• Radiation Oncology Journal
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• 제19권3호
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• pp.237-244
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• 2001

목적 : 침윤성 방광암 환자를 대상으로 TURBT (Transurethral Resection of Bladder Tumor)과 유도 항암화학요법(neoadjuvant MCV chemotherapy) 후 방사선 항암화학 병용요법(cisplatin chemotherapy and radiotherapy)을 받은 환자에서 치료의 적응도, 국소 반응율, 방광 보존율과 생존율을 알아보고자 하였다. 대상 및 방법 : 1990년 10월부터 1998년 6월까지 TURBT 시행 후 병리 조직검사 상 침윤성 방광 이행상피암으로 진단 받은 병기 T2-T4, Grade II 환자 21명을 대상으로 하였다. 치료과정은 TURBT 후 4주 간격으로 2회의 유도 MCV(methotrexate, cisplatin, vinblastine) 복합 항암화학요법을 시행하고 그 후 cisplatin과 방사선 동시 병용요법을 시행하였다. 방사선치료는 $6\~15$ MV X-ray를 사용하여 하루 1.8 Gy씩 $39.6\~45\;Gy$를 전 골반에 $4\~5$주간에 걸쳐 조사하였다. 치료 종료 후 방광내시경을 통해 관해율을 판정하여 완전 관해인 경우 $1\~2$주 후 보강 방사선조사를 cisplatin과 병용하여 19.8 Gy를 시행하였다. 부분 관해인 경우 근치적 방광 절제술을 예정하였고 수술이 불가능한 경우에는 항암제 병용 강화 방사선치료를 받도록 하였다. 환자의 추적관찰기간은 $34\~67$개월로 중앙값이 49.5개월이었다. 결과 : 총 26명의 환자가 유도 항암화학요법을 위해 등록되었으며 유도 항암화학요법과 방사선 항암화학 병용요법을 완료한 환자는 21명$(81\%)$이었다. 유도 항암화학요법과 방사선 항암화학 병용요법 후 방광내시경을 통해 완전 관해 판정을 받은 환자는 21명 중 7명$(33\%)$이었고 부분 관해 환자는 14명$(67\%)$이었다. 완전 관해 환자 중 강화 항암제 병용 방사선 19.8 Gy를 받은 환자는 7명 중 6명$(85\%)$이었고, 이들 중 5명$(14\%)$은 재발 없이 방광을 보존하였다. 부분관해 환자중 1명이 근치적 방광적출술을 받았으며 3명이 TURBT와 2회의 MCV 항암요법을, 10명이 추가의 항암화학 방사선 병용요법을 받았다. 근치적 방광적출술을 받은 1명은 수술 소견상 방광 내 종양이 존재했으나 수술 후 재발이 없었다. 전체 21명의 환자중 12명$(58\%)$이 방광을 보존하면서 생존하고 있고 8명이 방광암으로 사망하였으며 1명이 다른 질병으로 사망하였다. 전체 환자의 중앙 생존기간은 27개월이며, 5년 생존율은 $55\%$ 였다. 유도 항암화학요법과 항암제 방사선치료 후 완전 관해 환자의 경우 5년 생존율은 $80\%$, 부분 관해 환자 $14\%$로 의미 있는 차이를 보였다(p=0.001). 유도 항암화학요법과 항암제 병용 방사선치료를 받은 환자에서 grade 3 이상의 혈액학적 부작용의 빈도는 각각 백혈구 감소증 6명$(29\%)$, 혈소판 감소증 1명$(4\%)$이었으며 이로 인한 화학요법의 지연은 1명$(4\%)$에서 관찰되었다. 결론 : 침윤성 방광암 환자에서 유도 항암화학요법 및 항암제 병용 방사선치료를 적용하여 방광 보존을 및 5년 생존율에 있어 만족할 만한 결과를 얻었다. 완전한 TURBT와 유도 MCV 항암요법과 cisplatin 방사선 병용요법에서 완전관해 여부가 방광보존가능성과 생존율에 영향을 미치는 요소로 생각되고 만약 완전관해를 이루지 못하면 근치적 방광적출술을 시행하는 것이 바람직할 것이다.

