Characteristics of Nasal Resonance and Perceptual Rating in Prelingual Hearing Impaired Adults

OBJECTIVES: Resonance problems in hearing impaired (HI) individuals have been described as aspects of nasality. However, there are limitations in being able to explain the range of resonance problems. Therefore, this study suggests a perceptual rating that will effectively explain the characteristics of resonance problems in HI individuals. METHODS: Nasalance scores were obtained from 32 subjects in each of HI and normal hearing (NH) groups using a nasometer. The subjects were categorized into groups based on normal and abnormal nasalance ranges. The abnormal nasalance range group was further divided into hyper-, hypo-, and mixed-nasal groups. Nasalance scores were based the individuals performance in a series of passage and syllable tasks. The perceptual rating was evaluated using a newly introduced tool, 'vertical focus of resonance' (VFR), which focuses on the resonance energy in the frontal, throat, pharyngeal and nasal locations. RESULTS: The NH group demonstrated a significantly lower nasalance score in the oral coupling and passage tasks than the HI group. Based on the results of nasalance correlation analysis, the HI group showed highly significant correlations between syllable and passage tasks, as contrasted with the NH group. There were significant differences in VFR between the nasalance types in both the NH and the HI groups. CONCLUSION: The HI hyper-nasal group showed tendencies of velopharyngeal opening, as opposed to the HI hypo-nasal group which showed tendencies of velopharyngeal closure. The HI mixed-nasal group showed inappropriate coordination of velopharyngeal function. In the HI group, the results of VFR showed that the air flow and the resonance energy were not released from the cavity of resonance. The suggested VFR tool explains the focusing characteristics of resonance energy within a continuation of speech sound regardless of the phonetic environment. Therefore, VFR may be a useful tool in explaining the deviant resonance patterns of HI individuals.

A Case of Desmoplastic Malignant Mesothelioma

Malignant mesothelioma (MM) is a rare tumor that associated with asbestos exposure. For the reliable diagnosis, the adequate representative tissue samples are essential for the histology and immunohistochemical staining. We report a case of desmoplastic malignant mesothelioma (DMM), accounting for only 5 to 10% of all MM and having poor prognosis. A 76-year-old male visited emergency room presenting with chest pain. Chest computed tomography showed focal lobulated pleural enhancing mass in posterior aspect of left upper lobe. After video-assisted thoracoscopic surgery and several immunohistochemical stains, we could diagnose as DMM. The patient refused chemotherapy, but received analgesics and palliative radiation for the painful back area. Subsequently, he was transferred to hospice clinic after 17 months from appearance of the initial symptom.

Current Status and Factors Affecting Prenatal Care by Married Immigrant Women / 여성건강간호학회지

PURPOSE: The purpose of this study was to identify factors affecting prenatal care (PNC) by married immigrant women. METHODS: This study was a secondary analysis of "Reproductive Health Status of Married Immigrant Women and Policy Directions in Korea" by the Korea Institute for Health & Social Affairs. The participants were 727 married immigrant women from Asia. Data were analysed using descriptive statistics, chi2 test and logistic regression with SPSS 14.0. RESULTS: Of the 727 women interviewed, 91.7% visited prenatal clinic. However, first time for PNC was late and total number of PNC was lower (9.07) than the average of Korean women. Timing and number of PNC in rural area were later and fewer than those in urban area. PNC by these women was significantly lower in those who had lived in Korea longer and for those who the employed. However, PNC was significantly higher in those who attended health education during pregnancy and had not experienced premature delivery. Those who attended health education during pregnancy (OR=2.84, CI=1.49~5.40) or were unemployed (OR=0.51, CI=0.26~0.99) were more likely to have PNC. CONCLUSION: These findings illustrate the need to strengthen the public information and provide special services to their demands about PNC for married immigrant women.

Analysis of Respiratory Motional Effect on the Cone-beam CT Image / 의학물리

The cone-beam CT (CBCT) which is acquired using on-board imager (OBI) attached to a linear accelerator is widely used for the image guided radiation therapy. In this study, the effect of respiratory motion on the quality of CBCT image was evaluated. A phantom system was constructed in order to simulate respiratory motion. One part of the system is composed of a moving plate and a motor driving component which can control the motional cycle and motional range. The other part is solid water phantom containing a small cubic phantom (2 x 2 x 2 cm3) surrounded by air which simulate a small tumor volume in the lung air cavity. CBCT images of the phantom were acquired in 20 different cases and compared with the image in the static status. The 20 different cases are constituted with 4 different motional ranges (0.7 cm, 1.6 cm, 2.4 cm, 3.1 cm) and 5 different motional cycles (2, 3, 4, 5, 6 sec). The difference of CT number in the coronal image was evaluated as a deformation degree of image quality. The relative average pixel intensity values as a compared CT number of static CBCT image were 71.07% at 0.7 cm motional range, 48.88% at 1.6 cm motional range, 30.60% at 2.4 cm motional range, 17.38% at 3.1 cm motional range. The tumor phantom sizes which were defined as the length with different CT number compared with air were increased as the increase of motional range (2.1 cm: no motion, 2.66 cm: 0.7 cm motion, 3.06 cm: 1.6 cm motion, 3.62 cm: 2.4 cm motion, 4.04 cm: 3.1 cm motion). This study shows that respiratory motion in the region of inhomogeneous structures can degrade the image quality of CBCT and it must be considered in the process of setup error correction using CBCT images.

