• Tuberculosis and Respiratory Diseases
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• v.54 no.2
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• pp.219-229
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• 2003

Background : The management of thoracic empyema and complicated parapneumonic effusion requires adequate antibiotics use and prompt drainage of infected pleural space. Tube thoracostomy for loculated empyema has low success rate and is also an invasive procedure with potential morbidity. Complications include hemothorax, perforation of intra-abdominal or intra-thoracic organs, diaphragmatic laceration, empyema, pulmonary edema, and Horner's syndrome. Given the potential morbidity of traditional chest tube insertion, use of the image-guided pigtail catheter drainage(PCD) of empyema has been employed. We retrospectively analyzed the medical records of patients with empyema or complicated parapneumonic effusion to determine the efficacy of percutaneous pigtail catheter drainage. Materials and Methods : 45 patients with complicated parapneumonic effusions or empyema were treated at Gil medical center from January 1998 to June, 1999. All were initially given PCD procedure and the following data were collected: clinical symptoms at the time of diagnosis, alcohol and smoking history, the characteristics of pleural effusion, radiologic findings (at the time of catheter insertion, removal and 1 month after catheter removal), the amount of effusion drained for initial 24 hours, the time from catheter insertion to removal and the use of surgical approach. Results : Male gender was more frequent (42 men vs. 3 women), the mean age of the study population was 52(range: 21~74) years. Empyema was found in 23 patients, complicated parapneumonic effusion in 22 patients. Four patients(three, parapneumonic effusion and one, with empyema) with PCD only treated, were cast off. Among the available patients, 36(80%) patients were treated with PCD only or PCD with urokinase. Among the 23 patients with empyema, surgical approach was required in five patients(27.1%, one required decortication, four open thoracostomy), one patient, treated with surgical procedure, died of sepsis. There was no significant difference of the duration of catheter insertion, the duration of hospital admission after catheter insertion and the mean amount of effusion drained for initial 24 hours between the patients with only PCD treated and the patients treated with PCD and urokinase. The duration of catheter insertion($9.4{\pm}5.25days$ vs. $19.2{\pm}9.42days$, p<0.05) and the duration of hospital admission after catheter insertion($15.9{\pm}10.45days$ vs. $38.6{\pm}11.46days$, p<0.01) of the patients with only PCD treated were more longer than those of the patients treated with surgical procedure after PCD. They were same between the patients treated with urokinase after PCD and the patients treated with surgical procedure after PCD($11.1{\pm}7.35days$ vs. $19.2{\pm}9.42days$, p<0.05, $17.5{\pm}9.17days$ vs. $38.6{\pm}11.46days$, p<0.01). In 16 patients(44.4%) with only PCD treated or PCD and urokinase treated, the amount of effusion at the time of catheter removal was decreased more than 75% and in 17 patients(47.2%) effusion decreased 50~75%. .In one patient effusion decreased 25~50%, in two patients effusion decreased less than 25%. One month after catheter removal, in 35 patients(97.2%, four patients were cast off), the amount of pleural effusion was successfully decreased more than 50%. There were no complications related to pigtail catheter insertion. Conclusion : In this study, PCD seemed to be an early efficacious procedure in treating the patients with complicated parapneumonic effusion or empyema without any serious procedure related complication.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.303-314
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• 2001

