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The Bone Regenerative Effects of Chitosan on the Calvarial Critical Size Defectin Sprague Dawley Rats (백서 두개골 결손부에서 키토산의 골조직 재생 유도 효과)

  • Jung, Ui-Won;Suh, Jong-Jin;Choi, Seong-Ho;Choi, Kyoo-Sung;Chai, Jung-Kiu;Kim, Chong-Kwan
    • Journal of Periodontal and Implant Science
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    • v.30 no.4
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    • pp.851-870
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    • 2000
  • The major goals of periodontal therapy is the functional regeneration of periodontal supporting structures already destructed by periodontal disease as well as the reduction of signs and symptoms of progressive periodontal disease. There have been many efforts to develop materials and therapeutic methods to promote periodontal wound healing. There have been increasing interest on the chitosan made by chitin. Chitin is second only to cellulose as the most abundant natural biopolymer. It is a structural component of the exoskeleton of invertebrates(e.g., shrimp, crabs, lobsters), of the cell wall of fungi, and of the cuticle of insects. Chitosan is a derivative of chitin made by deacetylation of side chains. Many experiments using chitosan in various animal models have proven its beneficial effects. The aim of this study is to evaluate the osteogenesis of chitosan on the calvarial critical size defect in Sprague Dawley rats. An 8 mm surgical defect was produced with a trephine bur in the area of the midsagittal suture. The rats were divided into two groups: Untreated control group versus experimental group with 50mg of soluble chitosan gel. The animals were sacrificed at 2, 4 and 8 weeks after surgical procedure. The specimens were examined by histologic, histomorphometric and radiodensitometric analyses. The results are as follows: 1. The length of newly formed bone in the defects was $102.91{\pm}25.46{\mu}m$, $219.46{\pm}97.81{\mu}m$ at the 2 weeks, $130.95{\pm}39.24{\mu}m$, $212.39{\pm}89.22{\mu}m$ at the 4 weeks, $181.53{\pm}76.35{\mu}m$ and $257.12{\pm}51.22{\mu}m$ at the 8 weeks in the control group and experimental group respectively. At all periods, the means of experimental group was greater than those of control group. But, there was no statistically significant difference between the two groups. 2. The area of newly formed bone in the defects was $2962.06{\pm}1284.48{\mu}m^2$, $5194.88{\pm}1247.88{\mu}m^2$ at the 2 weeks, $5103.25{\pm}1375.88{\mu}m^2$, $7751.43{\pm}2228.20{\mu}m^2$ at the 4 weeks and $8046.20{\pm}818.99{\mu}m^2$, $15578.57{\pm}5606.55{\mu}m^2$ at the 8 weeks in the control group and experimental group respectively. At all periods, the means of experimental group was greater than those of control group. The experimental group showed statistically significant difference to the control group at the 2 and 8 weeks. 3. The density of newly formed bone in the defects was $14.26{\pm}6.33%$, $27.91{\pm}6.65%$ at the 2 weeks, $20.06{\pm}9.07%$, $27.86{\pm}8.20%$ at the 4 weeks and $22.99{\pm}3.76%$, $32.17{\pm}6.38%$ at the 8 weeks in the control group and experimental group respectively. At all periods, the means of experimental group was greater than those of control group. The experimental group showed statistically significant difference to the control group at the 2 and 8 weeks. These results suggest that the use of chitosan on the calvarial defects in rats has significant effect on the regeneration of bone tissue in itself

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A Comparative Considerations of the Moat at the East and West (동.서양 해자(垓字)의 비교 고찰)

  • Jung, Yong-Jo;Park, Joo-Sung;Sim, Woo-Kyung
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.28 no.3
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    • pp.29-38
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    • 2010
  • A moat is a pond or waterway paved on the outside of a fortress that is one of the facilities to prevent enemy from approaching the fortress wall or classify it as the boundary space, and this study was undertaken to find out the characteristics of the moat that was existed in the East and the West from ancient time to medieval time with the following result. First, the moat in the East was installed of natural moat and artificial moat at the same time while the moat in the West had the fortress built in naturally advantageous site to use natural most substantially more. Second, the moats of Korea were smaller in scale compared to other countries (Japan, China and the Western countries). Third, the fortresses in the East were built to protect towns or royal palace while the West had the fortress to protect the residence of kings, lords, great wealthy persons and the like, and they were used jointly with the natural moat and artificial moat to defend against the infiltration of enemy. Fourth, the Pungsujiri in the Orient is one of the numerous ideologies forming the supplementary ideologic system of Korean people that could not be denied as the perception that influences on Korean people after the Silla Dynasty, and this Pungsujiri was considered when determining the location of the castle. The moat surrounding the castle had the role to keep the good energy in the castle from escaping away. Fifth, the Ha-Ha technique in the west was designed to prevent the external power from infiltration by digging the ditch on the place applicable to the boundary of the garden site, rather than the fence. While walking around along the water-side path without knowing the existence of this ditch, when the road is discovered with the cut off in the ditch, people had the exclamation without actually recognizing such astonishment. It was originally the dike for military purpose during the medieval time that was designed to look into the garden without physical boundary surrounded with the vertical fence in the garden that by having the deep ditch like shape on the boundary line of the garden which was designed to form the farm by preventing various types of cattle from coming inside the garden and bring in the garden element for farms, forestry, agricultural land and the like.

