• Title/Summary/Keyword: Acceptable risk

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Therapeutic Efficacy and Complications of Automated Peritoneal Dialyzer in Dogs with Renal Failure (신부전 개에서 자동 복막투석기를 이용한 복막투석에 대한 평가)

  • Kwon, Heejung;Choi, Wonjin;Lee, Dong-Guk;Tan, David;Hyun, Changbaig
    • Journal of Veterinary Clinics
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    • v.32 no.5
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    • pp.399-403
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    • 2015
  • Peritoneal dialysis (PD) is a treatment for renal failure and acute poisoning, and uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances are exchanged from the blood. In this study, we evaluated the therapeutic efficacy and complications of automated peritoneal dialyzer (APD) in dogs with renal failure. PD was performed in 10 dogs using a swan neck catheter (Neonatal, Coviden) and automatic APD. The efficacy for each dog was assessed by calculating urea reduction ratio (URR) and creatinine reduction ratio (CRR). Mean concentrations of pre-dialysis creatinine and blood urea (BUN) were $7.09{\pm}3.84$ and $145.8{\pm}48.5$, respectively. The mean number of peritoneal dialysis cycles applied was $6{\pm}1$ cycles. Peritoneal dialysis resulted in a significant decrease in BUN concentration in 7/10 dogs, while a significant decrease in creatinine concentration in 9/10 dogs. The mean of URR was higher than that of CRR ($0.39{\pm}0.16$ vs $0.38{\pm}0.13$). The mean CRR and URR per dialysis cycles were $0.064{\pm}0.023$ and $0.065{\pm}0.023$, respectively. Complications found in this study were catheter occlusion, subcutaneous dialysate leakage, septic peritonitis, hypoalbuminemia and overhydration. This study found PD using a swan neck catheter and APD machine showed acceptable efficacy for successful peritoneal dialysis in dogs. However, close monitoring is required to minimize the risk of complication.

Establishment acceptable daily intakes(ADIs) for pesticides registered in Korea (국내등록농약의 일일섭취허용량(ADI) 설정)

  • Lee, Je-Bong;Shin, Jin-Sup;Park, Yeon-Ki;You, Are-Sun;Hong, Soon-Sung;Im, Gun-Jae;Kang, Kyu-Young
    • The Korean Journal of Pesticide Science
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    • v.11 no.4
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    • pp.289-298
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    • 2007
  • In order to set ADIs for pesticides registered for use in Korea, an analysis of guidelines on setting ADIs and ADIs established by international bodies and advanced countries was conducted General guidelines on the derivation ADIs are very similar among regulatory authorities. However, there were large differences in the ADIs' setting status and ADI values set for some individual pesticides. ADIs were established for 213 pesticides in UN, 332 in USA, 230 in Japan, 219 in UK and 435 in EU and Australia. Of the established ADIs in other countries, 87 to 252 pesticides were the pesticides registered in Korea depending countries. The number of lowest ADIs depending countries was 32 in USA, 23 in Japan, 6 in EU and Australia. The key target organs and endpoints used for setting ADIs were in the order of enzyme inhibition, body weight change and adverse effect on liver. The number of ADIs used for setting MRLs in Korea was high in the order of JMPR, Japan and USA. ADIs of EU and JMPR had highest similarity among bodies investigated. By referring to the guidances investigated at this study, guideline for setting ADI and ADIs for 64 pesticides registered in Korea were proposed.

Evaluation of Enzymatic Method using an Automated Chemistry Analyzers for Homocysteine Measurement