Background : Matrix metalioproteinase(MMP)-2 and MMP-9 have been known to play an important role in cell migration and the tissue remodeling process by type IV collagen lysis, a major component of the basement membrane. Intra-alveolar fibrosis, secondary to an injury to the basement membrane of the alveolar epithelial lining, is a major process in the pathogenesis of idiopathic pulmonary fibrosis(IPF). Therefore, MMP-2 and MMP-9 was hypothesized to play an important role in IPF pathogenesis. As a result, their level may reflect the activity or prognosis. Method : Forty one progressive IPF patients(age $59.82{\pm}1.73$ years, M:F=23:18), 16 patients with stable IPF for more than one year without therapy(age : $63.6{\pm}2.8$ years, M:F=13:3), and 7 normal controls were enrolled in this study. The MMP-2 and MMP-9 levels in the BAL fluid and alveolar macrophage conditioned media(AM-CM) were measured by zymography and the TIMP-1 level was measured by ELISA. Results : 1) The MMP-2 level in BALF was highest in the progressive IPF group ($1.36{\pm}0.28$) followed by the stable group ($0.46{\pm}0.13$) and the controls ($0.08{\pm}0.09$), which was statistically significant. The MMP-9 level of the IPF ($0.31{\pm}0.058$) and the stable group ($0.22{\pm}0.078$) were higher than that of the control group ($0.002{\pm}0.004$). In the AM-CM, only MMP-9 was detected, which was significantly higher in IPF group ($0.80{\pm}0.1O$) than in the control group($0.23{\pm}0.081$). The TIMP-1 level was also higher in both the IPF ($36.34{\pm}8.62\;{\mu}g/ml$) and stable group ($20.83{\pm}8.53\;{\mu}g/ml$) compared to the control group ($2.80{\pm}1.05\;{\mu}g/ml$) (p<0.05). 3) There was a correlation between the MMP-2 level in the BALF with the total cell number(r=0.298) and neutrophils(r=0.357) (p<0.05), and the MMP-9 level with the number of neutrophils (r=0.407) and lymphocytes (r=0.574)(p<0.05). The TIMP-1 level correlated with the total number of cell (r=0.338, p<0.05) and neutrophils(r=0.449, p=0.059). Conclusion : Both MMP and TIMP appear to play an important role in IPF pathogenesis, and their level may reflect the disease activity.

• Clinical and Experimental Pediatrics
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• v.48 no.3
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• pp.298-305
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• 2005

Purpose : We performed this study to evaluate the mean serum levels of insulin-like growth factor (IGF)-I, insulin-like growth factor binding protein(IGFBP)-2 and IGFBP-3 in healthy Korean children according to age and sex. Methods : Ninety two healthy children, consisting of 42 boys and 50 girls, were classified into five groups according to age : neonate; infancy; early childhood; late childhood; and adolescence. We measured serum levels of IGF-I, IGFBP-2 and IGFBP-3 by enzyme-linked immunosorbent assay(ELISA) and analysed the serum levels according to sex and age group. Results : For boys, the mean serum levels of IGF-I(ng/mL) in neonate, infancy, early childhood, late childhood and adolescence were $41.1{\pm}3.6$, $70.9{\pm}33.7$, $103.5{\pm}97.2$, $89.8{\pm}46.5$ and $51.4{\pm}27.8$, respectively. Those of IGFBP-2(ng/mL) were $8.2{\pm}3.4$, $5.8{\pm}0.4$, $9.3{\pm}4.0$, $9.5{\pm}1.1$ and $7.0{\pm}0.5$, respectively. Those of IGFBP-3(ng/mL) were $559.2{\pm}215.2$, $1,333.3{\pm}692.5$, $2,254.6{\pm}1,513.8$, $2,447.1{\pm}1,464.2$, $1,533.6{\pm}807.4$, respectively. For girls, the mean serum levels of IGF-I(ng/mL) according to five age groups were $53.3{\pm}9.5$, $99.3{\pm}45.8$, $69.6{\pm}51.1$, $106.2{\pm}67.0$ and $145.1{\pm}127.8$, respectively. Those of IGFBP-2 (ng/mL) were $9.1{\pm}7.4$, $5.3{\pm}0.9$, $6.9{\pm}2.0$, $10.5{\pm}3.0$ and $7.9{\pm}1.3$, respectively. Those of IGFBP-3(ng/mL) were $858.2{\pm}433.4$, $1,834.8{\pm}851.3$, $1,404.3{\pm}570.2$, $2,203.5{\pm}899.4$ and $2,029.3{\pm}1,316.7$, respectively. There were significant positive correlations observed between IGF-I and IGFBP-3 levels(r=0.589, P=0.000). Conclusion : IGF-I and IGFBP-3 levels increased as children get older. The peak level of IGFBP-3 was observed in late childhood for both boys and girls, suggesting a current trend of children reaching peak growth velocity before adolescence. The IGFBP-2 level was higher in neonates compare to infancy, suggesting that IGFBP-2 is an important substance for fetal growth.