Thoracic Radiotherapy Combined with Chemotherapy in Patients with Limited-stage Small-cell Lung Cancer

PURPOSE : We evaluated the optimal combination of thoracic radiotherapy with chemotherapy in patients with limited-stage small cell lung cancer (L-SCLC). MATERIALS AND METHODS : We retrospectively analyzed the data of 95 patients with L-SCLC who completed the planned thoracic radiotherapy combined with chemotherapy between January 1998 and March 2004. Thoracic radiotherapy was done with conventional fractionation to the median dose of 60Gy. Radiotherapy was combined with chemotherapy concurrently (n=67), alternating (n=19), or sequentially (n=9). Chemotherapy consisted of EP or EC (etoposide 100 mg/m2, cisplatin 60 mg/m2 or carboplatin 5~6xAUC ). The median cycle of chemotherapy was 6 with the range of 2 to 8. RESULTS : The median survival of all 95 patients was 20 months and 2-, 3-, and 5-year overall survival rate was 39%, 26%, and 19%, respectively. Radiation dose above 55 Gy did not show better survival result than dose below 55 Gy (p=0.59). The median survival and 5-year survival rate of 67 patients with concurrent chemoradiation was 23 months and 24% while those of 28 patients with alternating or sequential chemoradiation was 16 months and 8%, respectively (p=0.007). Concurrent thoracic radiotherapy combined after 2 cycles of chemotherapy showed the best survival results among the combination methods (p=0.29). The survival was improved in patients with chemotherapy more than 5 cycles comparing to patients with less than 5 (p=0.03). Patients with PCI showed the median survival of 43 months and 5-year survival rate of 35% vs. 18 months and 16% in patients without PCI, respectively (p=0.02). In multivariate analysis, the concurrent chemoradiation was the only significant prognostic factor affecting to the survival. CONCLUSION : Concurrent chemoradiation after 2 cycles of chemotherapy showed the best survival results in our study group. Full dose of chemotherapy to 6 cycles needed to be proceeded in tolerable patients. PCI can be recommended to the patients with complete response after chemoradiation

The Analysis of a Cerrobend Compensator and a Electronic Compensator Designed by a Radiation Treatment Planning System / 의학물리

In this study, the physical compensator made with the high density material, Cerrobend, and the electronic compensator realized by the movement of a dynamic multileaf collimator were analyzed in order to verify the properness of a design function in the commercial RTP (radiation treatment planning) system, Eclipse. The CT images of a phantom composed of the regions of five different thickness were acquired and the proper compensator which can make homogeneous dose distribution at the reference depth was designed in the RTP. The frame for the casting of Cerrobend compensator was made with a computerized automatic styrofoam cutting device and the Millennium MLC-120 was used for the electronic compensator. All the dose values and isodose distributions were measured with a radiographic EDR2 film. The deviation of a dose distribution was +/-0.99 cGy and +/-1.82 cGy in each case of a Cerrobend compensator and a electronic compensator compared with a +/-13.93 cGy deviation in an open beam condition. Which showed the proper function of the designed compensators in the view point of a homogeneous dose distribution. When the absolute dose value was analyzed, the Cerrobend compensator showed a +3.83% error and the electronic compensator showed a -4.37% error in comparison with a dose value which was calculated in the RTP. These errors can be admtted as an reasonable results that approve the accuracy of the compensator design in the RTP considering the error in the process of the manufacturing of the Cerrobend compensator and the limitation of a film in the absolute dosimetry.

Results of Curative Radiation Therapy with or without Chemotherapy for Stage III Unresectable Non-Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We retrospectively analyzed the patients who received curative radiotherapy for unresectable stage III NSCLC to investigate the impact of chemotherapy. MATERIALS AND METHODS: From 1998 to 2001, the records of 224 patients who completed curative radiotherapy for NSCLC were reviewed. There were 210 males and 14 females, and their median age was 64 years (range 38 ~83). 54 patients had stage IIIA disease and 170 patients had stage IIIB disease. Conventional radiotherapy was given and the radiation dose ranged from 50~70 Gy with a median of 60 Gy, and chemotherapy was combined for 116 patients (52%). RESULTS: The median survival, the 2-year, and 5-year actuarial survival rates of all 224 patients were 15 months, 30%, and 7%, respectively. The median survival of the patients with stage IIIA and IIIB disease were 21 months and 13 months, respectively (p=0.14). The median survival of patients who received chemoradiation was 18 months compared to 14 months for the patients who received RT alone (p=0.02). Among the chemoradiation group of patients, the median survival time of the patients who received 1 to 3 cycles of chemotherapy was 16 months and that for the patients who received more than 3 cycles was 22 months (p=0.07). We evaluated the effects of the timing of chemoradiation in 57 patients who received more than 3 cycles of chemotherapy. The median survival of the patients with the concurrent sequence was 25 months and that for the patients with the sequential chemotherapy was 19 months (p=0.81). CONCLUSIONS: For advanced stage III non-small cell lung cancer patients who completed the curative radiotherapy, the addition of chemotherapy improved the survival compared to the patients who received radiotherapy alone.

Evaluation of Premedical Curriculum at Korea University / 한국의학교육

The educational goal of premedical education is to provide a desired college-level training in liberal arts as well as sciences, and to provide a basis for future medical studies. However, there has been concern that the current premedical education at Korea University has been unproductive and has not met the educational goals. The objectives of this study were to evaluate the current premedical academic curriculum at Korea University and to provide baseline data for developing an improved premedical curriculum. A survey involving faculty, residents, and students from Korea University Medical School was conducted. The results of the study suggested that the current premedical curriculum was not relevant to future medical studies and the General Studies Program as a source for learning liberal arts and humanities, were not appropriate. There was a growing need for structural and functional integration between premedical and medical studies and in addition to requirement of reinforcing the social and human sciences into the premedical curriculum.