• Journal of Chest Surgery
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• v.9 no.1
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• pp.27-37
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• 1976

In the presence of clinical evidence and chest roentgenogram suggestive of bronchogenic carcinoma, reliance is almost wholly placed on Papanicolaou staining of the sputum, bronchoscopy, and biopsy of peripheral lesion, together referred to as the "diagnostic triad". However, bronchography remains relatively non-utilized. Our experience with 56 bronchograms in which the modality of bronchial obstruction, distance to obstruction and reduction rate of caliber in leading bronchus were used in an attempt to explain underlying chest pathology and operability of bronchogenic carcinoma, indicated as follows: 1. The bronchographic findings in bronchogenic cancer consist of malignant bronchial obstruction in which the modality of obstruction is classified as abrupt type, conical type and compressed type in incidence of 50.0%, 23.2% and 26.8%, respectively. 2. Abrupt type of bronchial obstruction is more common in hilar type and particularly in squamous cell and undifferentiated cell type of bronchogenic cancer. In this type of obstruction the inoperability revealed in 57.8% and resectability in 17.8%. 3. Conical type of obstruction was a sign of most malignancy, in which 61.5% was undifferentiated cell type and 38.4% was squamous cell type. All this type of obstruction was inoperable even feasibility was presumed in simple roentgenograms. 4. Compressed type of obstruction was more common in peripheral type of bronchogenic cancer and showed 50.0% of resectability. 5. The distance from carina to bronchial obstuction revealed average 3.8cm in undifferentiated type, 5.76cm in squamous cell type and 7.60am in adeno cell type of carcinoma. 6. The reduction rate of caliber in leading bronchus to obstruction (mm per unit cm lenghth of leading bronchus) revealed average 2.15mm/cm in undifferentiated type 1.90mm/cm in squamous cell type and 1.13mm/cm in adeno cell type of carcnoma. 7. The reduction rate of caliber in leading bronchus showed 2.14mm/cm in inoperable cases and 1.42mm/cm in resectable cases. 8. The modality of bronchial obstruction and estimation of the reduction rate of caliber seemed to be a most reliable key-point to decide feasibility of resection.

• Clinical and Experimental Pediatrics
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• v.51 no.6
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• pp.660-664
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• 2008

The term tracheal bronchus refers to an abnormal bronchus that comes directly off of the lateral wall of the trachea (above the carina) and supplies ventilation to the upper lobe. Tracheal bronchi occur almost exclusively on the right trachea and are associated with other congenital anomalies. In addition, tracheai bronchus may be related to other inflammatory conditions with persistent wheezing, such as recurrent pneumonia, chronic bronchitis and bronchiectasis, which is a result of the relatively poor local drainage of the involved bronchi. An infant with recurrent wheezing is likely to be a challenge for a clinician in the evaluation of the etiology of airway obstruction and in the differential diagnosis of wheezy breathing. The authors report a case of an 8-month-old female infant with a ventricular septal defect, who presented with stridor and recurrent respiratory infection and finally was finally diagnosed with a tracheal bronchus using computed tomography and a bronchoscopy. Therefore, tracheal bronchus should be included in the differential diagnosis of any child who presents with chronic or recurrent respiratory tract symptoms such as coughing, wheezing, stridor and recurrent respiratory infection, particularly in children with other congenital deformities.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.664-669
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• 2005

Objectives : To evaluate the clinical significance of abnormal bronchi originating from the trachea or main bronchi. Methods : 21 patients (male:female ratio, 13:8; mean age, 58.2 years, range 34-77), who were diagnosed with major tracheobronchial anomalies by bronchoscopy from January 2001 to March 2005, were enrolled in this study. The anomalous bronchi consisted of 13 tracheal bronchi and 8 cardiac accessory bronchus. The clinical features, bronchoscopic findings, and outcomes were analyzed retrospectively. Results : Common symptoms, including hemoptysis, cough and dyspnea, resulted from the underlying lung disease regardless of the bronchial anomalies. In this series of 13 tracheal bronchi, 7 cases originated from the trachea within 1cm of the carina (carinal type) and 6 cases originated at a higher level(tracheal type). Most patients had favorable outcome with conservative treatment for the underlying lung disease. Conclusion : Most tracheobronchial anomalies are found incidentally in the process of diagnosing lung disease. The clinical outcome of patients with a bronchial anomaly depends on the underlying lung disease.