• 한국보건간호학회지
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• 제3권2호
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• pp.77-108
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• 1989

The purpose of this study was to find out the present condition of clinical practice and to develop a scheme on the efficiency of clinical practice for nursing education in junior college of nursing in korea. This study was conducted by 2 sections. Ist section was to find out the present condition of clinical practice to 42 directors of nursing collegd and data were collected July 8 to September 30, 1988. 2nd section wat to develop a scheme on the efficiency of clinical practice for nursing education and subjects were nursing professors 258: and clinical nurses 223 in 42 junior nursing colleges their clinical settings in korea. So total subjects were 481. Data were collected july 8, 1988 to June 30, 1988 and were analysed to get the mean, standand deviation, frequency, percentage, t-test, x-test used by SPSS - pc. Major findings were as follows: 1. The present condition of clinical education in junior college of nursing in Korea. 1) 32 colleges (76.2%) were managed by a-yeas system. 2) 25 colleges (59.5%) were performed by individual practice for each subject. 3) 4 weeks interval between class education and clinical education was a major type among total colleges(36.6%, J5 colleges) 4) 30 colleges (71.4%) provided clinical education for all subjects that should be practiced. Nursing administration wes not practiced in 5 colleges (41.9%) among the remainder(12 colleges). The main cause that all practice subjects were not practiced was the lack or absence of suitable clinical settings(8 colleges. 66.7%) 5) 18 colleges (42.9%) responded that a clinical educator was, subject-charged professor. 6) 12 colleges (29.3%) responded that a clinical instructor was in charge of 6~10 students. 7) The evaluation ration ratio(professor to head nurse) by each evaluator was mostly 50% to 50 % and 60% to 40%, respectively 11 colleges(27.5%) The most common evaluation methods were evaluation by head nures, report, presence, conference (11 colleges, 27.5%) 8) The field carrier of professor was mostly 2 years (79 persons, 20.7%) and mean was 3.2 years. The education carrier of a professor was mostly over than 6 years (261 persons, 66.4%) and mean was 9.2 years. The charge hours per-week of a professor were mostly 16-18 hours (16 persons, 131.8%) 9) 34 colleges (82.9%) approved that clinical practice hour was class hour and 18 colleges (43.9 %) counted that 2 hours of clinical education equaled 1 hour of class education. 2. A study 'on the efficiency of clinical practice for nursing education. L) general characteristics of subjects were as follows: kung-sang province (145 persons, 30.5%), 30-34 years (190 persons, 39.8%), graduated degree (245 persons, 51.5%), 6-10 years of carrier (199 persons, 41.4%) were the majority. 2) suitable clinical setting was responded the systematic ward with responsible clinical educator by 210 persons(43.8%) The response by working field of subjects showed a significant difference (p< 0.01) 3) 259 subjects (54.0%) responded that the desirable qualfication of clinical instructor was 3-5 years of clinical experience with master degree or higher. 4) The mean score of desirable quality degree of clinical instructor was 3.43 professors, score (3.54) was significantly higher than clinical nurses' (3.28) (p<0.01) 412 subjects (86.0%) responded that the insufficient guality of instructor was improved by continuing to seek more new information in reference. 5) 196 subjects (41.4%) responded that desirable qualification of head nurse was more than 2 years of head position among 5 years of clinical experience. The response by working' field of subjects showed a significant difference (p<0.05) 6) The mean score of desirable quality degree of head nurse was 3.18 Clinical nurses' score(3.38) was significantly higher than professors' (3.01) (p<0.01) 419 subjects (87.8%) responded that the insufficient of head nurse was improved by continuing relationship with instructor and being responsible from planing of clinical education. 7) The mean score of performance level of the desirable clinical education guide incollege was 2.91 Professors' score (2.96) was significantly higher than clinical nurses' (2.84) (p<0.01) 340 subjects (71.1%) responded that the possible resolution for poor performance was the more specified syllabus of clinical education and the satisfiable orientation for students. 8) The mean score of performance level of the desirable clinical education guide in hospital was 3.03 9) 141 subjects (29.6%) responded that the desirable clinical evaluator was the group of professor, head nurse, staff nurse. Response by working field of subjects was a significant difference (p< 0.05) 10) The mean score of performance level of the evaluation content needed in clinical education was 3.50 Clinical nurses' score (3.56) was significantly higher than professors' (3.45) (p<0.01) 11) 433 subjects (90.2%) responded that6 desirable evaluation method for clinical education was the presence. 12) The mean score of performance level about how personal difference among clinical educators was minimized was 2.89 and response by working field of subjects was not significant. The cause of poor performance was too much workload at clinical settings and too many students st colleges by 386 subjects (81.1%).

