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Usefulness and Limitations of Fine Needle Aspiration Cytology in Adult Cervical Lymph Node Enlargement Patients: An analysis of 342 cases (성인 경부 림프절 비대 환자들에서 미세침 흡인 세포검사법의 유용성과 문제점: 342 증례의 분석)

  • Lee, Jaeho
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.1
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    • pp.18-28
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    • 2004
  • Background : Many diseases like lung cancer and tuberculosis can involve cervical lymph node. Fine needle aspiration cytology(FNAC) was known as a useful screening test for the evaluation of enlarged lymph node. But the usefulness and limitations of FNAC according to disease category or physical characteristics of lymph node were not yet fully established. Methods : Retrospective analysis of three hundred forty two adult patients who performed FNAC due to enlarged cervical lymph nodes at the Seoul Municipal Boramae Hospital during the period from January 1999 to December 2002 and final diagnosis could be made by surgical biopsy, microbiology or clinical observation. Results : Among the 342 cases, 176(51.5 %) were finally diagnosed as benign nature ncluding reactive hyperplasia, Kikuchi's disease and acute suppuration. Eighty eight(25.7 %) were diagnosed as tuberculous lymphadenitis, 66(19.3 %) as metastasis, and 12(3.5 %) as lymphoma. Tuberculosis, metastasis, and lymphoma all showed significantly larger diameter, longer duration of lymph node enlargement. There were higher frequency of supraclavicular involvement in the cases of tuberculosis and metastasis. The overall diagnostic sensitivity of FNAC was 88.0 %, and 88.6 % in benign nature lesion, 77.3 % in tuberculosis, 90.1% in metastasis and 58.3 % in lymphoma. The diagnosis of tuberculosis was made by FNAC in 68 cases (77.3 %) among 88 cases. Lung cancer(43.9 percent) was most frequent cause of cervical lymph node metastasis. Diagnostic sensitivity of FNAC was significantly lower in the supraclavicular than other cervical lymph node(80 % vs. 91.3 %) and not correlated with disease nature, node size or number. Conclusion : Though FNAC was a reliable screening test for enlarged cervical lymph node enlargement, the diagnostic sensitivity was low in the case of lymphoma or when the enlarged lymph node was located at the supraclavicular area.

Water Landscape Displaying Techinques of Traditional Gardens between China and Korea - With Soswaewon and ZhuozhengYuan - (한.중 전통원림의 수경관 연출기법 비교 연구 - 소쇄원과 졸정원을 중심으로 -)

  • Lee, Hang Lyoul;Kim, Sun Rye
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.30 no.4
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    • pp.1-13
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    • 2012
  • Landscape Garden tradition of excellent examples of places that are focused on hydroponics management. South Korea and China, this thing was noticeable among them South Korea which emphasizes the natural contours of the natural streams in accordance with the basic idea to use examples that feature will do. Gardens in China by constructing a flat terrain also naturally expect to find examples of conscious ideas depending on the water and the mountains are characterized. These differences and similarities through the Gardens of the tradition of separating the two countries to build their Garden by site Soswaewon and Zolzengwon appear in the target hand is to identify the characteristics between the director. Research methods literature survey, field survey of the natural environment through the plantation, background history, the people who intend to study, to configure the ground water space, Jian, construction and management has been studied in hydroponics. As a result, Damyang-gun, Jeollanam-do, South Korea in the Garden of the Soswaewon(瀟灑園) organization with inner garden and outer garden of a small, but the scale of production to Yang San-Bo's 'eunilgwan' implement security based rock mooring takes the form of a linear channel and the water came down from riding pending to avoid artifacts gathered again took the form of streams flowing into that. Hutton was a rubble pile structure Jian. Building an Gwangpunggak, Jewoldang, as Daebongdae consist, respectively, depending on the purpose of the mooring was deployed by focusing. The other hand, is located at Suzhou, Jiangsu of China Zolzengwon(拙政園) flat terrain is located on. Largely divided eastern gardens, Central Gardens and the Gardens of the West was conducted by five thirds of the total area of Water accounted for. Pavilion the center of the pond, Seokgasan achieve a variety of landscapes and architectural features that are most of the Ming. The two countries, each region's natural environment and human environment, different, unique characteristics to each other in the implementation of a unique hydroponic Garden tube and ideological backgrounds, but especially the 'eunilgwan' and the terrain that is divided according to the conditions of this study, so fulfilling Garden was conducted.

