• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.115-121
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• 2010

Purpose: The purpose of this study is to measure F-18 FDG with two different types of dose calibrator measuring radionuclide and radioactivity and investigate the effect of F-18 FDG on SUV (Standard Uptake Value) in human body. Materials and Methods: Two different dose calibrators used in this study are CRC-15 Dual PET (Capintec) and CRC-15R (Capintec). Inject 1 mL, 2 mL, 3 mL of F-18 FDG into three 2 mL syringes, respectively, and measure initial radioactivity from each dose calibrator. Then measure and record radioactivity at 30 minute interval for 270 minutes. According to the initial radioactivity, linearity between decay factor driven from radioactive decay formula and the values measured by dose calibrator have been analyzed by simple linear regression. Fine linear regression line optimizing values measured with CRC-15 through regression analysis on the basis of the volume of which the measured value is close to the most ideal one in CRC-15 Dual PET. Create ROI on lung, liver, and region part of 50 persons who has taken PET/CT test, applying values from linear regression equation, and find SUV. We have also performed paired t-test to examine statistically significant difference in the radioactivity measured with CRC-15 Dual PET, CRC-15R and its SUV. Results: Regression analysis of radioactivity measured with CRC-15 Dual PET and CRC-15R shows results as follows: in the case 1 mL, the r statistic representing correlation was 0.9999 and linear regression equation was y=1.0345x+0.2601; in 2 mL case, r=0.9999, linear regression equation y=1.0226x+0.1669; in 3 mL case, r=0.9999, linear regression equation y=1.0094x+0.1577. Based on the linear regression equation from each volume, t-test results show significant difference in SUV of ROI in lung, liver, region part in all three case. P-values in each case are as follows: in 1 mL case, lung, liver and region (p<0.0001); in 2 mL case, lung (p<0.002), liver and region (p<0.0001); in 3 mL case, lung (p<0.044), liver and region (p<0.0001). Conclusion: Radioactivity measured with CRC-15 Dual PET, CRC-15R, dose calibrator for F-18 FDG test, do not show difference correlation, while these values infer that SUV has significant differences in the aspect of uptake in human body. Therefore, it is necessary to consider the difference of SUV in human body when using these dose calibrator.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.6 no.2
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• pp.140-151
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• 2003

Purpose: We tried to evaluate the long term efficacy and positive predictive factors of interferon-alpha treatment in children with chronic hepatitis B. Methods: The study population included 113 children who received interferon therapy between May 1982 and July 2002 (20 years) for chronic hepatitis B in Department of Pediatrics, Yonsei University College of Medicine. Male to female ratio was 2.3 : 1 and the mean age at diagnosis was $11.1{\pm}4.1$ years old. Response to treatment was defined as normalization of alanine aminotransferase (ALT), disappearance of HBeAg and HBV-DNA Eighty two children responded while 32 did not. Interferon-alpha was given intramuscularly for 6 months at a dosage of $3{\times}10^6$ unit, 3 times weekly. In relapsed cases, lamivudine or interferon retreatment was done. Results: Seroconversion rate was 77.0% in terms of HBeAg, 74.3% in terms of HBV-DNA, and 80.5% in terms of ALT normalization after treatment. Seroconversion rate of both HBeAg and HBV-DNA was 72.6%. Analyzed by life table method, the effect of the treatment had been maintained over 10 years after cessation of therapy. Pre-treatment ALT level was the only significant positive predictive factor of response. Eleven cases (13.4%) relapsed, and 2 out of 3 showed response when treated with lamivudine and 1 out of 3 with interferon retreatment. Conclusion: Interferon-alpha showed significant efficacy in the treatment of chronic hepatitis B in our study. Further studies about the effect of interferon therapy on complications of hepatitis such as hepatocarcinoma, cirrhosis are warranted.

