An analytic expression for equivalent square fields and a table are derived using the empirical representations obtained from the measured field size dependence of output for square field in a phantom. The expression is applicable to radiation fields that consistent with the following two assumptions imposed on these representations. 1) It is a linear function of the logarithm of the field area. 2) It is approximately the same function for both square and circular field of similar areas. In this paper, the derived tables and BJR table were consulted.

Using same TDE factors, the authors studied the effects of whole abdominal irradiation on body weight and peripheral blood picture in 30±3 day old mice. Fractions of 100 and 200 cGy were given five times a week to the final TDF factors 17, 33, and 49. Total 80 mice were irradiated with orthovoltage x-ray machine. Our results can be summarized as follows: There were no significant differences by sex. Body weight was progressively decreased by the duration for irradiation, but no remarkable difference by fractional dose. Hemoglobin level showed no remarkable change by fractional dose or TDF factors. Leukopenic changes showed that severity of decrease seems to be more related to TDF factors. There were no significant changes of differential count by TDF factors of total doses.
Animals ; Body Weight* ; Dichlorodiphenyldichloroethane ; Mice*

In recent years there has been a growing interest in all forms of rotational therapy, and many different types of therapy machines designed for this kind of treatment have become available. To the medical radiation physicist, the dosimetry of rotation therapy has presented a number of interesting problems, and much useful work has been published on the basic date of dose distribution and dosage calculation. The setting dose for ARC therapy were obtained by computer calculation and measurement with cylindrical phantom. Authors compared computer calculation with measured value. And in ARC therapy, the region of maximum dose in shifted from the tumor center. The extent of shift was analyzed by isodose distribution for ARC therapy techniques.
Particle Accelerators*

The sign of Leser-Trelat refers to the sudden appearance and rapid increase in size and number of freckles and seborrheic keratoses, It is considered to be a sign of internal malignant tumors, most probable of the gastrointestinal tract. We report a case of adenocarcinoma of the stomach associated with the sign of Leser-Trelat and the literatures were reviewed. This 62-year-old man, over a period of 5 months, developed multiple seborrheic keratoses over his trunk and extremities. He came to our department in August 1981, because of sudden increse in their number and size during the several preceding months. He had never complained of the symptoms of gastrointestinal tract such as gastric pain, vomiting, indigestion, and weight loss. On examination of the skin, hundreds of brown or brown-black, more or less greasy verrucous papules were found almoat exclusively on the extensor aspects of forearms and lower legs. These lesions were variable in size and were consistent clinically with seborrheic keratoses. The findings of both fiberoptic biopsy and upper gastrointestinal tract series of roentgenographic studies were compatible with ulcer and adenocarcinoma of the stomach. Based on our experience, it is again suggested that though seborrheic keratoses are very common in the elderly, the rapid increase in size and number should arouse suspicion of an internal malignancy.
Adenocarcinoma ; Aged ; Biopsy ; Dyspepsia ; Extremities ; Forearm ; Gastrointestinal Tract ; Humans ; Keratosis, Seborrheic ; Leg ; Melanosis ; Middle Aged ; Skin ; Stomach ; Ulcer ; Upper Gastrointestinal Tract ; Vomiting ; Weight Loss

Diiodohydroxyquin introduced by Dillaha et al in 1953, had been the mainstay for the treatment of acrodermatitis enteropathica (A.E.). However, following the report by Moynahan and Barnes in 1973 of successful treatment with the oral administration of zinc sulfate, the clinical response to this treatment has been confirmed by different investigators in many countries. In Korean literature, Rhim et al reported two cases of A,E. in siblings successfully treated with oral zinc sulfate in 1980. In our case of cow's milk-fed, 7 month-old male infant, typical claasical features of total alopecia, diarrhea and periorificial dermatitis developed at about 3 months. of age and the zinc level in serum was 101 ug/dl at the first visit. Treatment first with diiodohydroxyquin was initiated at a dose of 315 mg/day by mouth for the first week and 630 mg/day for the second week, but this therapeutic regimen brought about little or no effect. Because of no definite improvement even with increasing dose of 1260 mg/day for another week, treatment was. changed to oral zinc sulfate. The patient began to receive zinc sulfate 50mg at first day by mouth and the dosage was immediately increased to l00mg daily from the next day. Within 72 hrs there found dramatic improvement in the skin lesions and diharrhea stopped. Twenty days after the start of zinc therapy, nearly all the skin lesions disappeared and the patient was discharged in satisfactory condition with only mild residual erythema. (countinued..)
Acrodermatitis* ; Administration, Oral ; Alopecia ; Dermatitis ; Diarrhea ; Erythema ; Humans ; Infant ; Iodoquinol ; Male ; Mouth ; Research Personnel ; Siblings ; Skin ; Zinc ; Zinc Sulfate

