• Nuclear Medicine and Molecular Imaging
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• v.42 no.4
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• pp.285-291
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• 2008

Purpose: Although automatic quantification software of myocardial perfusion SPECT provides highly objective and reproducible quantitative measurements, there is still some limitation in the direct use of quantitative measurements. In this study we derived parameters using normal variation of perfusion measurements, and tried to test the usefulness of these parameters. Materials and Methods: In order to calculate normal variation of perfusion measurements on myocardial perfusion SPECT, 55 patients (M:F = 28:27) of low-likelihood for coronary artery disease were enrolled and $^{201}TI$ rest/$^{99m}Tc$-MIBI stress SPECT studies were performed. Using 20-segment model, mean (m) and standard deviation (SD) of perfusion were calculated in each segment. As a myocardial viability assessment group, another 48 patients with known coronary artery disease, who underwent coronary artery bypass graft surgery (CABG) were enrolled. $^{201}TI$ rest/$^{99m}Tc$-MIBI stress / $^{201}TI$ 24-hr delayed SPECT was performed before CABG and SPECT was followed up 3 months after CABG. From the preoperative 24-hr delayed SPECT, $Q_{delay}$ (perfusion measurement), ${\Delta}_{delay}$ ($Q_{delay}$ - m) and $Z_{delay}$ (($Q_{delay}$ - m)/SD) were defined and diagnostic performances of them for myocardial viability were evaluated using area under curve (AUC) on receiver operating characteristic (ROC) curve analysis. Results: Segmental perfusion measurements showed considerable normal variations among segments. In men, the lowest segmental perfusion measurement was $51.8{\pm}6.5$ and the highest segmental perfusion was $87.0{\pm}5.9$, and they are $58.7{\pm}8.1$ and $87.3{\pm}6.0$, respectively in women. In the viability assessment $Q_{delay}$ showed AUC of 0.633, while those for ${\Delta}_{delay}$ and $Z_{delay}$ were 0.735 and 0.716, respectively. The AUCs of ${\Delta}_{delay}$ and $Z_{delay}$ were significantly higher than that of $Q_{delay}$ (p = 0.001 and 0.018, respectively). The diagnostic performance of ${\Delta}_{delay}$, which showed highest AUC, was 85% of sensitivity and 53% of specificity at the optimal cutoff of -24.7. Conclusion: On automatic quantification of myocardial perfusion SPECT, the normal variation of perfusion measurements were considerable among segments. In the viability assessment, the parameters considering normal variation showed better diagnostic performance than the direct perfusion measurement. This study suggests that consideration of normal variation is important in the analysis of measurements on quantitative myocardial perfusion SPECT.

• Proceedings of the Mineralogical Society of Korea Conference
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• 2003.05a
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• pp.51-51
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• 2003