• Pediatric Infection and Vaccine
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• v.10 no.2
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• pp.167-177
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• 2003

Purpose : To know the trends of antimicrobial susceptibility is critical for antimicrobial treatment. We studied the organisms isolated from blood, urine, stool, and cerebrospinal fluid from 1997 to 2001 to reveal the trends of their antimicrobial susceptibility. Methods : We conducted a retrospective study with isolates obtained from 0~18 year old outpatients and inpatients from 1997 to 2001 at Department of Pediatrics, Hanil general hospital. We gathered the data through the laboratory test files and the origin of microorganisms cultured from blood, urine, stool and cerebrospinal fluid and their antimicrobial susceptibility. Results : Microorganisms were isolated from 226(3.3%) out of 6,974 blood cultures, 365 (8.0%) out of 4,549 urine cultures, 50(1.9%) out of 2,593 stool cultures and 9(1.4%) in 655 cerebrospinal fluid cultures. The most frequently isolated organisms from blood cultures was Staphylococcus epidermidis(33.5%) which was followed by Staphylococcus aureus(19.7%), Escherichia coli(13.8%), and Burkholderia cepacia(9.0%). Among the urine cultures, E. coli was the most common(74.7%) which was followed by Group D Enterococcus(11.3%), Klebsiella pneumoniae(7.1%) and Proteus mirabilis(2.5%). The positive stool cultures all yield Salmonella species. Group D Salmonella was obtained most frequently. Among the positive cerebrospinal fluid cultures, Group B Streptococcus was isolated most frequently. Among the 40 cases of S. aureus in blood cultures, 27 cases were methicillin-resistant. The rates of susceptibility for amikacin, ceftizoxime and ceftriaxone of E. coli isolated from blood cultures were 80%, 100% and 60% in 1997 and 60%, 80% and 60% in 2001. The rates of susceptibility for amikacin, ceftizoxime and ceftriaxone of K. pnumoniae isolated from urine cultures. were 80%, 100% and 80% in 1997 and 50%, 83% and 50% in 2001 Enterococcus was isolated from 6.7% to 15.8% and vancomycin-resistant Enterococcus was observed in 17% of Group D Enterococcus isolated from urine cultures. The rates of susceptibility for amikacin, ceftizoxime and ceftriaxone of Group D Salmonella were 96%, 96% and 92% during the study period. Conclusion : Among the blood cultures S. epidermidis, S. aureus, E. coli and B. cepacia were isolated in order of frequency and among the urine cultures E. coli, Group D Enterococcus, K. pneumoniae and P. mirabilis were isolated in order of frequency. During the study period there was no big difference in major organisms isolated from blood and urine. The methicillin-resistant S. aureus was observed in 67% of S. aureus isolated from blood cultures but vancomycin-reistant S. aureus or vancomycin intermediate resistant S. aureus was not observed. The rates of susceptibility to amikacin and the third generation cephalosporin of E. coli isolated from blood cultures and K. pneumoniae from urine cultures have decreased. The isolation rates of Group D Enterococcus and vancomycin resistant Enterococcus have increased.

• Journal of the Korean Society of School Health
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• v.4 no.2
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• pp.176-192
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• 1991

