• Title/Summary/Keyword: Clinical Use

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Guideline in the Management of Antenatally Diagnosed Unilateral Hydronephrosis (산전 초음파로 발견된 수신증의 치료 방침)

  • Hahn Hye-Won;Jun Nu-Lee;Kim Kun-Seok;Moon Dae-Hyuk;Yoon Chong-Hyun;Park Young-Seo
    • Childhood Kidney Diseases
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    • v.7 no.1
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    • pp.60-66
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    • 2003
  • Purpose : Neonatal hydronephrosis has been detected with increasing frequency with the widespread use of prenatal ultrasonography, but the consensus about its postnatal management has not yet been reached, especially about surgical intervention. We attempted to determine the guideline of follow-up study and surgical intervention of hydronephrosis by analyzing clinical outcomes of neonates with hydronephrosis. Materials and Methods : Between 1994 and 2000, 128 hydronephrotic kidneys were postnatally confirmed. Cases associated with other urologic anomalies were excluded and 90 unilateral hydronephrotic kidneys with a minimum follow-up of 12 months were enrolled in this study. We classified the patients into 6 groups according to the anterior posterior pelvic diameter(APPD) at initial ultrasonography(USG) within 1 month after birth. Renal USG and $Tc^{99m}-mercaptoacetyl$ triglycerine(MAG3) scan were done according to a set protocol, and pyeloplasty was performed when indicated according to our protocol. Results : Most cases whose APPD were below 10 mm improved or resolved. Only few cases with APPD above 20 mm showed spontaneous improvement and most(88%) had undergone operation. Those with initial APPD within 10-19 mm showed variable outcomes. When the risk factors for irreversible renal functional deterioration were analyzed, the age at pyeloplasty and pre-operative functional deficit were significant. Conclusion : We concluded that in infants with initial APPD below 10 mm, consideration of surgery is not needed, and in those with initial APPD above 20 mm, early operation is recommended. Our set protocol based on initial USG is useful, but the cut-off value of relative renal function(RRF) for operation might be increased to 40% to improve post operative RRF.

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Comparison of Clinical Outcome According to the Duration of Corticosteroid Therapy in Childhood Henoch-$Sch{\ddot{o}}nlein$ Purpura: a Bicentric Study (소아 Henoch-$Sch{\ddot{o}}nlein$ purpura에서 스테로이드 치료 기간에 따른 임상적 결과의 비교)

  • Lee, Su-Jin;Shin, Jae-Il;Lee, Chong-Guk;Kim, Kee-Hyuck
    • Childhood Kidney Diseases
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    • v.12 no.2
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    • pp.170-177
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    • 2008
  • Purpose : The aim of this study was to evaluate whether the incidence of relapse or nephritis might be influenced by the duration of corticosteroid therapy in children with Henoch-Schonlein purpura(HSP). Methods : We retrospectively analyzed 186 children with a diagnosis of HSP in two major hospitals in Ilsan, Korea from the years 2000 to 2003. To evaluate whether renal involvement or relapse might be influenced by the duration of corticosteroid therapy in children with HSP, one pediatric nephrologist from hospital A, maintained corticosteroid therapy for at least 2 weeks(Group A, n=94). The other from hospital B used only during the symptomatic period(Group B, n=92). Results : There were no significant differences in age, sex, body weight, white blood cell count, hemoglobin, hematocrit, platelet count, serum protein and albumin levels between the two groups. The incidence of abdominal pain or arthralgia also did not differ between two groups. However, the duration of steroid therapy was significantly longer in Group A than in Group B and the cumulative dose of prednisolone was also higher in Group A than in Group B. The development of nephritis was more frequent in Group A. Conclusion : The longer duration of steroid use was not associated with the decreased rate of nephritis. Therefore, corticosteroids should be used carefully in a selected group of HSP children, and be tapered rapidly after control of the acute symptoms.