• Asian Pacific Journal of Cancer Prevention
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• 제15권4호
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• pp.1811-1815
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• 2014

Background: In clinical trials with no upper age limit, the proportion of older patients is usually small, probably reflecting the more conservative approach adopted by clinicians when treating the elderly. An exploratory analysis of elderly patients in the RECORD-1 Trial showed that patients ${\geq}$ 65 y.o. had superior median PFS than overall RECORD-1 population (5.4 months and 4.9 months, respectively). We investigated the efficacy, relative benefit and safety of Everolimus (EVE) as sequential therapy after failure of VEGFr-TKI therapy for older patients with metastatic renal cell cancer (mRCC), in daily practice. Materials and Methods: 172 consecutive IRB approved patients with mRCC (median age 65, M:F 135/37, 78% clear cell) who received salvage EVE at 39 tertiary institutions between October 2009 and August 2011 were included in this analysis. Some 31% had progressed on sunitinib, 22% on sorafenib, 1% on axitinib, 41% on sequential therapy, and 5% had received other therapy. Patients with brain metastases were not included and 95% of the patients had a ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 or 1. Previous radiotherapy was an exclusion criterion, but prior chemotherapy was permitted. Adequate organ function and hematologic parameters were mandatory. EVE administration was approved by the institutional review board at each participating institution and signed informed consent was obtained from all patients. Results: Median time of the whole cohort to last follow-up was 3.5 months (range 0.4-15.2 months). Forty four percent were continuing to take EVE at last followup. There were 86 (50%) patients ${\geq}$ 65 y.o. and 86 (50%) <65 y.o. The percentage of patients who showed PR/SD was higher in the older group than in the younger one (5.9%/61.2% vs 1.2%/46.5%, respectively). Median survival of older patients was also significantly longer (3.5 +/- 0.31 vs 3.1 +/- 0.34, hazard ratio=0.45, CI; 0.255-0.802). Analysis using Cox regression model adjusted for gender, PS, number of metastases, site of metastases, histology, smoking history and age detected an association between age and PFS (p=0.011). The frequency of adverse events in elderly patients treated with EVE was no greater than that in younger patients, although such toxicity may have had a greater impact on their quality of life. Conclusions: Older patients should not generally be excluded from accepted therapies (mTOR inhibitors after failure of VEGFr-TKI therapy) for mRCC.

• 대한수의학회지
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• 제33권4호
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• pp.719-734
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• 1993

