• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.35-46
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• 2016

Purpose : BoS(Base of Skull) Frame, the fixation tool which is used for the proton of brain cancer increases the lateral penumbra by increasing the airgap (the distance between patient and beam jet), due to the collision of the beam of the posterior oblique direction. Thus, we manufactured the fixation tool per se for improving the limits of BoS frame, and we'd like to evaluate the utility of the manufactured fixation tool throughout this study. Materials and Methods : We've selected the 3 patients of brain cancer who have received the proton therapy from our hospital, and also selected the 6 beam angles; for this, we've selected the beam angle of the posterior oblique direction. We' ve measured the planned BoS frame and the distance of Snout for each beam which are planned for the treatment of the patient using the BoS frame. After this, we've proceeded with the set-up that is above the location which was recommended by the manufacturer of the BoS frame, at the same beam angle of the same patient, by using our in-house Bos frame fixation tool. The set-up was above 21 cm toward the superior direction, compared to the situation when the BoS frame was only used with the basic couch. After that, we've stacked the snout to the BoS frame as much as possible, and measured the distance of snout. We've also measured the airgap, based on the gap of that snout distance; and we've proceeded the normalization based on each dose (100% of each dose), after that, we've conducted the comparative analysis of lateral penumbra. Moreover, we've established the treatment plan according to the changed airgap which has been transformed to the Raystation 5.0 proton therapy planning system, and we've conducted the comparative analysis of DVH(Dose Volume Histogram). Results : When comparing the result before using the in-house Bos frame fixation tool which was manufactured for each beam angle with the result after using the fixation tool, we could figure out that airgap than when not used in accordance with the use of the in-house Bos frame fixation tool was reduced by 5.4 cm ~ 15.4 cm, respectively angle. The reduced snout distance means the airgap. Lateral Penumbra could reduce left, right, 0.1 cm ~ 0.4 cm by an angle in accordance with decreasing the airgap while using each beam angle in-house Bos frame fixation tool. Due to the reduced lateral penumbra, Lt.eyeball, Lt.lens, Lt. hippocampus, Lt. cochlea, Rt. eyeball, Rt. lens, Rt. cochlea, Rt. hippocampus, stem that can be seen that the dose is decreased by 0 CGE ~ 4.4 CGE. Conclusion : It was possible to reduced the airgap by using our in-house Bos frame fixation tool for the proton therapy; as a result, it was possible to figure out that the lateral penumbra reduced. Moreover, it was also possible to check through the comparative analysis of the treatment plan that when we reduce the lateral penumbra, the reduction of the unnecessary irradiation for the normal tissues. Therefore, Using the posterior oblique the Brain cancer proton therapy should be preceded by decreasing the airgap, by using our in-house Bos frame fixation tool; also, the continuous efforts for reducing the airgap as much as possible for the proton therapy of other area will be necessary as well.

• Journal of Technologic Dentistry
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• v.17 no.1
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• pp.41-57
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• 1995

This study was conducted to collect and analyze previous information in order to manage efficience, improve experience effect and promote employment rate. The questionnaire interview with 27 chief of dental Laboratory refered clinical experience in technology department about clinical experience in 14 Jumior colleges were also investigated. The results were summarried as follows : The portion of age of 35-39 among chief of dental Laboratory was 40.7% which was the highest, that of male was 96.3%, that of junior college graduate was 97.5%, that of 10years experience was 92.6% and that of ceramic technician was 85.2%, 63.0% dental laboratory for clinical experience was a bore space of 30pyong. Aspect of dental laboratory management, manufacturing all part of prosthetic restoration was 29.6%, othodontic appliance and ceramic restoration was 7.4%, 3.8%, each. The percentage of 40.7 was having connection with 30-3a dental clinics and referring case per day was 10-19 cases(40.7%), manufacturing time of referred prosthetic restoration was 3-4 days(77.8%), places preparing seminar room for education was 29.6%, above a place of 40pyong was 11.1% 30-34 pyong and 35-39 pyong was 7.4% each. During training of 2 years education course student, 18.5% was rack of thorough occupational career. While 44.4% will want the more salary among 3years education course student, 74.1% will expect the more dental techmicians would engaged in their field, 51.9% will hope improve of their theory and practice, 29.6% be expected better skill and 14.8% be expected better theory. Attitude of clinical experience places was distributed by 59.3% of offering only experience chance, 25.9% of wasting time and 29.0% of annoying. The big emphasis of climical experience was thorough occupational career(44.4%). The clinical experience places of our college were selected after direct visiting, so their condition of management was not that bad but most of dental laboratory were poor in management state and working environment. Therefore it is difficult to choose appropriate places and dental Laboratory are also limited manpower and time as suppliers. So that it recommended to induce flexible management of experience period by interval and rotation of experience places among college and to applicate intern-system for employment ant industry-college cooperation aspect.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.213-221
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• 2001