Measurement of Image Quality According to the Time of Computed Radiography System (시간에 따르는 CR장비의 영상의 질평가)

  • Son, Soon-Yong;Choi, Kwan-Woo;Kim, Jung-Min;Jeong, Hoi-Woun;Kwon, Kyung-Tae;Hwang, Sun-Kwang;Lee, Ik-Pyo;Kim, Ki-Won;Jung, Jae-Yong;Lee, Young-Ah;Son, Jin-Hyun;Min, Jung-Whan
    • Journal of radiological science and technology
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    • v.38 no.4
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    • pp.365-374
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    • 2015
  • The regular quality assurance (RQA) of X-ray images is essential for maintaining a high accuracy of diagnosis. This study was to evaluate the modulation transfer function (MTF), the noise power spectrum (NPS), and the detective quantum efficiency (DQE) of a computed radiography (CR) system for various periods of use from 2006 to 2015. We measured the pre-sampling MTF using the edge method and RQA 5 based on commission standard international electro-technical commission (IEC). The spatial frequencies corresponding to the 50% MTF for the CR systems in 2006, 2009, 2012 and 2015 were 1.54, 1.14, 1.12, and $1.38mm^{-1}$, respectively and the10% MTF for 2006, 2009, 2012, and 2015 were 2.68, 2.44, 2.44, and $2.46mm^{-1}$, respectively. In the NPS results, the CR systems showed the best noise distribution in 2006, and with the quality of distributions in the order of 2015, 2009, and 2012. At peak DQE and DQE at $1mm^{-1}$, the CR systems showed the best efficiency in 2006, and showed better efficiency in order of 2015, 2009, and 2012. Because the eraser lamp in the CR systems was replaced, the image quality in 2015 was superior to those in 2009 and 2012. This study can be incorporated into used in clinical QA requiring performance and evaluation of the performance of the CR systems.

A Clinical Analysis of Abdominal Stab Wounds (복부 자상의 치료 방법에의 접근)

  • Park, Ji-Yeon;Chung, Min;Lee, Yeong-Don;Lee, Jung-Nam;Lee, Woon-Ki;Park, Yeon-Ho;Baek, Jung-Heum;Park, Heung-Gyu;Kim, Keon-Kuk;Kang, Jin-Mo;Choi, Sang-Tae;Lee, Won-Suk;Park, Seung-Youn
    • Journal of Trauma and Injury
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    • v.23 no.2
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    • pp.134-141
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    • 2010
  • Purpose: A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds. Methods: The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation. Results: The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days. Conclusion: This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation.

Dosimetric Characteristics on Penumbra Regions of the Multileaf Collimator as Compared with the Lead Alloy Block (다엽 콜리메이터(Multileaf Collimator)와 합금납 차폐물(Lead Alloy Block)의 반 그림자영역의 선량 분포상의 특성 비교)

  • Lee Sang Wook;Oh Young Tack;Kim Woo Cheol;Keum Ki Chang;Yoon Seong Ick;Kim Hyun Soo;Park Won;Chu Seong Sil;Kim Gwi Eon
    • Radiation Oncology Journal
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    • v.13 no.4
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    • pp.391-396
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    • 1995
  • Purpose : The Conformal Radiation Therapy has bee widely used under favour of development of computer technologies. The delivery of a large number of static radiation fields are being necessary for the conformal irradiation. In this paper we investigate dosimetric characteristics on penumbra regions of a multileaf collimator(MLC), and compare to those of lead alloy block for the optimal use of the system in 3-D conformal radiotherapy. Materials and Methods : The measurement of penumbra by MLC or lead alloy block was performed with 6 or 10 MV X-rays. The film was positioned at a dmax depth and 10 cm depth, and its optical density was determined using a scanning videodensitometer. The effective penumbra, the distance from $80{\%}$ to $20{\%}$ isodose lines and $90{\%}$ to $10{\%}$ were analyzed as a function of the angle between the direction of leaf motion and the edge defined by leaves. Results : Increasing MLC angle ($0-75^{\circ}$) was observed with increasing the penumbra widths and the scalloping effect. There was no definite differences of penumbra width from $80{\%}$ to $20{\%}$ isodose lines, while being the small increase of penumbra width from $90{\%}$ to $10{\%}$ isodose line varing the depth and energy. The effective penumbra width of lead alloy block are agree resonably with those of MLC within 4.8mm. Conclusion : The comparative qualitative study of the penumbra between MLC and lead alloy block demonstrate the clinical acceptability and suitability of the multileaf collimator for 3-D conformal radiotherapy.