The electrocardiographic(ECG) parameters on the standard limb leads in the normal Korean native cattle have been measured with a 3 channel Electrocardiograph built in a computed analysis. The study was conducted on the animals 98 heads of mean age of 17.7 months. Conduction parameters, waves, intervals and segments have been recorded. The recordings were analyzed as to shape and amplitude of the P and T waves and the components of the QRS complex. Heart rate was recorded by the Electrocardiogram which were a mean of $80.4{\pm}11.6beats/min$. And the younger had a higher heart rate than the older one. Average conduction times in the RP, the QRS complex and the QTc interval recorded $166.7{\pm}23.1msec.$, $79.7{\pm}8.8msec.$ and $395.5{\pm}30.4msec.$, in the P and T wave duration recorded $70.1{\pm}13.5msec.$ and $97.6{\pm}16.9msec.$, and in the PR and ST segment duration recorded $97.9{\pm}23.5msec.$ and $173.9{\pm}40.3msec.$, respectively. The wave forms in each lead observed various types. The amplitudes of wave type showed the highest frequency in each lead that were analyzed as follow : 1. In P wave, amplitudes of the positive type showed the frequency of 65.3%, 82.7% and 52.0% in leads I, II and III that were $103.1{\pm}47.8{\mu}V$, $115.2{\pm}37.3{\mu}V$ and $67.4{\pm}26.9{\mu}V$, and it showed the frequency of 54.1% and 85.7% in the leads aVL and aVF that were $63.7{\pm}23.0{\mu}V$, $88.0{\pm}83.6{\mu}V$, respectively. Average amplitude of the negative type showed the frequency of 78.6% in lead aVR which was $99.3{\pm}38.0{\mu}V$. 2. Average amplitude of the QRS complex were from $362.8{\pm}177.7{\mu}V$ to $532.8{\pm}253.9{\mu}V$(mean of $449.1{\pm}57.2{\mu}V$) that in all leads except lead I were manifested the Low-Voltage QRS complex(below 0.5mV). Average amplitudes of each wave type in the QRS complex aere $-50.2.4{\pm}258.2{\mu}V$ and $-428.6{\pm}195.1{\mu}V$ in the QS groups type that showed a frequency of 66.3%, 70.4% in the leads I and aVL, were $451.1{\pm}20.4.0{\mu}V$, $387.6{\pm}175.8{\mu}V$ and $299.3{\pm}146.5{\mu}V$ in the R groups type that showed a frequency of 48.0%, 53.1% and 34.7% in the leads III, aVR and aVF, and were $-307.5{\pm}180.3{\mu}V$, $201.4{\pm}77.2{\mu}V$ in the QR wave type which showed a frequency of 39.8% in lead II, respectively. 3. In T wave, amplitude of the positive type showed the frequency of 50.0%, 82.7%, 51.0% and 57.1% in leads II, III aVR and aVF which were $214.9{\pm}115.6{\mu}V$, $188.5{\pm}119.3{\mu}V$, $191.0{\pm}93.7{\mu}V$ and $165.7{\pm}91.9{\mu}V$, and the negative type showed a frequecny of 66.3% and 72.5% in leads I and aVL. that were $221.3{\pm}112.5{\mu}V$, $-173.6{\pm}86.7{\mu}V$, respectively. 4. Amplitude of ST segment in leads I, II and III were a mean of $-12.2{\pm}37.2{\mu}V$, $17.5{\pm}42.6{\mu}V$ and $28.3{\pm}40.4{\mu}V$, in leads aVR, aVL and aVF were $-3.9{\pm}32.5{\mu}V$, $-15.9{\pm}35.6{\mu}V$ and $26.2{\pm}37.5{\mu}V$, respectively.

• 대한핵의학회지
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• 제37권2호
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• pp.110-119
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• 2003