  • Shim, Moon-Jung
    • Korean Journal of Clinical Laboratory Science
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    • v.39 no.3
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    • pp.196-200
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    • 2007
  • In clinical practice, homocysteine has gained popularity because its elevated values are strongly associated with an increased risk of cardiovascular disease. More recently, a new enzymatic colorimetric assay for homocysteine in biological sample, suitable for automated clinical analyzers, has been proposed. To evaluate one of these enzymatic methods and compare the results obtained with this method with those of an immunoenzymatic method, thirty-two samples were analyzed for total homocysteine by HiSens$^{(R)}$ homocysteine reagent on the automated chemistry analyzers TBA 200FR and compared to the widely used immunoenzymatic method ADVIA Centaur. In TBA 200FR, the within-run CVs of two control materials were 3.23% and 0.92%, respectively; the between run CVs were 4.58% and 2.55%, respectively. And in ADVIA 1650, the within-run CVs were 6.81% and 0.99%, respectively; the between run CVs were 9.0% and 3.9%, respectively. The recovery for homocysteine was 100% ($60.8{\mu}mol/L$), 99.1% ($48.64{\mu}mol/L$), 96.3% ($36.48{\mu}mol/L$), 96.1% ($24.32{\mu}mol/L$), and 92.1% ($12.16{\mu}mol/L$). The regression equation of TBA 200FR vs. ADVIA Centaur was y=0.9095x-2.5086 (r=0.9632). And the regression equation for the ADVIA 1650 chemistry vs. Immulite 2000 was y=0.8418x + 0.3207 (r=0.9625). In conclusion, this enzymatic method using automated chemistry analyzer for homocysteine assay shows acceptable analytical performance. I suggest that this assay will be suitable for routine analysis.

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Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea

  • Jin, Bo Kyung;Bang, Ji Seok;Choi, Eun Young;Kim, Gi Beom;Kwon, Bo Sang;Bae, Eun Jung;Noh, Chung Il;Choi, Jung Yun;Kim, Woong Han
    • Clinical and Experimental Pediatrics
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    • v.56 no.3
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    • pp.125-129
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    • 2013
  • Purpose: The use of implantable cardioverter defibrillators (ICDs) to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was $14.5{\pm}5.4$ years (range, 2 to 22 years). The follow-up duration was $28.9{\pm}20.4$ months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1), cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years). Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia. During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

Retrospective Analysis on 76 Cases of Cerebral Arteriovenous Malformations Treated by Gamma Knife Radiosurgery

  • Choe, Jae-Gyun;Im, Yong-Seok;Kim, Jong-Soo;Hong, Seung-Chyul;Shin, Hyung-Jin;Lee, Jung-Il
    • Journal of Korean Neurosurgical Society
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    • v.43 no.6
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    • pp.265-269
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    • 2008
  • Objective : Outcome of gamma knife radiosurgery (GKS) in the consecutive 100 cases with cerebral arteriovenous malformations (AVMs) was analyzed. Methods : Data from initial 100 patients treated with GKS in the authors' institute were reviewed retrospectively. Spetzler-Martin grade at diagnosis were I in 18 patients, II in 27, III in 36, IV in 11, and V in 8. Thirty-five patients had experienced previous bleeding, 27 patients presented with seizure, and 31 patients presented with headache. The mean volume of the lesion was $4.3\;cm^3\;(0.1-29.3\;cm^3)$. The median radiation dose delivered to the margin was 20.0Gy (13-32Gy). Mean follow-up period was 37.5 months (5-63 months). Results : Angiographic follow-up was performed in 48 patients at least 2 years after GKS. Sixteen patients were lost in follow up following 2 years from GKS. Twenty-eight of 48 patients (58%) showed complete obliteration and 20 patients (42%) showed partial obliteration. Seven patients presented with post-GKS hemorrhage. Adverse radiation effect (ARE) was observed at follow-up MRI in 25 of 76 patients, and it was symptomatic in 5 patients. Complete obliteration was confirmed in 24 of 31 (77%) patients with volume less than $4\;cm^3$, meanwhile only 4 of 17 (24%) patients with volume of $4\;cm^3$ or more showed complete obliteration. Complete obliteration rate was 67% with 20Gy or higher marginal dose, 63% with 15-20 Gy, and 17% with less than 15Gy. Conclusion : GKS can provide high rates of obliteration with acceptable risk of morbidity in a subgroup of small AVMs. However, overall outcome in whole spectrum of AVMs, in which large proportion of cases have unfavorable characteristics for radiosurgery, is much worse. More effective therapeutic strategy needs to be developed for large AVMs that are difficult to be managed with current available treatment modalities.