School nurses, in service of 102 special schools in Korea, were urveyed by mail questionnaires from February to March, 1991 and 77 of hem responded. Collected data were analyzed to establish the direction of health management in special school and to provide basic reference data for improving the quality of the management of school-nurses' services. The major findings are as follows: Out of special schools surveyed, 67.5% is private school and 83.2% is located in city. The average number of classes, students, and educational personnels per special school is 17.2, 194, and 28 respectively. The average age of school-nurses surveyed is 32.7. The proportion of graduates from the junior college and upward was 97.4%, the proportion of the married was 71.4%. Out of respondents, 71.4% has religion : 79.2% has past career in the fields of clinics or public health: 62.3% accompanishes independent services: 77.9% belongs to primary school. About 69% of nursing room in special schools surveyed is located at the first floor. Out of special school surveyed, 90.9% has no organization for school health programms: Only 18.2% entrusted everyone of school doctor, school dentist, and school pharmacists with school health. 46.8% of respondents didn't know about the annual budget for school health programmes. The average annual expenditure for school health programme per special school was 317,000F26. won and the purchase cost for medical supplies accounted for the larger part of them. The monthly average number of students utilizing school nursing room was 71 per school, annual utilization times of school nursing room was 4.4 per student and utilization due to injury was prevalent by 26.6% and there is some differences in using the school nursing room according to disabled area. Rate of referral to medical facilities was 1.4%. The leading reason of referral to medical facilities was high fever among those who have visual handicaps, fracture among those who have emotional disturbance, injury by trauma among others. Nine hundred fifty six students of students in special school surveyed have sufferd from epilepsy and prevalence rate of epilepsy was 6.4%. Only 22.6% of respondents replied that they had physical examination more than 2 times per year. Out of respnodents, 98.7% answered that they had health education and 67.1% of them ansered that they educated in a classroom, 98.7% of respondents emphasized need of sex education. Respondents put the most emphasis on the personal hygiene when they performed health education and they used broadcasting education in the area of visual handicaps, OHP or VTR in hearing handicaps, home correspondence or OHP VTR in other area importantly. About 47% of repondents answered that health education was the most difficult and they emphasized that definite guide on health management was requested. Respondents had self-confidence and high perfomance rate in most of school-nurses' services completely, but so they was not in area of evaluation of school health programmes, an examination of physical strength, evaluation of health education, management of school purification area, suture of wounds. In consideration of above findings, we may conclude that special education for school-nurse in special schools as well as improvement of definite guiding principles are requested to establish direction for health management in special schools and to improve the degree of quality for school-nurses' sevices in special schools.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.349-356
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• 2005

Background: Arterial conduits using in coronary artery bypass grafting (CABG) have been known a great long term patency rates, and improved short and long term clinical outcomes. It has been reported that Off pump CABG has better clinical results than CABG using cardiopulmonary bypass. To evaluate the advantage of arterial conduits over venous conduits and to avoid the adverse effects of cardiopulmonary bypass, we performed total arterial Off pump CABG. Material and Method: From January 2001 to October 2004, Off pump CABG using only arterial conduits was performed on 325 patients with a mean age of $59.3\pm11.9$ years ($36\~83$). Mean ejection fraction was $55.4\pm14.0\%\;(15\~86).$ Angiography showed left main disease or triple-vessel disease in $81.9\%$ of the patients. Indications of using arterial conduits was stenosis $\ge50\%$ of left anterior descending artery, stenosis $\ge80\%$ of branches of left circumflex artery, and stenosis $\ge90\%$ of right coronary artery and its branches. Multi-slice computed tomography was performed on 194 patients to evaluate the short term patency rates. Result: A total of 928 distal anastomoses were performed and the average anastomoses per a patient were $2.86\pm0.78$. There was 1 operative mortality. Postoperative complications were mediastinitis in 6 patients ($1.8\%$), renal failure in 4 patients ($1.2\%$), perioperative myocardial infarction in 3 patients ($0.9\%$), reoperation for bleeding in 3 patients ($0.9\%$). There was no postoperative stroke. Patency rate of arterial conduits was $99.3\%$ (581/585). There were 4 stenoses or competitive flows in 2 radial arteries and 2 right internal mammary arteries. Conclusion: Total arterial Off pump CABG appears to be safe, showing a low surgical mortality and morbidity and excellent short term patency rates of arterial conduits.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.845-855
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• 2004