BACKGROUND: The purpose of this study was to investigate the characteristics of and to analyze the factors re-lated to the cost of the resolution of a medical dispute. METHODS: We have reviewed 2,346 cases reported to the Korean Medical Association(KMA)mutual-aid association from Nov. 1. 1981 to Oct. 31. 1994. RESULTS: The percentage rate of reported cases of were related field as follows .' obstetric gynecology(OBGYN) 31.9%, general practitice 28.1%, general surgery 13.3%, orthopedics 6.9% and internal medicine 6.4% 1,829 cases (80.0%) were settled out of court and without public intervention. 310 cases(13.2%) were settled by the police, the public procurators office or the court. The mean settlement amount per case was 9,340,000 won with annual growth rate 10.8%, and median settlement amount was 5,890,000 won. The mean settlement amount for OBGYN was 930,000 won, surgical group 8,900,000 won, medical group 7,710,000 won, and general practitice 7,490,000 won. The cases of medical dispute according to the types of medical care were : operation 21.1%, injection 18.0%, treat-ment and care 18.0%, delivery 13.0%, artificial abortion 10.3%, Cesarian section 7.2% and anesthesia 2.5%. The mean settlement amount according to the types of medical care were: delivery and Cesarian section 15,190,000 won, operation and anesthesia 9,500,000 won, others 6,610,000 won, and injection and medication 6,230,000 won. The mean settlement amount that was settled out of court without public intervention was 7,940,000 won. The mean settlement with public intervention in the court was 17,290,000 won. The cases of medical dispute according to the patients status were .' death 37.5%, complications 20.8%, disability 12.2% and others 28.9%. The mean settlement amout for death was 16,150,000 won, disability 9,430,000 won, others 4,850,000 won and complications 3,550,000 won. The mean settlement amount where doctors have asserted that the outcome was inevitable or have not agreed that it was their fault was higher than the cost of cases where they had admitted responsibility. The settlement amout where there was a misdiagnosis present had not shown to be higher than when the misdiagnosis was absent. The mean settlement amount for cases where multiple doctors were involved was higher than for cases of a single doctor. The mean settlement amount for disturbing the medical practice and suspension of are high. The mean settlement amount for complications was lower than others, and the mean settlement amount for disability and death presented were high. Concerning the types of care, the mean settlement amount for operation/anesthesia, delivery/ Cesarian sections were higher than for injection/medication. Concerning the type of settlement, the mean settlement amount in the police and public procurators office was higher than in out of court without public intervention. CONCLUSIONS: The mean settlement amount depended on the patient's status, the type of settlement, and the disturbance of medical practice regardless of the doctors misdiagnosis, fault, and standard care. Therefore, a reason-able method of resolution for medical dispute is needed.
Anesthesia ; Diagnostic Errors ; Dissent and Disputes ; Humans ; Internal Medicine ; Malpractice* ; Orthopedics ; Police

The primary treatment modality of malignant tumors of the nasopharynx is radiation therapy owing to its inaccessibility to surgical intervention. Over the last two decades there were many changes in techniques of delivery, which include the use of higher doses of radiotherapy, the use of wide radiation field, including the elective radiation of the whole neck, the combined use of brachy- and teletherapy, and the use of split-course therapy. In spite of these advances local and regional recurrences remain the major cause of death. As a boost therapy after external irradiation, high-dose-rate intracavitary irradiation using remote control afterloading system (RALS) was used in two patients. Our results were satisfactory, however, this procedure should only be performed by those who have developed enough expertise in the use of intracavitary techniques for the treatment of nasopharyngeal cancer and have a supportive team including a physicist, dosimetrist, nurse, and trained technologist.
Cause of Death ; Humans ; Nasopharyngeal Neoplasms ; Nasopharynx ; Neck ; Radiotherapy ; Recurrence