Early Outcomes of Sutureless Aortic Valves

  • Hanedan, Muhammet Onur;Mataraci, Ilker;Yuruk, Mehmet Ali;Ozer, Tanil;Sayar, Ufuk;Arslan, Ali Kemal;Ziyrek, Ugur;Yucel, Murat
    • Journal of Chest Surgery
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    • v.49 no.3
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    • pp.165-170
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    • 2016
  • Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was $71.15{\pm}8.60years$. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was $56.9{\pm}9.93$. The CPB time was $96.51{\pm}41.27minutes$ and the cross-clamping time was $60.85{\pm}27.08minutes$. The intubation time was $8.95{\pm}4.19hours$, and the intensive care unit and hospital stays were $2.89{\pm}1.42days$ and $7.86{\pm}1.42days$, respectively. The mean quantity of drainage from chest tubes was $407.69{\pm}149.28mL$. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was $687.24{\pm}24.76days$. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

Development of a Raster-based Two-dimensional Flood Inundation Model (래스터 기반의 2차원 홍수범람 모형의 개발)

  • Lee, Gi-Ha;Lee, Seung-Soo;Jung, Kwan-Sue
    • Journal of the Korean Society of Hazard Mitigation
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    • v.10 no.6
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    • pp.155-163
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    • 2010
  • The past researches on flood inundation simulation mainly focused on development of numerical models based on unstructured mesh networks to improve model performances. However, despite the accurate simulation results, such models are not suitable for real-time flood inundation forecasting due to a huge computational burden in terms of geographic data processing. In addition, even though various types of vector and raster data are available to be compatible with flood inundation models for post-processes such as flood hazard mapping and flood inundation risk analysis, the unstructured mesh-based models are not effective to fully use such information due to data incommensurability. Therefore, this study aims to develop a raster-based two-dimensional inundation model; it guarantees computational efficiency because of direct application of DEM for flood inundation modeling and also has a good compatibility with various types of raster data, compared to a commercial model such as FLUMEN. We applied the model to simulate the BaekSan levee break in the Nam river during a flood period from August 10 to 13, 2002. The simulation results showed a good agreement with the field-surveyed inundation area and were also very similar with results from the FLUMEN. Moreover, the model provided physically-acceptable velocity vectors with respect to inundating and returning flows due to the difference of water level between channel and lowland.

Monitoring of Ergosterol Biosynthesis Inhibitor (EBI) Pesticide Residues in Commercial Agricultural Products and Risk Assessment (국내 유통 농산물 중 EBI계 농약 모니터링과 위해도 평가)

  • Lee, Hee-Jung;Choe, Won-Jo;Lee, Ju-Young;Cho, Dae-Hyun;Kang, Chan-Soon;Kim, Woo-Seong
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.38 no.12
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    • pp.1779-1784
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    • 2009
  • Establishment of simultaneous analysis method and monitoring for individually analyzing residual eight ergosterol biosynthesis inhibitors, EBI (difenoconazole, diniconazole, fenarimol, fenbuconazole, hexaconazole, myclobutanil, nuarimol and paclobutrazol) pesticides in commercial agricultural products, were conducted. The simultaneous analysis method for the pesticides was established using a GC/MS/MS for EBI pesticides. Residual amount of those pesticides were investigated in 989 commercial agricultural products (fifteen kinds of cereal grains, vegetables, beans, nuts, fruits and mushrooms) from seven metropolitan cities and eight provinces. In EBI pesticides analysis, linearity of GC/MS/MS analysis was 0.9974-0.9992, and that of recoveries were 86-135% with relative standard deviations (RSD) <20%. The limit of quantification (LOQ) of the method ranged from 0.5 to 5.0 mg/kg for eight EBI pesticides. According to the monitoring of the EBI pesticides in commercial agricultural products, difenoconazole, fenarimol, hexaconazole showed various residual levels (total frequency of 8/989 detection, 0.8%). Paclobutrazole showed in excess levels of the MRLs (maximum residue limits) for pesticides in one chard sample by the Korea Food Code. As a result of exposure assessment on the detected 8 individual pesticides, all pesticides (difenoconazole, fenarimol, hexaconazole, paclobutrazole) were evaluated as safe level in comparison to toxicologically acceptable daily intake.

