• Journal of Chest Surgery
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• v.41 no.5
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• pp.591-597
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• 2008

Background: Pulmonary endarterectomy is widely accepted as a treatment for chronic thromboembolic pulmonary hypertension. Based on our experiences, we sought to find ways to reduce perioperative complications and to improve surgical outcomes in patients undergoing pulmonary endarterectomy. Material and Method: This study was designed as a retrospective analysis of 20 patients with pulmonary hypertension who underwent pulmonary endarterectomy between January 1998 and March 2008. All patients presented with chronic dyspnea. Deep vein thrombosis (DVT) was the major cause of chronic pulmonary thromboembolism (55%). Seventeen patients (85%) underwent inferior vena cava (IVC) filter placement. Thirteen patients underwent surgery under total circulatory arrest, while the others underwent surgery while on low flow cardiopulmonary bypass. Concomitant tricuspid annuloplasty was done in 6 patients (66%) whose tricuspid regurgitation was as severe as grade IV/IV. The mean follow-up duration was $45{\pm}32$ months. Result: Using of University of California, San Diego (UCSD), thromboembolism classification, 4 patients (20%) were type 1, 8 patients (40%) were type II, and 8 patients (40%) were type III. Right ventricular systolic pressure was reduced significantly from $77{\pm}29$ mmHg to $37{\pm}19$ mmHg after pulmonary endarterectomy (p<0.001). The degree of tricuspid regurgitation and the NYHA functional class were all improved postoperatively. Reperfusion edema occurred in 7 cases (35%). The incidence of reperfusion edema was higher in the UCSD type III group than in the other group (25% vs 50%, p=0.25) and the length of postoperative intensive care unit stay was longer in type III group ($5{\pm}2$ days vs $9{\pm}7$ days, p=0.07). The early mortality rate was 10%, and the late mortality rate was 15% (n=3); one death was due to progression of underlying non-Hodgkin's lymphoma, and the other deaths were related to recurrent thromboembolism and persistent pulmonary hypertension, respectively. Conclusion: Pulmonary endarterectomy, as a curative surgical method for treating chronic thromboernbolic pulmonary hypertension, should be performed aggressively in patients diagnosed with chronic thromboembolic pulmonary hypertension, and an effort should be made to reduce the frequency of perioperative complications and to improve surgical outcomes.

• The Journal of Korean Society for Radiation Therapy
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• v.19 no.2
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• pp.91-97
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• 2007

Purpose: To evaluate the feasibility of a commercial ion chamber array for intensity modulated radiation therapy (IMRT) quality assurance (QA) was performed IMRT patient-specific QA Materials and Methods: A use of IMRT patient-specific QA was examined for nasopharyngeal patient by using 6MV photon beams. The MatriXX (Wellhofer Dosimetrie, Germany) was used for IMRT QA. The case of nasopharyngeal cancer was performed inverse treatment planning. A hybrid dose distribution made on the CT data of MatriXX and solid phantom all of the same gantry angle (0$^\circ$). The measurement was acquired with geometrical condition that equal to hybrid treatment planning. The $\gamma$-index (dose difference 3%, DTA 3 mm) histogram was used for quantitative analysis of dose discrepancies. An absolute dose was compared at the high dose low gradient region. Results: The dose distribution was shown a good agreement by gamma evaluation. A proportion of acceptance criteria was 95.8%, 97.52%, 96.28%, 98.20%, 97.78%, 96.64% and 92.70% for gantry angles were 0$^\circ$, 55$^\circ$, 110$^\circ$, 140$^\circ$, 220$^\circ$, 250$^\circ$ and 305$^\circ$, respectively. The absolute dose in high dose low gradient region was shown reasonable agreement with the RTP calculation within $\pm$3%. Conclusion: The MatriXX offers the dosimetric characteristics required for performing both relative and absolute measurements. If MatriXX use in the clinic, it could be simplified and reduced the IMRT patient-specific QA workload. Therefore, the MatriXX is evaluated as a reliable and convenient dosimeter for IMRT patient-specific QA.