Background: No general consensus has been available regarding the necessity of postoperative radiation therapy (PORT) and its optimal techniques in the patients with chest wall invasion (pT3cw) and node negative (N0) non-small cell lung cancer (NSCLC). We did retrospective analyses on the pT3cwN0 NSCLC patients who received PORT because of presumed inadequate resection margin on surgical findings. And we compared them with the pT3cwN0 NSCLC patients who did not received PORT during the same period. Material and Method: From Aug. of 1994 till June of 2002, 22 pT3cwN0 NSCLC patients received PORT-PORT (＋) group- and 16 pT3cwN0 NSCLC patients had no PORT-PORT (-) group. The radiation target volume for PORT (＋) group was confined to the tumor bed plus the immediate adjacent tissue only, and no regional lymphatics were included. The prognostic factors for all patients were analyzed and survival rates, failure patterns were compared with two groups. Result: Age, tumor size, depth of chest wall invasion, postoperative mobidities were greater in PORT (-) group than PORT (＋) group. In PORT (-) group, four patients who were consulted for PORT did not receive the PORT because of self refusal (3 patients) and delay in the wound repair (1 patient). For all patients, overall survival (OS), disease-free survival (DFS), loco-regional recurrence-free survival (LRFS), and distant metastases-free survival (DMFS) rates at 5 years were 35.3%, 30.3%, 80.9%, 36.3%. In univariate and multivariate analysis, only PORT significantly affect the survival. The 5 year as rates were 43.3% in the PORT (＋) group and 25.0% in PORT (-) group (p=0.03). DFS, LRFS, DMFS rates were 36.9%, 84.9%, 43.1 % in PORT (＋) group and 18.8%, 79.4%, 21.9% in PORT(-) group respectively. Three patients in PORT (-) group died of intercurrent disease without the evidence of recurrence. Few suffered from acute and late radiation side effects, all of which were RTOG grade 2 or lower. Conclusion: The strategy of adding PORT to surgery to improve the probability not only of local control but also of survival could be justified, considering that local control was the most important component in the successful treatment of pT3cw NSCLC patients, especially when the resection margin was not adequate. Authors were successful in the marked reduction of the incidence as well as the severity of the acute and late side effects of PORT, without taking too high risk of the regional failures by eliminating the regional lymphatics from the radiation target volume.

• Journal of Chest Surgery
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• v.39 no.7 s.264
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• pp.534-543
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• 2006

Background: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardio-pulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. Material and Method: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005, Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups (<1 day, $1{\sim}3\;days,\;4{\sim}7\;days$, >8 days). OPCAB was performed a mean of $5.3{\pm}7.1$ days after AMI in total, which was $4.2{\pm}5.9$ days in group 1, and $6,6{\pm}8.3$ days in group 2. Result: Mean distal an-astomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months ($4{\sim}42$ months). The 42 months actuarial survival rate was $94.9{\pm}2.4%$, which was $91.4{\pm}4.7%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.26). The 42 months freedom rate from cardiac death was $97.6{\pm}1.4%$ which was $97.0{\pm}2.0%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.74). The 42 months freedom rate from cardiac event was $95.4{\pm}2.0%$ which was $94.8{\pm}2.9%$ in group 1 and $95.9{\pm}2.9%$ in group 2 (p=0.89). Conclusion: OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.280-287
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• 2007

Background: We retrospectively evaluated the clinical results of surgically managing patients with Ebstein's anomaly. Material and Method: Between Feb. f 984 and June 2006, 50 patients who underwent surgical treatment for Ebstein's anomaly at Yonsei Cardiovascular Center were retrospectively reviewed. The mean age of the patients was 26.9 years and 19 patients were male, Associated anomalies included atrial septal defect (33), patent ductus arteriosus (2), ventricular septal defect (1), and pulmonary stenosis (4), and 90%, (45/50) of the patients had more than a moderate degree of tricuspid regurgitation. Carpentier type A was present in 6 patients, type B in 26, type C in 14 and type D in 4. Ten patients were associated with WPW syndrome. Conservative surgery was possible in 31 patients (tricuspid annuloplasty, plication of the atrialized RV), Fontan's operation was peformed in 4 patients, tricuspid valve replacement was done in 12 and palliative surgery was done in 2 patients. Thirteen patients were associated with hi-directional cavopulmonary shunt (BCPS: one and a half ventricular repairs): 10 patients with WPW syndrome and 4 patients with atrial fibrillation underwent concomitant ablation. Result: The postoperative median NYHA functional class $(3{\rightarrow}1)$ and the mean cardio-thoracic ratio $(0.65{\rightarrow}0.59)$ were decreased significantly (p<0.001, p=0.014). The mean oxygen saturation $(86.6{\rightarrow}94.1%)$, and median TR grade $(4{\rightarrow}1)$ were also significantly improved (p=0.004, p<0.001). For comparison of BCPS and conservative surgery, the preoperative right ventricular pressure (33.0 vs. 41.3 mmHg), the ICU stay (2.80 vs. 1.89 days), the hospital say (10.6 vs. 16.8 days), and the left ventricular ejection fraction (64.3 vs. 72.8%) were statistically different. Postoperative mortality occurred in 3 patients (6%) due to biventricular failure in 2 patients and sepsis in the other patient. The mean follow up duration was 101.5 months, and one patient died of Fontan failure and 6 patients required reoperation (bioprosthetic degenerative change (2) and Fontan conversion (4)). The overall survival rate at 10 years was 90.2%, the freedom from reoperation rate and rate of cardiac related events were 78.9% and 49.2%, respectively. Conclusion: Surgical management of Ebstein's anomaly can be performed safely, and the associated BCPS may be helpful for high-risk patients. Adequate application of surgical management may increase the long-term survival with a reduced rate of reoperation.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.624-629
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• 2009