PURPOSE: The object of this study is to evaluate bone metabolism in healthy adolescents according to the progression of puberty. METHODS: Forty boys(13.9+/-1.7 years) and 42 girls(12.1+/-1.6 years) were classified by Tanner stage (TS) and bone age. Serum levels of osteocalcin(OC) and bone specific alkaline phosphatase(BALP) were measured as bone formation markers. Serum level of C-terminal telopeptide of type I collagen (ICTP) and urinary N-terminal telopeptide of type I collagen(NTx) concentrations adjusted by creatinine concentrations were measured as bone resorption markers. Serum or urine levels of bone turnover markers in each pubertal development group and bone age group were analysed. RESULTS: In boys, BALP and OC levels increased to peak levels significantly(P<0.05), and decreased significantly(P<0.05) from the peak levels to the levels at TS 5. ICTP and NTx levels seemed to increase to peak levels and to decrease from the peak levels to the levels at TS 5. But there were no significant differences except decreasing NTx levels. All showed peak levels between 13 and 15 years of bone age. In comparison with each TS group, BALP and OC levels were significantly different(P<0.05) between each TS group, but ICTP and NTx were not. In girls, the levels of all bone markers seemed to increase to peak levels without significance, and then decrease significantly(P< 0.05). All showed peak levels between 11 and 13 years of bone age. All except ICTP level were significantly different between each TS group(P<0.05). CONCLUSION: The bone metabolism seems to increase as progression of puberty, and to decrease during late puberty. Bone formation markers levels change more actively, rather than bone resorption markers levels during puberty. And the increment of bone formation in early puberty is more significant in boys rather than in girls.
Adolescent ; Bone Resorption ; Collagen Type I ; Creatinine ; Female ; Humans ; Metabolism* ; Osteogenesis ; Puberty*

PURPOSE: The incidence of type 2 diabetes in children and adolescents has been reported to increase recently. The aim of this study is to investigate the clinical features of type 2 diabetes developing during childhood and adolescent period. METHODS: The medical records of 33 patients with type 2 diabetes were reviewed. We analysed clinical manifestations, demographic data, and modes and responses of treatment. RESULTS: Age at diagnosis was 13.4+/-1.8 years. Seventy percent of patients revealed pubertal signs at diagnosis. Half of the patients had BMI more than 25 kg/m2. Seventy-three percent of patients had family history of type 2 diabetes. Acanthosis nigricans were found in 18% of patients. Nineteen(57.6%) patients were diagnosed incidentally by random urine or blood glucose test without any typical diabetic symptom or sign. The modes of therapy to control hyperglycemia were insulin alone(75.8%), oral hypoglycemic agents alone(9.1%), insulin and oral hypoglycemia agents(9.1%), and only diet with exercise(6%). At the time of investigation, 45.5% of patients were not using insulin. The typical diabetic symptoms at diagnosis were more prevalent in patients who required insulin for more than two years than patients who did not(P<0.05). CONCLUSION: The development of type 2 diabetes in children and adolescents is possibly related to puberty, obesity, family history, and defects in insulin secretion rather than insulin resistance. Many children and adolescents with type 2 diabetes required insulin initially and some of them could discontinue. More than half of the patients were diagnosed as diabetes without any typical symptom or sign, which might be one of the predictive factors of the prolonged insulin requirement.
Acanthosis Nigricans ; Adolescent* ; Blood Glucose ; Child* ; Diagnosis ; Diet ; Humans ; Hyperglycemia ; Hypoglycemia ; Hypoglycemic Agents ; Incidence ; Insulin ; Insulin Resistance ; Medical Records ; Obesity ; Puberty

BACKGROUND/AIMS: The mortality after pancretoduodenenctomy is decreased to less than 5 % in centers with experience. The morbidity, however, still remains high although the decrease has also been demonstrated. The aim of this study was to identify risk factors responsible for major complications following pancreatoduodenectomy. METHODS: Various features of forty nine consecutive patients who underwent pancreatoduodenectomy from 1990 to 1999 were statistically analyzed to determine risk factors for major postoperative complications. Anastomotic leakages, intraabdominal hemorrhage and intraabdominal abcess were categorized as major postoperative complication. RESULTS: In our series, postoperative mortality and morbidy rate were 6.1% and 51.0%, respectively. Seventeen major complications were found in 14 patients(28.6%): 7 cases with pancreaticojejuostomy leakage, 4 cases with biliojejunostomy leakage, 3 cases with intraabdominal hemorrhage and 1 case with intraabdominal abcess. The statistical analysis revealed that episode of intraoperative hypotension was the only independent risk factor for major postoperative complication.(Odds ratio: 25.4849, p=0.0048) CONCLUSION: Careful intraoperative management for maintenance of adequate blood pressure in hemodynamically unstable patients is important to reduce major complications after pancreatoduodenectomy.
Anastomotic Leak ; Blood Pressure ; Hemorrhage ; Humans ; Hypotension ; Mortality ; Pancreaticoduodenectomy* ; Postoperative Complications ; Risk Factors*