Infrared Thermography in the Assessment of Temporomandibular Joint Dysorder (측두하악장애에서의 적외선 체열 촬영 검사의 유용성)

  • Nahm, Sahngun Francis;Koo, Mi Suk;Kim, Yang Hyun;Suh, Jeong Hun;Shin, Hwa Yong;Choi, Yong Min;Kim, Yong Chul;Lee, Sang Chul;Lee, Pyung Bok
    • The Korean Journal of Pain
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    • v.20 no.2
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    • pp.163-168
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    • 2007
  • Background: Temporomandibular joint disorder (TMD) is a group of musculoskeletal conditions characterized by pain in the pre-auricular area, limitation of jaw movement and palpable muscle tenderness. Thermography is a nonionizing, noninvasive diagnostic alternative for the evaluation of TMD. This study was conducted to evaluate the usefulness of thermography in the assessment of TMD. Methods: Thermography was conducted on the 61 patients who had been diagnosed with TMD, and on the 34 normal symptom-free volunteers. The temperature differences between opposite sides of the temporomandibular joint (${\Delta}T_{TMJ}$) and the masseter muscle (${\Delta}T_{MST}$) were calculated. The sensitivity and specificity of thermography was calculated at the cut off values of 0.2, 0.3, and $0.4^{\circ}C$. Results: In the patient group, the ${\Delta}T_{TMJ}$ was $0.42{\pm}0.38^{\circ}C$ and the ${\Delta}T_{MST}$ was $0.38{\pm}0.33^{\circ}C$, whereas in the control group the ${\Delta}T_{TMJ}$ was $0.10{\pm}0.07^{\circ}C$ and the ${\Delta}T_{MST}\;0.15{\pm}0.10^{\circ}C$. In addition, the patient group demonstrated a significantly lower level of thermal symmetry than the control group (P < 0.001) in both the temporomandibular joints and the masseter muscles. The sensitivity of thermography at the cut off values of 0.2, 0.3 and $0.4^{\circ}C$ was 67.2, 49.2, and 42.6% in the temporomandibular joint (TMJ) and 60.7, 49.2 and 37.7% in the masseter muscle, respectively. The specificity of thermography at the cut off values of 0.2, 0.3 and $0.4^{\circ}C$ was 88.2, 100, and 100% in the TMJ and 61.8, 91.2 and 100% in the masseter muscles, respectively. The accuracy of thermography at the cut off values of 0.2, 0.3 and $0.4^{\circ}C$ was 74.7, 67.4, and 63.2% in TMJ and 61.1, 64.2 and 60.0% in the masseter muscles, respectively. Conclusions: Temperature differences exist between the opposite sides of the TMD and masseter muscles in patients with TMD. Although the sensitivity of thermography in the diagnosis of TMD is low, it has high specificity in the evaluation of TMD, and is therefore applicable to patients with TMD.

Perspectives on the Characteristics and Meanings as of a Traditional Ecological Landscape as Dangsan Forest and Dangsan Ritual Place in Seoseong-ri, Wando-gun (완도군 서성리 당산숲.당산제 공간의 전통생태경관적 특성 및 의미 고찰)

  • Choi, Jai-Ung;Kim, Dong-Yeob;Kim, Mi-Heui;Jo, Lock-Whan
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.30 no.1
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    • pp.135-145
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    • 2012
  • Traditional village forests called Dangsan forests and Bibo forests in Korea represent an unique cultural landscape with a history of more than several hundred years. Feng-shui forest in China, Satoyama and Shinto shrine forest in Japan are recognized internationally as 'traditional ecological landscapes'. Dangsan forests and Bibo forests have been preserved through generations in the villages, and are no less valuable than Feng-shui forest, and Satoyama. However, the names of Dangsan forest and Bibo forest have not been well recognized worldwide. Dangsan forest in Seoseong-ri, Wando-gun is located on a mountain slope at a riparian forest. It consists of an evergreen broadleaf forest and Carpinus laxiflora forest. The characteristics of Dangsan forest in Seoseong-ri could be found at 10 sacrifice offering places. Two Dangsan trees on the coastal area are included in the sacrifice offering places. Cultural heritage can retain their value when they are fully sustained. Additional construction, demolition or modification should be banned. Furthermore, all means must be taken to facilitate the preservation of monuments and the value and meanings pertaining to them should not be distorted. In a respect of authenticity, Dangsan forest in Seoseong-ri, Wando-gun seems to have original Dangsan culture based on animism with a philosophic background, where a religious service for the mountain god is held at rock of mountain god, and Dangsan ritual is held at shrine on January 8 at 4:00 am by lunar calendar. Relating to the conservation and management of cultural heritage in international discussion, the importance is that whether there is sustainability on the right to the enjoyment of cultural heritage. Dangsan forest in Seoseong-ri is leaved alone to the public. The forest need a social mechanism to support the recovery of deformed shrine and to heighten public awareness of Dangsan forest in order to claim the value as a unique traditional ecological landscape in Korea.