Propose : Tsutsugamushi fever is a acute febrile disease, which is caused by O. tsutsugamushi. Recently, this disease is increasingly reported in children. This study was undertaken to investigate clinical features of tsutsugamushi fever in children. Methods : This study involved 17 children with tsutsugamushi fever who were admitted to Masan Samsung hospital between September 1997 and December 2000. We investigated the age, sex ratio, clinical manifestations, laboratory findings, response of therapy and prognosis. Results : The age of patients was $6.9{\pm}3.6$ years, ranging from 6 months to 12 years and male predilection(58.8%) was noted and all cases of patients occured in October or November. The most common symptoms were fever in all cases and headache in 8(47.1%). The most common signs were skin rash in all cases, eschar in 14(82.4%) and lymphadenopathy 8(47.1%). Locations of the eschars were back and inguinal area in each 3 cases, neck and chest in each 2, popliteal area in 2, scalp and thigh in each 1. Laboratory findings included anemia in 1 case, leukopenia and thrombocytopenia in each 5, hematuria and proteinuria in each 1, ESR elevation in 2 and positive CRP in 12, AST elevation in 9 and ALT elevation in 7. Serologic diagnosis was made by passive hemagglutination assay(PHA) in 8 cases(47%) on admission, 4 cases in initial negative group were performed follow-up test at 2nd or 3rd weeks of illness and then all cases of 4 were converted to positive reaction. Clinical improvement was noticed in all cases after treatment to chloramhenicol or doxycycline. Mean duration for defervescence after treatment was $1.4{\pm}0.8$ days. Complications were interstitial pneumonia in 1 case and aseptic meningitis in 3, but all cases of patients were recovered without sequelae or recurrence. Conclusions : Tsutsugamushi fever in children was similiar to adult in the clinical features except male predilection. Early diagnosis and empirical treatment based on clinical manifestations such as fever, skin rash, eschar, lymphadenopathy is important and serologic diagnosis need to perform follow-up test at 2nd or 3rd weeks of illness.

• Pediatric Infection and Vaccine
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• v.14 no.2
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• pp.145-154
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• 2007

