• Journal of Chest Surgery
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• v.35 no.7
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• pp.517-522
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• 2002

Background: Congenital heart surgery may lead to myocardial swelling and hemodynamic instability. Delayed sternal closure may be beneficial in this setting. The purpose of this study was to assess mortality and mediastinal infection rate associated with delayed sternal closure after congenital heart surgery and to evaluate the risk factors which affect mortality and mediastinal infection rate. Material and Method: We retrospectively reviewed 40 patients who underwent delayed sternal closure after repair of congenital heart disease at Yonsei Cardiovascular Hospital, from January 1994 to May 2001. In these patients, we assessed the mortality and mediastinal infection rate, and evaluated their risk factors including operation time, bypass time, aortic cross clamp time, duration to sternal closure and postoperative artificial ventilation time. Mediastinal infection was defined to have positive culture in mediastinum. Result: Hemodynamic instability was the most common indication for delayed sternal closure(n=36) and other indications included postoperative bleeding(n=2) and conduit compression(n=2). The median age at operation was $14.4{\pm}33.4$months old(range, 2days-12years). The patients with postoperative bleeding and conduit compression were much older than the others. The sternum was left open for $4.5{\pm}3.4$ days(range, 1-20days). Overall mortality was 25%(10/40) and mediastinal infection occured in 24.3%(9/37) (3 patients were excluded in mediastinal infection for early death). In risk factor analyses, only aortic cross clamp time had statistical significance for mortality in univariate analyses. However, multivariate analyses revealed that there were no significant predictors for risk of mortality and mediastinal infection. Conclusion: Delayed sternal closure after repair of congenital cardiac disease had relatively high mortality and mediastinal infection rate. But, in patients with hemodynamic instability, postoperative bleeding and conduit compression after repair of congenital cardiac disease, delayed sternal closure may be an effective life saving method.

• The Korean Journal of Nuclear Medicine
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• v.39 no.1
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• pp.57-68
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• 2005

Purpose: The objective of this study was to assess attenuation correction algorithms with the $^{137}Cs$ point source for the brain positron omission tomography (PET) imaging process. Materials & Methods: Four different types of phantoms were used in this study for testing various types of the attenuation correction techniques. Transmission data of a $^{137}Cs$ point source were acquired after infusing the emission source into phantoms and then the emission data were subsequently acquired in 3D acquisition mode. Scatter corrections were performed with a background tail-fitting algorithm. Emission data were then reconstructed using iterative reconstruction method with a measured (MAC), elliptical (ELAC), segmented (SAC) and remapping (RAC) attenuation correction, respectively. Reconstructed images were then both qualitatively and quantitatively assessed. In addition, reconstructed images of a normal subject were assessed by nuclear medicine physicians. Subtracted images were also compared. Results: ELEC, SAC, and RAC provided a uniform phantom image with less noise for a cylindrical phantom. In contrast, a decrease in intensity at the central portion of the attenuation map was noticed at the result of the MAC. Reconstructed images of Jaszack and Hoffan phantoms presented better quality with RAC and SAC. The attenuation of a skull on images of the normal subject was clearly noticed and the attenuation correction without considering the attenuation of the skull resulted in artificial defects on images of the brain. Conclusion: the complicated and improved attenuation correction methods were needed to obtain the better accuracy of the quantitative brain PET images.