• The korean journal of orthodontics
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• v.31 no.2 s.85
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• pp.225-236
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• 2001

It is widely accepted that the shape and structure of bone are closely related to the activity of attached muscle. Numerous clinical and animal experimental studies indicated the significant effects of masticatory muscle function on maxillofacial morphology. Recently, the development of ultrasonography has spread throughout different fields of medicine. In the clinical examinations, ultrasonography is a convenient, inexpensive technique to apply with accurate and reliable results. The aim of this study is to assess the thickness of the masseter muscle and its correlation to maxillofacial skeleton by examining 35 male and 15 female dental students at Kangnung National University. The masseter muscle thickness of the subjects were measured by ultrasonographic scanning with a 7.5MHz linear probe, and their maxillofacial morphology were investigated by lateral cephalometric radiographs. The relationship between the masseter muscle thickness and maxillofacial morphology of normal adult was statistically analyzed, and the following results were obtained. 1. The average thickness of male masseter muscle was 13.8${\pm}$1.71mm in the relaxed state and 14.8${\pm}$1.77mm at maximal clenching state, while that of female was 11.6${\pm}$1.58mm and 12.4${\pm}$1.47mm, respectively. Ethnic difference in thickness of the masseter muscle and maxillofacial skeleton was found when the results of many researchers were compared with those of this study. 2. The thickness of the masseter muscle in both sexes increased significantly at maximal clenching state than in relaxed state(P<0.05). 3. The masseter muscle thickness of male was greater than that of female both in the relaxed state and maximal clenching states(P<0.05). 4. In males, the thickness of the masseter muscle was negatively correlated with the mandibular plane angle and positively correlated with the mandibular ramus height and anterior cranial base length(P<0.05). It may suggest that the male with thicker masseter muscle has smaller facial divergence. 5. No significant correlation was found between the masseter muscle thickness and maxillofacial morphology in females(P<0.05). Therefore, these data suggest that ultrasonography can add valuable information to the conventional examinations of masseter muscle function.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.600-612
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• 1996

Background : Recent studies deported that untreated patients with obstructive sleep apnea syndrome had high long-term mortality rates, and cardiovascular complications of these patients clad a major effect on mortality. Several data indicates that obstructive sheep apnea syndrome contributes to the development of diurnal systemic hypertension. But the pathophysiological mechanism of the development of systemic hypertension in these patients is still uncertain. This study was performed to evaluate the possible role of sympathetic nervous system activity for the development of systemic hypertension in patients with obstructive sleep apnea syndrome. Method : 35 patients with obstructive sleep apnea syndrome(OSAS) and 13 Control subjects(control) were included in this study. 21 patients of OSAS were normotensives(OSAS-NBP), and 14 patients of OSAS were hypertensives(OSAS-HBP). Full night polysomnography was undertaken to all subjects. We measured plasma norepinephrine(NE) and epinephrine(EP) concentrations during waking and sleep, using high performance liquid chromatography, in all patients and control subjects. Results : In OSAS, OSAS-NBP and control, plasma NE and EP concentrations during sleep were lowed than during waking(p<0.01). But, in OSAS-HBP, these was no difference between during waking and sleep. Plasma NE concentrations during sleep of OSAS, OSAS-NBP and OSAS-HBP were higher than Control(p<0.05). In OSAS-HBP, daytime systolic blood pressure correlated with plasma NE concentration during sleep(r=0.7415, p<0.01), arid correlated inversely with mean arterial oxygen saturation(r=-0.6465, p<0.05) or arterial oxygen saturation nadir(r=-0.6) 14, p<0.05) during sleep. Conclusion : The sympathetic activity during sleep of obstructive sleep apnea syndrome patients was higher than control subjects. In obstructive sleep apnea syndrome patients with systemic hypertension, there was no diurnal variation of sympathetic activity, and there was correlation between daytime systolic blood pressure and sympathetic activity during sleep. These data suggests that chronic hyperactivity of sympathetic nervous system may contribute to the development of diurnal systemic hypertension in patients with obstructive sleep apnea syndrome.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.21-25
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• 2010

