• Journal of Chest Surgery
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• v.38 no.3 s.248
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• pp.221-228
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• 2005

Reduction aortoplasty has been advocated for dilatation of the ascending aorta associated with aortic valve disease in older, high-risk patients. We report our results with modification of reduction aortoplasty and aortic valve replacement. Material and Method: Between July 2001 and December 2002, 14 consecutive patients who underwent modification of reduction aortoplasty, suture plication technique without excision of the dilated aortic wall, were reviewed. The mean age was 63.7$\pm$6.7 (50 to 75) years. Ten patients had congenital bicuspid aortic valve, Twelve patients had severe aortic valve stenosis and 6 had regurgitation of grade III$\~$IV. The diameter of the ascending aorta was measured before and immediately after surgery and 6 and 12 months postoperatively using echocardiography or computed tomography. Follow-up was complete in an average of 14.7$\~$5.4 (7 to 24) months. Result: There were no early postoperative deaths and no bleeding complications. Reduction aortoplasty with suture plication technique decreased the diameter of ascending aorta from 49.4$\pm$3.5 mm preoperatively to 33.2$\pm$3.4 mm postoperatively (p <0.001). During follow-up, there were no late deaths and no aneurysm recurrence on the ascending aorta. Conclusion: Suture plication technique of reduction aortoplasty without excision of the dilated aortic wall offers good early and short-term results in older, high-risk patients with dilatation of the ascending aorta associated with aortic valve disease. Surgical long-term results of our technique should be evaluated in further studies.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.44-65
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• 2003

Purpose : To conduct nationwide surgery on the principles In radiotherapy for rectal center, and develop the framework of a database of Korean Patterns of Care Study. Materials and Methods : A consensus committee was established to develop a tool for measuring the Patterns in radiotherapy Protocols for rectal cancer. The Panel was composed of radiation oncologists from 18 hospitals in Seoul Wetropolltan area. The committee developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer. The survey items developed for measuring the treatment principles were composed of 1) 8 eliglblllty criteria, 2) 20 Items for staging work-ups and prognostic factors, 3) 7 Items for principles of combined surgery and chemotherapy, 4) 9 patient set-ups, 5) 19 determining radiation fields, 6) S radiotherapy treatment pians, 7) 4 physicalilaboratory examination to monitor a patient's condition during treatment, and 8) 10 follow-up evaluations. These items were sent to radiation oncoioglsts In charge of gastrolntestlnal malignancies in all hospitals (48 hospitals) In Korea to which 30 replies were received (63$\%$). Results : Most of the surrey Items were replied to without no major between the repliers, but with the fellowing items only 50$\%$ of repliers were in agreement : 1) Indications of preoperative radiation, 2) use of endorectal ultrasound, CT scan, and bone scan for staging work-ups, 3) principles of combining chemotherapy with radiotherapy, 4) use of contrast material for small bowel delineation during simulation, 5) determination of field margins, and 6) use of CEA and colonoscopy for follow-up evaluations. Conclusions : The Items where considerable disaggrement was shown among the radiation oncologists seemed to make no serious difference In the treatment outcome, but a practical and reasonable consensus should be reached by the committee, with logical processes of agreement. These Items can be used for a basic database for the Patterns of Care Study, which will survey the practical radiotherapy Patterns for rectal cancer in Korea.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.101-109
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• 2005

Background: In sudden cardiac arrest, the effective maintenance of coronary artery blood flow is of paramount importance for myocardial preservation as well as cardiac recovery and patient survival. The purpose of this study was to directly compare the effects of pulsatile and non-pulsatile circulation to coronary artery flow and myocardial preservation in cardiac arrest condition. Material and Method: A cardiopulmonary bypass circuit was constructed in a ventricular fibrillation model using fourteen Yorkshire swine weighing $25\~35$ kg each. The animals were randomly assigned to group I (n=7, non-pulsatile centrifugal pump) or group II (n=7, pulsatile T-PLS pump). Extra-corporeal circulation was maintained for two hours at a pump flow of 2 L/min. The left anterior descending coronary artery flow was measured with an ultrasonic coronary artery flow measurement system at baseline (before bypass) and at every 20 minutes after bypass. Serologic parameters were collected simultaneously at baseline, 1 hour, and 2 hours after bypass in the coronary sinus venous blood. The Mann-Whitney U test of STATISTICA 6.0 was used to determine intergroup significances using a p value of < 0.05. Result: The resistance index of the coronary artery was lower in group II and the difference was significant at 40 min, 80 min, 100 min and 120 min (p < 0.05). The mean velocity of the coronary artery was higher in group II throughout the study, and the difference was significant from 20 min after starting the pump (p < 0.05). The coronary artery blood flow was higher in group II throughout the study, and the difference was significant from 40 min to 120 min (p < 0.05) except at 80 min. Serologic parameters showed no differences between the groups at 1 hour and 2 hours after bypass in the coronary sinus blood. Conclusion: In cardiac arrest condition, pulsatile extracorporeal circulation provides more blood flow, higher flow velocity and less resistance to coronary artery than non-pulsatile circulation.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.901-908
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• 2001