Purpose : Rotavirus is one of the most important etiologic agents of nosocomial infections among the neonates. This study was designed to investigate nosocomial rotavirus infection in neonates who were admitted to a postpartum-care center after birth. Methods : From March 2005 to September 2006, 957 healthy neonates were examined for rotavirus antigen in stool by immunochromatographic method and 216 neonates were rotavirus antigen positive within 24 hours after admitted to a postpartum-care center. We reviewed the nursing charts retrospectively such as characteristics, monthly distribution, birth hospitals, delivery methods, feeding types and clinical manifestations. Results : Among 957 neonates, 216 neonates (22.6%) were rotavirus antigen positive and there were no differences in sex, birth weight, gestational age. Monthly positive rate of rotavirus antigen showed diversity from 10% to 36%. According to birth hospitals, positive rate showed diversity from 3.5% to 53.6%. Out of 957 neonates, 655 cases (68.4%) were born of vaginal delivery and mean hospitalized duration was 2.4 days, 302 cases (31.6%) were born of cesarean section and mean hospitalized duration was 5.7 days. 17.6% of vaginal delivery and 33.4% of cesarean section were rotavirus antigen positive. The positive rate was higher in neonates by cesarean section than vaginal delivery (P<0.001). According to feeding types, positive rate of rotavirus antigen was lower in breast-fed group than formula-fed group (P<0.001). Proportion of symptomatic case among rotavirus antigen positive was 34.7%. Most common clinical manifestation was diarrhea (61.3%), following poor feeding (45.3%), fever (40.0%), vomiting (25.3%), delayed weight gain (12.0%), and decreased urine amount (5.3%). Conclusion : Some neonates were already infected before admission to a postpartum-care center. Without meticulous management, nosocomial rotavirus infection would transmit rapidly in a postpartum-care center spreading to the community. Recommendation of breast-feeding, routine rotavirus screeing test with or without symptom, and isolation of all rotavirus antigen positive neonates in a postpartum-care center seem to be necessary. Also attentive hygiene education and further investigations of rotavirus infection in a postpartum-care center would be needed.

• Pediatric Infection and Vaccine
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• v.10 no.1
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• pp.71-80
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• 2003

Purpose : Four kinds of Haemophilus influenzae type b protein conjugate vaccines, PRPD, PRP-T, PRP-OMP and PRP-CRM197, have been developed, and PRP-T vaccines are currently produced by two manufacturer, $ActHib^{(R)}$ by Aventis and $Hiberix^{TM}$ by GlaxoSmith-Kline Biologicals. The purpose of this study is to evaluate the immunogenicity and safety of $Hiberix^{TM}$ in Korean infants. Methods : Seventy-three healthy infants(43 male infants) were recruited for this study after parental informed consent was obtained. Each infant was vaccinated at 2, 4 and 6 months of age with the study vaccine. At each visit, infants were also immunized with DTaP, trivalent oral polio vaccine and hepatitis B vaccine when indicated. The serum anti-PRP antibody was measured at prevaccination, 2 month later after the 2nd dose, and 1 month later after the 3rd dose by the ELISA method. The local and systemic adverse reactions of vaccination were monitored for 3 consecutive days after each immunization. Immunogenicity of vaccine was evaluated in infants who received all the scheduled immunization and the adverse reactions were evaluated for infants who received at least one dose of the study vaccine. Results : Among seventy three infants, enrolled in this study; sixty three(37 male infants) completed all the scheduled immunizations. The geometric mean titer(GMT) of anti-PRP antibodies at prevaccination was 0.17 ${\mu}g/mL$(95% confidence interval[CI]; 0.13~0.22). The GMT of anti-PRP antibodies increased to 4.14 ${\mu}g/mL$(95% CI; 2.65~6.48) at 2 month later after the 2nd dose of PRP-T and 14.65 ${\mu}g/mL$(95% CI; 10.83~19.81) at 1 month later after the 3rd dose. Anti-PRP antibody ${\geq}0.15$ ${\mu}g/mL$, was observed in 98.4%(95% CI; 91.8~100) after 2 doses and 100%(95% CI; 100~100) after 3 doses. Anti-PRP antibody ${\geq}1.0$ ${\mu}g/mL$, was obtained in 77.8%(95% CI; 67.5~88.0) after 2 doses, and 98.4%(95% CI; 95.3~100) after 3 doses. Most of the adverse reaction after vaccination were mild. Irritability, the most common systemic reaction, was observed in 45.5%, followed by drowsiness(30.5%), poor feeding(26.7%) and fever(5.6%). Among the local reactions tenderness was observed in 7.9%, redness(${\geq}5$ mm) in 2.8% and swelling(${\geq}5$ mm) in 1.8%. Conclusion : The PRP-T vaccine used in this study was highly immunogenic and safe in Korean young infants. The finding that high GMT and high frequency of infants with a protective titer achieved after 2 doses is consistent with the previous studies which were done with a PRP-T vaccine of other manufacturer. This study suggests that the immunization schedule of PRP-T vaccine for Korean infants may need re-evaluation.