Purpose: For better PET imaging with accuracy the transmission scanning is inevitably required for attenuation correction. The attenuation is affected by condition of acquisition and patient position, consequently quantitative accuracy may be decreased in emission scan imaging. In this paper, the present study aims at providing the measurement for attenuation varying with the positions of the patient's arm in whole body PET/CT, further performing the comparative analysis over its SUV changes. Materials and Methods: NEMA 1994 PET phantom was filled with $^{18}F$-FDG and the concentration ratio of insert cylinder and background water fit to 4:1. Phantom images were acquired through emission scanning for 4min after conducting transmission scanning by using CT. In an attempt to acquire image at the state that the arm of the patient was positioned at the lower of ahead, image was acquired in away that two pieces of Teflon inserts were used additionally by fixing phantoms at both sides of phantom. The acquired imaged at a were reconstructed by applying the iterative reconstruction method (iteration: 2, subset: 28) as well as attenuation correction using the CT, and then VOI was drawn on each image plane so as to measure CT number and SUV and comparatively analyze axial uniformity (A.U=Standard deviation/Average SUV) of PET images. Results: It was found from the above phantom test that, when comparing two cases of whether Teflon insert was fixed or removed, the CT number of cylinder increased from -5.76 HU to 0 HU, while SUV decreased from 24.64 to 24.29 and A.U from 0.064 to 0.052. And the CT number of background water was identified to increase from -6.14 HU to -0.43 HU, whereas SUV decreased from 6.3 to 5.6 and A.U also decreased from 0.12 to 0.10. In addition, as for the patient image, CT number was verified to increase from 53.09 HU to 58.31 HU and SUV decreased from 24.96 to 21.81 when the patient's arm was positioned over the head rather than when it was lowered. Conclusion: When arms up protocol was applied, the SUV of phantom and patient image was decreased by 1.4% and 9.2% respectively. With the present study it was concluded that in case of PET/CT scanning against the whole body of a patient the position of patient's arm was not so much significant. Especially, the scanning under the condition that the arm is raised over to the head gives rise to more probability that the patient is likely to move due to long scanning time that causes the increase of uptake of $^{18}F$-FDG of brown fat at the shoulder part together with increased pain imposing to the shoulder and discomfort to a patient. As regarding consideration all of such factors, it could be rationally drawn that PET/CT scanning could be made with the arm of the subject lowered.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.159-165
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• 2010