Background : Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. Material and Methold : Clinical data of 31(4.1％) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98％) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84％) and first degree of Rentrop classification(16 cases, 52％) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9${\pm}$0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7${\pm}$3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9 ${\pm}$ 1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysrmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5% . Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5${\pm}$11.6%, p 0.001) as compared with preoperative left ventricular ejection fraction(25.3${\pm}$2.3%). The follow up period of out patient was 25. 3 months. Conclusion: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.

• Restorative Dentistry and Endodontics
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• v.24 no.1
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• pp.166-179
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• 1999

Apical sealing is essential for the success of surgical endodontic treatment. Root-end cavity is apt to be contaminated with moisture or blood, and is not always easy to be dried completely. The purpose of this study was to evaluate the influence of dry methods of retrocavity on the apical seal in endodontic surgery. Apical seal was investigated through the evaluation of apical leakage and adaptation of filling material over the cavity wall. To investigate the influence of various dry methods on the apical leakage, 125 palatal roots of extracted human maxillary molar teeth were used. The clinical crown of each tooth was removed at 10 mm from the root apex using a slow-speed diamond saw and water spray. Root canals of the all the specimens were prepared with step-back technique and filled with gutta-percha by lateral condensation method. After removing of the coronal 2 mm of filling material, the access cavities were closed with Cavit$^{(R)}$. Two coats of nail polish were applied to the external surface of each root. Apical three millimeters of each root was resected perpendicular to the long axis of the root with a diamond saw. Class I retrograde cavities were prepared with ultrasonic instruments. Retrocavities were washed with physiologic saline solution and dried with various methods or contaminated with human blood. Retrocavities were filled either with IRM, Super EBA or composite resin. All the specimens were immersed in 2% methylene blue solution for 7 days in an incubator at $37^{\circ}C$. The teeth were dissolved in 14 ml of 35% nitric acid solution and the dye present within the root canal system was returned to solution. The leakage of dye was quantitatively measured via spectrophotometric method. The obtained data were analysed statistically using one-way ANOVA and Duncan's Multiple Range Test. To evaluate the influence of various dry methods on the adaptation of filling material over the cavity wall, 12 palatal roots of extracted human maxillary molar teeth were used. After all the roots were prepared and filled, and retrograde cavities were made and filled as above, roots were sectioned longitudinally. Filling-dentin interface of cut surfaces were examined by scanning electron microscope. The results were as follows: 1. Cavities dried with paper point or compressed air showed less leakage than those dried with cotton pellet in Super EBA filled cavity (p<0.05). However, there was no difference between paper point- and compressed air-dried cavities. 2. When cavities were dried with compressed air, dentin-bonded composite resin-filled cavities showed less apical leakage than IRM- or Super EBA-filled ones (p<0.05). 3. Regardless of the filling material, cavities contaminated with human blood showed significantly more apical leakage than those dried with compressed air after saline irrigation (p<0.05). 4. Outer half of the cavity showed larger dentin-filling interface gap than inner half did when cavities were filled with IRM or Super EBA. 5. In all the filling material groups, cavities contaminated with blood or dried with cotton pellets only showed larger defects at the base of the cavity than ones dried with paper points or compressed air.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.2 no.2
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• pp.194-203
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• 1999