Analysis of Treatment Failures in Early Uterine Cervical Cancer (조기 자궁경부 악성종양의 치료실패에 대한 분석)

  • Kim Joo-Young;Lee Kyu-Chan;Choi Hyung-Sun
    • Radiation Oncology Journal
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    • v.9 no.2
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    • pp.285-291
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    • 1991
  • One hundred and twenty six patients with early uterine cervical cancer who had been treated at Departmen of Radiation Oncology of Korea University Hospital from Jan.1981 to Dec.1988 were analysed retrospectively by the treatment result and pattern of of failures. All patients had stage Ia to IIa disease and were grouped whether they had combination of operation and postop irradiation or radiation therapy alone. 1) Sixty six patients belonged to the combination treatment group and 60 patients to the radiation alone group. 2) Combination group consisted of $18.1\%$(12/66) stage Ia, $71.2\%$(47/66) stage Ib and $10.6\%$ (7/66) stage IIa patients. There were no stage Ia, 18.8$\%$(l1/60) stage Ib and 81.6$\%$(49/60) stage IIa patients for RT alone gronp. 3) There were total 23$\%$(29/126) treatment failures,13 patients in combination group and 16 patients in RT alone group. In 66 patients of combination group, they were found to have 5 locoregional failures, 7 distant failures and 1 at both sites. In 60 patients of RT alone group, 9 locoreginal failure and 7 distant failures occured. Eighty six percent (25/29) of total failures appeared within 18 month after completion of treatment. About 60$\%$ of the patients with regional recurrences which were located at pelvic side wall or pelvic lymph nodes paesented their recurrent disease after 1 year of completion of treatment, whereas same percent of distant failures appeared within 6 month. 5) In RT alone group, the first sites of distant failure were mostly para-aortic lymph node and/or left supraclavicular lymph node (71.4$\%$,5/7). In combination group, various sites such as inguinal lymph node, mediastinal lymph node, liver, lung and bone appeared first or at the same time with para-aortic and supraclavicular lymph node metastasis. 6) Logistic regression analysis was done for multivariate analysis of the factors contributing to locoregional and distant failures. In combination group, adequacy of the resection margin and the presence of positive pelvic node were found to be the most significant factors (p=0.0423 & 0.0060 respectively). In RT alone group, less than complete regression of the tumor at the end of treatment was the only significant contributing factor for the treatment failures (p=0.0013) with good liklihood ratio.

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Dust Spatial Distribution and Emission of Tunnel Ventilated Windowless Broiler Building (터널환기 무창육계사의 분진크기별 분포와 배출농도에 관한 연구)