임진강대의 변성이질암은 전형적인 바로비안형 변성분대를 보이며, 남쪽으로 갈수록 변성도가 증가하여 석류석$\longrightarrow$십자석$\longrightarrow$남정석 대를 정의한다. 우리는 반상변정의 성장과 여러번에 걸친 광역변형작용의 연관성을 밝히기 위해 광물의 반응관계와 성장순서 그리고 미구조(microstructure)를 -특히 석류석에 대해서- 연구하였다. 임진강대는 크게 세 번에 걸쳐 변형작용을 받은 것으로 해석된다: (1) 지각 두께의 증가에 수반된 압축변형작용 (D$_{n-1}$), (2) 주 엽리(Sn)를 만든 변형작용(Dn), 그리고 (3) 연성전단작용에 수반된 신장변형작용(D$_{n+1}$ ). 석류석대의 석류석 반상변정에서는 약간 휘어진 포유물 궤적(inclusion trail)이 주 엽리면에 대해 연속적이며, 이는 Dn과 동시기에 반상변정이 생성되었음을 지시한다. 이러한 석류석은 녹니석과 백운모로 구성된 주 엽리를 치환하면서 자라기 때문에, 녹니석+백운모+석영=석류석+흑운모+$H_2O$의 반응에 의해 만들어진 것으로 해석된다. 석류석 자형변정(idioblast)이 주 엽리를 자르면서 성장하기도 하는데, 이는 Dn 이후에도 석류석이 후구조(post-tectonic) 광물로 성장했음을 지시한다. 또한, 이러한 석류석은 흑운모를 치환하기 때문에, 동구조(syn-tectonic) 석류석의 생성반응에서와는 달리 흑운모가 반응물임을 알 수 있다. 한편, 십자석대의 석류석은 포유물 궤적에 의해 정의되는 S$_{n-1}$면이 주 엽리면과 사각을 이루며 단속적이기 때문에, D$_{n-1}$과 Dn 사이에 자란 것으로 해석된다. 이와는 대조적으로 십자석은 주 엽리를 치환하면서 자라고 있어서 Dn과 동시기 혹은 Dn 이후에 자랐을 것으로 해석된다..의 환경문제를 발생하지 않으며, 공정액에 첨가제를 투입하지 않으므로 순환형 친환경공정으로 각광받을 수 있다. 본 연구에서는 고온, 고농도의 NaOH 수용액의 처리에 적합한 막소재와 발생될 수 있는 제반 문제점 등을 파악하였고, 장기간의 실험을 거쳐 최적 투과 압력(Trans membrane pressue), 세정 조건 및 주기, 막재질에 있어서 보강하여야 할 Point, 최적 운전 조건들을 토출해 내었고, 향후 실제 Plant에 적용할 계획이다.는 양적으로 다른 두 가지의 유사한 마그마가 수반된 것으로 추정된다. 것으로 추정된다.를 사용하지 않음으로써 효과적이고 만족할 만한 심근보호 효과를 보였다.를 보였다.4주까지에서는 비교적 폐포는 정상적 구조를 유지하면서 부분적으로 소폐동맥 중막의 비후와 간질에 호산구 침윤의 소견이 특징적으로 관찰되었다. 결론: 분리 폐 관류는 정맥주입 방법에 비해 고농도의 cisplatin 투여로 인한 다른 장기에서의 농도 증가 없이 폐 조직에 약 50배 정도의 고농도 cisplatin을 투여할 수 있었으며, 또한 분리 폐 관류 시 cisplatin에 의한 직접적 폐 독성은 발견되지 않았다이 낮았으나 통계학적 의의는 없었다[10.0%(4/40) : 8.2%(20/244), p>0.05]. 결론: 비디오흉강경술에서 재발을 낮추기 위해 수술시 폐야 전체를 관찰하여 존재하는 폐기포를 놓치지 않는 것이 중요하며, 폐기포를 확인하지 못한 경우와 이차성 자연기흉에 대해서는 흉막유착술에 더 세심한 주의가 필요하다는 것을 확인하였다. 비디오흉강경수술은 통증이 적고, 입원기간이 짧고, 사회로의 복귀가 빠르며, 고위험군에 적용할 수 있고, 무엇보다도 미용상의 이점이 크다는 면에서 자연기흉에 대해 유용한 치료방법임에는 틀림이 없으나 개흉술에 비해 재발율이 높고 비용이 비싸다는 문제가 제기되고 있는 만큼 더 세심한 주의와 장기 추적관찰이 필요하리라 사료된다.전 도부타민 심초음파는 관상동맥우회로술 후

• Journal of Chest Surgery
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• v.30 no.2
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• pp.152-157
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• 1997

From August 1986 until June 1995, single aortic valve replacement was performed in 65 patients at the Chonnam National University Hospital. worthy-eight were male and 17 were female patients, ranging from 19 to 68 years of age(median : 43 years). The causes of the valve lesions were rheumatic in 29 patients (44.6%), bicuspid aortic valve in 6 patients (6.2%), endocarditis in 6 patients(6.2%), unknown in others. Concomitant surgical procedures were performed in 10 patients : repair of congenital defect in 5, pericardiectomy in 1, coronary artery bypass grafting in 1, noncoronary sinus plication in 1, Valsalva sinus aneurysmectomy in 1, subaortic membrane resection in 1 Used valves were 51. Jude-Medical valve in 42, Duromedics valve in 22, Bjork-Shiley valve in 2, Carpentier-Edward valve in 1. There were 3 hospital deaths (4.6%), and 2 late deaths (3.2%). Follow-up was 95.2% complete. The 10-year acturlal survival rate was 85.3%. Postoperative complications were low cardiac utput in 8, arrythmia in 5, valve related hemolysis in 1, cerebral infarction in 1, and gastrointestinal bleeding in 2. Reoperation was performed in 4 for surgical bleeding, in 3 for paravalvular leak. The mean improvement in New York Heart Association functional class is from 2.79 $\pm$ 0.66 preoperatively to 1.25 $\pm$ 0.49 postoperatively(p < 0.001) The change of cardiothoracic ratio from preoperative to postoperative is 0.57 $\pm$ 0.06 to 0.54 $\pm$ 0.05 (p < 0.05). The left ventricular ejection fraction change is not significant perioperatively. There are no mechanical failures. This early and intermediate-term follow-up suggests that in adults in whom valve repair is not possible, the mechanical valve is a reliable and durable prosthesis with good hemodynamic function and a low rate of thromboembolic event.