Purpose: Childhood pancreatitis has more various and somewhat different etiology than adult. Until now the analysis of severity in childhood pancreatitis were not well-known, although several studies have been made. Therefore, we studied the etiology and complications in childhood pancreatitis and analyzed whether Ranson and CT criteria could be applicated to evaluate the severity of childhood pancreatitis patients. Methods: The records of 30 patients with pancreatitis under 15 years of ages who were diagnosed in Asan medical center were reviewed. Age, sex, history, etiology, clinical features and treatment was reviewed in all patients but complications, Ranson and CT criteria were available in only 12 patients. Correlation between the number of complications and both Ranson and CT criteria were calculated with Spearman correlation coefficient. Results: 1. Median age at diagnosis was 7.3 years of age. 28 cases were acute pancreatitis and 2 cases were chronic pancreatitis. 2. Etiology: choledochal cyst(8 cases), drug (7 cases), trauma (4 cases), infection (3 cases), biliary stone or bile sludge (3 cases), idiopathic (2 cases) Hemolytic uremic syndrome, pancreatic duct obstruction, iatrogenic (1 case). 3. Local complications were ascites (5 cases), pseudocyts (4 cases) and systemic complications were hyperglycemia (4 cases), hypocalcemia (3 cases), pleural effusion (3 cases), etc. 4. Positive correlation was found between the number of complication and Ranson creteria (r=0.78, P=0.0016) and between the number of complication and CT criteria (r=0.65, P=0.015) in 13 cases. Conclusion: A trial to search the biliary duct anomaly may help to find the causes of childhood idiopathic pancreatitis, and both Ranson and CT criteria can be applicated to pediatric patients to evaluate the severity of childhood pancreatitis.

• Tuberculosis and Respiratory Diseases
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• v.57 no.4
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• pp.320-328
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• 2004

Background : Pulmonary vascular changes which occur early in the course of chronic obstructive pulmonary disease (COPD) are prevalent manifestation and later cause pulmonary hypertension, which is a bad prognostic factor in COPD. Beraprost sodium (BPS), an orally active prostacyclin analogue, has been shown to improve survival in patients with primary pulmonary hypertension. This study investigated the effect of BPS in the patients with COPD. Methods : This is a double-blind randomized placebo-controlled, two center clinical trial. Twenty one consecutive patients with COPD were enrolled from June 2003 to June 2004 (patients treated with BPS for 3 months, BPS group, n=11; those with placebo, placebo group, n=10). The baseline demographic, pulmonary function and hemodynamic data were not significantly different between two groups. Results : On echocardiographic examination, trans tricuspid valve pressure gradient has decreased significantly after 3 months with beraprost in the BPS group [17.7(${\pm}11.4$) to 8.2(${\pm}8.9$) mm Hg, p-value<0.05], while there was no significant change in the control group. Six-minute walking distance has decreased in the control group and increased in the BPS group, but there was no statistical significance. Conclusion : In patients with COPD oral administration of BPS reduced the pulmonary arterial pressure. The clinical significance of this finding, that is improving symptoms and natural course of the disease, needs further study.

• Childhood Kidney Diseases
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• v.2 no.1
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• pp.34-40
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• 1998

Present study was conducted to determine the frequency, clinical characteristics and long-term outcome of children with idiopathic hypercalciuria. Study patients consisted of 150 children with isolated hematuria (recurrent gross or persistent microscopic), and hypercalciuria was defined as urinary calcium excretion over 4 mg/kg/day. During follow-up period up to $6{\sim}8$ years, serial check-up of renal sonogram for stone formation and Dipstick examination for hematuria were done. Forty-four (29%) out of 150 cases were diagnosed as idiopathic hypercalciuria, and in hypercalciuric children compared to normocalciuric children boys were more common than girls (9:35) and gross hematuria was more common than microscopic hematuria (37:7) (P<0.05). Oral calcium loading test showed renal type in 29 cases, absorptive type in 8 cases and in 7 cases type could not be definable. Among 3 types no differences could be found in 24 hour urinary calcium excretion and in clinical or laboratory data. Urolithiasis developed in 4 out of 44 cases (2 at the time of initial diagnosis and 2 within $1{\sim}2$ years of follow-up periods) and these children showed lower chronologic age ($3.7{\pm}2.7\;vs\;7.2{\pm}2.9\;yr$) and more girl than boys (3:1 vs 6:34) (P<0.05) compared to the rest of the hypercalciuric children. Follow-up urinalysis showed disappearance of hematuria in 56, 50, 66 and 75% of children at $1{\sim}2,\;2{\sim}4,\;4{\sim}6$ and $6{\sim}8$ years after initial diagnosis respectively. In conclusion, present study demonstrates that idiopathic hypercalciuria is a major cause of isolated hematuria in children so that in these children 24 hour urinary calcium excretion test seems to be an essential test to be performed. And serial renal sonography should be done to detect development of nephrolithiasis. However, clinical significance of dividing hypercalciuric children into two pathophysiologically distinct subtypes by oral calcium loading test seems to be in doubt and further study is needed to solve this problem.