  • Choi, H.C.;Yeon, G.Y.;Spmg, J.I.;Kang, H.S.;Kwon, D.J.;Yoo, Y.H.;Yang, C.B.;Chun, S.S.;Kim, Y.K.
    • Journal of Animal Environmental Science
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    • v.12 no.3
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    • pp.115-122
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    • 2006
  • This study investigated the spatial distribution of dust originating from tunnel-ventilated windowless broiler building measuring 12 m wide, 61 m long, with a side wall height of 3 m and a capacity of 16,982 birds. Dust concentrations in terms of total suspended particles (TSP), and particulate matter of sizes $10\;{\mu}m$(PM10), $2.5\;{\mu}m$(PM2.5), and $1\;{\mu}m(PM1)$ were measured at 30 minutes interval by using GRIMM Aerosol Monitor (GRIMM AEROSOL). The spatial distribution of dust showed the lower dust concentration in the inlet than in the outlet of the tunnel ventilation, and dust concentration decreasing as the dust size decreased, as follows: $317.9\;{\mu}g/m^3$ TSP; $74.7{\mu}m/m^3$ PM10; $9.7\;{\mu}g/m^3$ PM2.5; and $6.2\;{\mu}g/m^3$ PM1 in the inlet; and $2,678.5\;{\mu}g/m^3$ TSP; $555.5\;{\mu}g/m^3$ PM10; $33.3\;{\mu}g/m^3$ PM2.5; and $10.2\;{\mu}g/m^3$ PM1 in the outlet. The dust concentration emitted from the tunnel ventilated fan was $446.6\;{\mu}g/m^3$ TSP; $129.1\;{\mu}g/m^3$ PM10; $15.8\;{\mu}g/m^3$ PM2.5; and $6.1\;{\mu}g/m^3$ PM1 in the 3 meters from the fan and $25.1\;{\mu}g/m^3$ TSP; $8.8\;{\mu}g/m^3$ PM10; $5.6\;{\mu}g/m^3$ PM2.5; and $4.9\;{\mu}g/m^3$ PM1 in the 50 meters from the fan.

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Studies on the Characteristics of Modified Landscape and the Transformational Processes of Ongnyucheon in Changdeok Palace (창덕궁 옥류천의 수경(修景) 특성과 변천과정)

  • Jung, Woo-Jin;Kim, Hyung-Suk;Sim, Woo-Kyung
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.30 no.3
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    • pp.42-56
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    • 2012
  • This study was carried out to investigate the construction characteristics and the landscaping design skill for Wiyiam at Ongnyucheon(玉流川) in the rear garden of Changdeok Palace focusing on constructing technique, space composition and transformational process of the site. The results of this study were summarized as follows; First, Wiyiam of Ongnyucheon was constructed as garden ornament which was modified the huge bedrock into the shape of the mountain. The waterfall of Wiyiam was originally made of torrent which water flowed into the bottom, but it was reconstructed to take the effect of Inak(離落: the method to drop water from high place) by carving rock into square shape at the era of King Gojong(高宗). Second, main characteristics of Wiyiam appeared in Donggwoldo was the hill built up with a square pond and ground at the back of Wiyiam and the profound scenery of mountains and stream from the view of Wiyiam. Also, pavilions such as Soyojeong(逍遙亭), Cheongujeong and Taegeukjeong(太極亭) built in Ongnyucheon seemed to be constructed as the spots to appreciate the view and waterfall sound of Wiyiam. Also the spots were not bounded by the function of creating special water systems such as Cheongujeong pond and Taegeukjeong pond and showed the outstanding landscape design skill to make people feel unusual interest from each spot. On the other hand, this study considered that the evening scenery of Wiyiam, beautiful sound of falling water, unusual water system with beautiful plant materials were landscaped for the function of the psychological peace and stability to the appreciators. Lastly, the extreme change of space composition in Ongnyucheon was assumed as a strategy to improve the existing poor drain environment by confirming that the mountain stream and wall of Soyojeong were removed and drainage in both side of Soyojeong was installed in the 21th year of King Gojong's reign(1884).

A study on the design and applicability of stereoscopic sign for improving the visibility of traffic sign in double-deck tunnel (복층터널 교통표지판 시인성 향상을 위한 입체표지판 설계 및 적용 가능성에 대한 연구)

  • Park, Sang-Heon;Hwang, Ju-Hwan;Han, Sang-Ju;An, Sung-Joo;Kim, Hoon-Jae
    • Journal of Korean Tunnelling and Underground Space Association
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    • v.20 no.6
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    • pp.899-915
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    • 2018
  • In this study, in order to construct an eco-friendly advanced road transportation network, the multi-layer tunnel, which is a small-sized car road, is designed to have a height of less than 60 cm. However, the shape of the tunnel is low and the height of the traffic sign is small. In order to solve these problems, traffic sign characters were designed in three dimensions, and the possibility of applying the design of the three - dimensional sign that can obtain greater visibility than the existing signs at the same distance and the possibility verification through virtual simulation were performed. The three-dimensional sign is horizontally installed on the ceiling of the multi-layer tunnel. To be seen vertically, it is enlarged by a certain ratio by the perspective, and the width and height are enlarged. Respectively. In addition, 3D simulation was performed to verify the visibility of the stereoscopic signs when the driver ran through the stereoscopic sign design specifications. As a result of the design and experimental study, it was confirmed that the stereoscopic sign could be designed through the theoretical formula and that it could provide the driver with a larger traffic sign character because there is no limitation of the facility limit compared to the existing vertical traffic sign. Also, we confirmed that it can be implemented in the side wall by using the stereoscopic sign design principle installed on the ceiling part. It was confirmed that the design of the stereoscopic sign can be designed to be smaller as the distance that the driver visually recognizes the sperm is shorter, the height of the protrusion vertically at the lower part of the stereoscopic sign becomes higher. As a result of 3D simulation running experiment based on the design information of the stereoscopic sign, it was confirmed that the stereoscopic sign is visually the same as the vertical sign at the planned distance. Although the detailed research and institutional improvement of stereoscopic signs have not been made in Korea and abroad, it is evolved into a core technology of new road traffic facilities through various studies through the possibility of designing and applying stereoscopic signs developed through this study Expect.