• Clinical and Experimental Pediatrics
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• v.48 no.8
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• pp.832-838
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• 2005

Purpose : Mycoplasma pneumoniae infection is relatively common in childhood. Its extrapulmonary manifestations have been reported so much, but hepatitis associated with it has been reported rarely in Korea. Methods : A clinical study was performed on 556 patients of M. pneumoniae pneumonia diagnosed serologically at Gil hospital from January 2001 to December 2004. We reviewed 65 cases among these patients, who had elevated level of serum AST and ALT greater than 50 IU/L respectively without evidence of hepatitis A, B, C, Cytomegalovirus and Ebstein-Barr virus infections. Results : Hepatitis occurred in 11.7% of Mycoplasma pneumoniae pneumonia, especially in fall and winter times. Male to female ratio was 1.2 : 1 and the mean age was 4 years and 3 months. Besides hepatitis, cough(95.4%), sputum(52.3%) and dyspnea(12.3%) were common as pulmonary manifestations. And among gastrointestinal manifestations, nausea/vomiting(26.2%) was the most common symptom, followed by poor oral intake(12.3%), diarrhea(12.3%) and abdominal pain(6.2%). In addition to hepatomegaly(4.6%) and splenomegaly(4.6%), coarse breathing sound was the most common physical manifestation, followed by rale(63.1%), pharyngeal injection(26.2%), and rash(10.8%). Anemia was noted in 20.0%, neutrophilia in 10.8%, eosinphilia in 38.5% and thrombocytosis in 6.2%, respectively. Mean level of ESR and CRP was 32.02 mm/hr and 6.69 mg/dL, respectively. Mean level of AST and ALT was 293.80 IU/L and 181.48 IU/L, respectively. Hyperbilirubinemia was noted in 7.7% and hypoalbuminemia was noted in 58.5%. Lobar or lobular pneumonia(78.5%) was the most common finding in chest X-ray and left lower lobe(39.2%) was most commonly affected. Pleural effusion was noted in 26.2%. Mean duration of hospitalization was 9.91 days. Serum AST/ALT level was normalized within 9.94 days and pulmonary consolidation resolved within 14.29 days. Conclusion : The prognosis of M. pneumoniae hepatitis is good. However, liver function should be considerately checked in M. pneumoniae infection because its incidence is not so low.

• Clinical and Experimental Reproductive Medicine
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• v.35 no.4
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• pp.309-317
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• 2008

Objectives: The aim of this study was to evaluate the usefulness of Anti-mullerian hormone (AMH) as a predictive marker for ovarian response and cycle outcome in IVF cycles. Methods: From Jan., to Aug., 2007, 111 patients undergoing IVF/ICSI stimulated by short or antagonist protocol were selected. On cycle day 3, basal serum AMH level and FSH level were measured. The correlation between basal serum AMH or FSH, and COH outcome was analyzed and IVF outcome was compared according to the AMH levels. To determine the threshold value of AMH for poor- and hyper-response, ROC curve was analyzed. Results: Serum AMH showed higher correlation coefficient (r=0.792, p<0.001) with the number of retrieved mature oocyte than serum FSH (r=-0.477, p<0.001). According to ovarian response, FSH and AMH leves showed significant differences among poor, normal, and hyperresponder. For predicting poor (${\leq}2$ oocytes) and hyperresponse (${\geq}17$ oocyets), AMH cut-off values were 0.5 ng/ml (the sensitivity 88.9% and the specificity 89.5%) and 2.5 ng/ml (sensitivity 85.7%, specificity 87.0%), respectively. According to the AMH level, patients were divided into 3 groups: low (${\leq}0.60\;ng/ml$), normal ($0.60{\sim}2.60\;ng/ml$), and high AMH (${\geq}2.60\;ng/ml$). The number of retrieved mature oocytes was significantly higher ($2.7{\pm}2.2$, $8.1{\pm}4.8$, $16.5{\pm}5.7$) and total gonadotropin dose was lower ($3530.5{\pm}1251.0$, $2957.1{\pm}1057.6$, and $2219.2{\pm}751.9\;IU$) in high AMH group (p<0.001). There was no significant difference in fertilization rates and pregnancy rates (23.8%, 34.0%, 37.5%) among the groups. Conclusions: Basal serum AMH level correlated better with the number of retrieved mature oocytes than FSH level, suggesting its usefulness for predicting ovarian response. However, IVF outcome was not significantly different according to the AMH levels. Serum AMH level presented good cut-off value for poor- or hyper-responders, therefore it could be useful in prediction of cycle cancellation, gonadotropin dose, and OHSS risk in IVF cycles.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.420-425
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• 2008