Surgical Outcomes of Schwannoma Occurred at the Brachial Plexus (상완 신경총에 발생한 신경초종의 수술적 치료 결과)

  • Lee, Hyuk-Jin;Lee, Young-Ho;Gong, Hyun-Sik;Rhee, Seung-Hwan;Lee, Joon-Oh;Roh, Young-Hak;Kim, Kang-Wook;Baek, Goo-Hyun
    • Archives of Reconstructive Microsurgery
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    • v.19 no.1
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    • pp.1-6
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    • 2010
  • Schwannoma of the brachial plexus region is very rare. There has not been general agreement in terms of surgical outcome from limited number of studies. We analyzed surgical outcomes from 11 cases of schwannomas which occurred in the brachial plexus. From February 2000 to August 2009, 11 patients with schwannomas of the brachial plexus region were surgically treated by a single surgeon. We retrospectively reviewed the medical records and MRI of our cases, and evaluated the neurologic deficit and the recurrence of tumors after surgery. All the cases were proven histologically as schwannomas. The mean age of the patients was 52.6(36~67) years old, 4 of them were male and 7 were female. The tumor was located in the left side in 9 patients, and right in 2. The mean postoperative follow-up was 24.7(6~78) months. Initial presentation was usually painless, palpable mass. The mass was located in various level of the brachial plexus such as root, trunk, cord, or terminal branch level. The size of mass was from $1.5{\times}1.5{\times}0.5$ cm to $11.0{\times}10.0{\times}6.0$ cm. Eight of 11 patients showed no neurologic deficit. Three patients showed postoperative neurologic deficit; two of them had transient sensory deficit, and one of them had weakness of flexor pollicis longus and 2nd flexor digitorum profundus. There were no recurrences. The schwannoma of the brachial plexus region should be considered as a curable lesion with an acceptable surgical risk of injury to neurovascular structures. With precise surgical techniques, these tumors can be removed to improve patient's symptoms with minimal morbidity.

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The Safety of Microsurgical Head and Neck Reconstruction in the Elderly Patients (고령 환자군에 있어서 유리피판술을 이용한 두경부재건의 안전성)

  • Choi, Bong Kyoon;Kim, Young Seok;Lee, Won Jai;Lew, Dae Hyun;Tark, Kwan Chul
    • Archives of Plastic Surgery
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    • v.33 no.3
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    • pp.289-293
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    • 2006
  • By means of microsurgical free-tissue transfer providing a large amount of required tissue, the surgeon can resect tumoral tissue more safely, which allows tumor-free margins and enhances the reliability of the ablative surgery that otherwise could not be performed radically. The morbidity of elective free-tissue transfer seems to be quite low, carrying acceptable risks for most patients. But the elderly patients are at risk for cardiac and respiratory problems, deep vein thrombosis, pulmonary emboli and infection merely as a function of age. This study was undertaken to define further risks of the elderly population with regards to free-tissue transfer. We retrospectively reviewed our experience with 110 microsurgical free-tissue transfers for head and neck reconstruction in patients greater than 60 years of age. Microsurgical procedures in all cases were preformed by the plastic and reconstructive department at Yonsei medical center. The investigated parameters were patient demographics, past medical history, American Society of Anesthesiologists(ASA) status, site and cause of defect, the free tissue transferred and postoperative complication including free-flap success or failure. There were 46 patients in the age group from 60 to 64 years, 34 patients from 65 to 70 years, and 30 patients 70 years or older. There happened 3 flap losses, resulting in a flap viability rate of 97%. Patients with a higher ASA designation experienced more medical complication(p=0.05, 0.01, 0.03 in each age group I, II, III) but not surgical complication p=0.17, 0.11, 0.54 in each age group I, II, III). And the relationship between postoperative complication and age groups was not significant. These observations suggest that major determinant for postoperative medical complication be the patient's American Society of Anesthesiologists score, and chronologic age alone should not be an exclusion criterion when selecting patients for free-tissue transfer