The Landscape Meaning and Literary Group Culture Carved in Danguedae and Samgaeseokmun of Imshil (임실(任實) 단구대(丹丘臺)와 삼계석문(三溪石門)에 새긴 의미경관과 단구구로회(丹丘九老會)의 아회(雅會)문화)

  • Lee, Hyun-Woo;Lee, Jung-Han;Rho, Jae-Hyun
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.29 no.4
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    • pp.170-181
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    • 2011
  • This Research will explore the meaning indicated in the landscape meaning and feature of literary group culture, focusing in Gurujeong(九老亭: pavilion for nine elders) and Samgaeseokmun(三溪石門: stone gate in three valleys) located in Dundeok-myun, Imshil-gun, and will seek to understand the implications by studying the cultural landscape spread out in the area. The place where Gurojeong and Samgaeseokmun is located is the meeting point of the three valleys, Dunnam stream, Osu stream, and Yul stream, which is the main location to view the beautiful scenery, which has the nickname as the dwelling place of a celestial being. Especially, based on the description of old maps, "Samgae(three valleys)" and "Samgaeseokmun" possesses significance as a landmark and shows a characteristic feature of landscape structures of low hills. Dangugurohwe(丹丘九老會: nine elders gathering on the dwelling of a celestial being) originated from Hyangsangurohwe(香山九老會: gathering of nine elders on a fragrant mountain), where Baekgeoi(白居易) of China was one of the main people. This group was organized by nine elders over the age of 60 desiring to view the scenery of Doyeonmyeong. The group enhanced the literary spirit on the low hill, erecting a tower, and enjoying the beautiful scenery changing every season with scholars from the same region. This phenomenon seems to have been formed upon the positive response to gatherings of elders, which were prevalent in the Joseon Dynasty. If the internal idea pursued by the group was "longevity," the external idea pursued can be summarized as "the spirit the respect for the elders." Naming the groups as 'Dangudae(place where the celestial being lives), Guseondong(valley of seeking a celestial life), Bangjangsan(mountain of a high priest), and Daecheondae(place of communicating with God) was likely a device to introspect oneself and symbolize one's life process. Furthermore, the reason Samgaeseokmun, which is an imitation of Choi, Chiwon's work, was built near Soyocheo, was probably to yearn the celestial land and based on the desire to follow Choi, Chiwon, who was the most self-fulfilling being presumed to have become a celestial being by practicing the pursuit of freedom, escaping from the reality. After tracing the symbolizing meaning of the four letters carved in the left side of the stone wall of Dangudae, the conclusion that this place was not only a place for literary gatherings of the nine elders of Saseong(four families), but was a place where the celestial being dwelled could be inferred. Corresponding with Dangudae and Gurojeong, which are places where the order of human and nature is harmonized and where its meaning associated with the location intensifies, arouses strong bond, can be said to be the symbol of the traces of celestial beings where the spirits of attachment to a certain place is embedded. The acts performed in Dangugurohwe were those of traditional leisure including strolling, viewing the scenery, drinking, composing poems, and playing instruments, and sometimes listening to stories, tea ceremony, prayers, and fishing were added, which indicates that the gathering had a strong tendency towards pastoral and hermit life.