Fixed Dose Regimen of Heparin Administration with Activated Coagulation Time During Cardiopulmonary Bypass (심폐바이패스시 활성응고시간을 이용한 헤파린 고정용량법)

  • 김원곤;박성식
    • Journal of Chest Surgery
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    • v.31 no.9
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    • pp.867-872
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    • 1998
  • Background: The fixed dose regimen with activated coagulation time(ACT) is the most commonly employed method for determining the required dosage of heparin and protamine during cardiopulmonary bypass(CPB). Material and Method: We performed a prospective study on a fixed dose regimen for analyzing adequate dosages of heparin and protamine, the incidence of heparin resistance and heparin-induced thrombocyt openia, factors affecting ACT during CPB, and changes of ACT during aprotinin usage. 300 units/kg of heparin were administered to patients, and ACTs were measured after 5 mins. ACTs were checked at 10 mins and 30 mins after the onset of CPB, and then at 30 min intervals thereafter. If the measured ACT was under 400 secs, we added 100 units/kg of heparin. The heparin was reversed with 1 mg of protamine for each 100 units administered. If the measured ACT was longer than 130 secs 30 mins after protamine administration or if there was definitive evidence of a coagulation defect, we administered a further 0.5 mg/kg of protamine. Result: We studied 80 patients(50 adults and 30 children) who underwent open heart surgery(OHS) at Seoul National University Hospital. Preoperative ACT was 114.3${\pm}$19.3 secs in adults, and 119.5${\pm}$18.2 secs in children. There were no differences in preoperative ACT due to age, body weight, body surface area, or sex. The preoperative ACT was not influenced by a positive past history of OHS. Ten adults(20%) and 3 pediatric patients(10%) needed additional doses of heparin to maintain the ACT above 400 secs. Additional protamine administration was needed in 9 adults(18%) and 10 children(33%). Heparin resistance was found in only two adults. Heparin-induced thrombocytopenia was detected in 2 adults and 1 child. During CPB, ACT was prolonged. 12 adult patients received a low dose of aprotinin and showed longer celite activated ACT compared to the control group.The kaolin activated ACT showed a lower tendency than the celite activated ACT in aprotinin users. Conclusion: In conclusion, fixed dose regimen of heparin and protamine can be used without significant problems, but the incidence of need of additional dosage remains unsatisfactory.

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Modification of the Cox-Maze Procedure for Atrial Fibrillation with Large Left Atrium ; Development of Surgical Technique to Increase the Left Atrial Contractility (좌심방 확장을 동반한 심방세동에 대한 Cox-Maze 수술법의 변형 -수술후 좌심방 수축력의 증진을 위한 수술법의 개량-)

  • 강창현;김기봉;손대원
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.249-254
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    • 1999
  • Background: Recovery of the left atrial contractile function after the Cox-Maze procedure is related to the size of the left atrium. We have postulated that if too wide area of the atrium were isolated electrically, then the atrial contractile function would be impaired postoperatively. We have modified the Cox-Maze procedure to dissect each pair of the pulmonary veins separately instead of the conventional pulmonary vein encircling incision, and compared the atrial contractile function after each procedure. Material and Method: From February 1995 to October 1997, 55 cases of the Cox-Maze procedure were performed in mitral valvular heart disease. We excluded the cases that did not covert to sinus rhythm. The patient groups were divided according to the interpulmonary vein distance(IPVD) and the procedure performed. Group I was IPVD under 6.5 cm(n=30), group II was IPVD over 6.5cm and the conventional Cox-Maze III procedure was performed(n=16), and group III was IPVD over 6.5cm and the modified Cox-Maze procedure was performed(n=9). Result: Atrial contractile function was evaluated by the echocardiography follow-up between 6 months to 12 months. The right atrial contractile function recovered gradually, the recovery rate after long-term follow-up was 90% in group I, 81% in group II, and 100% in group III(p>0/05). In the left atrium the recovery rate was 63% in group I, 31% in group II(p=0.03), and 66% in group III(p>0.05). Conclusion: The modified Cox-Maze procedure may have beneficial effects on the recovery of the left atrial contractile function, however, there are no statistically significant values. Therefore, further evaluation of this procedure is necessary.