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Outcome of LINAC Radiosurgery for a Cavernous Angioma (해면상혈관종에 대한 선형가속기를 이용한 고선량 정위 방사선수술의 임상경험)

  • Hong Semie;Chie Eui Kyu;Park Suk Won;Kim Il Han;Ha Sung Hwan;Park Charn Il
    • Radiation Oncology Journal
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    • v.21 no.2
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    • pp.107-111
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    • 2003
  • Purpose: To establish the role of stereoactic radiosurgery using a linear accelerator for the treatment of patients with cavernous angloma. Materials and Methods: Between February 1995 and May 1997, 11 patients with cavernous angioma were treated with stereotactic radiosurgery using a linear accelerator. Diagnoses were based on the magnetic resonance imaging in 8 patients, and the histological in 3. The vascular lesions were located on the brainstem (5 cases), cerebellum (2 cases) thalamus (1 case) and cerebrum (3 cases). The clinical presentation at onset included previous intracerebral hemorrhages (9 cases) and seizures (2 cases). All patients were treated with a a linac-based radiosurgery. The median dose of radiation delivered was 16 Gy ranging from 14 to 24 Gy, which was typically proscribed to the 80$\%$ isodose surface (range 50 $\~$ 80$\%$), corresponding to the periphery of the lesion with a single isocenter. Ten patients were followed-up. Results: The median follow-up was 49 months ranging from 8 to 73 months, during which time two patients developed an intracerebral hemorrhage, 1 at 8 months, with the other at 64 months post radiosurgery. One patient developed neurological deficit after radiosurgery, and two developed an edema on the T2 weighted images of the MRI surrounding the radiosurgical target. Conclusion: The use of stereotactic radiosurgery in the treatment of a cavernous angioma may be effective in the prevention of rebleedlng, and can be safely delivered. However, a longer follow-up period will be required.

Studies on Anisakis Type Larvae (Anisakis 형(型) 유충(幼蟲)에 관한 연구(硏究))

  • Lim, Jung Teck
    • Korean Journal of Veterinary Research
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    • v.15 no.2
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    • pp.293-307
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    • 1975
  • As it has been known recently that anisakis type larvae harbouring in marine fishes are a causal agent of zoonosis to human and probably to land living mammal animals, attention was focused on the study on the larvae in an aspect of epidemiology or epizootiology. The present work was conducted from 1966 to 1975 for i) survey on the harbouring status of anisakis type larvae in marine fishes of this country, ii) observation on the response to the experimental infestation of the larvae to the pigs, in the reason that they could well fetid raw fish viscera occasionally containing the larvae as a high protein source of swine food, and iii) observation on the larval resistance and response to vermicidal agents for the purpose of prevention of the larval infection to the mammal animals. The data obtained in the studies were summarized as follows: 1. In the survey on the status of larvae harbouring in main species of marine fishes of this country, 15 species, a total of 1,940 fishes, were observed and the result was summarized in table 2. Average number of larvae, in upper rank of 5 out of all 15 species of fishes, were as highest as 156 larvae ranging 74 to 450 in Pseudosciaena manchurica (chamjogi), 54.5 ranging 15 to 240 in Trichiurus haumela (kalchi), 35.6 ranging 8 to 112 in Trachurus japonica (junggengi), 30.6 ranging 4 to 65 in Parapristipama trilineatum (benjari) and 20.5 ranging 3 to 48 in Nibea argentata (boguchi) respectively. In morphological observation, size of the larvae in the fishes were varied, ranging from 2 to 32mm long, and a tendency to larger size and number of larvae in the fishes, which were wider sea migration, higher age and lager bodily size, was observed The favorite places harbouring the larvae in fishes were mainly around the intraperitoneal viscera such as mesentery, omentum, liver, pyloric suspensory, fat tissue and cloaca, and rarely in body muscles of fish. Fishes heartily infested with the larvae showed stunted growth decreased egg formation and severe damage of liver. 2. In the experimental infestation of the larvae to normal pigs, as illustrated in table 3, a group with large dose of larvae (a total of 1,800 larvae, 300 larvae Per dose, twice in a dart for 3 days) showed acute clinical syndrome terminatine death with a week course, whereas two groups with less dose of larvae (a total of 180~360 larvae, 10 larvae per dose, at 5 days interval for 70~180 days) showed subclinical syndrome with remarkably stunted growth as. much as approximately one half of body size in contest to the control pigs. In the pathological findings, a group with large dose of larvae showed macroscopically larvae penetrating to the gastric wall with severe gastroenteritis, and histopathologically various acute lesions caused by active larvae penetration into the wall of stomach and interstine, whereas two groups with less dose of larvae showed chronic lesions such as hypertrophy and verminous granulomatous swelling of gastric wall, suggesting strongly the possibility of natural infestation of larvae to swine. 3. In the resistance of the larvae to the chemical solutions, the larvae tolerated for 2 days in 15 percent solution of sodium chloride and acetic acid, and for 7 days in 70 percent solution of ethyl alcohol. In the resistance to the temperature, the larvae died within 1 second at $62^{\circ}C$ and tolerated for 24 hours at $-3^{\circ}C$, 12 hours $-5^{\circ}C$ respectively. 4. For the experiment on the vermicidal effect to larvae, general vermicidal drugs such as Neguvon, Combantrin, antimony Potassium, piperazine adipate and piperazine dihydrochloride, oxidizer such as potassium permanganate and potassium chlorate, and dyes such as gentian violet and crystal violet were used, and among them, as illustrated in table 6, potassium permanganate was proved as the best. In the successive test for the practical use of potassium permanganate, vermicidal effect in seawater solution of potassium permanganate and common-water solution of potassium permanganate were compared, and then retested by dipping the fish viscera including the larvae into the two different solutions of potassium permanganate. The result through these tests indicated that 0.01 percent common water and sea-water solution of potassium permanganate could be apparently recommended as a preventive vermicidal solution, having 90 to 100 percent vermicidal effect by dipping for 12 to 24 hours even though sea-water solution of potassium permanganate had a tendency to slightly less effect than the common-water solution of potassium permanganate (Table 8).