Heavy concrete shielding properties for carbon therapy

  • Jin-Long Wang;Jiade J Lu;Da-Jun Ding;Wen-Hua Jiang;Ya-Dong Li;Rui Qiu;Hui Zhang;Xiao-Zhong Wang;Huo-Sheng Ruan;Yan-Bing Teng;Xiao-Guang Wu;Yun Zheng;Zi-Hao Zhao;Kai-Zhong Liao;Huan-Cheng Mai;Xiao-Dong Wang;Ke Peng;Wei Wang;Zhan Tang;Zhao-Yan Yu;Zhen Wu;Hong-Hu Song;Shuo-Yang Wei;Sen-Lin Mao;Jun Xu;Jing Tao;Min-Qiang Zhang;Xi-Qiang Xue;Ming Wang
    • Nuclear Engineering and Technology
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    • v.55 no.6
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    • pp.2335-2347
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    • 2023
  • As medical facilities are usually built at urban areas, special concrete aggregates and evaluation methods are needed to optimize the design of concrete walls by balancing density, thickness, material composition, cost, and other factors. Carbon treatment rooms require a high radiation shielding requirement, as the neutron yield from carbon therapy is much higher than the neutron yield of protons. In this case study, the maximum carbon energy is 430 MeV/u and the maximum current is 0.27 nA from a hybrid particle therapy system. Hospital or facility construction should consider this requirement to design a special heavy concrete. In this work, magnetite is adopted as the major aggregate. Density is determined mainly by the major aggregate content of magnetite, and a heavy concrete test block was constructed for structural tests. The compressive strength is 35.7 MPa. The density ranges from 3.65 g/cm3 to 4.14 g/cm3, and the iron mass content ranges from 53.78% to 60.38% from the 12 cored sample measurements. It was found that there is a linear relationship between density and iron content, and mixing impurities should be the major reason leading to the nonuniform element and density distribution. The effect of this nonuniformity on radiation shielding properties for a carbon treatment room is investigated by three groups of Monte Carlo simulations. Higher density dominates to reduce shielding thickness. However, a higher content of high-Z elements will weaken the shielding strength, especially at a lower dose rate threshold and vice versa. The weakened side effect of a high iron content on the shielding property is obvious at 2.5 µSv=h. Therefore, we should not blindly pursue high Z content in engineering. If the thickness is constrained to 2 m, then the density can be reduced to 3.3 g/cm3, which will save cost by reducing the magnetite composition with 50.44% iron content. If a higher density of 3.9 g/cm3 with 57.65% iron content is selected for construction, then the thickness of the wall can be reduced to 174.2 cm, which will save space for equipment installation.

The Effect of the Gap between College Students' Perception of the Importance of Coffee Shops and Their Satisfaction after Patronizing Coffee Shops on Their Purchasing Behavior (대전원교학생대가배점중요성적감지화타문광고가배점지후적만의도지간적차거대타문구매행위적영향(大专院校学生对咖啡店重要性的感知和他们光顾咖啡店之后的满意度之间的差距对他们购买行为的影响))