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Results of Extracardiac Pericardial-flap Lateral Tunnel Fontan Operation (자가심낭막절편을 이용한 심외외측통로 Fontan 수술의 결과)

  • Park Han-Ki;Youn Young-Nam;Yang Hong-Seok;Yoo Byoung-Won;Choi Jae-Young;Park Young-Hwan
    • Journal of Chest Surgery
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    • v.39 no.4 s.261
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    • pp.281-288
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    • 2006
  • Background: Extracardiac pericardial-flap lateral tunnel Fontan operation has theoretical advantage of growth potentiality of the extracardiac tunnels. The mid-term results of this technique and morphologic change of the lateral tunnel were studied. Material and Method: Clinical data was reviewed in 42 patients who underwent extracardiac pericardial-flap lateral tunnel Fontan operation between November 1993 and December 2004. The age was $2.8{\pm}1.5$ years and the body weight was $12.3{\pm}3.2$ kg. Extracardiac tunnel was constructed using the pedicled pericardium with the base undetached. By reviewing the follow-up cardiac angiograms, the diameter and the cross-sectional area of the lateral tunnel was compared to those of inferior vena cava. Result: There were four operative mortality cases (9.8%) and the causes of death were low cardiac output for all four cases. Postoperatively, five patients had prolonged pleural effusion longer than two weeks and one patient required a permanent pacemaker due to complete heart block. Follow-up was possible in 37 patients and the follow up duration was $3.8{\pm}2.2$ years. During that period, one patient died, of upper gastrointestional bleeding combined with heart failure and one patient died a sudden death of unknown cause. Two patients required reoperation due to subaortic stenosis and anastomosis site stenosis between inferior vena cava and lateral tunnel. In one patient, bradyarrhythmia was anew but there was no thromboembolic complication. The lateral tunnel showed growth in proportion to the size of the inferior vena cava. Conclusion: Extracardiac pericardial-flap lateral tunnel Fontan operation is relatively simple and safe. The mid-term result was favorable and the extracardiac tunnel showed potential for growth.

Histidine-tryptophan-ketoglutarate Versus Blood Cardioplegic Solutions: A Prospective, Myocardial Ultrastructural Study (선천성 심장기형의 수술 후 Histidine-tryptophan-ketoglutarate 심정지액과 혈성 심정지액의 전자현미경적 심근 구조의 비교 관찰)

  • Kim, Si-Ho;Lee, Young-Seok;Woo, Jong-Soo;Sung, Si-Chan;Choi, Pil-Jo;Cho, Gwang-Jo;Bang, Jung-Heui;Roh, Mee-Sook
    • Journal of Chest Surgery
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    • v.40 no.1 s.270
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    • pp.8-16
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    • 2007
  • Background: We performed a prospective clinical study to evaluate the ultrastructural integrity of the myocardium after using Histidine-Tryptophan-Ketoglutarate (HTK) solution in comparison with blood cardioplegic solution during congenital heart surgery. Material and Method: Twenty two patients with acyanotic heart disease, who were scheduled for elective open heart surgery, were randomized into two groups. The HTK Group (n=11) received HTK cardioplegic solution; the blood group (n=11) received conventional blood cardioplegic solution during surgery. The preoperative diagnoses included ventricular septal defect (n=9) and atrial septal defect (n=2) in each group. A small biopsy specimen was taken from the right ventricle's myocardium, and this was processed for ultrastructural examination at the end of 30 minutes of reperfusion. Semiquantitative electron microscopy was carried out 'blindly' in 4 areas per specimen and in 5 test fields per area by 'random systematic sampling' and 'point and intersection counting'. The morphology of the mitochondrial membrane and cristae were then scored. The interstitial edema of the myocardium was also graded. Result: The semiquantitative score of the mitochondrial morphology was $19.65{\pm}4.75$ in the blood group and $25.25{\pm}5.85$ in the HTK group (p=0.03). 6 patients (54.5%) in the blood group and 3 patients (27.3%) in the HTK group were grade 3 or more for the interstitial edema of the myocardium. Conclusion: The ultrastructural integrity was preserved even better with HTK solution than with conventional blood cardioplegic solution.