• Radiation Oncology Journal
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• v.18 no.3
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• pp.177-181
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• 2000

Purpose : Rarity of olfactory neuroblastoma makes it difficult for treating Physician to Practice with a consistent protocol. This study is peformed to analyze our experience with various treatment modalities for patients with olfactory neuroblastoma. Discussion includes review of some recently published literatures. Methods and Materials : Between June of 1979 and April of 1997, 20 patients were treated under the diagnosis of olfactory neuroblastoma at Seoul National University Hospital. There were 14 male and 6 female patients. Age at initial treatment ranged from l3 to 77 years with median or 24 years. fifteen or 20 patients had Kadish stage C. They were treated with various combinations of surgery, radiation therapy and chemotherapy; surgery+postoperative radiation therapy+adjuvant chemotherapy for 2 patients, surgery+postoperative radiation therapy for 6, neoadjuvant chemotherapy+surgery for 1, surgery+adjuvant chemotherapy for 1, surgery only for 2, neoadiuvant chemotherapy+ radiation therapy for 3, radiation therapy+adjuvant chemotherapy for 1, radiation therapy only for 3, and no treatment for 1 patient. Results : Follow-up ranged from 2 month to 204 months with mean of 39.6 months. The overall 5- and 10-year survival rates are 20% and 10%, respectably. Four patients are alive at the time of data analysis. One of four living patients was treated with radical surgery, postoperative radiation therapy and adjuvant chemotherapy, two patients with radical surgery and postoperative radiation therapy, and one with radical surgery only. Conclusion : Multidisciplinary approach, including radical surgery, pre- or post-operative radiation therapy and chemotherapy, should be addressed at the initial time of diagnosis. Although limited by small number of the patients, this study suggests importance of local treatment modality, especially radical surgery in the treatment of lofactory neuroblastoma.

• Radiation Oncology Journal
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• v.12 no.1
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• pp.1-8
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• 1994

When cells are exposed to low doses of a mutagenic or clastogenic agents. they often become less sensitive to the effects of a higher dose administered subsequently. Such adaptive responses were first described in Escherichia coli and mammalian cells to low doses of an alkylating agent. Since most of the studies have been carried out with human lymphocytes, it is urgently necessary to study this effect in different cellular systems. Its relation with inherent cellular radiosensitivity and underlying mechanism also remain to be answered. In this study, adaptive response by 1 cGy of gamma rays was investigated in three human lymphoblastoid cell lines which were derived from ataxia telangiectasia homozygote, ataxia telangiectasia heterozygote, and normal individual. Experiments were carried out by delivering 1 cGy followed by 50 cGy of gamma radiation and chromatid breaks were scored as an endpoint. The results indicate that prior exposure to 1 cGy of gamma rays reduces the number of chromatid breaks induced by subsequent higher dose (50 cGy), The expression of this adaptive response was similar among three cell lines despite of their different radiosensitivity. When 3-aminobenzamide, an inhibitor of poly (ADP-ribose) polymerase, was added after 50 cGy, adaptive responses were abolished in all the tested cell lines. Therefore it is suggested that the adaptive response can be observed in human lymphoblastoid cell lines, which was first documented through this study. The expression of adaptive response was similar among the cell lines regardless of their radiosensitivity. The elimination of the adaptive response by 3-aminobenzamide is consistent with the proposal that this adaptive response is the result of the induction of a certain chromosomal repair mechanism.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.5
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• pp.359-363
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• 2007

Purpose: Incidental parotid lesions on F-18 FDG-PET can mimic distant metastasis of underlying malignancy. The prevalence and the clinico-pathologic findings of PET positive parotid lesions have not been known. We investigated how often incidental parotid lesions are found on clinical FDG-PET studies and what the clinico-pathologic characteristics of those parotid lesions are in the present study. Materials and Methods: We retrospectively reviewed 3,344 cases of FDG-PET which had been obtained in our hospital from May 2003 to Dec 2006. The indications of FDG-PET were: evaluation of known/suspected cancer (n= 3,212) or screening of cancer in healthy subjects (n=132). Incidental parotid lesion on FDG-PET was defined as an un-expected FDG uptake in one of parotid glands which was not primary target lesion of current FDG-PET. FDG uptake was represented by maximum standardized uptake value (maxSUV). Final diagnosis was made by pathologic analysis or clinical follow-up assessment. Results: Fifteen (0.45% = 15/3,344) incidental parotid lesions were found and they were all benign lesions. The maxSUV ranged from 1.7 to 8.6 (mean${\pm}$s.d. = $3.7{\pm}1.9$). Final diagnoses of the incidental parotid lesions were; Warthin's tumor (n=2), pleomorphic adenoma (n=1), other un-specified benign lesion (n=1), and benign lesions under bases of imaging studies (n=3) and of clinical follow-up (n=8). Conclusion: All of incidentally found parotid lesions in clinical FDG-PET studies were confirmed as benign lesions with prevalence of 0.45%. Close follow up using PET or CT might be a reasonable approach for determining the nature of incidentally found parotid lesions.

• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.3
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• pp.184-191
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• 2008

Purpose: To evaluate the degree of malignancy of incident thyroid lesion found in $^{18}F$-FDG PET/CT findings and the usefulness of the method suggested in this study, we applicate the Delay Scan Method that differentiate a false positive benign tumor, inflammation and malignancy, as well as make the criteria of SUV. Materials and Methods: A retrograde study was conducted of 800 patients who were admitted in E hospital to receive $^{18}F$-FDG PET/CT examination. One patient who was diagnosed as primary thyroid cancer and received $^{18}F$-FDG PET/CT examination was excluded. The number of final patients of this study was 799, the reasons of $^{18}F$-FDG PET/CT examination of these patients were follow-up of old cancer or suspicious tumorous lesion in 696 and disease screening in 103. $^{18}F$-FDG PET/CT image photographing was taken in Biograph-Duo made by SIEMENS, after taking normal $^{18}F$-FDG PET/CT image (1 hr) and then 1 hr later we took the thyroid 1 bed-delayed image for the patients who showed abnormal thyroid $^{18}F$-FDG uptake and above 2.0 SUV for 2 minutes every 1 bed. For the patients who showed abnormal thyroid uptake and above 2.0 SUV, 1 hr later, we took a 1 bed-delayed image and then made a comparative study between measured $SUV_{max}$ of 1 hr-abnormal uptake image and that of 2 hr-delayed image. Results and Conclusion: In this $^{18}F$-FDG PET/CT study among the patients who showed incidental $^{18}F$-FDG thyroidal uptake the number of thyroid incidentaloma was 5 (0.63%), all of then showed benign findings. And in the case of incidental $^{18}F$-FDG uptake in thyroid, $SUV_{max}$ variance obtained from 2 hr delayed image can be a indirect criteria in differentiating benign tumor from malignancy and decrease finding error. In the cases found thyroid incidentaloma when 1) $SUV_{max}$ of focal thyroid lesion is above 5.0 and 2) $SUV_{max}$ variance between normal $^{18}F$-FDG PET/CT exam and 2 hr delayed is $1.0{\pm}0.5$, they are suspected as malignancy and confirming biopsy is to be followed. Otherwise, I also think that distinct follow-up PET or CT image study is a reasonable diagnostic method.

• Economic and Environmental Geology
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• v.35 no.5
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• pp.395-406
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• 2002

The sixty natural springs and community wells used as a drinking water in the Daejeon area are mainly located at the parks and the natural green districts. The purpose of this study is to investigate the characteristics of water quality and the contamination of the springs and the wells, and to suggest the management strategy for the springs and wells. For this study, we undertook water quality data from Daejeon City. According to the statistic analysis of water quality data, unacceptable rate as a drinking water was about 28 percent in 1999 and 24.5 percent in 2000, respectively. Major unacceptable factor is coliform, and others are bacteria, yersinia, color, turbidity, Fe and F. The unacceptable rate shows a roughly positive relationship with precipitation, that is, it shows highest rate during a rainy season between June and September. The major contamination source is likely to be the excrement of wild animals around natural springs and wells. Most of springs are vulnerable to the contamination of coliform and bacteria because of short residence time and shallow circulation in subsurface environment. The water samples collected from 31 springs or wells show weak acidic pHs, the electrical conductivity ranging from 63 to 357 $\mu\textrm{S}$/cm, and the hydrochemical types of Na(Ca)-HC0$_3$ and Ca-HC0$_3$. The groundwater samples of low total dissolved solid(TDS) belong to Na(Ca)-HC0$_3$. type, and the groundwater of high total dissolved solid is shifted towards Ca-HC0$_3$ type in the chemical composition. These hydrochemical characteristics indicate that most natural springs is in the early stage of geochemical evolution. The natural springs should be closed during a rainy season, which shows a high contamination rate. We suggest that a protection barrier around the springs should be built to keep wild animals away from the springs.