Purpose: Positron emission tomography scan has been growing diagnostic equipment in the development of medical imaging system. Compare to $^{99m}Tc$ emitting 140 keV, Positron emission radionuclide emits 511 keV gamma rays. Because of this high energy, it needs to reduce radioactive emitting from patients for radiotechnologist. We searched the external dose rates by changing distance from patients and measure the external dose rates when we used shielder investigate change external dose rates. In this study, the external dose distribution were analyzed in order to help managing radiation protection of radiotechnologists. Materials and Methods: Ten patients were searched (mean age: $47.7{\pm}6.6$, mean height: $165.5{\pm}3.8$ cm and mean weight: $65.9{\pm}1.4$ kg). Radiation were measured on the location of head, chest, abdomen, knees and toes at the distance of 10, 50, 100, 150 and 200 cm. Then, all the procedure was given with a portable radiation shielding on the location of head, chest and abdomen at the distance of 100, 150 and 200 cm and transmittance was calculated. Results: In 10 cm, head (105.40 ${\mu}Sv/h$) was the highest and foot (15.85 ${\mu}Sv/h$) was the lowest. In 200 cm, head, chest and abdomen showed similar. On head, the measured dose rates were 9.56 ${\mu}Sv/h$, 5.23 ${\mu}Sv/h$, and 3.40 ${\mu}Sv/h$ in 100, 150 and 200 cm respectively. When using shielder, it shows 2.24 ${\mu}Sv/h$, 1.67 ${\mu}Sv/h$, and 1.27 ${\mu}Sv/h$ in 100, 150 and 200 cm on head. On chest, the measured dose rates were 8.54 ${\mu}Sv/h$, 4.90 ${\mu}Sv/h$, 3.44 ${\mu}Sv/h$ in 100, 150 and 200 cm, respectively. When using shielder, it shows 2.27 ${\mu}Sv/h$, 1.34 ${\mu}Sv/h$, and 1.13 ${\mu}Sv/h$ in 100, 150 and 200 cm on chest. On abdomen, the measured dose rates were 9.83 ${\mu}Sv/h$, 5.15 ${\mu}Sv/h$ and 3.18 ${\mu}Sv/h$ in 100, 150 and 200cm respectively. When using shielder, it shows 2.60 ${\mu}Sv/h$, 1.75 ${\mu}Sv/h$ and 1.23 ${\mu}Sv/h$ in 100, 150 and 200 cm on abdomen. Transmittance was increased as the distance was expanded. Conclusion: As the distance was further, the radiation dose were reduced. When using shielder, the dose were reduced as one-forth of without shielder. The Radio technologists are exposed of radioactivity and there were limitations on reducing the distance with Therefore, the proper shielding will be able to decrease radiation dose to the radiotechnologists.

• The Korean Journal of Nuclear Medicine Technology
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• v.22 no.1
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• pp.90-97
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• 2018

Purpose The lung segment ratio which is obtained through quantitative analyses of lung perfusion scan images is calculated to evaluate the lung function pre and post surgery. In this Study, the planar image production methods by using Q-Metrix (GE Healthcare, USA) program capable of not only quantitative analysis but also computation of the segment ratio after having performed SPECT/CT are comparatively evaluated. Materials and Methods Lung perfusion scan and SPECT/CT were performed on 50 lung cancer patients prior to surgery who visited our hospital from May 1, 2015 to September 13, 2016 by using Discovery 670(GE Healthcare, USA) equipment. AP(Anterior Posterior)method that uses planar image divided the frontal and rear images into three rectangular portions by means of ROI tool while PO(Posterior Oblique)method computed the segment ratio by dividing the right lobe into three parts and the left lobe into two parts on the oblique image. Segment ratio was computed by setting the ROI and VOI in the CT image by using Q-Metrix program and statistically analysis was performed with SPSS Ver. 23. Results Regarding the correlation concordance rate of Q-Metrix and AP methods, RUL(Right upper lobe), RML(Right middle lobe) and RLL(Right lower lobe) were 0.224, 0.035 and 0.447. LUL(Left upper lobe) and LLL(Left lower lobe) were found to be 0.643 and 0.456, respectively. In the PO method, the right lobe were 0.663, 0.623 and 0.702, respectively, while the left lobe were 0.754 and 0.823. When comparison was made by using the Paired sample T-test, Right lobe were $11.6{\pm}4.5$, $26.9{\pm}6.2$ and $17.8{\pm}4.2$, respectively in the AP method. Left lobe were $28.4{\pm}4.8$ and $15.4{\pm}5.6$. The right lobe of PO had values of $17.4{\pm}5.0$, $10.5{\pm}3.6$ and $27.3{\pm}6.0$, while the left lobe had values of $21.6{\pm}4.8$ and $23.1{\pm}6.6$, thereby having statistically significant difference in comparison to the Q-Metrix method for each of the lobes (P<0.05). However, there was no statistically significant difference in Right middle lobe (P>0.05). Conclusion The AP method showed low concordance rate in correlation with the Q-Metrix method. However, PO method displayed high concordance rate overall. although AP method had significant differences in all lobes, there was no significant difference in Right middle lobe of PO method. Therefore, at the time of production of lung perfusion scan results, utilization of Q-Metrix method of SPECT/CT would be useful in computation of accurate resultant values. Moreover, it is deemed possible to expect obtain more practical sectional computation result values by using PO method at the time of planar image acquisition.