• Journal of Radiation Protection and Research
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• v.37 no.2
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• pp.84-89
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• 2012

The purpose of this study was to compare radiation dose and image quality between low-dose (LDP) and standard-dose protocol (SDP). LDP (120 kVp, 30 mAs, 2-mm thickness) and SDP (120 kVp, 180 mAs, 1.2-mm thickness) images obtained from 61 subjects were retrospectively evaluated at level of carina bifurcation, using multi-detector CT (Brilliance 16, Philips Medical Systems). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated at ascending aorta and infraspinatus muscle, from CT number and back-ground noise. Radiation dose from two protocols measured at 5-point using acrylic-phantom, and CT number and noise measured at 4-point using water-phantom. All statistical analysis were performed using SPSS 19.0 program. LDP images showed significantly more noise and a significantly lower SNR and CNR than did SDP images at ascending aorta and infraspinatus muscle. Noise, SNR and CNR were significantly correlated with body mass index (p<0.001). Radiation dose, SNR and CNR from phantom were significant differences between two protocols. LDP showed a significant reduction of radiation dose with a significant change in SNR and CNR compared with SDP. Therefore, exposure dose on LDP in clinical applications needs resetting highly more considering image quality.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.517-523
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• 1996

From May 1988 to June 1994, )73 patients underwent exploratory thoracotomy for resection of non- small cell lung cancer, and 48 patients staged pathologically as lIIB were analyzed. 74 lesions were involvement of great vessel (n=26), heart (n=5), ipsilateral lung metastasis(n=4), esophagus (n=4), carina(n=3), mediastinum (n=2), trachea(n=1), spine (n=1) and 13lourO seeding(A=15). N3 lesions were involved in 6 patients. Extended pulmonary resection with radical mediastinal node dissection was possible in 25 patients, and exploration only was performed in 23 patients. The most frequent cause of unresectability was pleural seeding. Postoperative morbidity was )2 % (8125) and mortality was 16 % (41 25) in resected group. The adjutant therapy was given to 37 patients. The 1 year and 3 year survival for resected group ncluding operative deaths was 57.2%, and 2).8 % (median 15 months), but 48.4%, and 0 % (median 7 months) for exploration only group (Log-Rank test, p : 0.17). Our results suggest that extended pulmonary resection might be helpful for carefully selected patients with 74 non-small cell lung cancer, but meticulous preoperative work-up for staging, especially to detect pleural seeding and Invasion to the irlediastinal structures is a prerequisite to avoid unnecessary thoracotomy.

• KIPS Transactions on Software and Data Engineering
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• v.12 no.1
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• pp.51-58
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• 2023

In this paper, we propose an organ segmentation technique for the automatic extraction of medical diagnostic indicators from X-ray images. In order to calculate diagnostic indicators of heart disease and spinal disease such as VHS(vertebral heart scale) and Cobb angle, it is necessary to accurately segment the thoracic spine, carina, and heart in a chest X-ray image. A deep neural network model in which the high-resolution representation of the image for each layer and the structure converted into a low-resolution feature map are connected in parallel was adopted. This structure enables the relative position information in the image to be effectively reflected in the segmentation process. It is shown that learning performance can be improved by combining the OCR module, in which pixel information and object information are mutually interacted in a multi-step process, and the channel attention module, which allows each channel of the network to be reflected as different weight values. In addition, a method of augmenting learning data is presented in order to provide robust performance against changes in the position, shape, and size of the subject in the X-ray image. The effectiveness of the proposed theory was evaluated through an experiment using 145 human chest X-ray images and 118 animal X-ray images.

• Korean Journal of Radiology
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• v.22 no.7
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• pp.1213-1224
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• 2021

Objective: To develop a machine learning (ML) pipeline based on radiomics to predict Coronavirus Disease 2019 (COVID-19) severity and the future deterioration to critical illness using CT and clinical variables. Materials and Methods: Clinical data were collected from 981 patients from a multi-institutional international cohort with real-time polymerase chain reaction-confirmed COVID-19. Radiomics features were extracted from chest CT of the patients. The data of the cohort were randomly divided into training, validation, and test sets using a 7:1:2 ratio. A ML pipeline consisting of a model to predict severity and time-to-event model to predict progression to critical illness were trained on radiomics features and clinical variables. The receiver operating characteristic area under the curve (ROC-AUC), concordance index (C-index), and time-dependent ROC-AUC were calculated to determine model performance, which was compared with consensus CT severity scores obtained by visual interpretation by radiologists. Results: Among 981 patients with confirmed COVID-19, 274 patients developed critical illness. Radiomics features and clinical variables resulted in the best performance for the prediction of disease severity with a highest test ROC-AUC of 0.76 compared with 0.70 (0.76 vs. 0.70, p = 0.023) for visual CT severity score and clinical variables. The progression prediction model achieved a test C-index of 0.868 when it was based on the combination of CT radiomics and clinical variables compared with 0.767 when based on CT radiomics features alone (p < 0.001), 0.847 when based on clinical variables alone (p = 0.110), and 0.860 when based on the combination of visual CT severity scores and clinical variables (p = 0.549). Furthermore, the model based on the combination of CT radiomics and clinical variables achieved time-dependent ROC-AUCs of 0.897, 0.933, and 0.927 for the prediction of progression risks at 3, 5 and 7 days, respectively. Conclusion: CT radiomics features combined with clinical variables were predictive of COVID-19 severity and progression to critical illness with fairly high accuracy.

