• Progress in Medical Physics
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• v.14 no.2
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• pp.124-130
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• 2003

Currently, as a consequence of PACS (Picture Archiving Communication System) implementation many hospitals are replacing conventional film-type interpretations of diagnostic medical images with new digital-format interpretations that can also be saved, and retrieve However, the big limitation in PACS is considered to be the lack of mobility. The purpose of this study is to determine the optimal communication packet size. This was done by considering the terms occurred in the wireless communication. After encoding medical image using JPGE2000 image compression method, This method embodied auto-error correction technique preventing the loss of packets occurred during wireless communication. A PC class server, with capabilities to load, collect data, save images, and connect with other network, was installed. Image data were compressed using JPEG2000 algorithm which supports the capability of high energy density and compression ratio, to communicate through a wireless network. Image data were also transmitted in block units coeded by JPEG2000 to prevent the loss of the packets in a wireless network. When JPGE2000 image data were decoded in a PUA (Personal Digital Assistant), it was instantaneous for a MR (Magnetic Resonance) head image of 256${\times}$256 pixels, while it took approximately 5 seconds to decode a CR (Computed Radiography) chest image of 800${\times}$790 pixels. In the transmission of the image data using a CDMA 1X module (Code-Division Multiple Access 1st Generation), 256 byte/sec was considered a stable transmission rate, but packets were lost in the intervals at the transmission rate of 1Kbyte/sec. However, even with a transmission rate above 1 Kbyte/sec, packets were not lost in wireless LAN. Current PACS are not compatible with wireless networks. because it does not have an interface between wired and wireless. Thus, the mobile JPEG2000 image viewing system was developed in order to complement mobility-a limitation in PACS. Moreover, the weak-connections of the wireless network was enhanced by re-transmitting image data within a limitations The results of this study are expected to play an interface role between the current wired-networks PACS and the mobile devices.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.757-762
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• 2009

Background: Compression of the left common iliac vein by the overriding common iliac artery is frequently combined with acute deep vein thrombosis in patients with May-Thurner Syndrome. We evaluate the results of treatment with thrombolysis and thrombectomy followed by stenting in 34 patients with May-Thurner Syndrome combined with lower extremity deep venous thrombosis. Material and Method: The authors retrospectively reviewed the records of 34 patients (mean age: $65{\pm}14$ year old) who had undergone stent insertion for acute deep vein thrombosis that was caused by May-Thurner syndrome. After thrombectomy and thrombolysis, insertion of a wall stent and balloon angioplasty were performed to relieve the compression of the left common iliac vein. Urokinase at a rate of 80,000 to 120,000 U/hour was infused into the thrombosed vein via a multi-side hole thrombolysis catheter. A retrieval inferior vena cava (IVC) filter was placed to protect against pulmonary embolism in 30 patients (88%). Oral anticoagulation with warfarin was maintained for 3 months, and follow-up Multi Detector Computerized Tomography (MDCT) angiography was done at the date of the patients' hospital discharge and at the 6 months follow-up. Result: The symptoms of deep venous thrombosis disappeared in two patients (4%), and there was clinical improvement within 48 hours in twenty eight patients (82%), but there was no improvement in four patients (8%). The MDCT angiography at discharge showed no thrombus in 9 patients (26%) and partial thrombus in 21 (62%), whereas the follow-up MDCT at $6.4{\pm}5.5$ months (32 patients) revealed no thrombus in 23 patients (72%), and partial thrombus in 9 patients (26%). Two patients (6%) had recurrence of DVT, so they underwent retreatment. Conclusion: Stent insertion with catheter-directed thrombolysis and thrombectomy is an effective treatment for May-Thurner syndrome combined with acute deep vein thrombosis in the lower extremity.

• Tuberculosis and Respiratory Diseases
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• v.62 no.3
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• pp.192-196
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• 2007

Background: Right middle lobe syndrome (RMLS) is defined as transient or chronic and recurrent atelectasis of the right middle lobe. Although numerous conditions are associated with RMLS, there are very few recent reports in Korea. This study evaluated the causes of RMLS in a local tertiary hospitalover a period of 42 months. Method: Eighty-eight patients (M:F=64:22, mean age: $67.2{\pm}10.3years$), who had consistent chest radiography findings and underwent bronchoscopy in Gyeongsang University Hospital from January 2003 to July 2006, were enrolled in this study. The clinical characteristics and causes of RMLS in these patients were retrospectively reviewed. Results: The most common symptoms fo RMLS were cough, dyspnea and sputum. Tuberculosis was the most common cause (endobronchial tuberculosis in 22 and pulmonary tuberculosis in 1) The other causes were bronchial stenosis by benign fibrotic changes in 22 cases (25%), anthracofibrosis in 13 cases (14.8%), pneumonia in 11 cases (12.5%), lung cancer in 10 cases (11.4%), mucus impaction in 3 cases (3.4%), bronchiectasis in 2 cases (2.3%) and no demonstrable causes in 7 cases (8%). The bronchoscopy findings were mucosal edema with hyperemic changes in 38 cases (43.2%), mucosal edema with anthracotic pigmentation in 16 cases (18.2%), mucus impaction in 13 cases (14.8%), fibrotic stenosis in 13 cases (14.8%), a mass like lesion in 8 cases (9.1%), exudative necrotic material in 4 cases (4.5%), narrowing as a result of extrinsic compression in 2 cases (2.3%) and no demonstrable abnormalities in 12 cases (13.6%). Conclusion: Right middle lobe syndrome was observed more frequently in patients over the age of 65. The causes were mainly benign diseases with endobronchial tuberculosis being the most common.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.575-583
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• 1993