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Effect of Ischemic Preconditioning on Myocardial Protection - A Comparative Study between Normothermic and Moderate Hypothermic Ischemic Hearts Induced by Cardioplegia in Rats - (허혈 전처치가 심근보호에 미치는 영향 - 적출 쥐 심장에서 상온에서의 심근허혈과 중등도 저체온하에서 심근정지액 사용 시의 비교 연구 -)

  • 조성준;황재준;김학제
    • Journal of Chest Surgery
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    • v.36 no.5
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    • pp.242-254
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    • 2003
  • Background: Most of the studies conducted have investigated the beneficial effects of ischemic preconditioning on normothermic myocardial ischemia. However, the effect of preconditioning could be attenuated through the use of multidose cold cardioplegia as practiced in contemporary clinical heart surgical procedures. The purpose of this study was to investigate whether preconditioning improves postischemic cardiac function in a model of $25^{\circ}C$ moderate hypothermic ischemic heart induced by cold cardioplegia in isolated rat hearts. Material and Method: The isolated Sprague-Dawley rat hearts were randomly assigned to four groups All hearts were perfused at 37$^{\circ}C$ for 20 minutes with Krebs-Henseleit solution before the baseline hemodynamic data were obtained, Group 1 consisted of preconditioned hearts that received 3 minutes of global ischemic preconditioning at 37$^{\circ}C$, followed by 5 minutes of reperfusion before 120 minutes of cardioplegic arrest (n=6). Cold (4$^{\circ}C$) St. Thomas Hospital cardioplegia solution was infused to induce cardioplegic arrest. Maintaining the heart at $25^{\circ}C$, infusion of the cardioplegia solution was repeated every 20 minutes throughout the 120 minutes of ischemic period. Group 2 consisted of control hearts that underwent no manipulations between the periods of equilibrium and 120 minutes of cardioplegic arrest (n=6). After 2 hours of cardioplegic arrest, Krebs solution was infused and hemodynamic data were obtained for 30 minuts (group 1, 2: cold cardioplegia group). Group 3 received two episodes of ischemic preconditioning before 30 min of 37$^{\circ}C$ normothermic ischemia and 30 minutes of reperfusion (n=6) Group 4 soloed as ischemic controls for group 3 (group 3, 4: warm ischemia group). Result: Preconditioning did not influence parameters such as left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), rate-pressure product (RPP) and left ventricular dp/dt (LV dp/dt) in the cold cardioplegia group. (p=NS) However, preconditioning before warm ischemia attenuated the ischemia induced cardiac dysfunction, Improving the LVSP, LVEDP, RPP, and LV dp/dt. Less leakage of CPK and LDH were observed in the ischemic preconditioning group compared to the control group (p<0.05). Conclusion: Ischemic preconditioning improved postischemic cardiac function after warm ischemia, but did not protect cold cardioplegic hearts.

