ABSTRACT
PURPOSE: Adjuvant radiotherapy of breast cancer using a photon tangential field incurs a risk of late heart and lung toxicity. The use of free breathing (FB), expiration breath hold (EBH), and deep inspiration breath hold (DIBH) during tangential breast radiotherapy as a means of reducing irradiated lung and heart volume was evaluated. METHODS: In 10 women with left-sided breast cancer (mean age, 44 years) post-operative computed tomography (CT) scanning was done under different respiratory conditions using FB, EBH, and DIBH in 3 CT scans. For each scan, an optimized radiotherapy plan was designed with 6 MV photon tangential fields encompassing the clinical target volume after breast-conserving surgery. RESULTS: The results of dose-volume histograms were compared using three breathing pattern techniques for the irradiated volume and dose to the heart. A significant reduction dose to the irradiated heart volume for the DIBH breathing technique was compared to FB and EBH breathing techniques (p<0.05). CONCLUSION: This study demonstrated that the irradiated heart volume can be significantly reduced in patients with left-sided breast cancer using the DIBH breathing technique for tangential radiotherapy.
Subject(s)
Female , Humans , Breast , Breast Neoplasms , Cardiac Volume , Heart , Lung , Mastectomy, Segmental , Radiotherapy, Adjuvant , RespirationABSTRACT
PURPOSE: For the safety of donor and recipient in living donor liver transplantation, Asan Medical Center had attempted dual living donor liver transplantation (DLDLT) for the first time in the world. But bleeding chance and biliary problem occurred twofold in DLDLT, because DLDLT was used dual grafts. We analyzed the clinical features, the diagnosis, and management of biliary problem in DLDLT. METHODS: We retrospectively analyzed the cases of 61 patients had undergone DLDLT between July 2003 and June 2004. The cases with biliary problem was diagnosed by serologic examination (glutamic oxaloacetic transaminase/ glutamic pyruvic transaminase/alkaline phosphatase/total bilirubin) and image study (computed tomography and hepatobiliary scan). RESULTS: Among 61 cases had undergone DLDLT, 19 cases had biliary problem included biliary stricture only (14 cases), biliary stricture and bile leakage (5 cases). The major clinical manifestations of biliary problem were fever (12 cases), asymptomatic and/or increased liver enzyme (7 cases). Among 19 cases with biliary problem, 18 cases showed image study positive and serologic examination positive and/or symptomatic findings, and 1 cases showed image study positive and serologic examination negative and asymptomatic findings. The treatments of biliary stricture were endoscopic (naso/retrograde) biliary drainage (4 cases), percutaneous transhepatic biliary drainage (17 cases). In cases of bile leakage, we treated intraabdominal fluid collection with operative management (1 cases) and conservative managements (4 cases). Mortality rate related with biliary problem was 0%. CONCLUSION: Systemic and active postoperative management in biliary complication can help patients to minimize economic loss and sequelae.
Subject(s)
Humans , Bile , Constriction, Pathologic , Diagnosis , Drainage , Fever , Hemorrhage , Liver Transplantation , Liver , Living Donors , Mortality , Retrospective Studies , Tissue Donors , TransplantsABSTRACT
To understand the mode of transmission in clonorchiasis, a survey was made in Kim-hae Goon, South Kyong-sang Do (=Province). The mathematical analysis of the age prevalence was done on the egg positive rates. And another analysis for the comparison was also made to the cited data from two areas, North Kyong-sang Do and Ko-yang Goon, Kyong-gi Do. Some catalytic models of H. Muench (1959) were applied to the observed age prevalence. Because the both parameters, such as force of infection(a) and loss of positivity(b) were considered to be constant for a long period in the surveyed area, the two stage catalytic model by Muench was chosen to the analysis. In the surveyed area, Kim-hae Goon where the egg positive rates were 56.2 percent and 61.2 percent (by Kim, 1974), the constant values of 'a' were found to be 0.051 and 0.089 respectively. In other words, the force of infection was 51, 89 per 1,000 susceptibles. The values of 'b' were found to be 0.006 and 0.005. This means that the rates of disappearance from egg positive cases to negative were 6 and 5 per annum per l,000 positive cases in above area. Therefore, the two catalytic curves were expressed by the following equations, y = 1.133 {e(-0.006t) - e(-0.051t)} and y = 1.047 {e(-0.005t) - e(-0.089t)} respectively. In the cases of North Kyong-sang Do and Ko-yang Goon, Kyong-gi Do where the egg positive rates of clonorchis shown as 27.7 percent and 15.2 percent by Shin (1964) and Kim (l974), the curves were expressed by y = 1.769 {e(-0.010t) - e(-0.034t)} and y = 2.857 {e(-0.020t) - e(-0.027t)} respectively. From the above mathematical analyses by age prevalence in clonorchiasis, it was considered that the mode of transmission of clonorchiasis in the surveyed area, Kim-hae Goon presented more rapid pattern than those of North Kyong-sang Do and Ko-yang Goon, Kyong-gi Do.