• Health Policy and Management
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• v.17 no.3
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• pp.87-105
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• 2007

The purpose of this study was to analyze whether nonemergency, isolated coronary artery bypass graft (CABG) surgery for high- or low-risk patients biases the assessment of the risk-adjusted mortality rates of hospitals. This study used 2002 National Health Insurance claims data for tertiary hospitals in Korea. The study sample consisted of 1,959 patients from 23 tertiary hospitals. The risk-adjustment model used the patients' biological, admission, and comorbidity data identified in the claims. The subjects were classified into high- and low-risk groups based on predicted surgical risk. The crude mortality rates and risk-adjusted mortality rates for low-risk, high-risk, and all patients in a hospital were compared based on the rank and the four intervals defined by quartile. Also, the crude mortality rates of the three groups were compared with their 95% confidence intervals of predicted mortality rates. The C-statistic (0.83) and Hosmer-Lemeshow test ($X^2$=11.47, p=0.18) indicated that the risk-adjustment model performed well. Presenting crude mortality rates with their 95% confidence intervals of predicted rates showed higher agreements among the three groups than using the rank or intervals of mortality rates defined by quartile in the hospital performance assessment. The crude mortality rates for the low-risk patients in 21 of the 23 hospitals were located on the same side of their 95% confidence intervals compared to that for all patients. High-risk patients and all patients differed at only one hospital. In conclusion, the impact of risk selection by hospital on the assessment results was the smallest when comparing the crude inpatient mortality rates of CABG patients with the 95% confidence intervals of predicted mortality rates. Given the increasing importance of quality improvements in Korean health policy, it will be necessary to use the appropriate method of releasing the hospital performance data to the public to minimize any unwanted impact such as risk-based hospital selection.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.848-853
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• 2001

Background: Sternal infection or dehiscence after cardiac surgery through median sternotomy is rare. If suitable treatment is not performed for the complication, however, the mortality is high. For 12 patients with sternal dehiscence or infection, we performed wide excision of the infected and necrotic tissue and covered with muscle flap(s) to obliterate the mediastinal dead space. Material and method: Sternal infection or dehiscence occurred in 13 of patients who underwent cardiac surgery One patient, who died of cerebral infarction before the sternal complication was treated, was excluded in this study. The sternal wound complication occurred in 6 of patients with valve replacement and 6 of patients with coronary bypass surgery, respectively. Since 1991, 9 patients underwent definite surgical debridement and muscle transposition as soon as fever was controlled with closed irrigation and drainage. The necrotic tissue and bone was widely excised and the sternal dead space was eradicated with the single flap or the combined flaps of right pectoralis flap(turnover flap), left pectoralis flap(turnover flap or rotation-advancement flap), and right rectus muscle flap. Result : There was no mortality in 12 patients with coverage of muscle flap(s) for sternal infection or dehiscence The mean interval between the diagnosis of sternal complication and the myoplasty was 6.6$\pm$3.9 days. In 4 patients, one pectoralis muscle flap was used, and in 8 patients both pectoralis muscle flaps were used. For each 1 patient and 2 patients in each group, right rectus muscle flap was added. For the last 3 patients, a single pectoralis flap was used to eradicate the mediastinal dead space and the longer placement of the mediastinal drain catheter was needed. One patient, who had suffered from necrosis of left pectoralis flap(rotation-advancement flap) with subsequent chest wall abscess after coverage of both pectoralis flaps, was managed with reoperation using right rectum flap. Conclusion : Sternal dehiscence or infection after cardiac operation can be readily managed with wide excision of necrotic infected tissue(including bone) and muscle flap coverage after short-term irrigation of sternal wound. The sternal(mediastinal) dead space may be completely eradicated with right pectoralis major muscle flap alone.

• Korean Journal of Microbiology
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• v.39 no.3
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• pp.166-174
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• 2003

Microcystin produced by cyanobacteria in surface waters, such as eutrophic lake and river, is a kind of serious environmental problems due to its toxicity to human and wild animals. Microcystin is synthesized nonribosomally by the large modular multi-functional enzyme complex known as microcystin synthetase encoded by the mcy gene cluster. Amplification of mcy genes by PCR from cultures and environmental samples is a simple and efficient method to detect the toxigenic Microcystis. In order to evaluate primers designed to detect toxic microcystin-producing strains, 17 cyanobacterial strains and 20 environmental samples were examined by PCR with 7 pairs of primers. Some microcystin-producing cyanobacteria were not detected with FAA-RAA, TOX4F-TOX4R and FP-RP primers. The fragment of unexpected size was amplified with NSZW2-NSZW1 primers in Microcystis strains isolated from the lakes in Korea. TOX1P-TOX1F primers failed in amplification of toxin-producing strains. Only MSF-MSR and TOX2P- TOX2F primers amplified the fragments of mcy genes from 11 strains of microcystin-producing Microcystis. The water samples taken from 20 lakes in Korea were analyzed by PCR using each of the primers. In all the water samples, cyanobacteria capable of producing microcystin were detected by the PCR with TOX2P-TOX2F primers. These results indicate that TOX2P-TOX2F primers are better than the other primers for detection of microcystin-producing Microcystis strains in Korea. The nucleotide sequences of mcy gene in Microcystis aeruginosa NIER10010 suggest genetic diversity of Korean isolates.