Comparison of Collimator Choice on Image Quality of I-131 in SPECT/CT (I-131 SPECT/CT 검사의 에서 조준기 종류에 따른 영상 비교 평가)

  • Kim, Jung Yul;Kim, Joo Yeon;Nam-Koong, Hyuk;Kang, Chun Goo;Kim, Jae Sam
    • The Korean Journal of Nuclear Medicine Technology
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    • v.18 no.1
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    • pp.33-42
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    • 2014
  • Purpose: I-131 scan using High Energy (HE) collimator is generally used. While, Medium Energy (ME) collimator is not suggested to use in result of an excessive septal penetration effects, it is used to improve the sensitivities of count rate on lower dose of I-131. This research aims to evaluate I-131 SPECT/CT image quality using by HE and ME collimator and also find out the possibility of ME collimator clinical application. Materials and Methods: ME and HE collimator are substituted as Siemens symbia T16 SPECT/CT, using I-131 point source and NEMA NU-2 IQ phantom. Single Energy Window (SEW) and Triple Energy Windows (TEW) are applied for image acquisition and images with CTAC and Scatter correction application or not, applied different number of iteration and sub set are reconstructed by IR method, flash 3D. By analysis of acquired image, the comparison on sensitivities, contrast, noise and aspect ratio of two collimators are able to be evaluated. Results: ME Collimator is ahead of HE collimator in terms of sensitivity (ME collimator: 188.18 cps/MBq, HE collimator: 46.31 cps/MBq). For contrast, reconstruction image used by HE collimator with TEW, 16 subset 8 iteration applied CTAC is shown the highest contrast (TCQI=190.64). In same condition, ME collimator has lower contrast than HE collimator (TCQI=66.05). The lowest aspect ratio for ME collimator and HE collimator are 1.065 with SEW, CTAC (+) and 1.024 with TEW, CTAC (+) respectively. Conclusion: Selecting a proper collimator is important factor for image quality. This research finding tells that HE collimator, which is generally used for I-131 scan emitted high energy ${\gamma}$-ray is the most recommendable collimator for image quality. However, ME collimator is also applicable in condition of lower dose, lower sensitive if utilizing energy window, matrix size, IR parameter, CTAC and scatter correction appropriately.

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Meta-Analysis on Effectiveness of Intervention to Improve Patient Compliance in Korean (한국인 치료순응도 향상을 위한 개입 효과에 대한 메타분석)

  • 김춘배;조희숙;현숙정;박애화
    • Health Policy and Management
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    • v.12 no.2
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    • pp.23-42
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    • 2002
  • The purpose of this study was to analyze the results of 133 studies related to patient compliance published between 1980 and 2001 and to assess the effectiveness of intervention on compliance by using meta-analysis. We collected the existing literatures by using web and manual search 'patient compliance', 'sick role behavior', 'major clinical disease', and 'intervention' as key words and by reviewing content of journals related to medicine, nursing and public health. The compliance interventions were classified by theoretical focus into educational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance indicators broadly represent five classes of compliance-related assessments: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjective report (eg, patients' or others' reports), (5) utilization (appointment making and keeping, use of preventive services). Quantitative meta-analysis was performed by MetaKorea program which was developed for meta-analysis in Korea. Among the 133 articles, 10 studies were selected through the qualitative meta-analysis process, and then only 6 studies were selected for the quantitative meta-analysis finally. The interventions produced significant effects for all the compliance indicators with the magnitude of common effect size (4.1192) than the non-intervention group in a random effect model. The largest effects were each study for patient of hypertension using health outcome such as blood pressure (0.4679) and diabetes mellitus using direct indicator such as glucose level in blood and urine (0.7753). These results suggest that strategic interventions showed clear advantage for improvement of patient compliance compared with non-intervention group.