Purpose : The purpose of this study was to evaluate acute childhood seizures, one of the most important causes of emergency room visits, to provide appropriate medical services. Methods : We reviewed the medical records of 433 (4.6%) pediatric patients with acute seizures that visited the emergency room at Masan Samsung hospital from 2004 to 2006. Results : The male to female ratio was 1.4:1 and the mean age was $40.9{\pm}34.9$ months range. The order of geographical distribution was Masan, Changwon, Haman, and others. Fever was present in 40.6% of patients; December (14.8%) was the most frequent month for visits and generalized tonic clonic seizures (62.7%) were the most common type of seizure. The average frequency and duration of the seizure was $1.5{\pm}1.0$ and $6.7{\pm}13.2$ minutes respectively. Febrile seizures were present in 69.7% of patients and afebrile seizures in 30.3%. The causes of the febrile seizures were acute pharyngotonsillitis (44.6%), acute bronchitis, gastroenteritis, pneumonia, urinary tract infection, and unknown origin, in order of frequency. The most common cause of an afebrile seizure was epilepsy (71.5%) followed by a benign convulsion with mild gastroenteritis (BCwMG), sequela of a perinatal brain injury or brain malformation, and acute CNS infection. Evaluation of the causes of an acute seizure according to age showed that febrile seizures, epilepsy, and the sequela of perinatal brain injuries were more common between 2 and 6 years of age and epilepsy, febrile seizures and acute CNS infection, in order of frequency, were common between 6 and 15 years of age. Many patients, 49.4%, were discharged without admission. Conclusion : The common characteristics of pediatric patients presenting to the emergency room were male gender, an age between 2-6 years, presenting during the month of December, with generalized tonic clonic seizures due to acute pharyngitis. The most common presentation for the group less than 6 years of age was a febrile seizure and in the group more than 6 years of age, it was epilepsy. In many cases, the seizures stopped by the time the family presented to the emergency room.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.2
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• pp.97-106
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• 2015