• The Korean Journal of Nuclear Medicine
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• v.33 no.5
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• pp.452-460
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• 1999

Purpose: The purpose of this study was to evaluate the diagnostic usefulness of scintimammography per-formed with Tc-99m tetrofosmin in the detection of primary breast cancer Materials and Methods: Sixty-one patients underwent Tc-99m tetrofosmin scintimammography, plain-film mammography and ultrasonography. After intravenous injection of Tc-99m tetrofosmin (740 MBq), prone lateral and anterior scintimammograms were obtained. Scintimammogram was visually interpreted as positive, probably positive, probably negative and negative for malignancy. The tumor to background count ratio (T/B) was measured at 5 minutes and 1 hour. Plain-film mammogram was interpreted as one of 5 categories. Final diagnosis was achieved by surgical histology (58/61) or fine needle aspiration (3/61). Of 61 patients, 44 had cancer and 17 had benign lesion. Tumor size of malignant and benign lesions on ultrasonogram were $2.51{\pm}1.30cm$ (range 1-8 cm), $2.50{\pm}1.35cm$ (range 0.96-6 cm), respectively. Results: The sensitivity of plain-film mammography was 88.6%, specificity 58.8%, positive predictive value 84.7%, and negative predictive value 66.7% The sensitivity of Tc-99m tetrofosmin scintimammography was 90.9%; specificity, 88.2%; positive predictive value, 94.9%, negative predictive value, 18.9%. Of 25 patients with indeterminate degree of suspicion for malignancy on plain-film mammogram, 23 were correctly diagnosed by scintimammography. The T/B at 5 minutes and 1 hour were $3.78{\pm}2.21$, $3.25{\pm}1.80$ respectively. The T/B was decreased significantly at 1 hour (p<0.001). Conclusion: Tc-99m tetrofosmin scintimammography was useful dia-gnostic procedure in the detection of primary breast cancer, especially in patients with indeterminate degree of suspicion for malignancy on plain-film mammogram.

• Journal of Nuclear Fuel Cycle and Waste Technology(JNFCWT)
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• v.5 no.3
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• pp.199-212
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• 2007

If a type IP-2 transport package were to be subjected to a free drop test and a penetration test under the normal conditions of transport, it should prevent a loss or dispersal of the radioactive contents and a more than 20% increase in the maximum radiation level at any external surface of the package. In this paper, we suggested the analytic method to evaluate the structural safety of a type IP-2 transport package using a thick steel plate for a structure part and a bolt for tying a bolt. Using an analysis a loss or dispersal of the radioactive contents and a loss of shielding integrity were confirmed for two kinds of type IP-2 transport packages to transport radioactive waste drums from a waste facility to a temporary storage site in a nuclear power plant. Under the free drop condition the maximum average stress at the bolts and the maximum opening displacement of a lid were compared with the tensile stress of a bolt and the steps in a lid, which were made to avoid a streaming radiation in the shielding path, to evaluate a loss or dispersal of radioactive waste contents. Also a loss of shielding integrity was evaluated using the maximum decrease in a shielding thickness. To verify the impact dynamic analysis for free drop test condition and evaluate experimentally the safety of two kinds of type IP-2 transport packages, free drop tests were conducted with various drop directions. For the tests we examined the failure of bolts and the deformation of flange to evaluate a loss or dispersal of radioactive material and measured the shielding thickness using a ultrasonic thickness gauge to assess a loss of shielding integrity. The strains and accelerations acquired from tests were compared with those by analyses to verify the impact dynamic analysis. The analytic results were larger than the those of test so that the analysis showed the conservative results. Finally, we evaluated the safety of the type IP-2 transport package under the stacking test condition using a finite element analysis. Under the stacking test condition, the maximum Tresca stress of the shielding material was 1/3 of the yielding stress. Two kinds of a type IP-2 transport package were safe for the free drop test condition and the stacking test condition.