccines, especially in opened multi-dose vials. The toxicity of mercury is well known and those most at risk occurrs in unborn babies and newborn babies. Test methods included in vitro whole embryo culture (WEC) system and in vivo test of neonatal toxicity in Wistar rats. Ethylmercury and methylmercury were used as positive controls for the evaluating of toxic effects of mercury. In WEC assay, treated concentrations of thimerosal, ethylmercury and methylmercury were up to 0.01, 0.025, 0.05, 0.1, 0.25, 0.5, 1, 2.5 and 5 $\mu\textrm{g}$/$\textrm{m}{\ell}$, respectively. All compounds didn't show any morphological abnormalities, but showed retardation of growth and development in dose dependent manner (> 0.5 $\mu\textrm{g}$/$\textrm{m}{\ell}$). These data indicated that thimerosal showed developmental toxicity in vitro. In vivo neonatal toxicity, Wistar rats were administered subcutaneously with thimerosal, ethyl mercury, or methylmercury (5, 25, 50, 250, and 500 $\mu\textrm{g}$/kg) during from postnatal day (PND) 4 to 25. Significant effects of these compounds on relative organ weights and organ morphology were not observed in this experiment. However, accumulation of mercury was detected in the kidney and testis when treated with thimerosal, ethylmercury, or methylmercury. These results suggest that thimerosal may be a harmful compound to embryo and neonate, but used concentration of thimerosal in these experiments is much higher than that of clinical application. Further investigation is needed on the safety of vaccine components, i.e. a thimerosal using in vitro and in vivo tests in the future.

Comparative validity of microalbuminuria versus clinical mortality scores to predict pediatric intensive care unit outcomes

  • Nismath, Shifa;Rao, Suchetha S.;Baliga, B.S.;Kulkarni, Vaman;Rao, Gayatri M.
    • Clinical and Experimental Pediatrics
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    • v.63 no.1
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    • pp.20-24
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    • 2020
  • Background: Predicting the prognosis of patients admitted to the pediatric intensive care unit (PICU) is very important in determining further management and resource allocation. The prognostication of critically ill children can be challenging; hence, accurate methods for predicting outcomes are needed. Purpose: To evaluate the role of microalbuminuria at admission as a prognostic marker in comparison to standard Pediatric Risk of Mortality (PRISM) and Pediatric Logistic Organ Dysfunction (PELOD) mortality scores in children admitted to the PICU. Methods: This cross-sectional study was conducted from January 2015 to October 2016. Eighty-four patients aged 1 month to 18 years admitted to the PICU of teaching hospitals for more than 24 hours were enrolled by convenience sampling method. Microalbuminuria was estimated by spot urinary albumin-creatinine ratio. PRISM and PELOD scores were calculated using an online calculator. Outcome measures were PICU length of stay, inotrope usage, multiorgan dysfunction, and survival. ACR was compared with mortality scores for predicting survival. Results: Microalbuminuria was present in 79.8% with a median value of 85 mg/g (interquartile range, 41.5-254 mg/g). A positive correlation was found between albumin-creatinine ratio and PICU length of stay (P=0.013, r=0.271). Albumin-creatinine ratio was significantly associated with organ dysfunction (P=0.004) and need for inotropes (P=0.006). Eight deaths were observed in the PICU. The area under the curve for mortality for albumin-creatinine ratio (0.822) was comparable to that for PRISM (0.928) and PELOD (0.877). Albumin-creatinine ratio >109 mg/g predicted mortality with a sensitivity of 87.5% and specificity of 63.2%. Conclusion: Microalbuminuria is a good predictor of PICU outcomes comparable with mortality scores.