A Study on Radiation Management Status and Exposure Anxiety Awareness of Dental Hygienist (치과위생사의 방사선 안전 관리 실태 및 피폭 불안감 인식)

  • Kang, Eun-Ju;Hyeong, Ju-Hee
    • Journal of dental hygiene science
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    • v.15 no.2
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    • pp.172-181
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    • 2015
  • This study intends to improve the radiation safety management and the recognition for handling radiation using structured questionnaires to dental hygienists working at Jeollabuk-do from September 1 to October 31 in 2014. As a result, 63% of respondents have not received education for radiation safety management. Moreover, the practical degree for radiation safety management was $2.58{\pm}1.11$, while the degree of knowledge was $3.74{\pm}0.83$ of total 5.0. The results of insecurity for radiation danger were high as $3.88{\pm}0.92$, and insecurity for fetus during pregnancy shows the highest value as $4.43{\pm}0.71$. From the results of statistical significance level, the knowledge degree of radiation safety management is affected by total numbers of radiograpy for a day (p<0.05), and the practical degree of radiation safety management is affected by age group, academic background, monthly income, continuous service year, practice area, present position, and status of radiography in present (p<0.05). In addition, the knowledge degree of radiation safety management have a negative correlation (r=-0.232) with the practical degree, but have a positive correlation (r=0.262) with the insecurity for radiation danger. The high knowledge degree of radiation safety management (${\beta}=0.252$, p<0.001) and the short radiography work period (${\beta}=-0.341$, p<0.05) were the influential factors to the insecurity for radiation danger. Consequently, countermeasures are necessary to encourage dental hygienists to put their radiation safety management knowledge into the practice and to reduce the insecurity degree for radiation danger. Furthermore, it is important to prevent psychological and physical risks by radiation exposure through the improvement of radiation safety management level and recognition for handling radiation to improve medical environment.

Usefulness of Serum Thymidine Kinase 1 as a Biomarker for Aggressive Clinical Behavior in B-cell Lymphoma (B세포림프종의 임상적 악성도 표지자로서 혈청 Thymidine Kinase 1의 유용성)

  • Kim, Heyjin;Kang, Hye Jin;Lee, Jin Kyung;Hong, Young Jun;Hong, Seok-Il;Chang, Yoon Hwan
    • Laboratory Medicine Online
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    • v.6 no.1
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    • pp.25-30
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    • 2016
  • Background: The cell cycle-dependent enzyme thymidine kinase 1 (TK1) is known to increase during cancer cell proliferation and has been reported as a prognostic marker for various hematologic malignancies and solid tumors. This study aimed to determine the reference interval in Korean healthy controls and to evaluate the usefulness of TK1 as a biomarker for aggressive clinical behavior in B-cell lymphoma patients. Methods: We enrolled 72 previously untreated patients with B-cell lymphoma and 143 healthy controls. Serum TK1 levels were measured by chemiluminescence immunoassay ($Liaison^{(R)}$, DiaSorin, USA). We established the reference intervals in healthy controls. The diagnostic performance of serum TK1 was studied using receiver operating characteristic (ROC) analysis, and the correlation between the cutoff level for serum TK1 and clinical characteristics of B-cell lymphoma was evaluated. Results: The reference range (95th percentile) of serum TK1 in healthy controls was 5.4-21.8 U/L. There was a clear difference in TK1 levels between patients with B-cell lymphoma and healthy controls ($40.6{\pm}68.5$ vs. $11.8{\pm}4.4U/L$, P <0.001). The area under the curve of serum TK1 for the diagnosis of B-cell lymphoma was 0.73 (cutoff, 15.2 U/L; sensitivity, 59.7%; specificity, 83.2%). An increased TK1 level (${\geq}15.2U/L$) correlated with the advanced clinical stage (P <0.001), bone marrow involvement (P =0.013), international prognostic index score (P =0.001), lactate dehydrogenase level (P =0.001), low Hb level (<12 g/dL) (P =0.028), and lymphocyte count (P =0.023). Conclusions: The serum TK1 level could serve as a useful biomarker for aggressive clinical behavior in B-cell lymphoma patients.