• Journal of Hospice and Palliative Care
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• v.22 no.4
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• pp.185-197
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• 2019

Purpose: Hospice volunteers are serving an invisible yet pivotal role in the hospice and palliative care team. This study investigated how effectively a continuing education program could enhance hospice volunteers' competency. Methods: A total of 20 hours (four hours per week) of training was provided to 30 hospice volunteers who participated in the continuing education for hospice volunteers. Efficiency of the education was analyzed with an exploratory mixed-methods design. For quantitative analysis, the volunteers were asked, before and after the training, about their attitudes towards hospice care, what makes a meaningful life, self-efficacy and satisfaction with their volunteer service. Descriptive statistics, paired t-tests, and Wilcoxon signed-rank test were performed using SPSS Window 20.0. For qualitative research, participants were placed in three groups for a focus group interview, and data were analyzed by content analysis. Results: A quantitative study result shows that this training can significantly affect hospice volunteers' attitudes and improve their self-efficacy. A qualitative study result shows that participants wanted to receive continuous education from the physical/psychosocial/spiritual aspects to better serve end-of-life patients and their family members even though they have to spare significant time for the volunteer service. They wanted to know how to take good care of patients without getting themselves injured and how to provide spiritual care. Conclusion: The continuing education program reflecting volunteers' requests is strongly needed to improve their competency. An effective continuing education requires continuous training and support in areas where hospice volunteers are interested in. A good alternative is to combine web-based and hands-on training, thereby allowing hospice volunteers freely take training that suits their interest.

• Journal of dental hygiene science
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• v.15 no.2
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• pp.106-112
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• 2015

This study was conducted to provide with baseline data with the purpose of increasing the values of medical services. Self-administered questionnaire survey was conducted on 236 patients at a dental clinic follow-up visit in dentist clinic Gyeongnam area from June 2013 to August 2013. All statistical analyses were performed using SPSS. The motivation visiting the dental clinic is that the first one is introduction from the family and friends, the second is accessibility, the third is conspicuity and the last one is awareness of the dentist. The main variables in the process of treatment are service system, kindness, satisfaction of service, efficient of re-call system. The relief of discomfort at revisit show the highest score in the process of implant treatment and intention of revisit hereafter do in the prostheses process. In the correlation between main variables, service system and relief of discomfort at revisit (r=0.440, p<0.001), kindness and satisfaction of medical service (r=0.675, p<0.001), revisit hereafter and satisfaction of service (r=0.387, p<0.001) and efficiency of re-call system and revisit showed the highest correlation. The influence on satisfaction of dental service show meaningful level in kindness (p<0.001) and efficiency of re-call system (p<0.05). The intention of revisit is affected meaningfully by relief of uncomfort (p<0.05), service system (p<0.05), kindness (p<0.01) and efficiency of re-call system (p<0.01). In summary, the personal network of patients is most important variable at intention for revisit of dental clinic. As satisfaction of kindness and efficiency of re-call system is higher, satisfaction of medical service and intention for revisit are shown higher. Therefore further research for improvement of satisfaction for medical service and of intention of revisit at the dental clinic should be carried out.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.1
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• pp.54-59
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• 1999

This study was based on a series of 164 patients with zygomatic bone fracture treated at Department of Oral and Maxillofacial Surgery of Chonnam University Hospital from January 1992 to December 1996. The male-to-female ratio was 7:1. Their ages ranged from 8 to 78 years, with a median age of 35.6 years. The age frequency was highest in the second decade (30.5%), and third decade (23.8%), fifth decade (16.5%) in orders. The monthly distrbution of incidence showed October to be the month in which the greatest percentage occured (14.0%). The major cause of zygomatic bone fracture was alleged traffic accidents (53.7%). The incidence of concomitant facial bone fractures was 69,5%, and maxilla fracture (52.4%) was most frequently combined. The admission route was through emergency room (72.3%) and through outpatient department (26.8%). The incidence of associated injuries was 37.2%. The intraoral approach was the major method of treatment in zygomatic bone fracture (57.1%). The most frequent type of zygoma fracture was class IV (33.5%), and class III (25.6%) was next in order of frequency. Complications were enophthalmos (7.3%), facial asymmetry (6.7%), paresthesia (6.1%), and diplopia (2.4%) These results suggest that correct diagnosis and treatment of severity of fracture, concomitant fracture, and associated injuries are necessary, and co-operative treatment with medical department should be performed to reduce postoperative complication.