  • Lee, Won-Ok
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.4
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    • pp.1-10
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    • 2009
  • The purpose of this study was to categorize the gap between coffee shop 'importance' (as perceived by customers before patronizing the coffee shop) and 'satisfaction' (perception of customers after patronizing the coffee shop) as positive or negative and to analyze the effect of these gaps on purchasing behavior. To do this, I used the gap between importance and satisfaction regarding the choice of a coffee shop as the explanatory variable and performed an empirical analysis of the direction and size of the effect of the gap on purchasing behavior (overall satisfaction, willingness-to-revisit) by applying the Ordered Probit Model (OPM). A previous study that used IPA to evaluate the effects of gaps estimated the direction and size of a quadrant but failed to analyze the effect of gaps on customers. In this study, I evaluated the effects of positive and negative gaps on customer satisfaction and willingness-to-revisit. Using OPM, I quantified the effect of positive and negative gaps on overall customer satisfaction and willingness-to-revisit. Per-head expenditure, frequency of visits, and coffee-purchasing place had the most positive effects on overall customer satisfaction. Frequency of visits, followed by per-head expenditure and then coffee-purchasing place, had the most positive impact on willingness-to-visit. Thus per-head expenditure and frequency of visits had the greatest positive effects on overall satisfaction and willingness-to-revisit. This finding implies that the higher the actual satisfaction (gap) of customers who spend KRW5,000 or more once or more per week at coffee shops is, the higher their overall satisfaction and willingness-to-revisit are. Despite the fact that economical efficiency had a significant effect on overall satisfaction and willingness-to-revisit, college and university students still use coffee shops and are willing to spend KRW5,000 because they do not only purchase coffee as a product itself, but use the coffee shop for other activities, such as working, meeting friends, or relaxing. College and university students also access the Internet in coffee shops via personal laptops, watch movies, and study; thus, coffee shops should provide their customers with the appropriate facilities and services. The fact that a positive gap for coffee shop brand had a positive effect on willingness-to-revisit implies that the higher the level of customer satisfaction, the greater the willingness-to-revisit. A negative gap for this factor, on the other hand, implies that the lower the level of customer satisfaction, the lower the willingness-to-revisit. Thus, the brand factor has a comparatively greater effect on satisfaction than the other factors evaluated in this study. Given that the domestic coffee culture is becoming more upscale and college/university students are sensitive to this trend, students are attentive to brands. In most upscale coffee shops in Korea, the outer wall is built out of glass that can be opened, the interiors are exotic with an open kitchen. These upscale coffee shops function as landmarks and match the taste of college/university students. Coffee shops in Korea have become a cultural brand. To make customers feel that coffee shops are upscale, good quality establishments and measures to provide better services in terms of brand factor should be instituted. The intensified competition among coffee shop brands in Korea as a result of the booming industry indicates that provision of additional services is needed to differentiate competitors. These customers can also use a scanner free of charge. Another strategy that can be used to boost brands could be to provide and operate a seminar room for seminars and group study. If coffee shops adopt these types of strategies, college/university students would be more likely to consider the expenses they incur worthwhile and, subsequently, they would be more likely to be satisfied with the brands of these coffee shops, with an associated increase in their willingness-to-revisit. Gender and study year had the most negative effects on overall satisfaction and willingness-to-revisit. Female students were more likely to be satisfied and be willing to return than male students, and third and fourth-year students were more likely to be satisfied and willing-to-return than first or second-year students. Students who drink coffee, read books, and use laptops alone at coffee shops are easily noticeable. High-grade students tend to visit coffee shops alone in order to use their time efficiently for self-development and to find jobs. The economical efficiency factor had the greatest effect on overall satisfaction and willingness-to-revisit in terms of a positive gap. The higher the actual satisfaction (gap) of students with the price of the coffee, the greater their overall satisfaction and willingness-to-revisit. Economical efficiency with a negative gap had a negative effect on willingness-to-revisit, which implies that a less negative gap will result in a greater willingness-to-revisit. Amid worsening market conditions, coffee shops located around colleges/universities are using strategies, such as a point or membership card, strategic alliances with credit-card companies, development of a set menu or seasonal menu, and free coffee-shot services to increase their competitive edge. Product power also had a negative effect in terms of a negative gap, which indicates that a higher negative gap will result in a lower willingness-to-revisit. Because there are many more customers that enjoy coffee in this decade, as compared to previous decades, the new generation of customers, namely college/university students, want various menu items in addition to coffee, and coffee shops should, therefore, add side menu items, such as waffles, rice cakes, cakes, sandwiches, and salads. For example, Starbucks Korea is making efforts to enhance product power by selling rice cakes flavored in strawberry, wormwood, and pumpkin, and providing coffee or cream free of charge. In summary, coffee shops should focus on increasing their economical efficiency, brand, and product power to enhance the satisfaction of college/university students. Because shops adjacent to colleges or universities enjoy a locational advantage, providing differentiated services in terms of economical efficiency, brand, and product power, is likely to increase customer satisfaction and return visits. Coffee shop brands should, therefore, be innovative and embrace change to meet their customers' desires. Because this study only targeted college/university students in Seoul, comparative studies targeting diverse regions and age groups are required to generalize the findings and recommendations of this study.

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Rectal Bleeding and Its Management after Irradiation for Cervix Cancer (자궁경부암 환자에서 방사선치료 후에 발생한 직장출혈과 치료)

  • Chun Mison;Kang Seunghee;Kil Hoon-Jong;Oh Young-Taek;Sohn Jeong-Hye;Jung Hye-Young;Ryu Hee Suk;Lee Kwang-Jae
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.343-352
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    • 2002
  • Purpose : Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. Materials and Methods : total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The Point A dose from the HDR brachytherapy was 28 Gy to 30 Gy $(4\;Gy\times7,\;or\;5\;Gy\times6)$. The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months $(12\~86\;months)$. Results : The incidence of rectal bleeding was $12.7\%$ (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was $8.5\%$. Most complications $(92.6\%)$ developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding an icruCRBED greater than 100 Gy $(19.7\%\;vs.\;4.2\%)$, an EBRT dose to the parametrium over 55 Gy $(22.1\%\;vs.\;5.1\%)$ and higher stages of III and IV $(31.8\%\;vs.\;10.5\%)$. In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was peformed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. Conclusion : Moderate and several rectal bleeding occurred in $8.5\%$ of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.