Background: Mediastinal masses are not uncommon, and an overall incidence of one case per 100,000 population per year in individuals of all ages and with no difference in sex incidence may be a reasonable estimation. At least half of all mediastinal masses are asymptomatic and this proportion has increased in recent decades with wider use of screening chest roentgenography. Symptoms in patients with mediastinal mass lesions are usually due to compression or invasion of nearby intrathoracic structures. Most mediastinal mass lesions have characteristic predilectional locations. The basic focus of diagnostic evaluation is an orderly preparation for obtaining a tissue diagnosis but even lesions discovered to be benign must generally be removed. Seldom is this status known for certain preoperatively. In additaion, benign tumors may continue to enlarge, thus compromising vital organs; they may rupture, hemorrhage, become infected or have the possibility of various malignant degeneration. Therefore, all mediastinal masses must be surgically removed whether they are malignant or benign. Methods: We reviewed the medical records of 344 cases previously confirmed as mediastinal tumors or cysts from January, 1960 to August, 1992 and investigated the clinical findings. Results: Neurogenic tumors were the most common(24.7%) and thymomas were distinctively increased recently. Overall ratio between males and females was 1.1:1 and age distribution was relatively even among all age groups. Predilectional sites were posterior for neurogenic tumors, and anterior for teratodermoid tumors, thymomas and lymphomas. Dyspnea was the most common symptom in the patients of the mediastinal tumors and asymptomatic patients were 19.5%, Benign mediastinal mass lesions were 66.0% and malignant, 34.0%, Complete or partial resection was done in 42.4%. Conclusion: We could find the increasing incidence and the tendency of aggressive resection as possible in the mediastinal tumors. We expect the discovery of more mediastinal tumors with wider use of regular check-up and development of diagnostic methods.

• The Korean Journal of Emergency Medical Services
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• v.12 no.3
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• pp.87-98
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• 2008

Purpose : This study was designed to figure out the necessity of continuing basic CPR education for the higher grade students of elementary school. The assessment contents were knowledge, practice ability, precision level of CPR skills and continuation of the educational efficiency. Methods : Twenty two students of 4th and 5th grade of elementary school in K city in Chungcheongnam-do were recruited for this study. The study method was a control group of non-synchronized design. A preliminary study was done on October 27 in 2006. The main study was performed from February 14 to May 11 in 2007. The researcher adopted the method of Kyung-hui, Kang (1998) such as awareness, attitude and knowledge in control group, emergency medical technician test protocol, Anne/SkillReporter$^{(R)}$ in case of the basic CPR knowledge. Four times of measures were done in shortly after practicing CPR, 4 weeks after the education, 8 weeks after the education, and 12 weeks after the education. By using SPSS/PC+ (version 12.0), the researcher analyzed the collected data based on frequency, percentage, repeated measurement, ANOVA (analysis of variance), and sidak (multiple comparison - sidak). Results : 1) The confidence of people in the control group in terms of practicing CPR showed a statistically meaningful difference (t = 10.230, p = .000) before/after CPR education. Therefore, hypothesis No.1-1 was accepted. 2) The educational necessity of people in the control group showed no statistically meaningful difference (t = -1.695, p = 0.105) before/after CPR education. Therefore, hypothesis No.1-2 was rejected. 3) The knowledge points of people in the control group showed a statistically meaningful difference (t = -7.731, p = .000) before/after CPR education. Therefore, hypothesis No.2 was accepted. 4) The confidence of people in the control group in terms of practicing CRP showed no meaningful difference (F = 2.789, p = 0.072) as time passed. Therefore, hypothesis No.3 was rejected. 5) The knowledge of people in the control group showed a meaningful difference (F = 9.090, p = .000) as time passed. Therefore, hypothesis No.4 was accepted. 6) The capability of people in the control group in terms of practicing CPR showed a statistically meaningful difference (F = 42.795, p = .000) as time passed. Therefore, hypothesis No.5 was accepted. 7) The precision level of CPR skill of people in the control group showed a statistically meaningful difference (F = 25.198, p = .000) as time passed. Therefore, hypothesis No.6-1 was accepted. 8) The precision level of chest compression skill of people in the control group showed a statistically meaningful difference (F = 5.188, p = .003). Therefore, hypothesis No.6-2 was accepted. Conclusion : In a nutshell, CPR education for the 4th and 5th graders of elementary schools had an influence on their confidence in practicing CPR and on their knowledge. This study showed that as time passed. the educational effect declined in terms of knowledge point, capability of practicing CPR, and the precision level of CRP skill. The results of the study could be postulated into the fact that re-education within 8 weeks after the first education was essential to retaining the educational effect. Therefore, we need to vitalize the CPR education for elementary school students repeatedly on a regular basis in order to continue the educational effect after they were grown-ups and to make them play their roles as a first aider.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.1-11
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• 2008

Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.