Purpose : This study evaluate the thermal changes caused by use of the chemoport for drug administration and blood sampling during radiofrequency hyperthermia. Materials and Methods : 20cm size of the electrode radio frequency hyperthermia (EHY-2000, Oncotherm KFT, Hungary) was used. The materials of the chemoport in our hospital from currently being used therapy are plastics, metal-containing epoxy and titanium that were made of the diameter 20 cm, height 20 cm insertion of the self-made cylindrical Agar phantom to measure the temperature. Thermoscope(TM-100, Oncotherm Kft, Hungary) and Sim4Life (Ver2.0, Zurich, Switzerland) was compared to the actual measured temperature. Each of the electrode measurement position is the central axis and the central axis side 1.5 cm, 0 cm(surface), 0.5 cm, 1.8 cm, 2.8 cm in depth was respectively measured. The measured temperature is $24.5{\sim}25.5^{\circ}C$, humidity is 30% ~ 32%. In five-minute intervals to measure the output power of 100W, 60 min. Results : In the electrode central axis 2.8 cm depth, the maximum temperature of the case with the unused of the chemoport, plastic, epoxy and titanium were respectively $39.51^{\circ}C$, $39.11^{\circ}C$, $38.81^{\circ}C$, $40.64^{\circ}C$, simulated experimental data were $42.20^{\circ}C$, $41.50^{\circ}C$, $40.70^{\circ}C$, $42.50^{\circ}C$. And in the central axis electrode side 1.5 cm depth 2.8 cm, mesured data were $39.37^{\circ}C$, $39.32^{\circ}C$, $39.20^{\circ}C$, $39.46^{\circ}C$, the simulated experimental data were $42.00^{\circ}C$, $41.80^{\circ}C$, $41.20^{\circ}C$, $42.30^{\circ}C$. Conclusion : The thermal variations were caused by radiofrequency electromagnetic field surrounding the chemoport showed lower than in the case of unused in non-conductive plastic material and epoxy material, the titanum chemoport that made of conductor materials showed a slight differences. This is due to the metal contents in the chemoport and the geometry of the chemoport. And because it uses a low radio frequency bandwidth of the used equipment. That is, although use of the chemoport in this study do not significantly affect the surrounding tissue. That is, because the thermal change is insignificant, it is suggested that the hazard of the chemoport used in this study doesn't need to be considered.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.1
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• pp.1-10
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• 2012

Purpose: To evaluate dose distribution differences when the dose rates are randomly changed in intensity-modulated radiation therapy using a dynamic multileafcollimator. Materials and Methods: Two IMRT treatment plans including small-field and large-field plans were made using a commercial treatment planning system (Eclipse, Varian, Palo Alto, CA). Each plan had three sub-plans according to various dose rates of 100, 400, and 600 MU/min. A chamber array (2D-Array Seven729, PTW-Freiburg) was positioned between solid water phantom slabs to give measurement depth of 5 cm and backscattering depth of 5 cm. Beam deliveries were performed on the array detector using a 6 MV beam of a linear accelerator (Clinac 21EX, Varian, Palo Alto, CA) equipped with 120-leaf MLC (Millenium 120, Varian). At first, the beam was delivered with same dose rates as planned to obtain reference values. After the standard measurements, dose rates were then changed as follows: 1) for plans with 100 MU/min, dose rate was varied to 200, 300, 400, 500 and 600 MU/min, 2) for plans with 400 MU/min, dose rate was varied to 100, 200, 300, 500 and 600 MU/min, 3) for plans with 600 MU/min, dose rate was varied to 100, 200, 300, 400 and 500 MU/min. Finally, using an analysis software (Verisoft 3.1, PTW-Freiburg), the dose difference and distribution between the reference and dose-rate-varied measurements was evaluated. Results: For the small field plan, the local dose differences were -0.8, -1.1, -1.3, -1.5, and -1.6% for the dose rate of 200, 300, 400, 500, 600 MU/min, respectively (for 100 MU/min reference), +0.9, +0.3, +0.1, -0.2, and -0.2% for the dose rate of 100, 200, 300, 500, 600 MU/min, respectively (for 400 MU/min reference) and +1.4, +0.8, +0.5, +0.3, and +0.2% for the dose rate of 100, 200, 300, 400, 500 MU/min, respectively (for 600 MU/min reference). On the other hand, for the large field plan, the pass-rate differences were -1.3, -1.6, -1.8, -2.0, and -2.4% for the dose rate of 200, 300, 400, 500, 600 MU/min, respectively (for 100 MU/min reference), +2.0, +1.8, +0.5, -1.2, and -1.6% for the dose rate of 100, 200, 300, 500, 600 MU/min, respectively (for 400 MU/min reference) and +1.5, +1.9, +1.7, +1.9, and +1.2% for the dose rate of 100, 200, 300, 400, 500 MU/min, respectively (for 600 MU/min reference). In short, the dose difference of dose-rate variation was measured to the -2.4~+2.0%. Conclusion: Using the Varian linear accelerator with 120 MLC, the IMRT dose distribution is differed a little <(${\pm}3%$) even though the dose-rate is changed.