• Clinical and Experimental Pediatrics
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• v.45 no.7
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• pp.855-861
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• 2002

Purpose : Thymus size can be affected by several factors and perinatal diseases can be estimated by its size. The purpose of this study was to search for a relationship between cardiothymic/thoracic(CT/T) ratio and perinatal diseases such as neonatal respiratory distress syndrome(RDS) and intrauterine growth retardation(IUGR) by measuring the width of the cardiothymic shadow at the level of the carina and dividing it by the width of the thorax at the costophrenic angles. Methods : A clinical study was conducted on newborn infants with RDS(n=51), IUGR(n=27), and premature rupture of membranes(PROM, n=48), who were admitted at NICU of Catholic University of Daegu from June 2000 to Oct. 2001. CT/T ratio was measured within six hrs of age, at 2-3 days of age, and at 5-7 days of age. Results : CT/T ratios of RDS group, IUGR group, and PROM group were $0.46{\pm}0.07$, $0.32{\pm}0.04$. $0.36{\pm}0.06$, respectively. CT/T ratios of RDS group within 6hrs of age, at 2-3 days of age, and at 5-7 days of age were $0.43{\pm}0.07$, $0.34{\pm}0.06$, $0.25{\pm}0.04$, respectively. There were statistically significances among the RDS group, the IUGR group, and the PROM group and in the RDS group at different times. Regression for gestational age among three groups was not statistically significant but correlation for gestational age in the entire groups was statistically significant. CT/T ratio between normal spontaneous vaginal delivery and c-section among three groups was not statistically significant. CT/T ratios with dexamethasone-treated group and untreated group was not statistically significant. Conclusion : We concluded that thymus size differed significantly in the perinatal diseases such as RDS and IUGR, and so can be used as an early diagnostic tool for perinatal diseases.

• Childhood Kidney Diseases
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• v.13 no.2
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• pp.215-221
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• 2009

Purpose : Thymus is a lymphoproliferative organ that changes size in various physiological states in addition to some pathological conditions. Thymus is susceptible to involution, and shows a dramatic response to severe stress. Thymic measurements may be helpful in various diseases. UTI (urinary tract infection) is most common bacterial infection in infants and VUR (vesicoureteral reflux) is a common abnormality associated with UTI. In our study, the size of thymus was compared on the premise that a greater stress is exerted on the body when UTI is accompanied by VUR, than when occurs on its own. Methods : Thymic size was measured on standard chest anteroposterior radiographs and expressed as the ratio between the transverse diameter of the cardiothymic image at the level of the carina and that of the thorax (CT/T). The medical records of 99 febrile urinary tract infection infants without other genitourinary anomalies except VUR were reviewed retrospectively. Results : Among 99 patients with febrile UTIs, 25 were febrile UTI without VUR and 74 with VUR. For the UTI with VUR group, there was a significant decrease in the thymic size compared to the those without VUR group ($0.382{\pm}0.048$ vs $0.439{\pm}0.079$, P<0.05). However, there were no differences in the duration of fever and WBC, CRP between the UTI with VUR and UTI without VUR. In addition, there were no differences in the cardiothymic/thoracic ratios between renal defects and renal scars in febrile UTI patients. Conclusion : The results of this study show that the shirinkage of thymus was more frequently found in the UTI patients with VUR. Therefore, awareness of the risks associated with thymic size is important for the appropriate work up and management of UTI patients.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.457-462
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• 2008

Background: Emergency airway access is essential when a patient has dyspnea that's due to tracheal or bronchial obstruction. Such methods as laser therapy and PDT are now being used for the treatment of tracheal obstruction that's due to benign diseases or nonsurgical malignant diseases. Cryotherapy is a method that uses extreme hypothermia for freezing a tumor to cause necrosis. In this study, we have evaluated the clinical effectiveness of performing endobronchial cryoablation through a flexible bronchoscope. Material and Method: 10 patients with tracheal obstruction that was due to endotracheal tumors were evaluated between May 2005 and May 2007. Eight were male and the mean age of the 10 patients was $59.4{\pm}18.4$ years. Three cases of tracheal obstruction were due to benign tumors and 7 were due to malignant tumors. The obstruction sites were 3 at the trachea, 3 at the carina and 4 at the bronchus. A flexible bronchoscope was inserted and the tumor was eliminated using a flexible cryoprobe. Follow up bronchoscopy was performed at 1 week and 1 month after cryoablation, and then we evaluated the decrease of dyspnea, the improvement of the performance and the complications of the procedures. Result: Complete remission was achieved in 4 patients and partial remission was achieved in 6 patients. Complications such as hemoptysis (100%), and cough (50%) were noted. Hemoptysis was spontaneously resolved in 3 to 8 days (mean: 4.9 days). A decrease in dyspnea and improvement in the performance was noted in all patients. Conclusion: Endobronchial stenosis plays a detrimental role in the life quality of a terminal cancer patient. Due to its simplicity and effectiveness for controlling bleeding, endobronchial cryoablation is considered to be a safe method that is clinically applicable to a wide range of tumors, including the removal of large tumors. We concluded that endobronchial cryoablation through a flexible bronchoscope is a safe, effective method for treating tracheobroncheal obstructions.