• The Korean Journal of Nuclear Medicine
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• v.32 no.6
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• pp.490-496
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• 1998

Purpose: We evaluated brain perfusion SPECT findings of MELAS syndrome and mitochondrial myopathy in correlation with MR imaging in search of specific imaging features. Materials and Methods: Subjects were five patients (four females and one male; age range, 1 to 25 year) who presented with repeated stroke-like episodes, seizures or developmental delay or asymptomatic but had elevated lactic acid in CSF and serum. Conventional non-contrast MR imaging and Tc-99m-ethyl cysteinate dimer (ECD) brain perfusion SPECT were Performed and imaging features were analyzed. Results: MRI demonstrated increased T2 signal intensities in the affected areas of gray and white matters mainly in the parietal (4/5) and occipital lobes (4/5) and in the basal ganglia (1/5), which were not restricted to a specific vascular territory. SPECT demonstrated decreased perfusion in the corresponding regions of MRI lesions. In addition, there were perfusion defects in parietal (1 patient), temporal (2), and frontal (1) lobes and basal ganglia (1) and thalami (2). In a patient with mitochondrial myopathy who had normal MRI, decreased perfusion was noted in left parietal area and bilateral thalami. Conclusion: Tc-99m ECD SPECT imaging in patients with MELAS syndrome and mitochondrial myopathy showed hypoperfusion of parieto-occipital cortex, basal ganglia, thalamus and temporal cortex, which were not restricted to a specific vascular territory. There were no specific imaging features on SPECT. The significance of abnormal perfusion on SPECT without corresponding MR abnormalities needs to be evaluated further in larger number of patients.

• Clinical and Experimental Pediatrics
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• v.51 no.6
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• pp.634-639
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• 2008

Purpose : There has been considerable disagreement regarding the most appropriate dosage of gonadotropin-releasing hormone agonist in cases of central precocious puberty. The aim of this study was to determine the appropriate dosage for suppression of the puberty in girls with central precocious or early puberty. Methods : Twenty-two girls with early puberty were randomly subjected to 3 types of dosages of leuprolide acetate for at least 6 months. The number of cases in groups 1, 2, and 3 were 7, 7, and 8, and dosages were 70, 90, and $110{\mu}g/kg/-month$, respectively. Height, weight, bone age, Tanner stage of breast development, and serum levels of LH, FSH, estradiol, and progesterone were measured before treatment and after 6 months of treatment. The number of cases of puberty suppression was compared using a modified puberty suppression score with a nonparametric chi-square test. Results : There were no significant differences of chronologic and bone ages among the groups. There was a significant decrease in height SDS gain after 6 months in group 3 (P<0.05) compared with groups 1 and 2. Serum levels of LH, FSH, estradiol and progesterone were all significantly decreased after treatment in all 3 groups (P<0.05). The number of cases of puberty suppression in each group were 4 (57%), 5 (71%), and 8 (100%). There was a significantly increased proportion of suppression of puberty in group 3 (P<0.05). Conclusion : It was necessary to use a higher dose of gonadotropin-releasing hormone agonist to suppress early puberty in girls; however further longitudinal study will be needed for their prognosis of final adult height.