Background: Making the histologic diagnosis of small pulmonary nodules and ground glass opacity (GGO) lesions is difficult. CT-guided percutaneous needle biopsies often fail to provide enough specimen for making the diagnosis. Video-assisted thoracoscopic surgery (VATS) can be inefficient for treating non-palpable lesions. Preoperative localization of small intrapulmonary lesions provides a more obvious target to facilitate performing intraoperative. resection. We evaluated the efficacy of CT-guided localization with using a hook wire and this was followed by VATS for making the histologic diagnosis of small intrapulmonary nodules and GGO lesions. Material and Method: Eighteen patients (13 males) were included in this study from August 2005 to March 2008. 18 intrapulmonary lesions underwent preoperative localization by using a CT-guided a hook wire system prior to performing VATS resection for intrapulmonary lesions and GGO lesions. The clinical data such as the accuracy of localization, the rate of conversion-to-thoracotomy, the operation time, the postoperative complications and the histology of the pulmonary lesion were retrospectively collected. Result: Eighteen VATS resections were performed in 18 patients. Preoperative CT-guided localization with a hook-wire was successful in all the patients. Dislodgement of a hook wire was observed in one case. There was no conversion to thoracotomy, The median diameter of lesions was 8 mm (range: $3{\sim}15\;mm$). The median depth of the lesions from the pleural surfaces was 5.5 mm (range: $1{\sim}30\;mm$). The median interval between preoperative CT-guided with a hook-wire and VATS was 34.5 min (range: ($10{\sim}226$ min). The median operative time was 43.5.min (range: $26{\sim}83$ min). In two patients, clinically insignificant pneumothorax developed after CT-guided localization with a hook-wire and there were no other complications. Histological examinations confirmed 8 primary lung cancers, 3 cases of metastases, 3 cases of inflammation, 2 intrapulmonary lymph nodes and 2 other benign lesions. Conclusion: CT-guided localization with a hook-wire followed by VATS for treating small intrapulmonary nodules and GGO lesions provided a low conversion thoracotomy rate, a short operation time and few localization-related or postoperative complications. This procedure was efficient to confirm intrapulmonary lesions and GGO lesions.

• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.486-494
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• 2000

Background : The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to $M_3$ muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal $M_2$ muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these $M_2$, muscarinic receptors act as autoreceptors. Loss of function of these $M_2$ receptors, as it occurs in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of $M_2$ muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. Method : We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test ($PC_{20}$<16mg/ml). Methacholine provocation tests were performed twice on separate days allowing for an interval of one week. In the second test, pretreatment with the $M_2$ muscarinic receptor agonist pilocarpine($180{\mu}g$) through inhalation was performed be fore the routine procedures. Results : Eleven subjects with mild asthma and eight subjects with moderate asthma showed significant increase of $PC_{20}$ from 5.30$\pm$5.23mg/ml(mean$\pm$SD) to 20.82$\pm$22.56mg/ml(p=0.004) and from 2.79$\pm$1.51mg/ml to 4.67$\pm$3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of $PC_{20}$ from l.76$\pm$1.50mg/ml to 3.18$\pm$4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. Conclusion : In subjects with mild and moderate asthma, function of $M_2$ muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. ηlese results suggest that function of $M_2$ muscarinic receptors is different according to severity of asthma.