목적: 분화갑상선암 환자에 대한 방사성옥소(I-131) 치료는 재발율과 사망률을 감소시키는 효과적인 치료법이지만, 치료용량을 증가시킴으로써 치료율을 향상시킬 수 있는지에 대해서는 아직 논란이 있다. 본 연구에서는 최대허용선량 치료법의 효용성을 검증하고자 하였다. 대상 및 방법: 임상적 병기가 제3, 4병기이고, 6개월 이후에 I-131 전신스캔(이하 IWBS)과 혈중 thyroglobulin (이하 Tg), anti-thyroglobulin antibody (이하 ATA), 초음파검사(이하 US) 및 F-18 FDG PET 등을 통해 치료여부를 확인할 수 있었던 58명(남:여=9:49, 평균연령 $50{\pm}11$세)의 유두상갑상선암 환자를 대상으로 하였다. 이중 11명은 제4병기, 47명은 제3병기였으며, 43명(남:여=4:39, 평균연령 $50{\pm}11$세)은 7.4 GBq 이하의 고식적인 저용량치료법으로 치료하였고, 9.25 GBq 이상의 고용량 치료를 받은 환자는 15명(남:여=5:10, 평균연령 $50{\pm}12$세)으로 고용량군에서 남자가 더 많았으나 연령의 차이는 없었다. 고용량군 환자 모두에서 추적용량의 방사성옥소(평균 $77{\pm}3MBq$)를 경구 투여한 후 혈중 방사능소실곡선을 통해 최대허용선량(maximum permissible dose, 이하 MPD)을 계산하였으며, 7명에서는 말초혈액림프구의 중기염색 체분석법에 의해 생물학적으로 MPD를 계산하였다. 14명에서는 치료용량의 방사성옥소를 투여한 후 혈중 방사능소실곡선을 통해 MPD를 계산하였다. 완전치유(complete response, 이하 CR)는 IWBS에서 병소가 없어지고, 혈중 Tg치가 1 ng/mL 이하로 감소한 경우로 정의하였으며, 부분치유(partial response, 이하 PR)는 IWBS에서 병소가 없어졌더라도 혈중 Tg, ATA치가 높거나, US 또는 PET 검사에서 병소가 남아있는 경우로 정의하였다. 치료후 IWBS에서 병소가 오히려 증가하거나 변함없는 경우는 없었다. 방사성옥소 치료에 의한 부작용은 입원기간 중 타액선이 현저하게 붓고 통증이 있거나, 구토를 심하게 하는 경우, 그리고 퇴원후 1개월째 백혈구수가 20% 이상 감소한 경우로 정의하였다. 결과: 양 군간에 연속적인 수치변화를 비교하는 경우는 paired t-test를 이용하였으며, 대상군간 치료효과와 부작용의 비교는 chi-square test를 이용하였다. p값 0.05 미만을 통계적으로 유의한 차이로 인정하였다. 고용량군 환자 모두에서 추적용량과 치료용량의 방사성옥소 투여 후 혈액의 피폭선량은 각각 $0.012{\pm}0.3Gy,\;1.66{\pm}25Gy$였으며, 방사성옥소 투여 후 혈액에 전달되는 피폭선량은 추적용량보다 치료용량에서 더 많았고(1.21: 166 rad, p<0.0001), 방사성옥소 1 mCi당 혈액에 전달되는 피폭선량은 차이가 없었다($0.58{\pm}0.1\;vs.\;0.56{\pm}0.1$ rad/37 MBq, p=0.34). 추적용량 방사성옥소 투여 후 구한 MPD는 평균 $13.3{\pm}1.9GBq\;(9.7{\sim}16GBq)$ 이였고, 치료용량 방사성옥소 투여 후 구한 MPD는 평균 $13.8{\pm}2.1GBq(10.4{\sim}16.3GBq)$로 유의한 차이가 얻었으며 (p=0.20), 두 수치간에는 유의한 상관 관계가 있었다(r=0.8, p<0.0001). 7명의 환자에서 말초혈액림프구 중기염색체 분석법으로 MPD를 측정하였는데 혈액의 피폭선량은 $1.78{\pm}0.03Gy$였으며, 같은 환자에서 혈중 방사능소실곡선으로부터 구한 피폭선량은 $1.54{\pm}0.03Gy$로 유의하게 낮았으나 (p=0.01), 두 측 정치 간에는 유의한 상관관계(r=0.86, p=0.01)가 있었다. 저용량 치료군 43명 중 22명(51.2%)에서 완전치유를 보였고 21명(48.8%)에서는 부분치유를 보인 반면, 고용량 치료군 15명 중 12명(80%)에서 완전치유를 보였고 3명(20%)에서만 부분치유를 보여 고용량 치료군에서 유의하게 높은 완전치유를 얻을 수 있었다(p=0.05). 한편 부작용 발생빈도는 저용량 치료군 43명 중 13명(30.2%), 고용량 치료군 15명중 6명(40%)로 양군간에 유의한 차이가 없었다(p=0.46). 임상적인 병기, 연령 및 성별에 따라서는 치유의 차이가 없었다(모두 p>0.05). 결론: 혈중소실곡선으로부터 MPD를 결정하고 이를 토대로 환자 개개인별로 적절한 선량을 선택하여 치료하는 방법은 부작용을 최소화하면서도 치료효과를 높일 수 있는 매우 유용한 치료법이며, 고위험군 분화갑상선 암 환자에게 가장 적절한 치료법이라고 사료되었다.